Early Bone Formation at a Femur Defect Using CGF and PRF Grafts in Adult Dogs: A Comparative Study

Demineralized bone matrix combined with concentrated growth factors promotes intervertebral fusion in a novel rat extreme lateral interbody fusion model

BACKGROUND

Whether demineralized bone matrix (DBM) combined with concentrated growth factors (CGF) can accelerate intervertebral fusion remains uncertain. This study developed a novel rat model for extreme lateral interbody fusion (XLIF) and evaluated the fusion outcomes of DBM combined with CGF using imaging and histological analysis.

METHODS

A total of 70 male SD rats (3 months old, average body weight 300 ± 50 g) were included in this study. Among them, 10 rats were used for the anatomical study of the lumbar spine. The remaining 48 rats were randomly divided into four groups (n = 12 per group): Group A (control), Group B (titanium plate fixation), Group C (DBM + titanium plate fixation), and Group D (DBM + CGF + titanium plate fixation). The remaining 12 rats were used as donors to prepare fresh CGF. Eight weeks after surgery, the rats were euthanized and lumbar spine specimens were collected, with interbody fusion evaluated by manual palpation. Subsequently, specimens from groups B, C, and D were analyzed by micro-CT and histological examinations to comprehensively assess the fusion outcome.

RESULTS

The anatomical and surgical techniques for the rat XLIF model are described. Titanium plates (7 mm × 2.5 mm × 0.8 mm) and screws (3 mm × 1 mm) were designed based on the anatomical measurements. In Group A, spontaneous fusion occurred in 1 case; the remaining 11 cases showed intervertebral mobility. In Group B, 3 cases achieved fusion; in Group C, 8 cases; and in Group D, 11 cases. Micro-CT revealed fusion index scores (FIS) of 2.21 ± 0.51 for Group B, 3.62 ± 0.67 for Group C, and 4.57 ± 0.56 for Group D. Histological examination showed limited bone formation in Group B, with fibrous connective tissue filling the intervertebral space. Group C showed more bone formation, but some cartilage and fibrous tissue remained. Group D demonstrated abundant new bone formation and robust histological fusion, with substantial bridging between vertebrae.

CONCLUSION

The rat XLIF model for interbody fusion has been successfully established and validated. Using this model, it was preliminarily demonstrated that DBM combined with CGF can effectively promote intervertebral fusion in rats.

Concentrated growth factors as a graft material for endoscopic revision tympanoplasty

This study aims to evaluate the clinical efficacy of concentrated growth factors (CGF) as a graft material in endoscopic revision tympanoplasty for tympanic membrane perforation. A retrospective analysis was conducted on 30 cases of endoscopic revision tympanoplasty performed at the Otolaryngology Department of Shenzhen Nanshan People's Hospital between January 1, 2019, and December 31, 2023. Fifteen patients were assigned to the experimental group, in which CGF was used for perforation repair, while the control group (n = 15) received cartilage and perichondrium grafts. Surgical outcomes (intraoperative blood loss, operative time), complications (taste disturbance, ear numbness, postoperative pain, ear fullness, incision infection, etc.), postoperative hearing improvement, and follow-up results (tympanic membrane healing time and healing rate) were statistically analyzed between the two groups. Tympanic membrane perforations in both groups achieved complete healing during follow-up. The experimental group exhibited significantly reduced intraoperative blood loss (15.2 ± 3.8 mL vs. 28.6 ± 5.2 mL; P = 0.003), shorter operative time (52.4 ± 10.1 min vs. 78.9 ± 12.6 min, P = 0.001), lower postoperative complication rates (0% vs. 26.7%; P = 0.021), and accelerated tympanic membrane healing time (14.5 ± 2.3 days vs. 21.8 ± 3.7 days; P < 0.001) compared to the control group. However, no significant differences were observed in postoperative hearing outcomes (air-bone gap closure: 12.1 ± 3.5 dB vs. 13.4 ± 4.1 dB; P = 0.32) or tympanic membrane healing rates (93.3% vs. 86.7%, P = 0.48). Concentrated growth factors are effective and safe as a graft material in endoscopic revision tympanoplasty. CGF is readily available, minimally invasive, and particularly advantageous for use in endoscopic revision tympanoplasty.

Efficacy of concentrated growth factor combined with coronally advanced flap in the treatment of gingival recession: a systematic review and meta-analysis

OBJECTIVES

This study aims to evaluate the efficacy of combining the coronally advanced flap (CAF) technique with concentrated growth factor (CGF) in the treatment of gingival recession (GR), and to compare this approach with other alternative treatments.

METHODS

This systematic review and meta-analysis included randomized controlled trials (RCTs) comparing CAF combined with CGF to other treatments for root coverage procedures. Included studies evaluated systemically healthy adults (> 18 years) with Miller Class I/II or Cairo RT1 gingival recessions. Primary outcomes were complete root coverage (CRC) and mean root coverage (MRC); secondary outcomes included changes in keratinized tissue width (KTW), gingival thickness (GT), clinical attachment level (CAL), recession width (RW), recession depth (RD), and probing depth (PD). A comprehensive search was conducted across multiple databases, including PubMed, Scopus, Cochrane Library, Web of Science, and Embase, up to November 9, 2024. The study protocol was prospectively registered in PROSPERO (CRD42024556815). Statistical analyses were performed using Review Manager 5.4.1.

RESULTS

Eight studies were included in the meta-analysis. Compared to CAF alone, the combination of CAF and CGF significantly improved CRC (OR = 1.79, P = 0.04), MRC (MD = 10.38%, P = 0.04), KTW (MD = 0.40 mm, P = 0.02), GT (MD = 0.26 mm, P < 0.00001), and CAL (MD = 0.36 mm, P = 0.03). CAF combined with connective tissue graft (CTG) showed superior efficacy for CRC compared to CAF + CGF (OR = 0.25, P = 0.009). However, no significant differences were found between CAF + CTG and CAF + CGF for MRC, CAL, KTW, RD, RW, or PD. Additionally, no significant differences were observed when comparing CAF + CGF with CAF + PRF across all clinical parameters (all P > 0.05).

CONCLUSIONS

The findings of this meta-analysis indicate that CAF/CGF improves clinical outcomes in treating GR compared to CAF alone, and CGF may be a viable alternative to CTG when CTG is not applicable. Further studies are needed to validate the efficacy of CAF/CGF in the treatment of GR.

CLINICAL SIGNIFICANCE

In cases where CTG is not applicable, CGF may serve as a viable alternative for the treatment of Miller class I and II GR.

Clinical Studies on the Application of Concentrated Growth Factors for Enhancing the Recovery From Flap Ischemia-Reperfusion Injuries

OBJECTIVE

To evaluate the therapeutic potential of locally injecting concentrated growth factor (CGF) into flaps for treating flap ischemia-reperfusion injury (FIRI) following reconstructive surgery.

METHODS

Nineteen patients with FIRI were enrolled in this study. After clinical identification of ischemia-reperfusion (IR) injury, CGF was prepared from each patient's autologous blood and locally injected into the affected flap tissue. Flap viability was assessed using clinical indicators such as color, texture, and capillary refill. Patients were followed for 6 months postoperatively to assess long-term outcomes.

RESULTS

Seven days after CGF injection, 18 of 19 patients demonstrated complete flap survival. In one case, total necrosis occurred due to hematoma formation and insufficient dressing compression, but healing was achieved through dressing changes. Overall, patients showed improvements in flap color (from dark to ruddy), texture (softened), and skin tension (decreased), with visible wrinkle formation. Long-term follow-up confirmed satisfactory appearance and functional outcomes.

CONCLUSION

Local injection of CGF effectively enhances flap survival by promoting recovery from IR injury. This strategy may offer a promising adjunctive therapy in reconstructive procedures to improve tissue viability and healing.

Root Coverage Techniques: Coronally Advancement Flap vs. Tunnel Technique: A Systematic Review and Meta-Analysis

INTRODUCTION

Gingival recession, characterized by the apical displacement of the gingival margin, presents challenges to oral health. This study compares the effectiveness of the coronally advanced flap (CAF) and the tunnel technique (TT) for treating gingival recessions.

METHODS

Bibliographical searches included PubMed, Embase, Web of Science, Cochrane, Scopus, and the grey literature, with keywords "root coverage" "coronary advanced flap", and "tunnel". A systematic coreview was performed that included 26 studies evaluating root coverage, and 14 articles were included for the meta-analysis. Three groups were analyzed: Group 1 compared TT with connective tissue graft (CTG) versus CAF with CTG; Group 2 examined TT with CTG and/or other biomaterials versus TT with CTG alone; Group 3 compared TT with CAF, regardless of complementary biomaterials. Meta-analysis assessed mean root coverage (MRC), complete root coverage (CRC), and keratinized tissue gain (KTG).

RESULTS

In Group 1, TT with CTG demonstrated superior MRC compared with CAF with CTG (-8.68 CI95% -17.19 to -0.17; p = 0.0457). In Group 2, TT with CTG and/or other biomaterials showed similar MRC (4.17 CI95% -17.91 to 26.26; p = 0.7110) and CRC (0.37 CI95% -1.14 to 1.89; p = 0.6269) to TT with CTG alone, with variations in keratinized tissue gain. Group 3 indicated higher potential MRC for TT compared with CAF (5.73 CI95% -8.90 to 13.55; p = 0.685) but without statistically significant differences.

CONCLUSIONS

This study suggests that TT with CTG might offer better root coverage than CAF with CTG; however, biomaterial selection requires consideration.

The effects of mineral trioxide aggregate and second-generation autologous growth factor on pulpotomy via TNF-α and NF-kβ/p65 pathways

This study aims to investigate the effect of Mineral Trioxide Aggregate (MTA), a bioactive endodontic cement, and Concentrated Growth Factor (CGF), a second-generation autologous growth factor, on pulpotomy-induced pulp inflammation. The study utilized the maxillary anterior central teeth of thirty-six young male Sprague Dawley rats. Forty-eight teeth were randomly assigned to two groups (12 rats/group; 24 teeth/group) based on the capping material (MTA or CGF). Subsequently, two subgroups (MTAG and CGFG) were formed per group (12 teeth/group) based on the time following pulpotomy (2-weeks and 4-weeks). The central teeth of the 12 animals assigned to the control group (CG) were not manipulated in any way, both in the 2-week group and in the 4-week group. Tissue samples extracted from rats at the end of the experiment were stained with H&E for histopathological analysis. For immunohistochemical analysis, primary antibodies for TNF-α and NF-kβ/65 were incubated. Data obtained from semi-quantitative analysis were assessed for normal distribution using Skewness-Kurtosis values, Q-Q plot, Levene's test, and the Shapiro-Wilk test on statistical software. A P value < 0.05 was considered significant. When compared with the control group, both MTAG and CGFG showed increased edematous and inflammatory areas. In MTAG, edematous and inflammatory areas decreased significantly from the 2nd week (2(2-2), 2(1-2)) to the 4th week (1(1-1), 1(0-1)), while in CGFG, edematous areas decreased (2(2-3), 1.5(1-2)), and inflammatory areas increased significantly (2(2-3), 3(2-2.5)). When compared with the control group, TNF-α and NF-kβ/p65 positivity were higher in both MTAG and CGFG. In MTAG, TNF-α [2(1.5-2)] and NF-kβ/p65 [1.5(1-2)] positivity decreased significantly from the 2nd week to the 4th week [TNF-α: 1(1-1), NF-kβ/p65: 1(1-2)], while no significant change was observed in CGFG. In conclusion, this study revealed a reduction in cells showing TNF-α and NF-kβ/p65 positivity in the MTA treatment group compared to the CGF group. Although MTA demonstrated more favorable results than CGF in mitigating pulpal inflammation within the scope of this study, further experimental and clinical investigations are warranted to obtain comprehensive data regarding CGF.

Novel Applications of Concentrated Growth Factors in Facial Rejuvenation and Plastic Surgery

Concentrated growth factor (CGF), which is a third-generation platelet concentrate product, exhibits good potential for repair and regeneration of soft and hard tissues, and has gradually attracted attention in the field of cosmetic plastic surgery. The purpose of this review is to summarize the application and research of CGF in the field of facial rejuvenation and plastic surgery. A comprehensive review of the literature about the applications of CGF in facial rejuvenation and plastic surgery was conducted in PubMed, Ovid MEDLINE, and Web of Science. According to the inclusion and exclusion criteria, a total of 22 articles were included in this review. In recent years, CGF has been applied in many aspects in the field of facial rejuvenation and plastic surgery, including skin photoaging, repairment of soft-tissue defects, rhinoplasty, hair loss, autologous fat transplantation, and scars. In addition, no significant adverse reactions have been reported so far. CGF is rich in high-concentration growth factors, which has great potential and application prospects in facial rejuvenation and plastic surgery. However, the applications of CGF still have some problems, such as the mechanism, time of decomposition, and long-term efficacy and safety, which are needed to be resolved in future.

Single-flap approach versus without concentrate growth factor in the treatment of periodontal supra-osseous defects: A randomized controlled clinical trial

Objectives

We aimed to compare treatment outcomes of periodontal supra-bony defects using single flap (SFA) plus concentrate growth factor versus SFA alone.

Methods

32 supra-bony periodontal defects were randomly assigned to test and control groups. Outcome variables were clinical attachment level (primary outcome). Probing pocket depths, gingival recessions, bone gain, post-surgical pain using visual analogue scale and wound healing index were recorded as secondary outcomes. Clinical and radiographic assessments were recorded at baseline and 6 months after treatment, whereas pain score and wound healing index were recorded within 10 days after surgery.

Results

Test group showed a significant improvement in all tested parameters compared to control group (P-value ≤ 0.05). Better patient centered outcomes (wound healing and pain scores) were highly achieved in the test group compared to controls.

Conclusion

The tested combined approach offers better periodontal and patient centered treatment outcomes in management of periodontal supra-bony defects.

Advances with Platelet-Rich Plasma for Bone Healing

Despite significant advances in the understanding and delivery of osteosynthesis, fracture non-union remains a challenging clinical problem in orthopaedic surgery. To bridge the gap, basic science characterization of fracture healing provides a platform to identify and target biological strategies to enhance fracture healing. Of immense interest, Platelet-rich plasma (PRP) is a point of care orthobiologic that has been extensively studied in bone and soft tissue healing given its relative ease of translation from the benchtop to the clinic. The aim of this narrative review is to describe and relate pre-clinical in-vitro and in-vivo findings to clinical observations investigating the efficacy of PRP to enhance bone healing for primary fracture management and non-union treatment. A particular emphasis is placed on the heterogeneity of PRP preparation techniques, composition, activation strategies, and delivery. In the context of existing data, the routine use of PRP to enhance primary fracture healing and non-union management cannot be supported. However, it is acknowledged that extensive heterogeneity of PRP treatments in clinical studies adds obscurity; ultimately, refinement (and consensus) of PRP treatments for specific clinical indications, including repetition studies are warranted.

The application of CGF combined with GBR in alveolar bone increment for patients with anxiety disorder: A rare case report and literature review

RATIONALE

Selective serotonin reuptake inhibitors (SSRIs), one of the commonly used anti-anxiety drugs, may have impacts on bone metabolism and potentially lead to drug-induced osteoporosis. The traditional approach of oral implantation in individuals with both anxiety disorder and drug-induced osteoporosis poses a significant challenge. To address this issue, concentrated growth factor (CGF) has been utilized in patients undergoing concurrent alveolar ridge augmentation during oral implantation, resulting in favorable clinical outcomes. Consequently, combining CGF with guided bone regeneration (GBR) in alveolar bone increment may represent a promising new surgical approach for such patients. In this report, we present a case study of a 25-year-old male with anxiety disorder and drug-induced osteoporosis, in who CGF combined with GBR was employed in alveolar bone increment.

PATIENT CONCERNS

This article reports the case of a 25-year-old male who underwent cone beam computed tomography (CBCT) due to the absence of his right lower second molar for a period of six months. The CBCT scan revealed significant bone defects, which were attributed to the tooth loss and prolonged use of anti-anxiety drugs. Consequently, the patient sought medical assistance from our department.

DIAGNOSES

Based on the patient's self-report, he was diagnosed with an anxiety disorder. Additionally, the CBCT scan confirmed the loss of the right mandibular second molar and revealed the presence of dental irregularity and an alveolar bone defect.

INTERVENTIONS

During the patient's course of treatment with anti-anxiety medication, a combination of CGF and GBR was employed for the simultaneous implantation of the missing right mandibular second molar, along with bone augmentation.

OUTCOMES

The patient had a follow-up visit two weeks after the surgical procedure, and the wound in the operation area had healed satisfactorily. Six months later, CBCT images revealed excellent osseointegration. The buccal and lingual width of the alveolar bone measured 6.95mm, which was an increase of 1.35mm compared to the pre-implantation stage.

LESSONS

This article presents a case study in which CGF combined with GBR were utilized to address alveolar bone augmentation during the implantation phase in patients taking anti-anxiety medication. The results demonstrated that CGF combined with GBR, as a cutting-edge platelet concentrate technique, could effectively stimulate bone tissue proliferation in individuals who have been on long-term anti-anxiety medication, specifically in oral implant areas. This approach can help prevent poor osseointegration, promote higher osseointegration rates, and facilitate wound healing.

A novel concentrated growth factor (CGF) and bio-oss based strategy for second molar protection after impacted mandibular third molar extraction: a randomized controlled clinical study

BACKGROUND

The extraction of impacted mandibular third molars might cause large bone defects in the distal area of second molars. A new strategy was innovatively employed here combining autologous bone, Bio-Oss, concentrated growth factors (CGF) gel and CGF membrane for bone repair, and the present study aimed at exploring safety as well as short- and long-term efficacy of this new protocol clinically.

MATERIALS AND METHODS

A total of 66 participants were enrolled in this randomized single-blind clinical trial, and randomly allocated to control group (only blood clots), test A group (autogenous bone, Bio-Oss with barrier membrane) and test B group (autogenous bone, Bio-Oss, CGF gel with CGF membrane). The postoperative outcomes including PoSSe scale, periodontal probing depth (PD), degree of gingival recession and computed tomography measurements were assessed at 3rd, 6th, 12th month. A p-value < 0.05 was considered statistically significant.

RESULTS

In PoSSe scale, no significant difference was observed except a significant alleviation of early-stage pain perception in test B group (p < 0.05). Also, test B group exhibited better effect on periodontal healing and gingival recession reduction after 6 months (p < 0.05). Both two test groups showed more new bone formation than the control group (p < 0.05). It is noteworthy that the bone repair of test B group was significantly better than that of test A at 3rd and 6th month (p < 0.05), yet no difference was observed at 12th month (p > 0.05).

CONCLUSION

Both two test groups could achieve stable long-term efficacy on bone defect repair. The use of CGF gel and CGF membrane could accelerate early-stage bone repair, alleviate short-term pain after surgery, reduce long-term probing depth and relieve economic cost for patients. This new bone repair protocol is worthy of promoting by clinicians.

TRIAL REGISTRATION

This study was registered with the identification number ChiCTR2300068466 on 20/02/2023 at Chinese Clinical Trial Registry. Also, it was ethically approved from the institutional ethics committee at the Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (No:2023-010-01), and has been conducted in accordance to the guidelines of the declaration of Helsinki. Written informed consent was obtained from all participants in the study.

Study on the Application of Concentrated Growth Factor Combined With Adipose Transplantation in Repairing Depressed Deformities of Soft Tissue in the Face

BACKGROUND

Autologous fat is a rich source of adipose tissue that is safe for transplantation. Decreasing the long-term absorption rate is key to improve the survival of transplanted adipose tissue. The aim of this study was to assess the effect of concentrated growth factor (CGF) on the survival of transplanted adipose tissue for repair of facial depression malformations.

METHODS

Coleman adipose granules (CAGs) were prepared from venous blood. In the animal experiment, the ears of 30 healthy male New Zealand white rabbits were randomly allocated to 1 of 4 groups: CGF + CAG (CGF group), platelet-rich fibrin (PRF) + CAG (PRF group), CAG alone (CAG group), and adipose granule transplantation group (control group). Postoperative survival of the transplanted adipose tissue was assessed, the survival and absorption rates of adipose were calculated, and immunohistochemical analysis of specimens was conducted by staining with hematoxylin and eosin and Oil Red O. Of 43 outpatients, 22 received simple adipose transplantation and 21 received autologous CGF combined with adipose transplantation. The adipose absorption rate, complication rate, and cosmetic improvement of the 2 groups were compared.

RESULTS

More adipocytes that are normal were observed in the CGF group, with fewer vacuoles and more uniform distribution of adipose tissue. Survival of the adipose tissue was superior in the CGF and PRF groups. Meanwhile, vascular density and long-term stability were better in the CGF group than the PRF group. In terms of clinical efficacy, the uniformity and survival rate of the adipose tissue were relatively improved in the CGF group compared with the simple adipose particle transplantation group, with less early liquefaction.

CONCLUSION

Concentrated growth factor stabilized and improved the survival of transplanted adipose tissue for filling of facial depression malformations.

Progress in Regenerative Medicine: Exploring Autologous Platelet Concentrates and Their Clinical Applications

The goal of regenerative medicine is to achieve tissue regeneration. In the past, commonly used techniques included autologous or allogeneic transplantation and stem cell therapy, which have limitations, such as a lack of donor sites in the case of autologous transplantation and the invasiveness of stem cell harvesting. In recent years, research has, therefore, focused on new and less invasive strategies to achieve tissue regeneration. A step forward in this direction has been made with the development of autologous platelet concentrates (APCs), which are derived from the patient's own blood. They can be classified into three generations: platelet-rich plasma (PRP), platelet-rich fibrin (PRF), and concentrated growth factors (CGFs). These APCs have different structural characteristics, depending on the distinctive preparation method, and contain platelets, leukocytes, and multiple growth factors, including those most involved in regenerative processes. The purpose of this review is to clarify the most used techniques in the field of regenerative medicine in recent years, comparing the different types of APCs and analyzing the preparation protocols, the composition of the growth factors, the level of characterization achieved, and their clinical applications to date.

DLP printed hDPSC-loaded GelMA microsphere regenerates dental pulp and repairs spinal cord

Dental pulp regeneration is ideal for irreversible pulp or periapical lesions, and in situ stem cell therapy is one of the most effective therapies for pulp regeneration. In this study, we provided an atlas of the non-cultured and monolayer cultured dental pulp cells with single-cell RNA sequencing and analysis. Monolayer cultured dental pulp cells cluster more closely together than non-cultured dental pulp cells, suggesting a lower heterogeneous population with relatively consistent clusters and similar cellular composition. We successfully fabricated hDPSC-loaded microspheres by layer-by-layer photocuring with a digital light processing (DLP) printer. These hDPSC-loaded microspheres have improved stemness and higher multi-directional differentiation potential, including angiogenic, neurogenic, and odontogenic differentiation. The hDPSC-loaded microspheres could promote spinal cord regeneration in rat spinal cord injury models. Moreover, in heterotopic implantation tests on nude mice, CD31, MAP2, and DSPP immunofluorescence signals were observed, implying the formation of vascular, neural, and odontogenetic tissues. In situ experiments in minipigs demonstrated highly vascularized dental pulp and uniformly arranged odontoblast-like cells in root canals of incisors. In short, hDPSC-loaded microspheres can promote full-length dental pulp regeneration at the root canals' coronal, middle, and apical sections, particularly for blood vessels and nerve formation, which is a promising therapeutic strategy for necrotic pulp.

Clinical Effect Evaluation of Concentrated Growth Factor in Endodontic Microsurgery: A Cross-Sectional Study

INTRODUCTION

Concentrated growth factor (CGF) is the third-generation platelet concentrate product. This study aimed to evaluate whether the use of CGF during endodontic microsurgery had a positive influence on surgical outcomes.

METHODS

Fifty-four patients who underwent endodontic microsurgery from January 2017 to November 2021 were enrolled. They were assigned to the CGF and the control group according to whether CGF was used during the surgery and followed up at 6, 12, and 18 months post-surgery. Preoperative classification of the cases and follow-up radiographic outcomes were based on Kim's classification and Molven's criteria respectively and evaluated by two calibrated endodontists. Student t-test and Chi-square test were used to assess the baseline of two groups. Rank sum test was used to determine whether CGF had an impact on the surgical outcome.

RESULTS

Thirty-one patients (41 periapical lesion sites) were included in the CGF group, and twenty-three patients (26 periapical lesion sites) were included in the control group. The overall success rate of endodontic microsurgery was above 90%. The baseline of the two groups had no difference (P<0.05). In the CGF group, the success rate was always 100% in three follow-ups, while the success rate was 84.2%, 92.8%, and 90% respectively in the control group. The success rate between the CGF group and the control group was statistically significant in all three follow-up points (P<0.05).

CONCLUSIONS

The application of CGF during endodontic microsurgery might have a positive influence on surgical outcomes, thus, its prognosis. However, higher-grade evidence is needed to demonstrate its role.

Self-Assembling Peptide RADA16 Nanofiber Scaffold Hydrogel-Wrapped Concentrated Growth Factors in Osteogenesis of MC3T3

Concentrated growth factors (CGFs) are widely used in surgery with bone grafting, but the release of growth factors from CGFs is rapid. RADA16, a self-assembling peptide, can form a scaffold that is similar to the extracellular matrix. Based on the properties of RADA16 and CGF, we hypothesized that the RADA16 nanofiber scaffold hydrogel could enhance the function of CGFs and that the RADA16 nanofiber scaffold hydrogel-wrapped CGFs (RADA16-CGFs) would perform a good osteoinductive function. This study aimed to investigate the osteoinductive function of RADA16-CGFs. Scanning electron microscopy, rheometry, and ELISA were performed, and MC3T3-E1 cells were used to test cell adhesion, cytotoxicity, and mineralization after administration with RADA16-CGFs. We found that RADA16 endowed with the sustained release of growth factors from CGFs, which can help maximize the function of CGFs in osteoinduction. The application of the atoxic RADA16 nanofiber scaffold hydrogel with CGFs can be a new therapeutic strategy for the treatment of alveolar bone loss and other problems that require bone regeneration.

Mechanism of Pulp Regeneration Based on Concentrated Growth Factors Regulating Cell Differentiation

Concentrated growth factors (CGF) is the newest generation platelet concentrate product, which has been reported to promote the proliferation and differentiation of human dental pulp cells (hDPCs). However, the effect of liquid phase of CGF (LPCGF) has not been reported. This study was aimed to evaluate the influence of LPCGF on the biological properties of hDPCs, and to explore the in vivo mechanism of dental pulp regeneration based on the hDPCs-LPCGF complex transplantation. It was found that LPCGF could promote the proliferation, migration and odontogenic differentiation of hDPCs, and 25% LPCGF induced the most mineralization nodule formation and the highest DSPP gene expression. The heterotopic transplantation of the hDPCs-LPCGF complex resulted in the formation of regenerative pulp tissue with newly formed dentin, neovascularization and nerve-like tissue. Together, these findings provide key data on the effect of LPCGF on the proliferation, migration, odontogenic/osteogenic differentiation of hDPCs, and the in vivo mechanism of hDPCs-LPCGF complex autologous transplantation in pulp regeneration therapy.

Concentrated growth factor combined with iRoot BP Plus promotes inflamed pulp repair: an in vitro and in vivo study

BACKGROUND

Platelet concentrates combined with calcium silicate cements may promote reparative dentin formation. However, few studies have reported their effect on dental pulp inflammation. This study aimed to evaluate the effects of concentrated growth factor (CGF) combined with iRoot BP Plus on inflammatory human dental pulp stem cells (hDPSCs) in vitro and inflamed pulp in rats in vivo.

METHODS

The proliferation of LPS-stimulated hDPSCs treated with 50% CGF with/without 25% iRoot BP Plus was evaluated using Cell Counting Kit-8 on days 1, 4 and 7. The expression of genes associated with inflammation on day 1 and differentiation on day 14 was analysed by real-time polymerase chain reaction. The exposed pulp of rat maxillary molars was injected with 10 mg/mL LPS and directly capped with CGF membrane with/without iRoot BP Plus extract for 1, 7 and 28 days. The teeth were subjected to histologic analyses and immunohistochemistry.

RESULTS

The proliferation rates of the inflammatory hDPSCs after the combination treatment were significantly higher than those after the other treatments on days 4 and 7 (P < 0.05). IL-1β, IL-6, and TNF-α levels were increased in inflammatory hDPSCs but decreased after treatment with CGF combined with iRoot BP Plus extract, whereas IL-4 and IL-10 showed the opposite expression patterns. Expression of the odontogenesis-related genes OCN, Runx2, and ALP was dramatically enhanced by combined treatment with CGF and iRoot BP Plus extract. In rat pulp, the average inflammation scores of the CGF and CGF-iRoot BP Plus groups significantly decreased in comparison with those of the LPS group (P < 0.05), and the CGF-iRoot BP Plus group had more reparative dentin than the CGF and BP groups. Immunohistochemical staining showed fewer M1 macrophages on day 1 and more M2 macrophages on day 7 in the CGF-iRoot BP Plus group than in the other groups.

CONCLUSIONS

The combination of CGF and iRoot BP Plus showed a synergistic effect on anti-inflammatory potential and promoted greater pulp healing than CGF or iRoot BP Plus alone.

Standardization of Animal Models and Techniques for Platelet-Rich Fibrin Production: A Narrative Review and Guideline

Experimental research is critical for advancing medical knowledge and enhancing patient outcomes, including in vitro and in vivo preclinical assessments. Platelet-rich fibrin (PRF) is a blood by-product that has garnered attention in the medical and dental fields due to its potential for tissue regeneration and wound healing. Animal models, such as rabbits and rats, have been used to produce PRF and examine its properties and applications. PRF has demonstrated potential in the dental and medical fields for reducing inflammation, promoting tissue repair, and accelerating wound healing. This narrative review aims to compare existing evidence and provide guidelines for PRF animal research, emphasizing the importance of standardizing animal models, following ethical considerations, and maintaining transparency and accountability. The authors highlight the necessity to use the correct relative centrifugal force (RCF), standardize centrifugal calibration, and report detailed information about blood collection and centrifuge parameters for reproducible results. Standardizing animal models and techniques is crucial for narrowing the gap between laboratory research and clinical applications, ultimately enhancing the translation of findings from bench to bedside.

Treatment of multiple gingival recessions with concentrated growth factor membrane and coronally advanced tunnel technique via digital measurements: A randomized controlled clinical trial

BACKGROUND/PURPOSE

Research into biomaterial alternatives to connective tissue grafts (CTG) is a research hotspot. The purpose of this clinical trial was to compare the effectiveness of root coverage through tunnel technique with concentrated growth factor (CGF) vs CTG in treating multiple gingival recessions using digital measurements.

MATERIALS AND METHODS

Seventy Cairo Class I multiple gingival recessions (in 28 patients) were treated with either CGF or CTG combined with coronally advanced tunnel technique. Digital models were obtained at baseline, 2 weeks, 6 weeks, and 6 months post-op to compare the gain in gingival height, area, volume, and thickness. Tooth sensitivity, post-operative pain, and healing index were also recorded.

RESULTS

Complete root coverage at 6 months post-op were 47.06% in the CGF group and 77.78% in the CTG groups. Mean root coverages were 80.55% and 96.18%, respectively. No statistical difference was demonstrated between the two groups in terms of gingival area gain at 2 weeks post-op, but the CTG group had greater increases in gingival height, area, volume, and thickness in the period after 2 weeks post-op. Pain scores were statistically significantly lower in the CGF group. At 6 months post-op, sensitivity scores decreased more significantly in the CTG group.

CONCLUSION

Digital measurements revealed post-operative gingival shrinkage was more pronounced in the CGF group than in the CTG group when combined with coronally advanced tunnel technique. Despite the ease-of-use and minimal post-operative discomfort, it is difficult to achieve similar root coverage outcomes to CTG when using CGF alone in treating multiple gingival recessions.

A comparative study of the effects of platelet-rich fibrin, concentrated growth factor and platelet-poor plasma on the healing of tooth extraction sockets in rabbits

BACKGROUND

Autologous platelet concentrate has been widely used to encourage the regeneration of hard and soft tissues. Up to now, there are three generations of autologous platelet concentrates. Many studies have shown that the three autologous concentrates have different effects, but the specific diversities have not been studied. The purpose of this study was to explore and compare the effects of platelet-rich fibrin, concentrated growth factor and platelet-poor plasma on the healing of tooth extraction sockets in New Zealand rabbits.

METHODS

A total of 24 healthy male New Zealand white rabbits aged 8-12 weeks were selected. The experimental animals were randomly divided into four groups: three experimental groups were respectively implanted with PPP, CGF and PRF gel after bilateral mandibular anterior teeth were extracted, and the control group did not implant any material. The alveolar bone of the mandibular anterior region was taken at 2, 4 and 8 weeks after operation. The height and width of the extraction wound were detected by CBCT, the growth of the new bone was observed by HE and Masson staining, and the expression of osteogenic genes was detected by real-time PCR. Data were analyzed using IBM SPSS statistical package 22.0.

RESULTS

The radiological results showed that alveolar bone resorption in all groups gradually increased over time. However, the experimental groups showed lower amounts of bone resorption. The histological results showed that new bone formation was observed in all groups. Over time, the new bone trabeculae of the CGF group became closely aligned while those in the PPP and PRF groups remained scattered. PCR results showed that the expression of BMP-2 and ALP was higher in the experimental groups than the control group.

CONCLUSION

In conclusion, the application of PRF, CGF and PPP in tooth extraction sockets effectively promoted bone regeneration. CGF showed more effective bone induction and tissue regeneration ability in the long term.

Platelet-rich fibrin and concentrated growth factors as novel platelet concentrates for chronic hard-to-heal skin ulcers: a systematic review and Meta-analysis of randomized controlled trials

BACKGROUND

This study aimed to determine superior outcomes of platelet-rich fibrin and concentrated growth factors dressings in chronic hard-to-heal skin ulcers.

METHODS

A search in PubMed, EMBASE, Cochrane Library and CINAHL(EBSCO) was performed for randomized controlled trials comparing platelet-rich fibrin or concentrated growth factors dressings to standard wound care in chronic hard-to-heal skin ulcers. Primary outcome was the number of ulcers completely healed. Secondary outcomes were percentage of ulcers area reduction and complications. Dichotomous and continuous results were pooled in risk difference and mean difference respectively, with a 95% confidence interval (CI).

RESULTS

Eight studies with 578 patients were included. The number of ulcers completely healed in platelet-rich fibrin was significantly higher than in control group, during the fourth week of follow-up (risk difference, 0.48; 95% CI, 0.31-0.66; p < .00001) and at the end of follow-up (risk difference, 0.17; 95% CI, 0.08-0.26; p = .0003). The pooled result between concentrated growth factors and control group was inconclusive due to two few studies included.

CONCLUSIONS

Platelet-rich fibrin is safe and promising to promote healing of chronic hard-to-heal skin ulcers versus standard wound care. Further studies are warranted to evaluate the roles of concentrated growth factors.

Effect of advanced platelet-rich fibrin and concentrated growth factor on tissues around implants in maxillary anterior region

Aim

To assess the effect of advanced platelet-rich fibrin (APRF) and concentrated growth factor (CGF) on tissues around implants in the maxillary anterior region.

Settings and Design

This was a prospective clinical study.

Materials and Methods

Thirty subjects were divided into three groups with 10 dental implants in each group, i.e., Group 1: Control group, Group 2: Endosseous implant placement with APRF, and Group 3: Endosseous implant placement with CGF. The subjects were assessed at baseline (at the time of prosthesis placement), 2 weeks, 2 months, 6 months, and 1 year for modified sulcular bleeding index, periimplant probing depth, mucosal suppuration, bleeding on probing, crestal bone level as well as implant stability.

Statistical Analysis Used

Oneway Analysis of variance and Post hoc Bonferroni were the statistical tests used.

Results

The difference in implant stability at 2 months was significantly (P < 0.05) more among the control and CGF groups compared to APRF group. However; the crestal bone levels, periimplant probing depth, modified sulcular bleeding index, mucosal suppuration, and bleeding on probing were statistically non-significant (P > 0.05).

Conclusion

CGF and APRF accelerated osseointegration. Furthermore, they had a positive effect on stabilization values. However, CGF showed better results and with further clinical trials may show a positive effect on implant healing period.

Evaluation of the efficacy of concentrated growth factor along with bovine-derived xenograft and collagen membrane in the treatment of Degree II mandibular molar furcation defect – A clinicoradiographic study

Background:

The ultimate goal of furcation defect therapy is furcation closure via periodontal regeneration. However, the process of periodontal regeneration is affected by the regenerative environment of signaling molecules and growth factors due to which consistent findings of complete furcation closure could not be attained. In this study, we have evaluated the use of concentrated growth factor (CGF) which provides sustained release growth factors in conjunction with bovine-derived xenograft anorganic bovine bone (ABB) in guided tissue regeneration (GTR) of Degree II mandibular molar furcation defect.

Materials and Methods:

Twenty patients with Degree II mandibular molar furcation defects were selected for the study. Each group consisted of 10 patients and a total of 10 sites were treated in each group. The control sites were treated with GTR and ABB, while the experimental sites received CGF mixed with ABB along with GTR. Clinical parameters recorded were Plaque Index, Gingival Index, vertical probing depth, and horizontal probing depth measured at baseline and 6 months. Radiographic parameters such as the vertical height of defect, horizontal depth of defect, and percentage of vertical and horizontal bone fill were recorded at baseline and 6 months.

Results:

All the parameters recorded showed a significant reduction from baseline to 6 months in both the groups. Significantly higher vertical and horizontal bone fill was observed in the experimental group as compared to the control group.

Conclusion:

The use of CGF showed a positive additive efficacy in enhancing the events of periodontal regeneration in the treatment of Degree II mandibular molar furcation defect.

CGFe and TGF-β1 enhance viability and osteogenic differentiation of human dental pulp stem cells through the MAPK pathway

The present study aimed to evaluate the effects of concentrated growth factor exudate (CGFe) and TGF-β1 on the viability and osteogenic differentiation of human dental pulp stem cells (hDPSCs). CGFe was prepared from the peripheral blood of healthy donors (obtained with informed consent). STRO-1⁺ hDPSCs were isolated from dental pulp tissues and treated in four groups: i) Control; ii) TGF-β1 (1 ng/ml); iii) 100% CGFe; and iv) TGF-β1 (1 ng/ml) + 100% CGFe group. hDPSC viability was measured via MTT assay. The osteogenic differentiation of hDPSCs was quantified via alkaline phosphatase (ALP) activity, western blotting and reverse transcription-quantitative PCR assays. CGFe and TGF-β1 enhanced hDPSC viability, upregulated ALP activity, upregulated the expression of phosphorylated (p)-ERK1/2, p-JNK and p-p38 in hDPSCs, and promoted transcription and protein expression of osteogenic-related genes (bone sialoprotein, Runt-related transcription factor 2 and osteocalcin) in hDPSCs. The present study demonstrated that CGFe and TGF-β1 facilitated the viability and osteogenic differentiation of hDPSCs potentially through activation of the MAPK signaling pathway.

Analysis of CGF Biomolecules, Structure and Cell Population: Characterization of the Stemness Features of CGF Cells and Osteogenic Potential

Concentrated Growth Factors (CGF) represent new autologous (blood-derived biomaterial), attracting growing interest in the field of regenerative medicine. In this study, the chemical, structural, and biological characterization of CGF was carried out. CGF molecular characterization was performed by GC/MS to quantify small metabolites and by ELISA to measure growth factors and matrix metalloproteinases (MMPs) release; structural CGF characterization was carried out by SEM analysis and immunohistochemistry; CGF has been cultured, and its primary cells were isolated for the identification of their surface markers by flow cytometry, Western blot, and real-time PCR; finally, the osteogenic differentiation of CGF primary cells was evaluated through matrix mineralization by alizarin red staining and through mRNA quantification of osteogenic differentiation markers by real-time PCR. We found that CGF has a complex inner structure capable of influencing the release of growth factors, metabolites, and cells. These cells, which could regulate the production and release of the CGF growth factors, show stem features and are able to differentiate into osteoblasts producing a mineralized matrix. These data, taken together, highlight interesting new perspectives for the use of CGF in regenerative medicine.

The extract of concentrated growth factor enhances osteogenic activity of osteoblast through PI3K/AKT pathway and promotes bone regeneration in vivo

BACKGROUND

Concentrated growth factor (CGF) is a third-generation platelet concentrate product; the major source of growth factors in CGF is its extract; however, there are few studies on the overall effects of the extract of CGF (CGF-e). The aim of this study was to investigate the effect and mechanism of CGF-e on MC3T3-E1 cells in vitro and to explore the effect of combination of CGF-e and bone collagen (Bio-Oss Collagen, Geistlich, Switzerland) for bone formation in cranial defect model of rats in vivo.

METHODS

The cell proliferation, ALP activity, mineral deposition, osteogenic-related gene, and protein expression were evaluated in vitro; the newly formed bone was evaluated by histological and immunohistochemical analysis through critical-sized cranial defect rat model in vivo.

RESULTS

The cell proliferation, ALP activity, mineral deposition, osteogenic-related gene, and protein expression of CGF-e group were significantly increased compared with the control group. In addition, there was significantly more newly formed bone in the CGF-e + bone collagen group, compared to the blank control group and bone collagen only group.

CONCLUSIONS

CGF-e activated the PI3K/AKT signaling pathway to enhance osteogenic differentiation and mineralization of MC3T3-E1 cells and promoted the bone formation of rat cranial defect model.

The Combination of Concentrated Growth Factor and Adipose-Derived Stem Cell Sheet Repairs Skull Defects in Rats

BACKGROUND

The goal of this study was to create a biomaterial which combines concentrated growth factor (CGF) with an adipose-derived stem cell (ADSC) sheet to promote the repair of skull defects in rats.

METHODS

We determined the optimal concentration of CGF extract by investigating the effects of different concentrations (0, 5%, 10%, and 20%) on the proliferation and differentiation of ADSCs. Then we created a complex combining CGF with an ADSC sheet, and tested the effects on bone repair in four experimental rat groups: (A) control; (B) ADSC sheet; (C) CGF particles; (D) combination of CGF + ADSCs. Eight weeks after the procedure, osteogenesis was assessed by micro-CT and hematoxylin and eosin staining.

RESULTS

We found that the concentration of CGF extract that promoted optimal ADSC proliferation and differentiation in vitro was 20%. In turn, bone regeneration was promoted the most by the combination of CGF and ADSCs.

CONCLUSION

In this study, we determined the optimal ratio of CGF and ADSCs to be used in a biomaterial for bone regeneration. The resulting CGF/ADSCs complex promotes maxillofacial bone defect repair in rats.

The impact of autologous concentrated growth factors on the alveolar ridge preservation after posterior tooth extraction: A prospective, randomized controlled clinical trial

BACKGROUND

Alveolar ridge preservation can effectively decrease alveolar ridge resorption following tooth extraction, but it can be limited by reducing new bone formation and residual bone graft material. Efforts to develop more efficacious approaches are thus an area of active research.

PURPOSE

To assess the impact of autologous concentrated growth factors (CGF) on alveolar ridge absorption and osteogenesis following posterior tooth extraction.

MATERIALS AND METHODS

Fifty patients were randomly assigned to have extraction sockets treated with CGF or no treatment. At 10 days, 1 month, and 3 months postextraction, soft tissue color and texture were examined and evaluated with healing score. Cone-beam computed tomography (CBCT) scans were performed before and 3 months after extraction, while radiographic analyses were used to assess vertical and horizontal bone changes. Bone samples were collected from the extraction sockets during implant placement, and micro-computed tomography (micro-CT) scans and histological analysis were performed to evaluate new bone formation. t-Test or Mann-Whitney U test was used to compare data and the level of statistical significance was set at 0.05 for all analyses.

RESULTS

Forty-six patients completed the trial. Sockets in the experimental group exhibited significantly better healing score on Day 10 postextraction relative to the control group, whereas comparable healing was observed in both groups at 1 and 3 months postextraction. Experimental group exhibited reduced vertical bone changes relative to the control (p < 0.05). Significant reductions were observed in ridge width changes at 1 and 2 mm apical to the crest (p < 0.05), although differences at 3 and 5 mm apical to the crest were not significant. Significant differences of bone mineral density (BMD) and microarchitecture of trabecular bone were observed via micro-CT analyses, and the experimental group had better results.

CONCLUSION

CGF application following posterior tooth extraction may reduce vertical and horizontal bone resorption and promote new bone formation.

Effect of Platelet-Derived Concentrated Growth Factor on Single-Layer, Multi-Layer, and Crushed Onlay Cartilage Grafts

BACKGROUND

The main concern with utilizing cartilage grafts to achieve structural integrity and volume restoration is the loss of volume over time and their unpredictable viability. Preservation of the volume of cartilage grafts is necessary to ensure their long-term success.

OBJECTIVES

The main aim of this study was to investigate the effect of concentrated growth factor (CGF) sheet on single-layer, multi-layer, and crushed block cartilage grafts.

METHODS

Cartilage grafts obtained from the ears of rabbits were prepared in 3 different forms: single-layer, triple-layer, and crushed. After measuring the weight and thickness of the cartilage grafts, the grafts in the experimental group were wrapped with the prepared autologous CGF. These cartilage grafts were placed in subcutaneous pouches created on the backs of the rabbits. After 4 months, the rabbits were killed. The weight and thickness of the cartilage grafts were measured and the cartilage viability and peripheral changes were examined microscopically.

RESULTS

The percentage changes in the weights and thicknesses of the single-layer, multi-layer, and crushed cartilage grafts wrapped with CGF were found to be statistically significantly lower than in the control group. When the cartilage viability and changes in peripheral tissue were evaluated, CGF-wrapped cartilage groups did not achieve statistically significantly better scores than the untreated control groups.

CONCLUSIONS

In cases planned to receive a block cartilage graft, especially if graft resorption is not desired or should be minimized, wrapping the graft with autologous CGF is a feasible option.

Clinical evaluation of the treatment of multiple gingival recessions with connective tissue graft or concentrated growth factor using tunnel technique: a randomized controlled clinical trial

OBJECTIVE

To assess the effectiveness of the combination of tunnel technique (TT) and concentrated growth factor (CGF) for root coverage in treating multiple gingival recessions (GR) and compare with the connective tissue graft (CTG).

MATERIALS AND METHODS

Forty patients with Miller Class I and II maxillary or mandibular GR were randomly divided into two groups as follows: TT + CTG and TT + CGF. The results at baseline and 6 months were evaluated for the following clinical parameters: complete root coverage (CRC), mean root coverage (MRC), gingival thickness (GT), gingival recession width (RW), gingival recession depth (RD), and keratinized tissue width (KTW).

RESULTS

At 6 months, a statistically significant difference was found in RD, RW, MRC, CRC, KTW, and GT compared with the baseline (p < 0.05). MRC was determined 89.52±16.36% in the TT + CTG and 76.60±24.10% in the TT + CGF (p < 0.05). CRC was achieved in 66.7% of the TT + CTG and 47.4% of the TT + CGF (p < 0.05). The increase in KTW and GT was significantly better in the TT + CTG group compared to the TT + CGF (p < 0.05).

CONCLUSIONS

The study showed that TT + CGF did not improve the results as much as TT + CTG in the treatment of Miller Class I and II GR. However, this finding is not sufficient to advocate the true clinical effects of CGF on GR treatment with TT.

CLINICAL RELEVANCE

CGF could not serve as a direct alternative biomaterial to the gold standard CTG.

TRIAL REGISTRATION

ClinicalTrials.gov Identification Number: NCT04561947.

Application of a New Type of Natural Calcined Bone Repair Material Combined with Concentrated Growth Factors in Bone Regeneration in Rabbit Critical-Sized Calvarial Defect

Purpose

This study is aimed at investigating bone regeneration in critical-sized defects in rabbit calvarium using a novel nano- (n-) hydroxyapatite hybrid scaffold with concentrated growth factors (CGFs).

Methods

Twenty-four male adult rabbits were chosen to establish a critical-sized bone defect model and randomly divided into two groups. Two defects of 15 mm diameter each were created in the parietal bone of each animal. Group A had n-hydroxyapatite hybrid scaffold placed in the experimental defect on the right, and the left defect was unfilled as blank. Group B had hydroxyapatite hybrid scaffold mixed with CGF placed in the right defect and CGF on the left. Six animals in each group were sacrificed after 6 and 12 weeks. Cone-beam computed tomography system scanning and hematoxylin and eosin (HE) staining were used to detect osteogenesis within the defects.

Results

The treatment with n-hydroxyapatite hybrid scaffold along with CGF resulted in a significantly higher amount of new bone at 6 and 12 weeks compared to the treatment with CGF alone and the controls. No apparent inflammation and foreign body reaction were observed through HE staining.

Conclusions

The new synthesized n-hydroxyapatite hybrid scaffold and CGF can be applied for bone defect regeneration to promote the process to a certain extent.

Concentrated Growth Factor - Surgical Management of Large Periapical Lesion Using a Novel Platelet Concentrate in Combination with Bone Graft

Although endodontic therapy is typically successful, in approximately 10%-15% of the cases, symptoms can persist or reoccur. Periapical surgery is the preferred treatment of choice in failed root canal therapy, chronic periapical lesion, persistent apical periodontitis, etc., i.e., when conventional treatment modalities fail. Over the past few decades, although the list of indications for endodontic surgery has diminished, there exist definite cases in which the tooth cannot be retained without surgery. This case report, however, sheds light on the incorporation of a novel autologous platelet concentrate-concentrated growth factor (CGF) coupled with an osseograft in surgical endodontic procedure to ensure a swift and successful recovery of the periapical region subjected to extensive lesions. The use of an osseograft combined with CGF has numerous advantages as well due to the formation of sticky bone. There are no articles published in the literature with respect to the potent application of CGF and bone graft (sticky bone) in large periapical lesions to aid in the reparative process. In this case report, the 1-year follow-up radiographs and cone-beam computed tomography showed complete healing of the hard and soft-tissue lesions that conform to achieving repair and regeneration at a rapid rate in extensive periapical lesions.

Does Concentrated Growth Factor Used With Allografts in Maxillary Sinus Lifting Have Adjunctive Benefits?

PURPOSE

Recent studies have shown that the use of platelet concentration products alone, or in combination with variable graft materials, accelerates the new bone formation associated with sinus augmentation. The aim of this study was to measure the adjunctive effects of concentrated growth factor (CGF) used with allograft on new bone formation and augmentation stability in sinus lifting.

MATERIALS AND METHODS

This randomized controlled study included patients who presented for dental implant placement in atrophic posterior maxilla at the Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ege University, and who needed maxillary sinus augmentation. All patients were treated with a 2-stage surgical technique using sinus lifting bilaterally and implant placement 6 months later. During sinus lifting surgery, one side was grafted with allograft (group 1) and the other side with allograft mixed CGF (group 2). Cone-beam computed tomography was carried out immediately postoperatively and also 6 months after the augmentation to evaluate vertical bone height and percentage of resorption. Bone specimens were obtained at the time of implant placement and evaluated histomorphometrically to analyze the percentage of new bone formation and residual graft particle. Statistical comparisons were conducted between groups for all these measurements.

RESULTS

A total of 10 patients (2 females and 8 males) with a mean age of 57 years (range, 39 to 72) were enrolled in the study. Cone-beam computed tomography analysis revealed a significantly higher percentage of bone height resorption at the sixth month in group 1 (median, 9.32%) compared with group 2 (median, 6.37%) (P < .05). According to the histomorphometric examination, the percentage of new bone formation in group 2 (median, 36.41%) was higher than group 1 (median, 35.49%), but this difference did not reach statistical significance.

CONCLUSIONS

Using CGF with allografts supports the stabilization of gained vertical bone height after sinus augmentation, but further research is needed to determine the accelerating effects of CGF on new bone formation.

Effects of Autologous Platelet-Rich Fibrin in Post-Extraction Alveolar Sockets: A Randomized, Controlled Split-Mouth Trial in Dogs with Spontaneous Periodontal Disease

Simple Summary

The effects of autologous platelet-rich fibrin were evaluated in dogs with spontaneous periodontal disease after tooth extraction. Both radiographic and histological findings attributed to the platelet-rich fibrin a potential ability to stimulate the natural process of tissue healing and regeneration of bone and soft tissues. Platelet-rich fibrin could, therefore, be considered as a simple and effective therapeutic aid in the management of post-extraction socket healing in dogs.

Abstract

Periodontal disease (PD) is a common inflammatory condition in dogs; in severe stages, dental extraction is frequently required. Platelet-rich fibrin (PRF) has been used in human oral surgical procedures and has been experimentally tested on post-extraction sockets in healthy dogs. This is the first split-mouth, randomized, controlled trial designed to compare post-extractive alveolar socket healing with and without topical application of PRF in canine spontaneous PD. Clinical evaluation, radiographic density, and histological scores for inflammation and regeneration were assessed at recruitment (T0) and after a three-week follow up (T1) on 12 dogs, for a total of 31 pairs of sockets. No complications or clinically evident differences between the treated sites and the control sites were observed. Comparing the radiographic densities of the extraction sites measured at T0 and T1, a significant enhancement was observed within the PRF group, but not within control group. The histological score decreased significantly from T0 to T1 within group PRF, but not within the control group; at T1, the PRF group showed a significantly lower histological score than the control group. These findings suggest that PRF could be able to stimulate the natural process of tissue healing and regeneration of post-extraction sites in dogs with spontaneous periodontal disease (PD).

A Comprehensive Review of Concentrated Growth Factors and Their Novel Applications in Facial Reconstructive and Regenerative Medicine

BACKGROUND

Concentrated growth factors (CGFs) are the latest generation of platelet concentrates. The objective of developing CGF is to increase therapeutic efficacy. However, few studies have supported the superiority of CGF in composition and efficacy. The reconstruction and regeneration process is complicated and long term, whereas bioactivity of CGF is not durable. The purpose of this review is threefold. The first is to recommend more comparative studies between CGF and other platelet concentrates. The second is to constitute a continuous drug delivery system by combining CGF with other biomaterials. Finally, the novel use of CGF in facial regenerative and reconstructive medicine will be highlighted.

METHODS

A comprehensive review of literature regarding the use of CGF in facial regenerative and reconstructive medicine was performed. Based on the inclusion and exclusion criteria, a total of 135 articles were included.

RESULTS

The use of CGF involving facial rejuvenation, cartilage grafting, facial bone defects, facial peripheral nerve injury and wounding is reviewed. The reconstructive and regenerative principles lie in firm fibrin scaffolds and continuous in situ delivery of multiple growth factors.

CONCLUSIONS

CGF represents an advance in personalized medicine concept. However, the current scientific evidences about the use of CGF are limited. More basic and clinical studies should be conducted to understand the characteristics and clinical application of CGF.

LEVEL OF EVIDENCE V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Tensile strength, growth factor content and proliferation activities for two platelet concentrates of platelet-rich fibrin and concentrated growth factor

Background/purpose

Platelet-rich fibrin (PRF) can be obtained by centrifuging fresh blood in the absence of anticoagulants. Varying the centrifugation speeds may produce tougher and richer concentrated growth factors (CGF). This study examines tensile strength, growth factor content, and the potential of CGF and PRF in promoting periodontal cell proliferation.

Materials and methods

Blood (40 mL/subject) was collected from 44 healthy subjects. PRF and CGF were prepared by centrifuging at 3000 rpm and switching speeds ranging within 3000 rpm, respectively. Fibrin strip was prepared and its tensile strength was measured. Transforming growth factor beta 1 (TGF-β1), platelet-derived growth factor BB (PDGF-BB), and epidermal growth factor (EGF) in the residual serum and fibrin clots were determined by enzyme-linked immunosorbent assay, and their effects on the proliferation of hFOB1.19 osteoblasts and human gingival fibroblasts were evaluated by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide assay.

Results

Compared with PRF, tensile strength of CGF was significantly higher. Concentrations and amounts of PDGF-BB and EGF in CGF were significantly higher than those in PRF. Osteoblast number was significantly higher in the cultures with fetal bovine serum (FBS, 10%) and with PRF or CGF fibrin clots (5%, 10%, and 50%) compared to that without FBS. Moreover, osteoblast number in CGF, regardless of the preparation of 10% and 50%, was significantly greater than that in PRF. Similar findings were also observed for gingival fibroblasts among the various subjects.

Conclusion

Varying centrifugation speeds can modify the tensile strength and biological activities of platelet fibrin clots.

The Effect of Concentrated Growth Factor on Calvarial Bone in Diabetic Healing

The aim of this study was to evaluate the effect of Concentrated Growth Factor (CGF) on bone healing in diabetic rat model. Experimental diabetes was induced in 24 male Sprague-Dawley rats by streptozotocin. Twenty-four animals served as healthy controls. The animals were divided into 4 subgroups; empty bone defect, grafting with xenogenous graft (Geno-os, OsteoBiol, Turin-Italy), CGF administration, and combined application of the CGF with the xenogenous graft in critical-sized defects in the calvaria of the rats. The diabetic group was given 4 units of Neutral Protamin Hagedorn per day. After 6 weeks, all animals were sacrificed and bone healing was histologically and histomorphometrically analyzed, and the evaluation revealed that the new bone formation in diabetic animals was significantly lower than in healthy group (P: 0.001, P: 0.023). In both groups, the highest rate of ossification was observed in the combined use of xenogenous graft and CGF. When the new bone formation was examined in the graft and CGF group, no significant difference was found between control and diabetic group (P = 0.562; P > 0.05). In conclusion, in patients with diabetes mellitus, combination therapy of CGF with graft is expected to contribute positively to the healing of bone defect.

A novel approach to regenerate bone loss in an adolescent using concentrated growth factors: One-year follow-up

Destructive periodontal diseases are rare occurrences in the paediatric population. Moreover, the regenerative potential of the periodontal tissues and supporting structures of teeth is even rare, once irreversible damage has occurred. The aim of this paper is to discuss the regeneration of alveolar bone defect in a 14-year-old using concentrated growth factors (CGF). Following crown removal, scaling, debridement and site preparation, CGF was placed and secured in one-walled defect in the mesial side of the lower right permanent molar. The crown was replaced on to the tooth and the patient was followed up at 1, 3, 6, 9 and 12 months for clinical and radiographic evaluation. After 12 months, the radiographic evaluation revealed the defect to be filled with alveolar bone and probing pocket depth had reduced significantly. Thus, CGF can be an effective agent and can act as a potential scaffold for periodontal regeneration in adolescents with bone loss.

In vitro and in vivo effects of concentrated growth factor on cells and tissues

This article reviews the biological outcome of the concentrated growth factor (CGF), a new platelet derivative used for tissue regeneration, in published articles related to the use of this product in basic and clinical studies. An electronic literature research using PubMed and SCOPUS was performed using combination of keywords: "concentrated growth factor" (OR "CGF"), AND "stem cells," AND "cells" OR "cell proliferation" OR "cell migration" OR "cell differentiation," AND "repair" OR "survival" OR "revitalization," AND "tissue" OR "bone." Forty-five articles that were published between 2012 and 2020 met the inclusion criteria. These studies have used CGF as fresh solid form, freeze-dried, membrane, extract, or exudate. Most studies demonstrate the positive effects of CGF in a dose-dependent manner under certain concentrations. Studies comparing CGF with other platelet concentrates, report lower efficiency, no statistically significant differences, or better results for CGF. Combination of CGF with stem cells and biomaterials significantly improves bone regeneration and the effect of allograft or collagen membrane is better than CGF alone. For a better examination of the biological outcomes of CGF, the standardization of CGF preparation regarding the choice of the test tube material for blood collection, the required volume of blood, the necessary count of platelets in CGF, and the most appropriate type of CGF are recommended.

Concentrated Growth Factor Promotes Dental Pulp Cells Proliferation and Mineralization and Facilitates Recovery of Dental Pulp Tissue

Background

Dental pulp cells (DPCs) play vital roles in the recovery of dental pulp tissue. Concentrated growth factor (CGF) can promote proliferation and mineralization of various cells. However, the functions of CGF on DPCs and dental pulp tissue are unclear. The object of our study was to identify the roles of CGF in DPCs proliferation and mineralization in vitro and to assess the effects of CGF on direct pulp capping in vivo.

Material/Methods

We performed CCK-8 and Transwell assay to detect proliferation and migration activity of DPCs. Alizarin Red staining was performed to examine mineralized nodules. Alkaline phosphatase activity test was used to measure the mineralization capacity of DPCs. We assessed the odontogenic differentiation gene expression level by Western blot and qPCR. The effect of CGF on direct pulp capping in vivo were evaluated by radiography and histopathology.

Results

CGF increased the number of proliferative and migratory DPCs. CGF enhanced DPCs mineralized nodules and improved the gene expression levels of DSPP, DMP-1, BSP, and ALP. CGF upregulated the protein levels of ALP, BMP2, SMAD5, Runx2, and p-Smad, and the effect could be partially reversed by Noggin. CGF promoted pulp recovery and kept its vitality in directly pulp capping.

Conclusions

CGF promotes DPCs proliferation and mineralization. It regulates the mineralization of DPCs via the BMP2/SMAD5/Runx2 signaling pathway. CGF can be used as the effective graft for direct pulp capping.

Effect of autogenous growth factors released from platelet concentrates on the osteogenic differentiation of periodontal ligament fibroblasts: a comparative study

Background

Platelet concentrates have been used in tissue regeneration. The purpose of this study was to examine effects of growth factors released from leukocyte- and platelet-rich fibrin (L-PRF) and concentrated growth factor (CGF) on the osteogenic differentiation of periodontal ligament fibroblasts (PDLFs).

Methods

Leukocyte- and platelet-rich fibrins, CGFs and PDLFs were obtained from New Zealand rabbits. The release of basic fibroblast growth factor (bFGF), bone morphogenetic protein 2 (BMP-2) and transforming growth factor β1 (TGF-β1) from L-PRFs and CGFs was measured at 5 h and 1, 3, 5, 7 days, using the enzyme linked immunosorbent assay. The PDLFs were treated with exudates of L-PRF or CGF. After the treatment, cell counting kit-8 assay was performed at day 1, 3, 5 and 7. Alkaline phosphatase (ALP) assay and Western blotting were applied at day 7. Three blocking antibodies were used to neutralize the proteins of bFGF, BMP-2 and TGF-β1.

Results

Leukocyte- and platelet-rich fibrin and CGF showed different growth factor release pattern, but similar accumulated concentration of these growth factors. PDLFs proliferation was significantly promoted by both L-PRF and CGF at day 1, 3 and 7, and CGF group was superior to L-PRF group at day 1 and 3. Both L-PRF and CGF significantly enhanced PDLFs ALP activity and protein expression of osteogenic markers. The osteopontin level was higher in CGF group than in L-PRF group, but no significant differences were found between two groups for ALP activity. Three blocking antibodies significantly downregulated both L-PRF and CGF induced osteogenic markers expression.

Conclusion

Both CGF and L-PRF can promote the proliferation and osteogenic differentiation of PDLFs. The bFGF, BMP-2 and TGF-β1 are involved in both L-PRF and CGF induced osteogenic differentiation of PDLFs.

Effects of Platelet-Derived Material (Platelet-Rich Fibrin) on Bone Regeneration

PURPOSE

The purpose of this study was to evaluate the effects of the growth factor within platelet-rich fibrin (PRF) in proliferation and differentiation of osteoblast and to observe the effectiveness of PRF.

MATERIALS AND METHODS

The colorimetric MTT assay, cell live and dead assay, alkaline phosphatase staining and activity assay, alizarine red S, and von Kossa staining were performed. Finally, the alterations of biomarkers associated with bone formation were verified at the mRNA level by quantitative polymerase chain reaction (PCR) and quantitative real-time PCR. In in vivo study, 6 adult mongrel dogs were used. The defect was performed and divided into 3 groups: (1) defect left unfilled, (2) defect filled with only 0.25-g Bio-Oss, and (3) defect filled with 0.25-g Bio-Oss mixed with PRF.

RESULTS

MTT and cell live and dead assay showed that PRF did not affect the cell viability in MG-63 cells. The alkaline phosphatase activity, calcification, and mineralization were gradually increased in the MG-63 cells treated with PRF. Furthermore, the mRNA levels of biomarker gene in the MG-63 cells treated with PRF were significantly higher than those of control. In in vivo study, both radiographical and histological evaluations showed that the new bone formations were significantly increased in the defecting bone region transplanted with Bio-Oss and PRF compared with Bio-Oss only at 2 weeks after transplantation.

CONCLUSION

PRF can promote the bone regeneration without any complications.

The Additional Effect of Autologous Platelet Concentrates to Coronally Advanced Flap in the Treatment of Gingival Recessions: A Systematic Review and Meta-Analysis

Background

To improve the efficacy of regenerative treatment for gingival recessions, the autologous platelet concentrates (APCs) combined with coronally advanced flap (CAF) have been investigated. However, few studies systematically assess the complementary effect of APCs in periodontal regeneration. The present study aims to evaluate the additional effect of different types of APCs to CAF in the treatment of gingival recessions.

Methods

Electronic databases (EMBASE, MEDLINE, and Cochrane Central Register of Controlled Trails) and relevant journals were searched until May 15, 2019. Only randomized controlled trials (RCTs) in English were included. Outcome variables include root coverage (RC), recession depth (RD), clinical attachment level (CAL), keratinized tissue width (KTW), and gingival thickness (GT). Data were analyzed with Revman5.3. The estimate of effect sizes was expressed as the mean differences and the 95% confidence interval.

Results

8 RCTs involving 170 patients (328 sites) were included. Our meta-analysis indicated RC, RD, CAL, KTW, and GT were better improved in the CAF plus APCs groups than the CAF alone. The subgroup analyses revealed that platelet-rich fibrin (PRF) brought significant improvement in RC, RD, CAL, and GT. Concentrated growth factors (CGF) lead clinic beneficial in CAL, KTW, and GT. No significant effect of platelet-rich plasma (PRP) could be found in any clinical parameters when combined with CAF.

Conclusions

PRF could exert additional effect to CAF; the preferred treatment for gingival recessions was considered. Based on the limited studies, it seemed that PRP failed to show any additional effect and it was not suggested for gingival recessions. Given the limited research and high risk of bias, it is still needed to confirm the additional effect of CGF by more high-quality studies.

A comparative study of the effects of concentrated growth factors in two different forms on osteogenesis in vitro

Extending the release cycle of growth factors to match the cycle of bone remodeling is difficult. When using concentrated growth factors (CGFs), the release of growth factors is excessively rapid. In the present study, CGF samples were prepared by centrifugation. CGF samples were then lyophilized and grinded into a powder, which was termed freeze‑dried CGF. The freeze‑dried CGF samples were mixed with chitosan‑alginate composite hydrogels, and the mixture was lyophilized. The result was a chitosan‑alginate composite CGF membrane, which was called sustained‑release CGF. This study investigated whether freeze‑dried CGF in a chitosan‑alginate composite gel can release CGF steadily to achieve effective osteogenesis. The proliferation and osteogenic expression of MC3T3‑E1 cells induced by the supernatants from incubation with freeze‑dried CGF and sustained‑release CGF were evaluated. The concentrations of the growth factors, transforming growth factor β1 (TGF‑β1), insulin‑like growth factor‑1 (IGF‑1), platelet‑derived growth factor‑AB (PDGF‑AB) and vascular endothelial growth factor (VEGF), in these two experimental groups at different times were determined by ELISA kits. The freeze‑dried CGF showed better osteogenic performance than the sustained‑release CGF in the early stages. At later stages, the sustained‑release CGF had significant advantages over freeze‑dried CGF in terms of promoting osteogenic mineralization. By characterizing the biologic properties of the CGF in the two different forms in vitro, we obtained a better understanding of their clinical effects.

Concentrated growth factor exudate enhances the proliferation of human periodontal ligament cells in the presence of TNF‑α

The purpose of this study was to evaluate the effects of concentrated growth factor exudate (CGFe) on human periodontal ligament cells (hPDLCs) stimulated by tumor necrosis factor (TNF)‑α. From the peripheral blood of healthy donors, CGFe was prepared according to the Sacco protocol after 7 days of incubation. The hPDLCs were cultured by a tissue explant method and identified with anti‑vimentin and anti‑cytokeratin antibodies. Cells were subjected to four different treatments: i) Control; ii) TNF‑α (10 ng/ml); iii) CGFe (concentration 50%); and iv) CGFe+TNF‑α. The proliferation of hPDLCs was measured with Cell Counting Kit‑8 assays. Osteogenic differentiation and mineralization were determined by Alizarin Red S staining, alkaline phosphatase activity, western blotting and reverse transcription‑quantitative polymerase chain reaction. CGFe enhanced cell proliferation and upregulated ALP activity, the mineralization level, and osteogenic‑associated osteocalcin, runt‑related transcription factor 2 and Osterix gene expression in hPDLCs under inflammatory conditions induced by TNF‑α. The present study demonstrated that CGFe enhanced hPDLC proliferation and osteogenic differentiation in the presence of TNF‑α‑induced inflammation. As CGFe can be obtained from the venous blood of patients, it generates no immune reaction. Thus, it is more economical and beneficial to use CGFe in clinical periodontal regeneration practice than synthetic growth factors.

Concentrated Growth Factors as an Ingenious Biomaterial in Regeneration of Bony Defects after Periapical Surgery: A Report of Two Cases

The overall success of a periapical surgery is assessed in terms of regeneration of functional periradicular tissues. The regenerative potential of platelets has been well documented. This article describes the use of concentrated growth factors (CGF), a new family of autologous platelet concentrates, as a sole material for bone regeneration after periapical surgery. 32- and 35-year-old female patients diagnosed with Ellis Class IV, an open apex in 11 with apical periodontitis in 11 and 12 and previously root canal-treated 31 and 41 with a chronic apical abscess, respectively, were managed with endodontic surgery. Subsequent to apicectomy and retrograde filling, the CGF fibrin block and membrane were used before suturing. There was uneventful healing during the immediate post-op and the subsequent follow-up periods. CGF is produced by a differential centrifugation process that results in the formation of a denser fibrin matrix richer in growth factors than those observed in PRF. Reasonable osseous healing was seen as early as 6-month follow-up, thereby recommending the use of CGF as an alternative to bone grafts and membranes in extensive periapical lesions to enhance bone regeneration and to decrease the healing time.