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Woo HN, Cho YJ, Tarafder S, Lee CH. The recent advances in scaffolds for integrated periodontal regeneration. Bioact Mater 2021; 6:3328-3342. [PMID: 33817414 PMCID: PMC7985477 DOI: 10.1016/j.bioactmat.2021.03.012] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 03/01/2021] [Accepted: 03/02/2021] [Indexed: 02/06/2023] Open
Abstract
The periodontium is an integrated, functional unit of multiple tissues surrounding and supporting the tooth, including but not limited to cementum (CM), periodontal ligament (PDL) and alveolar bone (AB). Periodontal tissues can be destructed by chronic periodontal disease, which can lead to tooth loss. In support of the treatment for periodontally diseased tooth, various biomaterials have been applied starting as a contact inhibition membrane in the guided tissue regeneration (GTR) that is the current gold standard in dental clinic. Recently, various biomaterials have been prepared in a form of tissue engineering scaffold to facilitate the regeneration of damaged periodontal tissues. From a physical substrate to support healing of a single type of periodontal tissue to multi-phase/bioactive scaffold system to guide an integrated regeneration of periodontium, technologies for scaffold fabrication have emerged in last years. This review covers the recent advancements in development of scaffolds designed for periodontal tissue regeneration and their efficacy tested in vitro and in vivo. Pros and Cons of different biomaterials and design parameters implemented for periodontal tissue regeneration are also discussed, including future perspectives.
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Affiliation(s)
| | | | - Solaiman Tarafder
- Center for Dental and Craniofacial Research, Columbia University Medical Center, 630 W. 168 St., VC12-212, New York, NY, 10032, USA
| | - Chang H. Lee
- Center for Dental and Craniofacial Research, Columbia University Medical Center, 630 W. 168 St., VC12-212, New York, NY, 10032, USA
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Qian B, Yang Q, Wang M, Huang S, Jiang C, Shi H, Long Q, Zhou M, Zhao Q, Ye X. Encapsulation of lyophilized platelet-rich fibrin in alginate-hyaluronic acid hydrogel as a novel vascularized substitution for myocardial infarction. Bioact Mater 2021; 7:401-411. [PMID: 34466741 PMCID: PMC8379365 DOI: 10.1016/j.bioactmat.2021.05.042] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 05/19/2021] [Accepted: 05/24/2021] [Indexed: 12/23/2022] Open
Abstract
Cardiovascular diseases such as myocardial infarction (MI) are among the major causes of death worldwide. Although intramyocardial injection of hydrogels can effectively enhance the ventricular wall, this approach is limited because of its restriction to the poor vascularization in the infarcted myocardium. Here, we reported a new type of hydrogel composed of alginate (ALG) and hyaluronic acid (HA) with lyophilized platelet-rich fibrin (Ly-PRF) for releasing abundant growth factors to realize their respective functions. The results of in vitro studies demonstrated favorable mechanical property and release ability of ALG-HA with Ly-PRF. When injected into the infarcted myocardium, this composite hydrogel preserved heart function and the Ly-PRF within the hydrogel promoted angiogenesis and increased vascular density in both infarcted and border zone, which rescued the ischemic myocardium. These beneficial effects were also accompanied by macrophage polarization and regulation of myocardial fibrosis. Moreover, the autologous origin of Ly-PRF with ALG-HA hydrogel offers myriad advantages including safety profile, easiness to obtain and cost-effectiveness. Overall, this study demonstrated the versatile therapeutic effects of a novel composite hydrogel ALG-HA with Ly-PRF, which optimizes a promising vascularized substitution strategy for improving cardiac function after MI.
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Key Words
- ALG, alginate
- BZ, border zone
- Drug delivery
- HA, hyaluronic acid
- IZ, infarcted zone
- Injectable hydrogel
- LVEDd, left ventricular end-diastolic diameter
- LVEF, left ventricular ejection fractions
- LVESd, left ventricular end-systolic diameter
- LVFS, left ventricular fractional shortening
- Ly-PRF, lyophilized platelet-rich fibrin
- Lyophilized platelet-rich fibrin
- MI, myocardial infarction
- Myocardial infarction
- PET-CT, positron emission tomography-computerized tomography
- PRF, platelet-rich fibrin
- PRP, platelet rich plasma
- SUV, standardized uptake value
- TUNEL, terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick-end labeling
- Vascularization
- iNOS, inducible nitric oxide synthase
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Affiliation(s)
- Bei Qian
- Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Qi Yang
- Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Mingliang Wang
- Department of Cardiology, Putuo People's Hospital, Tongji University, Shanghai, 200060, China
| | - Shixing Huang
- Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Chenyu Jiang
- Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Hongpeng Shi
- Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Qiang Long
- Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Mi Zhou
- Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Qiang Zhao
- Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Xiaofeng Ye
- Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
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Samani MK, Saberi BV, Ali Tabatabaei SM, Moghadam MG. The clinical evaluation of platelet-rich plasma on free gingival graft's donor site wound healing. Eur J Dent 2019; 11:447-454. [PMID: 29279669 PMCID: PMC5727728 DOI: 10.4103/ejd.ejd_76_17] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Objective It has been proved that platelet-rich plasma (PRP) can promote wound healing. In this way, PRP can be advantageous in periodontal plastic surgeries, free gingival graft (FGG) being one such surgery. Materials and Methods In this randomized split-mouth controlled trial, 10 patients who needed bilateral FGG were selected, and two donor sites were randomly assigned to experience either natural healing or healing-assisted with PRP. The outcome was assessed based on the comparison of the extent of wound closure, Manchester scale, Landry healing scale, visual analog scale, and tissue thickness between the study groups at different time intervals. Statistical Analysis Used Repeated measurements of analysis of variance and paired t-test were used. Statistical significance was P ≤ 0.05. Results Significant differences between the study groups and also across different time intervals were seen in all parameters except for the changes in tissue thickness. Conclusion PRP accelerates the healing process of wounds and reduces the healing time.
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Affiliation(s)
- Mahmoud Khosravi Samani
- Department of Periodontology, Oral Health Research Center, Faculty of Dentistry, Babol University of Medical Sciences, Babol, Iran
| | - Bardia Vadiati Saberi
- Department of Periodontology, Faculty of Dentistry, Guilan University of Medical Sciences, Guilan, Iran
| | - S M Ali Tabatabaei
- Department of Periodontology, Faculty of Dentistry, Birjand University of Medical Sciences, Birjand, Iran
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Murray PE. Platelet-Rich Plasma and Platelet-Rich Fibrin Can Induce Apical Closure More Frequently Than Blood-Clot Revascularization for the Regeneration of Immature Permanent Teeth: A Meta-Analysis of Clinical Efficacy. Front Bioeng Biotechnol 2018; 6:139. [PMID: 30364277 PMCID: PMC6193104 DOI: 10.3389/fbioe.2018.00139] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 09/17/2018] [Indexed: 12/21/2022] Open
Abstract
The purpose of this review was to compare the clinical efficacy of platelet-rich plasma (PRP) and platelet-rich fibrin (PRF), vs. blood clot revascularization (BCR) for the regeneration of immature permanent teeth. A survey of the literature identified 222 cases of immature permanent teeth which had been given PRP, PRF or BCR regeneration treatment with at least a year-long follow-up in 12 different articles. A meta-analysis of the 222 immature permanent teeth after 1 year, were compared to assess the ability of PRP, PRF, and BCR to accomplish apical closure, a periapical lesion healing response, root lengthening, and dentinal wall thickening. The mean success rate for apical closure or reduction after 1 year was: PRP (85.1%) PRF (85.2%), and BCR (58.8%). The mean success rate for root lengthening after 1 year was: BCR (64.1%), PRP (64.2%), and PRF (74.1%). The periapical lesion healing response was 88.9% for BCR, 100% for PRP, and 100% for PRF. Dentinal wall thickening was 100% for BCR, 100% for PRP, and 100% for PRF. Apical closure occurred more frequently following PRP and PRF than with BCR (Fischer test, P < 0.0011), for all the other effects the PRP, PRF, and BCR treatments were similarly effective (Fischer tests, P > 0.05). In conclusion, the fractured or decayed immature permanent teeth of children and young adults aged 6 years to 28 which have a restorable crown, but thin dentinal walls may be regenerated by using a revascularization procedure which draws blood and stem cells into a disinfected root canal space. Although BCR is most common revascularization method, apical closure may occur more frequently if PRF and PRP are used instead of BCR for the regeneration of immature permanent teeth. The proper use of regenerative procedures can be very successful at the disinfection of bacteria from the periapical region of immature permanent teeth, which helps to heal localized lesions, and avoid the need for complex apical surgery, in addition to regenerating tissues to strengthen the structure of immature teeth, to help prevent tooth fracture and tooth loss.
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Affiliation(s)
- Peter E Murray
- Department of Periodontics, College of Dental Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States
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Murray PE. Minireview of the clinical efficacy of platelet-rich plasma, platelet-rich fibrin and blood-clot revascularization for the regeneration of immature permanent teeth. World J Stomatol 2018; 6:1-5. [DOI: 10.5321/wjs.v6.i1.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 05/30/2018] [Accepted: 06/15/2018] [Indexed: 02/06/2023] Open
Abstract
The aim of this mini-review was to investigate and compare the clinical efficacy of platelet-rich plasma (PRP) and platelet-rich fibrin (PRF), vs blood clot revascularization (BCR) for the regeneration of immature permanent teeth. The clinical efficacy of PRP, PRF, and BCR to regenerate 90 immature permanent teeth after one year, were compared for their ability to accomplish apical closure, a periapical lesion healing response, root lengthening, and dentinal wall thickening. The 90 cases were published in three different articles. The mean success rate for apical closure after one year was: PRP (89.2%) PRF (80%), and BCR (75.6%). The mean success rate for root lengthening after one year was: BCR (88.9%), PRP (68.2%), and PRF (65%). The periapical lesion healing response was 100% for BCR and 100% for PRP. Dentinal wall thickening was 100% for BCR, and 100% for PRP. All the PRP, PRF, and BCR treatments appeared to be effective. The published clinical results for PRP, PRF, and BCR indicate that these treatments are effective for the regeneration of immature permanent teeth.
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Affiliation(s)
- Peter E Murray
- Department of Endodontics, College of Dental Medicine, Nova Southeastern University, Fort Lauderdale, FL 33328, United States
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Fawzy El-Sayed KM, Dörfer CE. Animal Models for Periodontal Tissue Engineering: A Knowledge-Generating Process. Tissue Eng Part C Methods 2017; 23:900-925. [DOI: 10.1089/ten.tec.2017.0130] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Karim M. Fawzy El-Sayed
- Department of Oral Medicine and Periodontology, Faculty of Oral and Dental Medicine, Cairo University, Giza, Egypt
- Clinic for Conservative Dentistry and Periodontology, School of Dental Medicine, Christian Albrechts University, Kiel, Germany
| | - Christof E. Dörfer
- Clinic for Conservative Dentistry and Periodontology, School of Dental Medicine, Christian Albrechts University, Kiel, Germany
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Kantarci A, Hasturk H, Van Dyke TE. Animal models for periodontal regeneration and peri-implant responses. Periodontol 2000 2017; 68:66-82. [PMID: 25867980 DOI: 10.1111/prd.12052] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2013] [Indexed: 11/28/2022]
Abstract
Translation of experimental data to the clinical setting requires the safety and efficacy of such data to be confirmed in animal systems before application in humans. In dental research, the animal species used is dependent largely on the research question or on the disease model. Periodontal disease and, by analogy, peri-implant disease, are complex infections that result in a tissue-degrading inflammatory response. It is impossible to explore the complex pathogenesis of periodontitis or peri-implantitis using only reductionist in-vitro methods. Both the disease process and healing of the periodontal and peri-implant tissues can be studied in animals. Regeneration (after periodontal surgery), in response to various biologic materials with potential for tissue engineering, is a continuous process involving various types of tissue, including epithelia, connective tissues and alveolar bone. The same principles apply to peri-implant healing. Given the complexity of the biology, animal models are necessary and serve as the standard for successful translation of regenerative materials and dental implants to the clinical setting. Smaller species of animal are more convenient for disease-associated research, whereas larger animals are more appropriate for studies that target tissue healing as the anatomy of larger animals more closely resembles human dento-alveolar architecture. This review focuses on the animal models available for the study of regeneration in periodontal research and implantology; the advantages and disadvantages of each animal model; the interpretation of data acquired; and future perspectives of animal research, with a discussion of possible nonanimal alternatives. Power calculations in such studies are crucial in order to use a sample size that is large enough to generate statistically useful data, whilst, at the same time, small enough to prevent the unnecessary use of animals.
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Venter NG, Marques RG, Santos JSD, Monte-Alto-Costa A. Use of platelet-rich plasma in deep second- and third-degree burns. Burns 2016; 42:807-14. [PMID: 26822695 DOI: 10.1016/j.burns.2016.01.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 10/28/2015] [Accepted: 01/02/2016] [Indexed: 02/08/2023]
Abstract
Unfortunately burns are a common occurrence, leading to scarring or death. Platelet-rich plasma (PRP) contains many growth factors that can accelerate wound healing. We analyzed the use of PRP in deep second-degree (dSD), deep second-degree associated with diabetes mellitus (dSDD), and third-degree (TD) burns in rats. Sixty syngeneic rats divided into three groups (dSD, dSDD, and TD) were burned, half receiving topical PRP and half being used as control; 10 additional rats per group were used for PRP preparation. On day 21, the animals were sacrificed and skin biopsies were collected. dSD and dSDD wounds treated with PRP showed faster wound closure, reduction in CD31-, CD68-, CD163-, MPO-, and in TGF-β-positive cells, and an increase in MMP2-positive cells. The neo-epidermis was thinner in the control of both the dSD and dSDD groups and granulation tissue was less reduced in the control of both the dSDD and TD groups. These results indicate that PRP can accelerate the healing process in dSD and dSDD, but not in TD burns.
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Affiliation(s)
- Neil Grant Venter
- Department of General Surgery, Post-graduation Program in Physiopathology and Surgical Sciences-Rio de Janeiro State University, Brazil
| | - Ruy Garcia Marques
- Department of General Surgery, Post-graduation Program in Physiopathology and Surgical Sciences-Rio de Janeiro State University, Brazil
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Jungbluth P, Grassmann JP, Thelen S, Wild M, Sager M, Windolf J, Hakimi M. Concentration of platelets and growth factors in platelet-rich plasma from Goettingen minipigs. GMS INTERDISCIPLINARY PLASTIC AND RECONSTRUCTIVE SURGERY DGPW 2014; 3:Doc11. [PMID: 26504722 PMCID: PMC4582514 DOI: 10.3205/iprs000052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In minipigs little is known about the concentration of growth factors in plasma, despite their major role in several patho-physiological processes such as healing of fractures. This prompted us to study the concentration of platelets and selected growth factors in plasma and platelet-rich plasma (PRP) preparation of sixteen Goettingen minipigs. Platelet concentrations increased significantly in PRP in comparison to native blood plasma. Generally, significant increase in the concentration of all growth factors tested was observed in the PRP in comparison to the corresponding plasma or serum. Five of the plasma samples examined contained detectable levels of bone morphogenic protein 2 (BMP-2) whereas eleven of the plasma or serum samples contained minimal amounts of vascular endothelial growth factor (VEGF) and platelet-derived growth factor (PDGF-bb) respectively. On the other hand variable concentrations of bone morphogenic protein 7 (BMP-7) and transforming growth factor β1 (TGF-β1) were measured in all plasma samples. In contrast, all PRP samples contained significantly increased amounts of growth factors. The level of BMP-2, BMP-7, TGF-β1, VEGF and PDGF-bb increased by 17.6, 1.5, 7.1, 7.2 and 103.3 fold, in comparison to the corresponding non-enriched preparations. Moreover significant positive correlations were found between platelet count and the concentrations of BMP-2 (r=0.62, p<0.001), TGF-β1 (r=0.85, p<0.001), VEGF (r=0.46, p<0.01) and PDGF-bb (r=0.9, p<0.001). Our results demonstrate that selected growth factors are present in the platelet-rich plasma of minipigs which might thus serve as a source of autologous growth factors.
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Affiliation(s)
- Pascal Jungbluth
- Heinrich Heine University Hospital Düsseldorf, Department of Trauma and Handsurgery, Düsseldorf, Germany
| | - Jan-Peter Grassmann
- Heinrich Heine University Hospital Düsseldorf, Department of Trauma and Handsurgery, Düsseldorf, Germany
| | - Simon Thelen
- Heinrich Heine University Hospital Düsseldorf, Department of Trauma and Handsurgery, Düsseldorf, Germany
| | - Michael Wild
- Klinikum Darmstadt Department of Trauma, Orthopedics and Handsurgery, Darmstadt, Germany
| | - Martin Sager
- Heinrich Heine University Hospital Duesseldorf Animal Research Institute, Düsseldorf, Germany
| | - Joachim Windolf
- Heinrich Heine University Hospital Düsseldorf, Department of Trauma and Handsurgery, Düsseldorf, Germany
| | - Mohssen Hakimi
- Vivantes Klinikum Am Urban, Department of Trauma, Orthopedics and Handsurgery, Berlin, Germany
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Toregeani JF, Nassar CA, Toregeani KAM, Nassar PO. Periodontal disease and atherosclerosis. J Vasc Bras 2014. [DOI: 10.1590/jvb.2014.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Atherosclerotic disease (AD) is one of the most important causes of morbidity and mortality in the world. It expresses inflammatory markers such as C-reactive protein (CRP) and can provoke arterial wall thickening, which can be evaluated using Doppler ultrasound. Risk factors associated with AD include diabetes mellitus, systemic arterial hypertension, dyslipidemia and smoking. More recently, periodontal disease (PD) has been identified as a factor related to AD. Periodontal disease has a high prevalence in the global population and the inflammatory process and bacterial activity at the periodontium appear to increase the risk of AD. Encouraging good oral hygiene can reduce expression of inflammatory markers of AD. A review of literature on PD, AD and inflammatory markers and the interrelationships between the two diseases was conducted using data published in articles indexed on the PUBMED, SCIELO and BIREME databases.
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Ergun G, Egilmez F, Cekic-Nagas I, Karaca İR, Bozkaya S. Effect of Platelet-Rich Plasma on the Outcome of Early Loaded Dental Implants: A 3-Year Follow-up Study. J ORAL IMPLANTOL 2013. [DOI: 10.1563/aaid-joi-d-11-00151] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study evaluated the effect of local application of platelet-rich plasma (PRP) on the outcome of early loaded implants. Two implants were placed in the posterior region or bilaterally symmetric to the median line of the maxilla. Then, PRP was either applied or not applied to the implant sockets. Outcome measures were prosthesis and implant success as well as biological and prosthetic complications. Stability of individual implants was assessed manually and with a resonance frequency analysis device. The implant stability quotient (ISQ) was recorded on the operation day, on postoperative day 4, and at postoperative week 1. At the end of the first postoperative week, implants with ISQ values >60 were early loaded on day 7 with metal-ceramic crowns. Measurements were repeated at postoperative weeks 2, 3, and 4 and at postoperative months 6, 12, 24, and 36. One of the 64 implants was dropped out after 3 months of loading. No prosthesis failed. There were no prosthetic complications. Statistical analysis revealed significant differences between ISQ values of PRP and non-PRP implants on the operation day. Moreover, no statistically significant differences were found between ISQ values of PRP and non-PRP implants in the follow-up periods (P > .05). No appreciable clinical effect was observed when using PRP in the maxilla.
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Affiliation(s)
- Gulfem Ergun
- Gazi University, Faculty of Dentistry, Department of Prosthodontics, Ankara, Turkey
| | - Ferhan Egilmez
- Gazi University, Faculty of Dentistry, Department of Prosthodontics, Ankara, Turkey
| | - Isil Cekic-Nagas
- Gazi University, Faculty of Dentistry, Department of Prosthodontics, Ankara, Turkey
| | - İnci Rana Karaca
- Gazi University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Ankara, Turkey
| | - Suleyman Bozkaya
- Gazi University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Ankara, Turkey
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Herrera BS, Coimbra LS, Bastos AS, Teixeira SA, Steffens JP, Muscara MN, Spolidorio LC. Platelet-rich plasma stimulates cytokine expression and alkaline phosphatase activity in osteoblast-derived osteosarcoma cells. Arch Oral Biol 2012; 57:1282-9. [DOI: 10.1016/j.archoralbio.2012.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Revised: 02/27/2012] [Accepted: 03/16/2012] [Indexed: 11/16/2022]
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Schuckert KH, Osadnik M. Bone tissue engineering in oral surgery: a new method of bone development in periodontal surgery. Tissue Eng Part C Methods 2011; 17:1179-87. [PMID: 21895495 DOI: 10.1089/ten.tec.2011.0213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This article describes the development of a new surgical approach to periodontal treatment. Twenty patients who suffered from bone defects without existing bony walls due to adult periodontitis were treated in three different groups using methods of bone tissue engineering. At that time no surgical technique existed that could be applied to those patients to generate new bone. The periodontal surgeries were performed between 2004 and 2008. All patients received follow-up examinations at 6, 12, and 24 months after surgical procedure. Measured parameters were compared to baseline. The surgical approach and the augmentation material have been improved based on the results of the previous group. This strategy was applied because of the ethical fact that a medical treatment of patients has to be carried out with the knowledge and experience of previous settings. All groups received recombinant human bone morphogenetic protein 2 and platelet-rich plasma. The above-mentioned procedure had been approved in other indications in the field of oral and maxillofacial surgery. The first group underwent conventional muco-periosteal flap technique and obtained an augmentation with absorbable collagen sponge (ACS). The second and third groups were treated using endoscopically assisted microsurgery due to wound healing disturbances that appeared in the first group. The augmentation was carried out with demineralized bone matrix (DBM) instead of ACS (group 2) or tricalciumphosphate as a further development instead of DBM (group 3). The radiological control 12 months (group 1), 18 months (group 2), and 2 years (group 3) after surgery proved the following results-first group: 1.7 mm (average) vertical bone development (VBD); second group: 2.5 mm (average) VBD; third group: 3.2 mm (average) VBD. These results of single patient treatment open new ways into periodontal surgery. They have to be confirmed by prospective case series and multicenter studies.
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Affiliation(s)
- Karl-Heinz Schuckert
- Institute Indente-Institute of Innovative Oral Surgery and Medicine, Centre for Tissue Engineering, Hannover, Germany.
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Javed F, Al-Askar M, Al-Rasheed A, Al-Hezaimi K. Significance of the platelet-derived growth factor in periodontal tissue regeneration. Arch Oral Biol 2011; 56:1476-84. [PMID: 21774915 DOI: 10.1016/j.archoralbio.2011.06.020] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Revised: 06/27/2011] [Accepted: 06/28/2011] [Indexed: 11/25/2022]
Abstract
AIM The aim was to review the significance of the platelet derived growth factor (PGDF) in periodontal tissue regeneration. METHODS AND RESULTS Databases were searched using the following terms in different combinations: "growth factors", "guided bone regeneration", "guided tissue regeneration", "periodontal", "platelet rich plasma" and "platelet derived growth factor". Titles and abstracts of articles obtained using the above-described criteria were then screened by the authors and checked for agreement. The next step was to hand-search the reference lists of original and review studies that were found to be relevant in the previous step. PDGF has a stimulatory effect on the DNA replication and chemotaxis of osteoblasts, fibroblasts, leukocytes, monocytes, neutrophils periodontal and alveolar bone cells. Proliferation of mesenchymal stem cells is also promoted by supplement treatment with PDGF. PDGF in combination with other growth factors enhances periodontal tissue repair. CONCLUSIONS The PDGF plays a significant role in periodontal bone and tissue regeneration.
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Affiliation(s)
- Fawad Javed
- Eng. AB Research Chair for Growth Factors and Bone Regeneration, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
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Schuckert KH, Jopp S, Osadnik M. The use of platelet rich plasma, bone morphogenetic protein-2 and different scaffolds in oral and maxillofacial surgery - literature review in comparison with own clinical experience. EJOURNAL OF ORAL MAXILLOFACIAL RESEARCH 2011; 2:e2. [PMID: 24421984 PMCID: PMC3886066 DOI: 10.5037/jomr.2011.2102] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Accepted: 01/18/2011] [Indexed: 12/16/2022]
Abstract
Objectives The purpose of this article was to review and critically assess the use of
platelet rich plasma, recombinant human bone morphogenetic protein-2 and
different scaffolds (i.e. tricalciumphosphate, polycaprolactone,
demineralized bone matrix and anorganic bovine bone mineral) in oral and
maxillofacial surgery comparing the relevant literature and own clinical
experience. Material and Methods A literature review was conducted using MEDLINE, MEDPILOT and COCHRANE
DATABASE OF SYSTEMATIC REVIEWS. It concentrated on manuscripts and overviews
published in the last five years (2006-2010). The key terms employed were
platelet rich plasma, bone morphogenetic proteins and their combinations
with the above mentioned scaffolds. The results of clinical studies and
animal trials were especially emphasized. The statements from the literature
were compared with authors’ own clinical data. Results New publications and overviews demonstrate the advantages of platelet rich
plasma in bone regeneration. The results from the literature review were
discussed and compared with the publications detailing authors' own
experiences. Conclusions A favourable outcome concerning newly grown bone was achieved combining
platelet rich plasma in addition to optimal matrices with or without
recombinant human bone morphogenetic protein-2, depending on the clinical
case. As a consequence, the paradigm shift from transplantation of
autogenous bone to bone tissue engineering appears promising.
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Affiliation(s)
- Karl-Heinz Schuckert
- Institute Indente - Institute of Innovative Oral Surgery and Medicine, Centre for Tissue Engineering Hannover Germany
| | - Stefan Jopp
- Institute Indente - Institute of Innovative Oral Surgery and Medicine, Centre for Tissue Engineering Hannover Germany
| | - Magdalena Osadnik
- Institute Indente - Institute of Innovative Oral Surgery and Medicine, Centre for Tissue Engineering Hannover Germany
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16
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Rodrigues SV, Acharya AB, Thakur SL. An evaluation of platelet-rich plasma without thrombin activation with or without anorganic bone mineral in the treatment of human periodontal intrabony defects. Platelets 2011; 22:353-60. [PMID: 21381872 DOI: 10.3109/09537104.2011.552135] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The efficacy of platelet-rich plasma (PRP) in periodontal regeneration is not well understood and the definite clinical viability of blood derived platelets lacks clarity. Also, the use of thrombin for platelet activation is disputed. Hence, the purpose of this study was to evaluate the efficacy of blood derived platelets without thrombin activation, alone or in combination with bovine anorganic bone mineral (ABM), in the treatment of human periodontal intrabony defects. PRP was prepared using a simple tabletop centrifuge and activated using calcium chloride without the addition of thrombin. This PRP was used alone (in Group A) and in combination with bovine ABM (in Group B) in the treatment of human periodontal angular defects. Both the control and the test groups showed definite improvement in clinical parameters. On comparison, however, there was a statistically significant improvement in the probing pocket depths and relative attachment level in Group B over Group A at 3 and 6 months intervals, whereas at the end of 9 months this difference was not statistically significant. There was no statistically significant difference between the groups with respect to the relative defect depth. Within the limitations of this study and the type of PRP used, i.e. without thrombin mediated activation, it can be concluded that both PRP and PRP combined with bovine ABM results in significant clinical improvement. Albeit statistically insignificant, there is a preponderance of better clinical results with the addition of ABM to PRP. Further studies need to be carried out on a larger sample size to confirm the results of the present study.
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Affiliation(s)
- Silvia V Rodrigues
- Department of Periodontics, Terna Dental College & Hospital, Nerul, Navi Mumbai 400706, India.
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17
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Coimbra LS, Rossa C, Guimarães MR, Gerlach RF, Muscará MN, Spolidorio DMP, Herrera BS, Spolidorio LC. Influence of antiplatelet drugs in the pathogenesis of experimental periodontitis and periodontal repair in rats. J Periodontol 2010; 82:767-77. [PMID: 21073332 DOI: 10.1902/jop.2010.100555] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Platelets contain an array of biologic mediators that can modulate inflammation and repair processes including proinflammatory mediators and growth factors. Previous studies have shown that periodontitis and periodontal repair are associated with platelet activation. We hypothesized that drug-induced platelet inactivation may interfere in the processes of inflammation and repair in experimental periodontitis in rats by suppressing the release of biologic mediators from platelets to the site of injury. METHODS To measure the effects on periodontitis, ligatures were placed around first molars, and aspirin (Asp, 30 mg/kg) or clopidogrel (Clo, 75 mg/kg) was given intragastrically once daily for 15 days. Interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and thromboxane A(2) levels were measured by enzyme-linked immunosorbent assay. To evaluate the effects of antiplatelet drugs on periodontal repair, ligatures were removed after 15 days of periodontitis induction, and Asp or Clo were administered beginning the following day for 15 days. Periodontal repair was assessed by microcomputed tomography. RESULTS On periodontitis phase, Asp and Clo significantly reduced levels of TNF-α and Il-6 (P <0.05), but only Asp decreased thromboxane A(2) (P <0.05). Asp and Clo decreased inflammatory infiltration; however, this reduction was more pronounced with Clo treatment (P <0.05). Histometric analysis showed that Asp and Clo impaired alveolar bone resorption. During the repair phase and after removal of the ligatures, microcomputed tomography analysis demonstrated that treatment with Asp and Clo did not impair alveolar bone repair. CONCLUSION Systemic administration of Asp and Clo attenuates the inflammation associated with periodontitis without affecting the repair process when stimulus is removed.
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Affiliation(s)
- Leila S Coimbra
- Department of Physiology and Pathology, Faculdade de Odontologia de Araraquara, UNESP, Universidade Estadual Paulista, Araraquara, SP, Brazil
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18
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Chen FM, Zhang J, Zhang M, An Y, Chen F, Wu ZF. A review on endogenous regenerative technology in periodontal regenerative medicine. Biomaterials 2010; 31:7892-927. [PMID: 20684986 DOI: 10.1016/j.biomaterials.2010.07.019] [Citation(s) in RCA: 235] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2010] [Accepted: 07/04/2010] [Indexed: 12/17/2022]
Abstract
Periodontitis is a globally prevalent inflammatory disease that causes the destruction of the tooth-supporting apparatus and potentially leads to tooth loss. Currently, the methods to reconstitute lost periodontal structures (i.e. alveolar bone, periodontal ligament, and root cementum) have relied on conventional mechanical, anti-infective modalities followed by a range of regenerative procedures such as guided tissue regeneration, the use of bone replacement grafts and exogenous growth factors (GFs), and recently developed tissue engineering technologies. However, all current or emerging paradigms have either been shown to have limited and variable outcomes or have yet to be developed for clinical use. To accelerate clinical translation, there is an ongoing need to develop therapeutics based on endogenous regenerative technology (ERT), which can stimulate latent self-repair mechanisms in patients and harness the host's innate capacity for regeneration. ERT in periodontics applies the patient's own regenerative 'tools', i.e. patient-derived GFs and fibrin scaffolds, sometimes in association with commercialized products (e.g. Emdogain and Bio-Oss), to create a material niche in an injured site where the progenitor/stem cells from neighboring tissues can be recruited for in situ periodontal regeneration. The choice of materials and the design of implantable devices influence therapeutic potential and the number and invasiveness of the associated clinical procedures. The interplay and optimization of each niche component involved in ERT are particularly important to comprehend how to make the desired cell response safe and effective for therapeutics. In this review, the emerging opportunities and challenges of ERT that avoid the ex vivo culture of autologous cells are addressed in the context of new approaches for engineering or regeneration of functional periodontal tissues by exploiting the use of platelet-rich products and its associated formulations as key endogenous resources for future clinical management of periodontal tissue defects.
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Affiliation(s)
- Fa-Ming Chen
- Department of Periodontology & Oral Medicine, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi, People's Republic of China.
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Donovan TE, Becker W, Cagna DR, Hilton TJ, Rouse J. Annual review of selected scientific literature: Report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry. J Prosthet Dent 2010; 104:13-47. [DOI: 10.1016/s0022-3913(10)60087-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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20
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Schuckert KH, Jopp S, Osadnik M. Modern bone regeneration instead of bone transplantation: a combination of recombinant human bone morphogenetic protein-2 and platelet-rich plasma for the vertical augmentation of the maxillary bone-a single case report. Tissue Eng Part C Methods 2010; 16:1335-46. [PMID: 20302447 DOI: 10.1089/ten.tec.2010.0020] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This publication describes the clinical case of a 75-year-old woman. She suffered from total alveolar ridge atrophy due to 20 years of wearing dentures. Bone transplantation, including harvesting of the iliac crest, was rejected by another clinic due to various existing diseases and risk of blood loss on donor side. Moreover, the minimal residual alveolar ridge did not allow bone fixation using screws nor did it allow osteodistraction. Before deciding which bone tissue engineering techniques should best be employed in this surgical treatment, cardiological and internistic consultations and treatments were carried out. In addition, anesthetic preparations were made. The surgical treatment was performed implementing special bridge flap techniques to preserve the periosteum. Tricalcium phosphate blocks soaked with recombinant human bone morphogenetic protein-2 and platelet-rich plasma were implanted on the narrow alveolar ridge. They were attached by tightening the soft tissue, including the periosteum. Four months later, after complication-free wound healing and bone regeneration, six dental implants were inserted into the new alveolar ridge. The histology of all bone samples showed vital lamellar bone. Three months after implantation, a new dental structure was fixed on the implants. The patient's quality of life improved significantly with this new situation.
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Affiliation(s)
- Karl-Heinz Schuckert
- Institute Indente-Institute of Innovative Oral Surgery and Medicine, Centre for Tissue Engineering, Hannover, Germany.
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