Comparison of platelet-rich plasma, bovine porous bone mineral, and guided tissue regeneration versus platelet-rich plasma and bovine porous bone mineral in the treatment of intrabony defects: a reentry study

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.

The Effectiveness and Safety of Autologous Platelet Concentrates as Hemostatic Agents after Tooth Extraction in Patients on Anticoagulant Therapy: A Systematic Review of Randomized, Controlled Trials

One of the common challenges in oral surgery is dealing with patients who are taking oral anticoagulant/antiaggregant drugs. Several local hemostatic agents have been proposed as an alternative to conventional suturing. Among these, autologous platelet concentrates (APCs) have been widely used to decrease the risk of hemorrhage after dental extraction. Nevertheless, there is a lack of consensus regarding the superiority of any one specific hemostatic agent over the others. This systematic review is aimed at evaluating the effectiveness of APCs as hemostatic agents after tooth extraction in patients on anticoagulant therapy. A literature search was conducted of articles published before March 2023 on PubMed, Scopus, and the Cochrane Central Register of Controlled Trials (CENTRAL). Studies on the use of APCs in patients undergoing dental extractions and being treated with anticoagulant drugs were included. Only randomized, controlled trials (RCTs) published up to March 2023 were included; the outcomes assessed were the time to hemostasis, the presence of post-operative bleeding and pain, and the effectiveness of wound healing. The risk of bias for each RCT was assessed by using the 'risk of bias' tool (RoB 1.0). The research revealed 6 RCTs. The findings indicated that patients on anticoagulant therapy who received APCs without discontinuing their medication experienced a decreased post-operative bleeding, a shorter hemostasis time, reduced pain, and accelerated wound healing. However, due to the high/unclear risk of bias of the studies included, no definitive conclusions can be drawn on the superiority of APCs as hemostatic agents over other similar products. Additional studies are required to validate these findings.

Effect of platelet-rich plasma on the attachment of periodontal ligament fibroblasts to the diseased root surface and the attendant collagen formation

OBJECTIVE

To investigate the effect of different concentrations of platelet-rich plasma (PRP) on collagen formation via periodontal ligament fibroblasts (PDLFs) on the surface of demineralised diseased tooth roots.

METHODS

Various PDLFs were grown from tissue explants, with the cells between the fifth and eighth passage in the culture used. Human whole blood obtained from healthy subjects was collected in tubes containing an anticoagulant (acid-citrate-dextrose) and centrifuged (1300 rpm for 10 min) before the supernatant PRP layer was removed. A second spin at (2000 rpm for 10 min) produced the PRP fraction. The effect of PRP of various concentrations on the attachment of PDLFs on the diseased root surface of human teeth demineralised with ethylenediaminetetraacetic acid (EDTA) and treated with the PRP was then investigated in terms of PRP collagen formation, with the formation observed using the Sirius red staining method.

RESULTS

The optical density values of the experimental groups were statistically significantly higher than those of the control groups (P < 0.05), while the Sirius red staining returned positive results for both the experimental group (A) and the control group (B). The images were analysed using a histogram, and a statistically significant difference was found (P < 0.05).

CONCLUSION

While PRP could promote the attachment and collagen formation of PDLFs on the diseased root surface of human teeth demineralised with EDTA and treated with PRP, the effect is potentially reduced when the dose exceeds 20%.

Efficacy of biologics for the treatment of periodontal infrabony defects: An American Academy of Periodontology best evidence systematic review and network meta-analysis

BACKGROUND

A large variety of biomaterials, biologics and membranes have been utilized in the past 40 years for the regenerative treatment of periodontal infrabony defects. Biologic agents have progressively gained popularity among clinicians and are routinely used for periodontal regeneration. In alignment with the goals of the American Academy of Periodontology (AAP) Best Evidence Consensus (BEC) on the use of biologic mediators in contemporary clinical practice, the aim of this sytematic review was to evaluate the effect of biologic agents, specifically autogenous blood-dervied products (ABPs), enamel matrix derivative (EMD) and recombinant human platelet-derived growth factor-BB (rhPDGF-BB), on the regenerative outcomes of infrabony defects.

METHODS

A detailed systematic search was conducted to identify eligible randomized control trials (RCTs) reporting the outcomes of periodontal regenerative therapy using biologics for the treatment of infrabony defects. A frequentist mixed-modeling approach to network meta-analysis (NMA), characterized by the assessment of three individual components for the treatment of an infrabony defect (the bone graft material [BG], the biologic agent, the application of a barrier membrane) was performed to evaluate and compare the relative efficacy of the different components, on the outcomes of different therapeutic modalities of periodontal regeneration.

RESULTS

A total of 153 eligible RCTs were included, with 150 studies contributing to the NMA. The quantitative analysis showed that the addition of biologic agents to bone graft significantly improves the clinical and radiographic outcomes, as compared to BG and flap procedures alone. Barrier membranes enhanced the regenerative outcomes of BG but did not provide further benefits in combination with biologics. The type of BG (autogenous, allogeneic, xenogeneic or alloplastic) and the biologic agent (EMD, platelet-rich fibrin [PRF], platelet-rich plasma [PRP] or rhPDGF-BB) played a significant role on the final outcomes of infrabony defects. Allogeneic and xenogeneic BGs exhibited statistically significantly superior clinical gain than synthetic and autogenous BGs (p < 0.05 in all the comparisons), while rhPDGF-BB and PRF demonstrated significantly higher stability of the gingival margin (p < 0.01) and radiographic bone fill/gain (p < 0.05), together with greater, although not statistically significant, clinical attachment level gain and pocket depth reduction, than EMD and PRP. Overall, rhPDGF-BB exhibited the largest effect size for most parameters, including clinical attachment level gain, pocket depth reduction, less gingival recession and radiographic linear bone gain. Considering the relatively high number of trials presenting an unclear or high risk of bias, the strength of recommendation supporting the use of PRP was judged weak, while the recommendation for EMD, PRF and rhPDGF-BB was deemed in favor.

CONCLUSIONS

Biologics enhance the outcomes of periodontal regenerative therapy. Combination therapies involving BGs + biologics or BGs + barrier membrane demonstrated to be superior to monotherapies. The choice of the type of BG and biologic agent seems to have significant impact on the clinical and radiographic outcomes of infrabony defects.

Use of PRP, PRF and CGF in Periodontal Regeneration and Facial Rejuvenation-A Narrative Review

Growth factors (GFs) play a vital role in cell proliferation, migration, differentiation and angiogenesis. Autologous platelet concentrates (APCs) which contain high levels of GFs make them especially suitable for periodontal regeneration and facial rejuvenation. The main generations of APCs presented are platelet-rich plasma (PRP), platelet-rich fibrin (PRF) and concentrated growth factor (CGF) techniques. The purpose of this review is to provide the clinician with an overview of APCs' evolution over the past decade in order to give reliable and useful information to be used in clinical work. This review summarizes the most interesting and novel articles published between 1997 and 2020. Electronic and manual searches were conducted in the following databases: Pubmed, Scopus, Cochrane Library and Embase. The following keywords were used: growth factors, VEGF, TGF-b1, PRP, PRF, CGF and periodontal regeneration and/or facial rejuvenation. A total of 73 articles were finally included. The review then addresses the uses of the three different techniques in the two disciplines, as well as the advantages and limitations of each technique. Overall, PRP is mainly used in cases of hard and soft tissue procedures, while PRF is used in gingival recession and the treatment of furcation and intrabony defects; CGF is mainly used in bone regeneration.

Biomaterials Regulating Bone Hematoma for Osteogenesis

Blood coagulation in tissue healing not only prevents blood loss, but also forms a natural scaffold for tissue repair and regeneration. As blood clot formation is the initial and foremost phase upon bone injury, and the quality of blood clot (hematoma) orchestrates the following inflammatory and cellular processes as well as the subsequent callus formation and bone remodeling process. Inspired by the natural healing hematoma, tissue-engineered biomimic scaffold/hydrogels and blood prefabrication strategies attract significant interests in developing functional bone substitutes. The alteration of the fracture hematoma ca significantly accelerate or impair the overall bone healing process. This review summarizes the impact of biomaterials on blood coagulation and provides evidence on fibrin network structure, growth factors, and biomolecules that contribute to bone healing within the hematoma. The aim is to provide insights into the development of novel implant and bone biomaterials for enhanced osteogenesis. Advances in the understanding of biomaterial characteristics (e.g., morphology, chemistry, wettability, and protein adsorption) and their effect on hematoma properties are highlighted. Emphasizing the importance of the initial healing phase of the hematoma endows the design of advanced biomaterials with the desired regulatory properties for optimal coagulation and hematoma properties, thereby facilitating enhanced osteogenesis and ideal therapeutic effects.

A split-mouth clinico-radiographic comparative study for evaluation of crestal bone and peri-implant soft tissues in immediately loaded implants with and without platelet-rich plasma bioactivation

Background. This study evaluated the viability of platelet-rich plasma for enhancement of osseous and associated soft tissue healing around single-piece implants, subjected to immediate loading and to compare it with a control site not treated with PRP. Methods. Twenty completely edentulous patients were selected and 2 one-piece implants with O-ball head were placed for mandibular overdenture. The implant on the right side was treated with PRP whereas the left side implant served as a control. All the cases were immediately loaded and marginal bone loss, probing depth, percussion, implant mobility and peri-implantitis were assessed and compared at 3, 6, 9 and 12 months. Results. Overall analysis of the results showed less marginal bone loss, probing depth, percussion, implant mobility and periimplantitis around implants treated with PRP; however, the results were insignificant statistically. Conclusion. PRP can be used as a viable treatment adjunct in immediately loaded one-piece implants.

Effects of platelet rich plasma (PRP) on human gingival fibroblast, osteoblast and periodontal ligament cell behaviour

BACKGROUND

The use of platelet rich plasma (PRP, GLO) has been used as an adjunct to various regenerative dental procedures. The aim of the present study was to characterize the influence of PRP on human gingival fibroblasts, periodontal ligament (PDL) cells and osteoblast cell behavior in vitro.

METHODS

Human gingival fibroblasts, PDL cells and osteoblasts were cultured with conditioned media from PRP and investigated for cell migration, proliferation and collagen1 (COL1) immunostaining. Furthermore, gingival fibroblasts were tested for genes encoding TGF-β, PDGF and COL1a whereas PDL cells and osteoblasts were additionally tested for alkaline phosphatase (ALP) activity, alizarin red staining and mRNA levels of osteoblast differentiation markers including Runx2, COL1a2, ALP and osteocalcin (OCN).

RESULTS

It was first found that PRP significantly increased cell migration of all cells up to 4 fold. Furthermore, PRP increased cell proliferation at 3 and 5 days of gingival fibroblasts, and at 3 days for PDL cells, whereas no effect was observed on osteoblasts. Gingival fibroblasts cultured with PRP increased TGF-β, PDGF-B and COL1 mRNA levels at 7 days and further increased over 3-fold COL1 staining at 14 days. PDL cells cultured with PRP increased Runx2 mRNA levels but significantly down-regulated OCN mRNA levels at 3 days. No differences in COL1 staining or ALP staining were observed in PDL cells. Furthermore, PRP decreased mineralization of PDL cells at 14 days post seeding as assessed by alizarin red staining. In osteoblasts, PRP increased COL1 staining at 14 days, increased COL1 and ALP at 3 days, as well as increased ALP staining at 14 days. No significant differences were observed for alizarin red staining of osteoblasts following culture with PRP.

CONCLUSIONS

The results demonstrate that PRP promoted gingival fibroblast migration, proliferation and mRNA expression of pro-wound healing molecules. While PRP induced PDL cells and osteoblast migration and proliferation, it tended to have little to no effect on osteoblast differentiation. Therefore, while the effects seem to favor soft tissue regeneration, the additional effects of PRP on hard tissue formation of PDL cells and osteoblasts could not be fully confirmed in the present in vitro culture system.

Patient-centered Microsurgical Management of Gingival Recession using Coronally Advanced Flap with Either Platelet-rich Fibrin or Connective Tissue Graft: A Comparative Analysis

Purpose:

To evaluate autologous platelet-rich fibrin (PRF) and autogenous connective tissue graft (CTG) in gingival recession defects in conjunction with coronally advanced flap (CAF) using a microsurgical technique.

Materials and Methods:

Forty-five Class I and II recession defects were randomly equally (n = 15) divided into three groups: Group I sites treated with CAF with PRF, Group II sites treated with CAF with CTG, and Group III sites treated with CAF alone using microsurgical approach. Parameters recorded were vertical gingival recession (VGR) and horizontal gingival recession (HGR), % complete root coverage (CRC), patient comfort score (PCS), patient esthetic score (PES), and hypersensitivity score (HS) at 10 days, 3 months, and 6 months.

Results:

CAF surgery alone and in combination with PRF or CTG are effective procedures to cover denuded roots with mean VGR values of 1.26 ± 0.70 mm (74.4%), 1.26 ± 0.59 mm (58%), and 1.06 ± 0.79 mm (53.3%) for Groups I, II, and III, respectively. In terms of CRC achieved at 6 months, results showed that 100% CRC was obtained in 60% sites of Group I, 20% sites of Group II, and 27% sites of Group III. Patient response and acceptance for surgical treatment modality in terms of PCS and PES were highest for Group I (PRF and CAF) followed by Group III and Group II, and there was decrease in HS for Group I (PRF and CAF) while no significant changes in HS were observed for Group II and Group III. At the end of 6 months follow-up, there was a significant increase in gingival thickness measurements using transgingival probing in Group II, whereas nonsignificant changes were observed in Group I and Group III.

Conclusions:

A long-term multicenter randomized controlled clinical study may be necessary to evaluate the clinical outcome for autologous PRF in comparison to CTG and CAF alone.

The effect of concentrated growth factors in the treatment of periodontal intrabony defects

AIM

To investigate the effect of concentrated growth factors (CGFs) in human intrabony defect treatment.

METHODS

Thirty-one intrabony defects were randomly treated with CGFs + bovine porous bone mineral (BPBM) or BPBM alone. Probing depth, clinical attachment level and hard tissue fill were evaluated at baseline and 1 year post surgery.

RESULTS

No differences in any of the investigated parameters were observed at baseline. At 1 year post therapy, both groups showed significant improvement in clinical parameters (p < 0.001). CGFs + BPBM was more effective than BPBM alone at decreasing probing depth (4.2 ± 1.3 mm vs 3.0 ± 1.6 mm) and clinical attachment level gain (3.7 ± 1.3 mm vs 2.4 ± 1.1 mm; p ≤ 0.05). A favorable increase of hard tissue fill was noted in CGFs + BPBM group compared with BPBM group (p > 0.05). The contents of growth factors in CGFs were statistically higher than those in platelet poor plasma (p < 0.001).

CONCLUSION

Addition of CGFs significantly improved clinical effectiveness of BPBM for intrabony defect treatment.

The effect of platelet-rich plasma on clinical outcomes of the surgical treatment of periodontal intrabony defects: A systematic review and meta-analysis

Background

Studies investigating the use of platelet–rich plasma (PRP) in the treatment of intrabony defects have yielded mixed results. The aim of our study was to evaluate the efficacy of PRP by comparing clinical attachment level (CAL) and pocket depth (PD) for patients who received PRP as an adjunct to periodontal intrabony defect therapy with those for patients who did not. We also analyzed the influence of guided tissue regeneration (GTR) and different study designs (parallel and split–mouth studies) on the clinical outcomes of intrabony defects.

Methods

We performed a systematic review of articles published in any language up to June 7, 2015 by searching PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials. We included only randomized controlled clinical trials (RCTs) that compared clinical outcomes between patients who received PRP as an adjunct to periodontal intrabony defect therapy and patients who did not. We combined data from randomized trials to assess clinical outcomes using a random–effects model.

Results

Of the 307 abstracts that were initially identified, 12 RCTs related to the treatment of periodontal intrabony defects were included in the final analysis. Clinically and significantly greater CAL gains and PD reductions were observed in subjects who received PRP as an adjunct to periodontal intrabony defect therapy than in subjects who did not (CAL: WMD 0.76 mm, 95 % CI = 0.34 to 1.18 mm, P = 0.0004; PD: WMD 0.53 mm, 95 % CI = 0.21 to 0.85 mm, P = 0.001). Subgroup meta-analyses of patients who underwent GTR demonstrated that this approach did not significantly affect treatment outcomes (CAL: WMD 0.08 mm, 95 % CI = −0.30 to 0.46 mm, P = 0.67), as indicated by a comparison with patients who did not undergo GTR (CAL: WMD 1.22 mm, 95 % CI = 0.88 to 1.57 mm, P < 0.00001). Univariate meta-regression analyses revealed that the use of GTR explained the heterogeneity among the included studies (P < 0.05).

Conclusions

Within its limitations, this review suggests that PRP may be beneficial as an adjunct to graft materials for the treatment of periodontal intrabony defects, except in cases involving the use of GTR.

Structural properties of fracture haematoma: current status and future clinical implications

Blood clots (haematomas) that form immediately following a bone fracture have been shown to be vital for the subsequent healing process. During the clotting process, a number of factors can influence the fibrin clot structure, such as fibrin polymerization, growth factor binding, cellular infiltration (including platelet retraction), protein concentrations and cytokines. The modulation of the fibrin clot structure within the fracture site has important clinical implications and could result in the development of multifunctional scaffolds that mimic the natural structure of a haematoma. Artificial haematoma structures such as these can be created from the patient's own blood and can therefore act as an ideal bone defect filling material for potential clinical application to accelerate bone regeneration. Copyright © 2016 John Wiley & Sons, Ltd.

Evaluation of platelet-rich plasma alone or in combination with demineralized freeze dried bone allograft in treatment of periodontal infrabony defects: A comparative clinical trial

Aims:

The use of platelet-rich plasma (PRP) alone in periodontal defects has been controversial and inconclusive. Hence, the present study was designed with the aim to assess the clinical and radiographic effectiveness of PRP alone in infrabony defects.

Materials and Methods:

Thirty infrabony defects were treated with either autologous PRP with open flap debridement (OFD) or autologous PRP + demineralized freeze dried bone graft (DFDBA) with OFD or OFD alone. Clinical parameters recorded were gingival index, plaque index, probing depth (PD), clinical attachment level (CAL), and gingival recession (REC). Radiographic parameters included defect depth reduction, defect resolution, and crestal bone level. All the parameters were recorded at baseline and 12 months postoperatively.

Results:

Mean PD reduction and CAL gain were greater in PRP + DFDBA (4.88 ± 1.12 mm and 4.26 ± 1.85 mm) and PRP (4.86 ± 2.12 mm and 4.10 ± 1.47 mm) groups than the control group (2.69 ± 1.37 mm and 1.27 ± 0.89 mm).

Conclusions:

Within the limits of the study, all the three groups showed significant improvement in clinical parameters from baseline to postoperative 12 months. The amount of defect depth reduction and defect resolution treated with PRP alone group were significantly < PRP + DFDBA. The results pertaining to these parameters were significantly better than the control group.

Osteocalcin and osteonectin expression after double application of platelet-rich plasma in rabbits

Purpose:

Platelet-rich plasma (PRP) is a novel method for transferring autogenous growth factors to the wound area. The aim of this study was to evaluate the efficacy of double-application of PRP (DA-PRP) on bone healing in rabbit cranial defects by examining osteonectin (ON) and osteocalcin (OC) expression.

Materials and Methods:

Twenty-eight rabbits, each with two surgically prepared calvarial bone defects, were included in this study and divided into six groups: The defects (N=56) were treated with either a single-application of PRP (SA-PRP) (n=10), a combination of SA-PRP and betatricalciumphosphate (SA-PRP+β-TCP) (n=10), only DAPRP (n=8), both DA-PRP and beta-tricalciumphosphate (DA-PRP+β-TCP) (n=8), only beta-tricalciumphosphate (β-TCP) (n=10), or controls (n=10). The animals were sacrificed at 30th day postoperatively and samples were immunohistochemically examined for ON and OC expressions.

Results:

It was determined that DA-PRP did not significantly improve the ON and OC percentages achieved by SA-PRP or the controls. The three groups treated with β-TCP showed a higher percentage of ON than those treated without β-TCP (p<0.05). The β-TCP treated groups and SA-PRP group demonstrated higher OC percentage than DA-PRP and control groups (p<0.05).

Conclusion:

The present findings suggest that DAPRP did not have a significant effect on the healing of non-critical size rabbit cranial bone defects.

Patient-centered evaluation of microsurgical management of gingival recession using coronally advanced flap with platelet-rich fibrin or amnion membrane: A comparative analysis

OBJECTIVE

To evaluate the efficacy of coronally advanced flap (CAF) procedure under microsurgical approach for the management of Miller's Class I and II gingival recession defects with the use of either platelet-rich fibrin (PRF) or amnion membrane (AM) in comparison to CAF alone.

MATERIALS AND METHODS

A total of 45 sites with Miller's Class I or II gingival recession defect were randomly distributed for: Experimental Group I (CAF with PRF) sites (n = 15) which were treated with the microsurgical approach using CAF along with PRF; experimental Group II (CAF with AM) sites (n = 15) were treated with the microsurgical approach using CAF along with AM; control Group III (CAF alone) sites (n = 15) were treated with the microsurgical approach using CAF alone. Vertical gingival recession (VGR), horizontal gingival recession (HGR), gingival thickness (GT) (using transgingival probing [TGP] and ultrasonography [USG]) and patients' response and acceptance were documented at baseline, 3 months and 6 months after surgical interventions.

RESULTS

CAF alone and in combination with PRF or AM, were effective techniques for root coverage with average VGR values of 1.47 ± 0.92 mm (56%), 0.67 ± 1.23 mm (36%) and 0.60 ± 1.06 mm (33%) in Group I (CAF with PRF), Group II (CAF with AM), and Group III (CAF alone), respectively. Complete coverage (100%) was obtained in 33.3% sites of Group I (CAF with PRF), 26.6% sites of Group II (CAF with AM) and 13.3% in Group III (CAF alone). Patients' response and acceptance for surgical treatment modality in terms of patient esthetic score and decrease in hypersensitivity score was highest for Group I (CAF with PRF), whereas patient comfort score was highest for Group II (CAF with AM). At 6 months follow-up, significant increase in GT measurements (using TGP and USG) in Group I (CAF with PRF), whereas, nonsignificant increase for Group II (CAF with AM) and no change or decrease for Group III (CAF alone) as compared to baseline was observed.

CONCLUSION

The present study observed enhancement in root coverage when PRF or AM are used in conjunction with CAF as compared to CAF alone. These results are based on 6-month follow-up. Therefore, the long-term evaluation may be necessary to appreciate the clinical effect of autologous PRF and AM.

Platelet-Rich Plasma: A Study of the Variables that May Influence Its Effect on Bone Regeneration

BACKGROUND

Currently, the use of platelet-rich plasma in bone regeneration is a real option, although more than one opinion has alerted us to the absence of clinical benefits.

PURPOSE

Analysis of the factors able to modify the characteristics of the platelet preparation obtained by Curasan, Plasma Rich in Growth Factors (PRGF), Platelet Concentrate Collection System (PCCS) and SmartPrep systems, relating them to the type of clinical application and the final bone regeneration achieved.

MATERIALS AND METHODS

A search was conducted in PubMed using the keywords "platelet-rich plasma," "PRP," "platelet rich growth factors," and "oral bone regeneration." Four widely accepted protocols for the obtention of PRP (above) were analyzed. Any clinical studies with controls, using the four preparation protocols and with a 4 to 6 weeks follow-up period were compared. The protocols were also grouped according to the type of PRP application: PRP-alone, with bone, or with bone substitutes.

RESULTS

Bone regeneration was not achieved in any of the cases using PRP obtained by Curasan and PCCS systems, whereas PRP obtained by SmartPrep achieved it only in one in three published cases and PRGF in one in six.

CONCLUSION

Based on the poor results observed in current literature, the use of PRP in oral surgery cannot be recommended.

Platelet rich fibrin combined with decalcified freeze-dried bone allograft for the treatment of human intrabony periodontal defects: a randomized split mouth clinical trail

OBJECTIVE

Polypeptide growth factors of platelet rich fibrin (PRF) have the potential to regenerate periodontal tissues. Osteoinductive property of demineralized freeze-dried bone allograft (DFDBA) has been successfully utilized in periodontal regeneration. The aim of the present randomized, split mouth, clinical trial was to determine the additive effects of PRF with a DFDBA in the treatment of human intrabony periodontal defects.

MATERIALS AND METHODS

Sixty interproximal infrabony defects in 30 healthy, non-smoker patients diagnosed with chronic periodontitis were randomly assigned to PRF/DFDBA group or the DFDBA/saline. Clinical [pocket depth (PD), clinical attachment level (CAL) and gingival recession (REC)] and radiographic (bone fill, defect resolution and alveolar crest resorption) measurements were made at baseline and at a 12-month evaluation.

RESULTS

Compared with baseline, 12-month results indicated that both treatment modalities resulted in significant changes in all clinical and radiographic parameters. However, the PRP/DFDBA group exhibited statistically significantly greater changes compared with the DFDBA/saline group in PD (4.15 ± 0.84 vs 3.60 ± 0.51 mm), CAL (3.73 ± 0.74 vs 2.61 ± 0.68 mm), REC (0.47 ± 0.56 vs 1.00 ± 0.61 mm), bone fill (3.50 ± 0.67 vs 2.49 ± 0.64 mm) and defect resolution (3.73 ± 0.63 vs 2.75 ± 0.57 mm).

CONCLUSION

Observations indicate that a combination of PRF and DFDBA is more effective than DFDBA with saline for the treatment of infrabony periodontal defects.

A comparative evaluation of platelet-rich plasma in combination with demineralized freeze-dried bone allograft and DFDBA alone in the treatment of periodontal intrabony defects: A clinicoradiographic study

BACKGROUND

The aim of the present clinical trial was to compare PRP combined with a DFDBA to DFDBA mixed with a normal saline solution in the treatment of human intrabony defects.

MATERIALS AND METHODS

Twenty interproximal intrabony osseous defects in twenty non-smoking, healthy subjects diagnosed with chronic periodontitis were treated in this study. Ten subjects each were randomly assigned to the test group (PRP + DFDBA) or the control group (DFDBA + saline). Clinical and radiographic measurements were made at baseline, three month and at six-month evaluation.

RESULTS

The results at three and six months, when compared to the baseline, indicated that both treatment modalities resulted in significant changes in all clinical parameters (gingival index, bleeding on probing, probing depth, clinical attachment level and gingival recession; P < 0.01) and radiographic parameters (hard-tissue fill and bone-depth reduction; P < 0.01). However, the test group exhibited statistically significantly greater changes compared to the control group in plaque index at three months (P = 0.00), probing depth reduction at 6 months (P = 0.02) and the radiographic defect fill at 6 months (P = 0.01).

CONCLUSIONS

Treatment with a combination of PRP and DFDBA led to a statistically significantly greater improvement in plaque index at 3 months, probing depth at 6 months and radiographic defect fill at 6 months in intrabony periodontal defects as compared to DFDBA with normal saline.

Clinical and radiographic evaluation of intra-bony defects in localized aggressive periodontitis patients with platelet rich plasma/hydroxyapatite graft: A comparative controlled clinical trial

Background:

Aggressive periodontitis is a characterized by rapid attachment loss, bone destruction and familial aggregation. Platelet-rich plasma (PRP) has been proposed to promote regeneration of the lost periodontal tissues. The aim of this study was to evaluate and compare the efficacy of PRP combined with hydroxyapatite (HA) graft in the treatment of intra-bony defects in localized aggressive periodontitis (L-AgP) patients.

Materials and Methods:

Ten L-AgP patients having bilateral intra-bony defect ≥2 mm and probing depth (PD) ≥6 mm were randomly treated either with the PRP/HA graft or HA graft alone. The clinical (plaque control record, bleeding on probing index, PD, and relative attachment level [RAL]), and radiographic parameters (size of the bone defect) were recorded pre- and post-operatively at 3, 6, and 12 months.

Results:

After 12 months, for both maxillary and mandibular arches, the mean PD decrease was significantly more (P < 0.05) for the test group than the control group (3.2 mm vs. 1.9 mm and 3.6 mm vs. 1.9 mm, respectively). Furthermore, the mean RAL decrease in both maxillary and mandibular arches was significantly more (P < 0.05) for the test group than the control group (3.0 mm vs. 1.2 mm and 3.1 mm vs. 1.4 mm, respectively). Radiographically, the test group showed significantly more defect fill as compared with the control group.

Conclusion:

Both treatments provided significant improvements in clinical and radiographic parameters in a 12-month postoperative period. PRP/HA group presented superior results regarding PD reduction, clinical attachment gain and radiographic bone fill than HA group.

Platelet-rich preparations to improve healing. Part II: platelet activation and enrichment, leukocyte inclusion, and other selection criteria

Multiple platelet-rich preparations have been reported to improve wound and bone healing, such as platelet-rich plasma (PRP) and platelet rich fibrin (PRF). The different methods employed during their preparation are important, as they influence the quality of the product applied to a wound or surgical site. Besides the general protocol for preparing the platelet-rich product (discussed in Part 1 of this review), multiple choices need to be considered during its preparation. For example, activation of the platelets is required for the release and enmeshment of growth factors, but the method of activation may influence the resulting matrix, growth factor availability, and healing. Additionally, some methods enrich leukocytes as well as platelets, but others are designed to be leukocyte-poor. Leukocytes have many important roles in healing and their inclusion in PRP results in increased platelet concentrations. Platelet and growth factor enrichment reported for the different types of platelet-rich preparations are also compared. Generally, TGF-β1 and PDGF levels were higher in preparations that contain leukocytes compared to leukocyte-poor PRP. However, platelet concentration may be the most reliable criterion for comparing different preparations. These and other criteria are described to help guide dental and medical professionals, in large and small practices, in selecting the best procedures for their patients. The healing benefits of platelet-rich preparations along with the low risk and availability of simple preparation procedures should encourage more clinicians to incorporate platelet-rich products in their practice to accelerate healing, reduce adverse events, and improve patient outcomes.

Additive effect of autologous platelet concentrates in treatment of intrabony defects: a systematic review and meta-analysis

The aim of the present review is to systematically evaluate the additive effect of autologous platelet concentrates (APCs) in treatment of intrabony defects when used along with other regenerative procedures and when used alone in terms of clinical and radiological outcomes. A search was performed in electronic databases (i.e., MEDLINE and the Cochrane Central Register of Controlled Trials) in order to identify randomized clinical trials (RCTs) assessing the additive efficacy of APCs for healing and regeneration of hard and soft tissues in patients undergoing regenerative surgical procedures for the treatment of intrabony defects, having a follow-up of at least 9 months. Included studies underwent risk of bias assessment and data extraction. The main variables evaluated for efficacy were: pocket depth (PD), clinical attachment level (CAL), radiographic bone filling, and postoperative pain. The effect of APCs adjunct was evaluated for the following procedures: open flap debridement (OFD) alone, OFD plus grafting of the defect with autogenous bone or bone substitutes, and grafting in combination with a covering membrane for guided tissue regeneration (GTR). Platelet-rich fibrin (PRF) has a significant additive effect when used along with OFD. Platelet-rich plasma (PRP) has a significant additive effect when used along with bone grafts. Conversely, PRP was found to be ineffective when used in combination with GTR procedures. No study evaluated the effect of APCs on postoperative pain. Platelet-rich plasma may be used advantageously as an adjunct to grafting materials, but not in combination with GTR, for treatment of intrabony defects. Moreover, PRF can be effective as a sole regenerative material, in combination with OFD. There is still a lack of evidence regarding the effect of PRF in combination with grafting materials and GTR, the effect of other types of APCs such as plasma rich in growth factors, and the effect of APCs on postoperative pain.

Comparative evaluation of clinical efficacy of β-tri calcium phosphate (Septodont-RTR)™ alone and in combination with platelet rich plasma for treatment of intrabony defects in chronic periodontitis

Aim:

To assess the clinical outcome by comparing β-tri calcium phosphate (Septodont RTR)™ along with platelet rich plasma (PRP) and β-tri calcium phosphate (β-TCP) alone in intrabony defects, by clinical evaluation in a 6-month analysis.

Methodology:

Ten patients participated in the study. Using a split-mouth design, interproximal bony defects were surgically treated with either platelet rich plasma (PRP) combined with β-tri calcium phosphate (β-TCP) or β-TCP alone. Plaque Index (PI), Gingival Index, Probing Pocket Depth (PPD), Clinical Attachment Level (CAL) were recorded 6 months after surgery.

Results:

At 6 months after therapy, the PRP combined with β-TCP group showed mean PPD reduction of 2.50, CAL mean gain of 2.60 + 1.43. The β-TCP group showed mean PPD reduction of 2.80 mm, mean CAL gain of 2.60 mm. On intra-group comparison, there was greater PPD reduction and CAL gain at 6 months in both the groups. In intergroup comparison of PRP/β-TCP and β-TCP alone, there was no statistical significant difference observed. (P = 0.55, and 0.87 for PPD and CAL gain).

Conclusion:

Both therapies resulted in significant PPD reduction, CAL gain. The present study shows that treatment of intrabony periodontal defects with combination of PRP and β-TCP does not have additional improvements when compared with β-TCP alone within 6 months follow-up.

A comparative evaluation of the effectiveness of guided tissue regeneration by using a collagen membrane with or without decalcified freeze-dried bone allograft in the treatment of infrabony defects: A clinical and radiographic study

BACKGROUND

The present, randomized, controlled clinical and radiographic study was undertaken to compare the effectiveness of guided tissue regeneration (GTR) by using a collagen membrane barrier with or without decalcified freeze-dried bone allograft (DFDBA) in the treatment of periodontal infrabony defects characterized by unfavorable architecture.

MATERIALS AND METHODS

Sixteen systemically healthy patients with 20 periodontal infrabony defects were selected for the study. Each patient had at least ≥ 5 mm clinical probing pocket depth (PPD) at the selected site and depth of intrabony component ≥ 3 mm as assessed by clinical and radiographic measurements. Baseline measurements included plaque index, papillary bleeding index, PPD, gingival recession, clinical attachment level and radiographic defect depth (DD). At the time of surgery, the defects were randomly assigned to either the test group (collagen membrane plus DFDBA) or the control group (collagen membrane only).

RESULTS

At the 6-month examination, PPPD reduction was significantly greater in the GTR + DFDBA group (4.06 ± 0.38 mm) compared with the GTR group (3.2 ± 0.74 mm). The mean gains of clinical attachment were 3.54 ± 0.36 mm in the test group and 2.50 ± 0.74 mm in the control group. Radiographic DD reduction was similarly greater in the GTR + DFDBA group (2.40 ± 0.51 mm) compared with the GTR group (1.60 ± 0.51 mm).

CONCLUSIONS

The results of the present study indicate that the use of a GTR membrane with bone graft has significantly improved all clinical parameters tested as compared with the use of bioresorbable membrane alone in the treatment of infrabony defects characterized by unfavorable architecture.

Effect of osteoblast cell culture on the bone implant contact

PURPOSE

The aim of this study is to acquire an ideal bone implant contact under the cover of osteogenic effect of osteoblasts derived from Mesenchymal Stem Cells (MSCs).

MATERIALS AND METHODS

Thirty dental implants were used for this study. Implants were placed in sheep mandibles and defects were created 4 mm coronally in the dental implants. These defects were filled with Platelet Rich Plasma (PRP) in one group and with PRP + Osteoblast Cell Culture (OCC) in another group. No procedure was conducted on the control group defects (empty defect group). Eight weeks later, osseointegration was investigated with Bone Implant Contact (BIC) measurements histomorphologically. Data were checked statistically.

RESULTS

The variation of BIC rates between Empty Defect Group and PRP groups was significant (p <0.05). The BIC rate of the PRP group was higher than that of the Empty Defect Group. The variation of BIC rates between Empty Defect Group and PRP + OCC groups was significant (p <0.05). The BIC rate of the PRP + OCC group was higher than that of the Empty Defect Group. The variation of BIC rates between PRP and PRP + MSC groups was significant (p<0.05). The BIC rate of the PRP + OCC group was higher than that of the PRP group. At the end of the 8-week healing period, it was observed that the percentage of BIC was highest in the PRP + OCC group.

CONCLUSIONS

Implant-bone connection was better in the OCC-PRP group compared with the PRP group and the empty defect group. The use of OCC-PRP combination was effective on healing. The BIC value was increased significantly by OCC.

Clinical Comparison of Autogenous Bone Graft with and without Plasma Rich in Growth Factors in the Treatment of Grade II Furcation Involvement of Mandibular Molars

Background and aims

Plasma rich in growth factors (PRGF) is a concentrated suspension of growth factors, which is used to promote periodontal tissue regeneration. The aim of this randomized, controlled, clinical trial was to evaluate of the treatment of grade II mandibular molar furcation involvement using autogenous bone graft with and without PRGF.

Materials and methods

In this double-blind clinical trial, thirty mandibular molars with grade II furcation involvement in 30 patients were selected. The test group received bone graft combined with PRGF, while the control group was treated with bone graft only. Clinical parameters included clinical probing depth (CPD), vertical clinical attachment level (V-CAL), horizontal clinical attachment level (H-CAL), location of gingival margin (LGM), surgically exposed horizontal probing depth of bony defect (E-HPD), vertical depth of bone crest (V-DBC), vertical depth of the base of bony defect (V-DBD), and length of the intrabony defect (LID). After six months, a re-entry surgery was performed. Data were analyzed by SPSS 14, using Kolmogorov, Mann-Whitney U, and paired t-test.

Results

After 6 months, both treatment methods led to significant improvement in V-CAL and H-CAL and significant decreases in CPD, E-HPD, V-DBD and LID; there was no significant difference in LGM and V-DBC in any of the treated groups compared to the baseline values. Also, none of the parameters showed significant differences between the study groups.

Conclusion

Although autogenous bone grafts, with or without PRGF, were successful in treating grade II furcation involvement, no differences between the study groups were observed.

Subepithelial connective tissue graft with and without the use of plasma rich in growth factors for treating root exposure

Purpose

The aim of this study was to evaluate the clinical efficiency of the subepithelial connective tissue graft (SCTG) with and without plasma rich in growth factor (PRGF) in the treatment of gingival recessions.

Methods

Twenty bilateral buccal gingival Miller's Class I and II recessions were selected. Ten of the recessions were treated with SCTG and PRGF (test group). The rest ten of the recessions were treated with SCTG (control group). The clinical parameters including recession depth (RD), percentage of root coverage (RC), mucogingival junction (MGJ) position, clinical attachment level (CAL), and probing depth (PD) were measured at the baseline, and 1 and 3 months later. The data were analyzed using the Wilcoxon signed rank and Mann-Whitney U tests.

Results

After 3 months, both groups showed a significant improvement in all of the mentioned criteria except PD. Although the amount of improvement was better in the SCTG+PRGF group than the SCTG only group, this difference was not statistically significant. The mean RC was 70.85±12.57 in the test group and 75.83±24.68 in the control group.

Conclusions

Both SCTG+PRGF and SCTG only result in favorable clinical outcomes, but the added benefit of PRGF is not evident.

Coronally advanced flap and combination therapy for root coverage. Clinical strategies based on scientific evidence and clinical experience

During the past three decades, several surgical techniques have been proposed to treat single and multiple gingival recessions. Evidence indicates that coronally advanced flap-based approaches result in the best clinical results. Among all the different techniques, the use of a graft under a coronally advanced flap results in the best short- and long-term outcomes in terms of root coverage and gain in keratinized tissue. The use of a coronally advanced flap + connective tissue graft would appear to be the best choice for root coverage. However, harvesting a graft from the palate adds morbidity, surgical chair-time and requires increased surgical skills. A potential alternative could be the use of enamel matrix derivatives under a coronally advanced flap, and this achieves similar clinical outcomes and is less invasive, but adds economic costs to the treatment. Evidence shows that a coronally advanced flap alone in many instances results in complete root coverage and is stable over time. A coronally advanced flap is less invasive for the patient, requires less chair-time and probably less surgical skill. It would therefore be desirable to use a coronally advanced flap approach when indicated. It has been hypothesized that a coronally advanced flap approach alone could be successfully applied when the residual gingiva is thick and wide, although existing evidence does not support this hypothesis in full. Accordingly, the adjunctive use of a graft or enamel matrix derivatives could be restricted to sites at which there is thin and narrow residual gingiva.

Pool of bovine morphogenetic proteins and guided tissue regeneration in the treatment of intrabony periodontal defects: I- Clinical measurements

The purpose of this study was to evaluate the effect of the pool of bovine BMPs on the treatment of intrabony defects. The sample comprised 15 patients aged 26 to 57 years old presenting with 10 pairs of lesions of 2 or 3 walls or 2-3 walls ³5mm, located in the same type teeth (premolar or molar) and same jaw. The test defects were treated with combination of a pool of bovine bone morphogenetic and resorbable hydroxyapatite carrier (BMPs- HA), bovine demineralized bone matrix (MB) and coverage by a bovine collagen barrier membrane. The control defects were treated with MB-HA and covered by a bovine collagen membrane. The clinical measurements at six months after therapy in the test group revealed a reduction in the mean probing pocket depth (PPD) of 1.63 ± 1.41mm (B) and 1.93 ± 0.96mm (L) and a mean change in the clinical attachment level (CAL) of 1.60 ± 1.16mm (B) and 1.46 ± 0.97mm (L). The control group showed a mean reduction of PPD of 1.93 ± 1.34mm (B) and 2.0 ± 1.51mm (L) and a mean change of CAL of 1.03 ± 1.24mm (B) and 1.30 ± 1.14 mm (L). The analysis of variance (ANOVA) demonstrated that the changes in the clinical parameters were statistically significant (p<0.05). There were no significant differences between the test and controls subjects (Student's test, p<0.005). These findings suggest that the use of a pool of bovine BMPs do not provide added effects to GTR in the treatment of intrabony defects.

Use of platelet rich fibrin in a fenestration defect around an implant

Guided bone regeneration (GBR) in implant therapy is especially useful for implant placement with dehiscence defects or fenestration defects. In alveolar ridges with marked facial/buccal depressions or in knifeedge alveolar crests, the position and direction of fixture placement is restricted. Improvement of alveolar ridge morphology becomes possible with GBR. This article describes a case in which the fenestration defect around an implant was treated by the application of platelet rich fibrin, a second generation platelet concentrate along with bone graft, and guided tissue regeneration membrane.

Tissue engineering: A new vista in periodontal regeneration

Tissue engineering is a highly promising field of reconstructive biology that draws on recent advances in medicine, surgery, molecular and cellular biology, polymer chemistry, and physiology. The objective of using tissue engineering as therapeutic application has been to harness its ability to exploit selected and primed cells together with an appropriate mix of regulatory factors, to allow growth and specialization of cells and matrix. The authors reviewed controlled clinical trials which also included histological studies that evaluated the potential of tissue engineering as a clinical tool in regeneration. PubMed/MEDLINE databases were searched for studies up to and including June 2010 to identify appropriate articles. A comprehensive search was designed, and the articles were independently screened for eligibility. Articles with authentic controls and proper randomization and pertaining specifically to their role in periodontal regeneration were included. Studies demonstrated that the periodontal regeneration with the use of combination of tissue engineered products with an osteoconductive matrix improve the beneficial effect of these materials by accelerating cellular in growth and revascularization of the wound site. Studies have suggested the use of rh Platelet-derived growth factor + beta tricalcium phosphate for regeneration of the periodontal attachment apparatus in combination with collagen membranes as an acceptable alternative to connective tissue graft for covering gingival recession defects. The studies concluded that growth factors promote true regeneration of the periodontal attachment apparatus and the use of combination protein therapeutics which is commercially available can provide more predictable, faster, less invasive, less traumatic, and efficient outcome for the patient.

Platelet-rich plasma in the treatment of Class II furcation defects: a histometrical study in dogs

Objective

This study was designed to evaluate the potential adjunctive benefits of platelet-rich plasma (PRP) when used with guided-tissue regeneration (GTR) and bioactive glass (BG) in the treatment of Class II furcation lesions.

Material and Methods

Bilateral Class II furcation lesions were surgically created and allowed to become chronic in the mandibular third premolars of 9 dogs. The defects were randomly assigned to: A) GTR+BG and B) GTR+BG+PRP. Similar defects were created in the maxillary third premolars and received the same treatments after 45 days. Dogs were sacrificed 90 days after the first treatment. The histometric parameters evaluated were: connective tissue adaptation, new cementum, new bone, mineralized bone area, non-mineralized bone area, and residual BG particle area.

Results

Data analysis showed a superior length of new cementum and a greater mineralized bone area for group B in both periods (p<0.05). The non-mineralized bone area was greater in the control group (p<0.05) in both periods.

Conclusion

Within the limits of this study, it can be concluded that the use of PRP in the treatment of Class II furcation defects may enhance the amount of new cementum and provide a more mineralized bone in a shorter period of time.

Treatment of intrabony defects with beta-tricalciumphosphate alone and in combination with platelet-rich plasma

BACKGROUND

The therapeutic efficacy of platelet-rich plasma (PRP) still remains controversial. This study aimed to compare the efficacy of a beta-tricalcium phosphate (β-TCP) and PRP/β-TCP combination both clinically and radiographically.

METHODS

Fourteen chronic periodontitis patients with at least two similar three-walled defects were included in the study. Each patient was randomly treated with both β-TCP (n = 14) and PRP/β-TCP (n = 14) in the same session. Baseline and 6-month evaluations of plaque index (PI), gingival index (GI), probing pocket depth (PPD), clinical attachment level (CAL), gingival recession (GR), bleeding on probing, and radiographic intrabony defect depth (RIDD) were assessed statistically.

RESULTS

At 6 months, statistically significant reductions of GI, PPD, BOP, and RIDD were observed in both groups. The median values of CAL decreased from 7.0 to 6.0 mm in the β-TCP group (p = 0.002), and 7.5 to 5.0 mm in the PRP/β-TCP group (p < 0.001). No statistically significant difference was detected between the two groups for all clinical indices.

CONCLUSION

After a 6-month healing period, both β-TCP and PRP/β-TCP were found effective in the treatment of three-walled intrabony defects and no additional statistically significant benefits were found with PRP.

Double-application of platelet-rich plasma on bone healing in rabbits

OBJECTIVE

Platelet-rich plasma (PRP) is considered to enhance bone formation especially at early stages of wound healing, depending on the limited and short life-span of platelets and growth factors. The aim of this study was to evaluate efficacy of double-application of PRP (DA-PRP) on bone healing in a rabbit calvarial defect model.

STUDY DESIGN

Twenty-eight rabbits, each had two surgically prepared calvarial bone defects (10mm diameter), were included in this study and randomly divided into six groups. Defects (n=56) were treated with single-application of PRP (SA-PRP)(n=10), SA-PRP and beta-tricalciumphosphate (SA-PRP+TCP)(n=10), DA-PRP (n=8), DA-PRP and beta-tricalciumphosphate (DA-PRP+TCP)(n=8), beta-tricalciumphosphate (TCP)(n=10) or left empty (Control)(n=10). Animals were sacrificed at 30 days postoperatively.

RESULTS

The new bone (NB%) and defect fill (DF%) percentages were calculated from histological slides by image-analyzer software and statistically analysed. All test groups showed higher NB% than control, but differences among all groups were insignificant. The TCP treated groups had significantly higher DF% than groups treated without TCP, however the DF% differences between control, SA-PRP and DA-PRP or TCP, SA-PRP+TCP or DA-PRP+TCP were insignificant.

CONCLUSION

Although new bone formation was histomorphologically remarkable at double-application PRP groups, statistical analyses of the histomorphometric data revealed no significant difference.

Platelet-rich fibrin and bovine porous bone mineral vs. platelet-rich fibrin in the treatment of intrabony periodontal defects

BACKGROUND AND OBJECTIVE

Bovine porous bone mineral (BPBM) is a xenograft that has been successfully utilized in periodontal regeneration. Platelet-rich fibrin (PRF) is a leukocyte and platelet preparation that concentrates various polypeptide growth factors and therefore has the potential to be used as regenerative treatment for periodontal defects. The purpose of this study was to examine the suitability of autologous PRF as regenerative treatment for periodontal intrabony defects in humans and to examine the ability of BPBM to augment the regenerative effects exerted by PRF.

MATERIAL AND METHODS

Using a split-mouth design, 17 paired intrabony defects were randomly treated either with PRF or with PRF-BPBM combination. Re-entry surgeries were performed at 6 mo. Primary study outcomes were changes in pocket depth, attachment level and defect fill.

RESULTS

Preoperative pocket depths, attachment levels and transoperative bone measurements were similar for the PRF and PRF-BPBM groups. Postsurgical measurements revealed a significantly greater reduction in pocket depth in the PRF-BPBM group (4.47±0.78 mm on buccal and 4.29±0.82 mm on lingual sites) when compared with the PRF group (3.35±0.68 mm on buccal and 3.24±0.73 mm on lingual sites). The PRF-BPBM group presented with significantly greater attachment gain (3.82±0.78 mm on buccal and 3.71±0.75 mm on lingual sites) than the PRF group (2.24±0.73 mm on buccal and 2.12±0.68 mm on lingual sites). Defect fill was also greater in the PRF-BPBM group (4.06±0.87 mm on buccal and 3.94±0.73 mm on lingual sites) than in the PRF group (2.21±0.68 mm on buccal and 2.06±0.64 mm on lingual sites).

CONCLUSION

The results of this study indicate that PRF can improve clinical parameters associated with human intrabony periodontal defects, and BPBM has the ability to augment the effects of PRF in reducing pocket depth, improving clinical attachment levels and promoting defect fill.

Treatment of endodontically induced periapical lesions using hydroxyapatite, platelet-rich plasma, and a combination of both: An in vivo study

Aim and Objectives:

To evaluate bone regeneration in endodontically induced periapical lesions using Hydroxyapatite, Platelet-Rich Plasma (PRP), and a combination of Hydroxyapatite and Platelet-Rich Plasma for a period of one year.

Materials and Methods:

Twenty systemically healthy patients of both genders between the ages 20 and 40 years were included. To qualify, the patient had to have a tooth where non-surgical root canal therapy had failed, periapical radiolucency was present, and periapical root end surgery was required. The bony defect had to be confined to the apical area, with the bone covering the entire root surface coronally, with an intact lingual cortical plate. Patients were randomly divided into four groups, with five patients each, as follows: Group I — Replacement with Hydroxyapatite, Group II — Replacement with PRP, Group III — Replacement with PRP and Hydroxyapatite, and Group IV — Control group with no substitutes. The patients were evaluated both clinically and radiographically.

Results:

The radiographic evaluation revealed that Group I patients showed complete bone regeneration with evidence of a trabecular pattern, at the end of one year, Group II patients showed complete bone regeneration at the end of nine months, Group III patients showed complete bone regeneration at the end of six months, and Group IV patients showed bone regeneration, which was not satisfactory even after one year.

Conclusions:

The PRP and Hydroxyapatite combination facilitated better and faster bone regeneration when compared to PRP alone.

Comparative evaluation of bovine porous bone mineral

BACKGROUND

The aim of the present clinical study was to compare the efficacy of bovine porous bone mineral (BPBM) with and without platelet-rich plasma (PRP) for the treatment of periodontal intrabony defects.

MATERIALS AND METHODS

Twenty eight identical bilateral periodontal intrabony defects were selected from 14 chronic periodontitis patients. The subjects were randomly assigned to test group (BPBM+PRP) or the control group (BPBM). The clinical, radiographic, and intrasurgical (re-entry) measurements were made at baseline and at 9 months postoperatively.

RESULTS

Both treatment modalities resulted in significant reduction in probing depth and gain in clinical attachment level as compared to baseline values. The probing depth reduction was 6.20±1.40 mm in BPBM and 6.60±1.43 mm for the BPBM/PRP-treated sites. The gain in clinical attachment level observed was 4.16±1.05 mm for BPBM and 4.70±0.76 mm for the BPBM/PRP group. Radiographically, there was a significant defect fill (3.83±1.01 mm) for the BPBM group and (4.04±1.77 mm) in the BPBM/PRP group. Similar trend was observed between the two groups in relation to intrasurgical parameters.

CONCLUSIONS

The combination therapy (BPBM+PRP) showed more favorable clinical outcome in the treatment of intrabony defects than the BPBM alone group, although the mean difference between the two groups was statistically nonsignificant.

Effects of autogenous growth factors on heterotopic bone formation of osteogenic cells in small animal model

AIMS

This study used a new approach to investigate the effective concentrations of growth factors released from platelet concentrate (PC) on the bone formation capacity of osteogenically differentiated rat bone marrow stromal cells (rBMSCs).

MATERIALS AND METHODS

Rat BMSCs and whole blood were harvested from 40 adult male Spraque-Dawly rats. Rat BMSCs were expanded in an osteogenic medium and seeded on inert collagenous bovine bone matrix (ICBM). Growth factors released from degranulated PC (GFs) containing TGF-β1 1 (25ng/ml)-10ng (250ng/ml) and rhBMP-2 400ng (10μg/ml) were suspended in 40μl platelet poor plasma (PPP) and applied on the ICBM-rBMSC constructs or ICBM only, respectively. The constructs were then transplanted in autologous hosts for 4 weeks. Concurrently, osteoblastic differentiation of rBMSCs on ICBM-rBMSC-PPP constructs was characterized in vitro.

RESULTS

Rat BMSCs in osteogenic medium exhibited phenotypes of mature osteoblasts. The amount of newly formed bone among groups of ICBM-rBMSC-PPP with and without GFs was not significantly different (p>0.05) and was significantly lower than a group of ICBM-PPP-BMP-2 (p<0.05).

CONCLUSIONS

Autogenous GFs had no effect on the capacity of rBMSCs to form new bone. The ability to measure the bone formation capacity of transplanted autologous cells and growth factors in a small animal model was demonstrated.

Effect of platelet-rich plasma on dental stem cells derived from human impacted third molars

AIM

Platelet-rich plasma (PRP) is fabricated from autologous blood and extensively used to promote soft and hard tissue healing. In the dental field, autologous PRP is widely used combined with dental implant installation and bone graft. This study will evaluate the biologic effect of PRP on the proliferation and the differentiation of human dental stem cells, and find the key cytokines inducing these effects to estimate the clinical feasibility of PRP for dental tissue engineering.

MATERIALS & METHODS

Venous blood was obtained from four individuals and each PRP was fabricated. The human dental stem cells were obtained from the periodontal ligament (PDL) and dental pulp of the surgically extracted human third molars and expanded in vitro. Immunocytochemical staining and flow cytometry with STRO-1 and CD146 confirmed existence of mesenchymal stem cells in the PDL and dental pulp. The effect of PRP on the proliferation of PDL stem cells (PDLSCs) and dental pulp stem cells (DPSCs) was assessed by colony-forming ability measurement, 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay and bromodeoxyuridine incorporation assay. Alkaline phosphatase activity and calcium deposit were measured to evaluate the mineralization effect of PRP PDLSCs and DPSCs. Alizarin red S staining was used to detect mineral nodules. Odontogenic and osteogenic gene expressions were evaluated in the PRP-treated PDLSCs and DPSCs by real-time quantitative PCR. A protein array was performed to detect the key cytokines that have an important role in the tissue regenerative effect of PRP.

RESULTS

Flow cytometry cell sorting showed that the cells from human PDL and dental pulp contained mesenchymal stem cell populations. Colony-forming ability and cellular proliferation of the dental stem cells were increased at 0.5 and 1% PRP concentration but decreased at 5% concentration. Long-term treatment with 1% PRP enhanced proliferation of the human dental stem cells PDLSCs and DPSCs by 120 h and showed the most significant enhancement at 96 h. PRP also promoted mineralization differentiation of the two kinds of dental stem cells as shown by measurement of alkaline phosphatase activity and calcium deposit under mineralization conditioned media. Increased formation of mineral nodules stained with alizarin red was observed in both PDLSCs and DPSCs after treatment with 1% PRP. Real-time quantitative PCR showed higher odontogenic and osteogenic gene expressions in PRP-treated PDLSCs and DPSCs. RANTES/CCL5 and ICAM-1 were the two key cytokines that were detected in human cytokine array with PRP.

CONCLUSION

The appropriate concentration of the PRP treatment enhanced proliferation and mineralization differentiation of human dental stem cells. RANTES/CCL5 and ICAM-1 might play an important role in PRP-induced tissue regeneration but further study is needed to investigate the whole mechanism.

Randomized controlled trial on lateral augmentation using two collagen membranes: morphometric results on mineralized tissue compound

BACKGROUND

Guided bone regeneration is considered an effective tool for gaining mineralized tissue either at exposed implant surface or in deficient alveolar ridge areas before implant placement.

MATERIAL AND METHODS

Customized casts obtained following impression taking at surgery and re-entry allowed for morphometric assessment of alveolar ridge alterations 6 months after one-stage augmentation of bone dehiscences. In a randomized pilot study using biphasic calcium phosphate tests (n=17) received treatment with ribose cross-linked collagen membranes (RCLM), whereas controls (n=20) received non-cross-linked membranes. The primary endpoint was to quantify the effect of membrane type on dimensional changes in bone margins at crestal level of endosseous implants.

RESULTS

Soft tissue dehiscencies occurred at 70.5% and 55% frequency for tests and controls, respectively. Gain in clinically hard newly mineralized tissue at the crestal level was significantly higher in test group in lateral (1.8 versus 0.7 mm; p=.046) and in vertical dimensions (1.1 versus 0.2 mm; p=.035) compared with controls. Second measurement obtained at the border of reflected flap revealed no significant difference between groups (3.0 versus 2.1 mm; p=0.57) for lateral dimension.

CONCLUSIONS

Both collagen devices were effective in bone augmentation. RCLMs supported mineralization process and remodelling even in sites showing compromised healing as indicated by morphometric outcome.

Is platelet concentrate advantageous for the surgical treatment of periodontal diseases? A systematic review and meta-analysis

BACKGROUND

The aim of the present review is to systematically evaluate the effects of autogenous platelet concentrates on clinical outcomes of the surgical treatment of periodontal diseases.

METHODS

MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched using a combination of specific search terms. Furthermore, a hand search of relevant journals and bibliographies of reviews was performed. Only randomized clinical trials were included. For periodontal intrabony defects, the primary outcome variable was the clinical attachment level. For gingival recession, outcome variables were root coverage and keratinized tissue increase. Data were adjusted for baseline values. The methodologic quality of the included studies was assessed. The results of studies in which the only difference between test and control groups was the adjunct of platelet concentrates were aggregated using a meta-analysis. For intrabony defects, the influences of guided tissue regeneration (GTR) and study type (split-mouth versus parallel studies) were also evaluated.

RESULTS

The initial search yielded 424 studies. Of the 29 eligible studies, 24 studies were included. There were 16 studies on the treatment of periodontal intrabony defects, all of which used platelet-rich plasma (PRP); six studies on gingival recession treatment; and two studies on the treatment of furcation defects. A significant positive effect of the adjunct of PRP was found for intrabony defects. Such an effect was magnified in studies in which GTR was not used, whereas in studies using GTR, the use of PRP had no adjunctive effect. No effect of the study type was found. No significant effect of platelet concentrates was found for gingival recession treatment in which only studies with a follow-up ≤6 months displayed positive results. No significant benefit of PRP could be demonstrated for furcation treatment.

CONCLUSIONS

PRP may exert a positive adjunctive effect when used in combination with graft materials, but not with GTR, for the treatment of intrabony defects. No significant benefit of platelet concentrates was found for the treatment of gingival recession.

Treatment of intrabony periodontal defects with platelet-rich plasma versus platelet-poor plasma combined with a bovine-derived xenograft: a controlled clinical trial

BACKGROUND

The purpose of this study is to assess the healing outcomes of intrabony defects after treatment with platelet-rich plasma (PRP) versus platelet-poor plasma (PPP) combined with bovine-derived xenograft (BDX).

METHODS

Using a split-mouth design, a total of 79 intrabony defects with an intrabony component of ≥3 mm in 20 patients were treated either with PRP/BDX (group 1) or PPP/BDX (group 2). At baseline and 12 months after surgery, plaque and sulcus bleeding indices, probing depth (PD), relative attachment level, recession, and probing and radiographic bone levels were recorded.

RESULTS

After 12 months, groups 1 and 2 presented a mean PD reduction of 3.87 ± 0.86 and 3.76 ± 0.80 mm, recession of 1.35 ± 0.68 and 1.58 ± 0.54 mm, attachment gain of 2.51 ± 0.97 and 2.18 ± 0.87 mm, clinical bone gain of 2.18 ± 0.86 and 2.09 ± 0.89 mm, and radiographic bone gain of 2.11 ± 0.87 and 2.19 ± 0.96 mm, respectively. Intergroup differences were found to be insignificant.

CONCLUSIONS

Within its limits, these results suggest that the outcomes of the treatment after PRP/BDX and PPP/BDX applications in intrabony defects are similar. When the platelet counts are taken into consideration, PPP seems to demonstrate similar clinical efficacy as the PRP.