Autogenous platelet-rich plasma in combination with bovine-derived hydroxyapatite xenograft for treatment of a cystic lesion of the jaw

The Effect of Xenograft and Platelet-Rich Plasma in the Surgical Management of Intrabony Defects in Periodontitis Patients: A Systematic Review

When treating intrabony defects to regenerate periodontal structure, platelet-rich plasma (PRP) alone or in conjunction with various grafting materials, enamel matrix proteins, and barrier membranes have shown promising results. This evidence-based review aimed to systematically appraise the efficacy of xenograft in combination with PRP in the surgical treatment of periodontal intrabony defects in comparison to xenograft alone in terms of clinical and radiographic outcomes in adults with periodontitis. Electronic and manual data were searched exhaustively by 2 reviewers, including PubMed-Medline, Cochrane Central Register of Controlled Trials, Embase and Scopus from the earliest available date till January 31, 2023 without restriction on language. Randomized controlled clinical trials of either parallel or a split-mouth design and studies where xenograft and PRP were in the intervention group or as a comparator was included. After screening the articles, 3 studies were included. The current systematic review reveals that PRP used as an adjunct with a xenograft resulted in a significant reduction in pocket depth and greater clinical attachment level gain in comparison to xenograft alone. The analysis of the present review concludes that PRP in conjunction with xenograft for the treatment of intrabony defects shows promising outcomes. However, owing to the short follow-up time and heterogeneity of included studies, caution should be followed while using this material clinically.

Effect of low-level laser therapy on the healing of sites grafted with coagulum, deproteinized bovine bone, and biphasic ceramic made of hydroxyapatite and β-tricalcium phosphate. In vivo study in rats

OBJECTIVE

The aim of this study was to evaluate the effect of low-level laser therapy (LLLT) on the healing of biomaterial graft areas (i.e., coagulum, deproteinized bovine bone, and biphasic ceramics comprising hydroxyapatite and β-tricalcium phosphate).

MATERIAL AND METHODS

Ninety rats were divided into two groups according to laser irradiation use (λ 808 nm, 100 mW, φ ∼600 μm, seven sessions with 28 J of irradiation dose in total): a laser group and a control group. Each of these groups was divided into three subgroups of 15 animals each according to the type of biomaterial used: Coagulum (COA), deproteinized bovine bone (DBB), and hydroxyapatite/β-tricalcium phosphate (HA/βTCP). Biomaterials were inserted into Teflon domes, and these domes were grafted to the lateral aspect of the mandibular branch of the rats. The animals were sacrificed after 30, 60, and 90 days. Scarring patterns were evaluated by microtomography and histometry. The expression levels of BMP2, osteocalcin (OCN), and alkaline phosphatase (ALP) were evaluated by immunohistochemistry. The mRNA expression levels of ALP, BMP2, Jagged1, Osterix, Runx2, and TGFβ1 were determined by RT-qPCR.

RESULTS

The animals treated with LLLT exhibited increased mineralized tissues and bone, particularly after 90 days. These increases were associated with increased BMP2, OCN, and ALP protein expression and ALP, BMP2, and Jagged1 mRNA expression.

CONCLUSION

LLLT improved the osteoconductive potential of DBB and HA/βTCP grafts and bone formation in ungrafted areas. Lasers Surg. Med. © 2018 Wiley Periodicals, Inc.

Ceramic and non-ceramic hydroxyapatite as a bone graft material: a brief review

Treatment of dental, craniofacial and orthopedic defects with bone graft substitutes has shown promising result achieving almost complete bone regeneration depending on product resorption similar to human bone's physicochemical and crystallographic characteristics. Among these, non-ceramic and ceramic hydroxyapatite being the main inorganic salt of bone is the most studied calcium phosphate material in clinical practices ever since 1970s and non-ceramic since 1985. Its "chemical similarity" with the mineralized phase of biologic bone makes it unique. Hydroxyapatite as an excellent carrier of osteoinductive growth factors and osteogenic cell populations is also useful as drug delivery vehicle regardless of its density. Porous ceramic and non-ceramic hydroxyapatite is osteoconductive, biocompatible and very inert. The need for bone graft material keeps on increasing with increased age of the population and the increased conditions of trauma. Recent advances in genetic engineering and doping techniques have made it possible to use non-ceramic hydroxyapatite in larger non-ceramic crystals and cluster forms as a successful bone graft substitute to treat various types of bone defects. In this paper we have mentioned some recently studied properties of hydroxyapatite and its various uses through a brief review of the literatures available to date.

Spontaneous Bone Healing after Cysts Enucleation without Bone Grafting Materials: A Randomized Clinical Study

The aim of this study was to evaluate spontaneous bone regeneration after cysts enucleation of the jaws without the use of bone grafting materials. We included 18 patients at random (11 men and 7 women) with a mean age of 31.8 years, with jaw cysts treated by enucleation, without the use of grafting materials. A method of measurements to assess the percentage of reduction of the bone cavities was used to objectify the results. The patients were evaluated before and at least 6 months after surgery, with radiographic scans based on linear measures with a computerized method using Nemoceph program (Nemotec, NemoCeph Software, Madrid, España). The analysis of the sample shows an average of 85.59% decrease in horizontal measures, 89.53% in the vertical, and 88.98 and 89.81% in the diagonal left and right, respectively. The total average reduction was 88.47%. It showed a greater decrease in vertical and diagonal measurements with respect to horizontal. Regeneration in 12 patients was 100% and in 6 patients was higher at 50.4%. Bone density increased in the postoperative radiographs. The results suggest that in some cases, spontaneous bone regeneration can be achieved by cysts enucleation without bone grafting materials.

Platelet-rich plasma in bone regeneration: engineering the delivery for improved clinical efficacy

Human bone is a tissue with a fairly remarkable inherent capacity for regeneration; however, this regenerative capacity has its limitations, and defects larger than a critical size lack the ability to spontaneously heal. As such, the development and clinical translation of effective bone regeneration modalities are paramount. One regenerative medicine approach that is beginning to gain momentum in the clinical setting is the use of platelet-rich plasma (PRP). PRP therapy is essentially a method for concentrating platelets and their intrinsic growth factors to stimulate and accelerate a healing response. While PRP has shown some efficacy in both in vitro and in vivo scenarios, to date its use and delivery have not been optimized for bone regeneration. Issues remain with the effective delivery of the platelet-derived growth factors to a localized site of injury, the activation and temporal release of the growth factors, and the rate of growth factor clearance. This review will briefly describe the physiological principles behind PRP use and then discuss how engineering its method of delivery may ultimately impact its ability to successfully translate to widespread clinical use.

Bone regeneration with plasma-rich-protein following enucleation of traumatic bone cyst

Traumatic bone cyst is an uncommon non-epithelium lined cavity and is seen frequently in young individuals. The lesion occurs more commonly in the mandible, involving the posterior region. It is generally asymptomatic and is diagnosed on routine radiographic examination. The cystic cavity is usually empty and there is scanty material for histological examination. Surgical curettage is usually done and recurrence is rare. A case of traumatic bone cyst occurring in the anterior region of mandible in a young boy is presented. Following surgical intervention, plasma-rich-protein was placed in the cystic cavity. The lesion showed progressive resolution and bone regeneration of the cystic cavity within a short period of time.

Multidetector CT Dentascan evaluation of bone regeneration obtained with deproteinised bovine graft in residual cavity after mandibular cyst enucleation

PURPOSE

This study compared spontaneous bone healing and regeneration obtained with deproteinised bovine graft in residual cavities after mandibular cyst enucleation using computed tomography (CT) Dentascan.

MATERIALS AND METHODS

Eighty patients with a radiological diagnosis of mandibular cyst underwent surgical enucleation. Patients were divided into a control group (spontaneous healing, 40 patients) and a test group (deproteinised bovine graft, 40 patients). All patients underwent follow-up CT Dentascan 12 months after the procedure. For each residual cavity, apical-coronal and mesial-distal distance, average pixel intensity and volume were calculated and results compared between two groups using the t test.

RESULTS

The control group showed mean volume, apical-coronal and mesial-distal distance of 703.2 ± 185.3 mm(3), 28.6 ± 9.4 mm and 25 ± 2.84 mm, respectively. In the test group, values were 738.2 ± 189.2 mm(3), 27.5 ± 3.6 mm and 25.3 ± 2.97 mm, respectively. There was no statistically significant difference between groups. Average pixel intensity was 1,102.8 ± 124.3 in the test group and 624.9 ± 133.3 in the control group, with a significant difference between groups (p<0.0001).

CONCLUSIONS

The significantly higher average pixel intensity observed in the test group demonstrates the cavalue of treatment with biomaterials to obtain earlier bone regeneration.

A review on endogenous regenerative technology in periodontal regenerative medicine

Periodontitis is a globally prevalent inflammatory disease that causes the destruction of the tooth-supporting apparatus and potentially leads to tooth loss. Currently, the methods to reconstitute lost periodontal structures (i.e. alveolar bone, periodontal ligament, and root cementum) have relied on conventional mechanical, anti-infective modalities followed by a range of regenerative procedures such as guided tissue regeneration, the use of bone replacement grafts and exogenous growth factors (GFs), and recently developed tissue engineering technologies. However, all current or emerging paradigms have either been shown to have limited and variable outcomes or have yet to be developed for clinical use. To accelerate clinical translation, there is an ongoing need to develop therapeutics based on endogenous regenerative technology (ERT), which can stimulate latent self-repair mechanisms in patients and harness the host's innate capacity for regeneration. ERT in periodontics applies the patient's own regenerative 'tools', i.e. patient-derived GFs and fibrin scaffolds, sometimes in association with commercialized products (e.g. Emdogain and Bio-Oss), to create a material niche in an injured site where the progenitor/stem cells from neighboring tissues can be recruited for in situ periodontal regeneration. The choice of materials and the design of implantable devices influence therapeutic potential and the number and invasiveness of the associated clinical procedures. The interplay and optimization of each niche component involved in ERT are particularly important to comprehend how to make the desired cell response safe and effective for therapeutics. In this review, the emerging opportunities and challenges of ERT that avoid the ex vivo culture of autologous cells are addressed in the context of new approaches for engineering or regeneration of functional periodontal tissues by exploiting the use of platelet-rich products and its associated formulations as key endogenous resources for future clinical management of periodontal tissue defects.

Treatment of benign lesions of humerus with resection and non-vascularised, autologous fibular graft

The aim of this study was to analyse the long-term results of surgical en bloc resection and replacement with non-vascularised, autologous fibular graft for the treatment of large benign humeral lesions without fixation. We retrospectively reviewed data of seven females and 13 males with unilateral benign lesions where steroid injection, curettage and bone grafting or pathological fracture failed to restore integrity. Subperiosteal, en bloc resection of the cystic lesion with a margin of the normal bone was performed. The average age of the patients at the time of operation was 11.8 years (range 4-28 years). All patients were skeletally mature at last follow-up. Aneurysmal bone cysts were histologically identified in seven cases, solitary cysts in 11 and fibrous dysplasia in two cases. No recurrence of the pathology, pain, graft fracture or limitation in range of motion was noted. In three patients in whom the cyst was adjacent to the proximal growth plate of the humerus, there was shortening of the bone at the last follow-up examination measuring 2 cm, 4.5 cm and 6 cm, respectively. Two cases had a valgus deformity of 10° and 15°, respectively, which was evident radiographically at the time of last follow-up. The results of en bloc resection with non-vascularised, autologous fibular graft for the treatment of large benign humeral lesions without fixation are encouraging. The risk of associated complications is low. In our opinion this should be the method of choice in the treatment of large, multi-chamber benign bone lesions of the humerus which fail more "conservative" treatment.

Effect of autologous platelet gel on early and late graft fusion in anterior cervical spine surgery

Object

In a double-blind randomized study, platelet concentrate was used to treat 50 patients who underwent anterior cervical fusion with allograft bone and internal fixation, predominantly for degenerative disc disease or soft herniated cervical disc. The goal in this study was to compare the outcomes in patients treated with and without the platelet gel.

Methods

Patients were assessed radiographically at 6, 12, and 52 weeks and at 2 years if needed. Clinically, patients were evaluated with the visual analog scale, Neck Disability Index, Short Form–36, and a modified Prolo Scale.

Results

Follow-up included 90% of the patients at 1 year and 84% at 2 years. The overall fusion rate was 84%.

Conclusions

Whereas patients with degenerative discs treated with platelet gel demonstrated early fusion at the 12-week follow-up interval, no consistent early fusion was obtained with the use of the platelet gel preparation in patients with a soft disc herniation.

Sinus floor elevation using autogenous bone or bone substitute combined with platelet-rich plasma

OBJECTIVE

Sinus augmentation is a common approach for patients with severe alveolar ridge atrophy. However, autogenous bone sometimes results in donor site complications. Bone substitutes with platelet-rich plasma (PRP) promote early bone formation with autogenous bone. Use of PRP on autogenous bone and a bovine bone substitute were investigated in this split-mouth animal study.

STUDY DESIGN

Premolars were extracted from minipigs. Each animal received sinus augmentation using a lateral approach with simultaneous insertion of 3 implants in each site. Groups were randomized using autogenous bone alone and combined with PRP or a bovine hydroxyapatite alone in combination with PRP.

RESULTS

Microradiographic findings in the autogenous group did not show significantly different rates by using autogenous bone alone or combined with PRP. Using the bovine hydroxyapatite as augmentation material only at 8 weeks, a nonsignificant effect in the PRP group could be seen. At all other observation periods, no significant influence was observed.

CONCLUSION

No significant influence of PRP was found.