Alveolar ridge preservation in post-extraction sockets using concentrated growth factors: a split-mouth, randomized, controlled clinical trial

Hybrid Nanocomposite Mini-Tablet to Be Applied into the Post-Extraction Socket: Matching the Potentialities of Resveratrol-Loaded Lipid Nanoparticles and Hydroxyapatite to Promote Alveolar Wound Healing

Background/Objectives: Following tooth extraction, resveratrol (RSV) can support healing by reducing inflammation and microbial risks, though its poor solubility limits its effectiveness. This study aims to develop a solid nanocomposite by embedding RSV in lipid nanoparticles (mLNP) within a hydrophilic matrix, to the scope of improving local delivery and enhancing healing. Hydroxyapatite (HXA), often used as a bone substitute, was added to prevent post-extraction alveolus volume reduction. Methods: The mLNP-RSV dispersion was mixed with seven different polymers in various mLNP/polymer ratios. Following freeze-drying, the powders were redispersed, and the resulting dispersions were tested by DLS experiments. Then, the best two nanocomposites underwent extensive characterization by SEM, XRD, FTIR, Raman spectroscopy, and thermal analysis as well as in vitro partitioning studies aimed at verifying their ability to yield the mLNP-RSV from the hydrophilic matrix to a lipophilic tissue. The characterizations led to identify the best nanocomposite, which was further combined with HXA to obtain hybrid nanocomposites, further evaluated as pharmaceutical powders or in form of mini-tablets. Results: PEG-based nanocomposites emerged as optimal and, following HXA insertion, the resulting powders revealed adequate bulk properties, making them useful as a pharmaceutical intermediate to produce ≈59 mm3 mini-tablets, compliant with the post-extraction socket. Moreover, they were proven ex vivo to be able to promote RSV and GA accumulation into the buccal tissue over time. Conclusions: The here-proposed mini-tablet offers an innovative therapeutic approach for alveolar wound healing promotion as they led to a standardized dose administration, while being handy and stable in terms of physical solid identity as long as it takes to suture the wound.

Autologous and Heterologous Minor and Major Bone Regeneration with Platelet-Derived Growth Factors

AIM

This review aims to explore the clinical applications, biological mechanisms, and potential benefits of concentrated growth factors (CGFs), autologous materials, and xenografts in bone regeneration, particularly in dental treatments such as alveolar ridge preservation, mandibular osteonecrosis, and peri-implantitis.

MATERIALS AND METHODS

A systematic literature search was conducted using databases like PubMed, Scopus, and Web of Science, with keywords such as "bone regeneration" and "CGF" from 2014 to 2024. Only English-language clinical studies involving human subjects were included. A total of 10 studies were selected for qualitative analysis. Data were processed through multiple stages, including title and abstract screening and full-text evaluation.

CONCLUSION

The findings of the reviewed studies underscore the potential of the CGF in enhancing bone regeneration through stimulating cell proliferation, angiogenesis, and extracellular matrix mineralization. Autologous materials have also demonstrated promising results due to their biocompatibility and capacity for seamless integration with natural bone tissue. When combined with xenografts, these materials show synergistic effects in improving bone quantity and quality, which are crucial for dental implant success. Future research should focus on direct comparisons of different techniques, the optimization of protocols, and broader applications beyond dental medicine. The integration of CGFs and autologous materials into routine clinical practice represents a significant advancement in regenerative dental medicine, with the potential for improved patient outcomes and satisfaction.

Guided Bone Regeneration: CGF and PRF Combined With Various Types of Scaffolds-A Systematic Review

Objective: Bone regeneration plays a pivotal role in modern oral surgery, particularly in facilitating successful implant-prosthetic rehabilitation. This systematic review explores the regenerative potential of growth factors, such as platelet-rich fibrin (PRF) and concentrated growth factors (CGFs), when combined with various types of scaffolds in bone augmentation procedures, including guided bone regeneration, split crest, sinus lift (SL), and alveolar ridge preservation. Method: A comprehensive search strategy yielded 18 relevant studies, which were analyzed for bone formation and stabilization outcomes. Results: Results indicate that PRF enhances bone regeneration and stabilization in SL and ridge augmentation procedures, while CGFs facilitate surgical techniques and augment bone. However, some studies did not report significant differences. Growth factors also demonstrate benefits in wound healing, reducing bone resorption, and enhancing socket preservation. Conclusion: Despite valuable insights, further research is needed to comprehensively understand the characteristics of growth factors in various surgical interventions, ensuring informed decision-making in bone regeneration surgery.

Combined application of artificial bone powders and concentrated growth factor membranes on the autotransplantation of mature third molars: A 5-year retrospective case series

AIM

This study aimed to observe the efficacy and outcomes of the combined application of artificial bone powder and concentrated growth factor (CGF) membranes for tooth transplantation in cases with wide recipient sockets and small donor teeth.

MATERIAL AND METHODS

A total of 36 teeth from 36 patients with wide recipient sockets and small donor teeth were enrolled. Autogenous tooth transplantation was performed using bone powders and CGF membranes. After transplantation, the visual analog scale (VAS) score, Landry Wound Healing Index, probing depth (PD), mobility, and gray value of the alveolar bone around the transplanted teeth were measured, and a patient satisfaction questionnaire was administered. All patients underwent clinical and radiographic examinations during follow-up.

RESULTS

The VAS score of 16 (44.4%) cases after 1 week was 0, and 26 (72.2%) patients showed excellent gingival healing after 2-4 weeks. The PD of a few cases was deeper than 3 mm during the first month; however, returned to normal after 3 months. Although the majority of the transplanted teeth possessed mobility greater than grade I during the first month, the mobility gradually improved within 3 months. The gray value of the alveolar bone around the transplanted teeth, 1 year postoperatively showed no difference with pre-operation (p > .05). During the mean follow-up period of 42.7 months (range 20-72 months), 33 of the 36 transplanted teeth remained in situ without clinical or radiographic complications, with an overall success rate of 91.7%.

CONCLUSIONS

Although the PD and mobility of the transplanted teeth were not ideal during the early stages of healing, most of the transplanted teeth had good clinical outcomes. In cases with large recipient sites accompanied by small donor teeth, autotransplantation of teeth using artificial bone powder combined with CGF membranes is a viable option and can lead to optimistic results with favorable success rates.

Autologous platelet concentrates after third molar extraction: A systematic review

Surgical removal of impacted mandibular third molars is often followed by postoperative sequelae like pain, swelling, trismus, etc. This systematic review explored the benefits of applying different autologous platelet concentrates (APCs) in the extraction socket of third molars. For this systematic review, PubMed, EMBASE, Web of Science, and Scopus have been utilized, initially yielding 544 papers. The search was narrowed to randomized controlled trials (RCTs, n = 59) published before 2024, all comparing the outcome of applying APCs in the extraction socket of surgically removed impacted mandibular third molars with unassisted healing (blood clot). Most RCTs primarily assessed the impact of APCs on postoperative sequelae. Some RCTs looked at soft- and hard-tissue healing. Eleven studies used PRP, three PRGF, and 45 L-PRF. A detailed analysis revealed a large heterogeneity between studies rendering a meta-analysis impossible. Moreover, the risk of bias was considered high. In the majority of RCTs, the application of an APC resulted in statistically significant reductions of postoperative sequelae (lower pain intensity, lower consumption of analgesics, less postoperative edema, and a lower incidence of trismus and alveolar osteitis), as well as a faster soft tissue healing, and qualitatively and quantitatively better bone healing. A minority of studies reported significant differences in periodontal parameters distally from the second molar.

Exploring the correlation between periodontal disease and serum biomarkers in haemodialysis patients

BACKGROUND

Patients undergoing haemodialysis are more susceptible to infectious diseases, including periodontitis. This study aimed to investigate the Correlation between periodontal disease and serum markers in Yemeni haemodialysis patients.

METHODS

A cross-sectional study was conducted on a sample of 70 haemodialysis patients. Patient interviews, clinical examinations, and laboratory tests were performed to collect data. Serum levels of albumin, calcium, phosphorus, haemoglobin, ferritin, and creatinine were measured, with separate measurements for cystatin C The association between categorical variables was assessed using the chi-square test and Pearson's correlation coefficient, considering a significance level of p < 0.05.

RESULTS

Significant correlations were found between serum biomarkers and periodontal clinical parameters. Phosphorus, creatinine, albumin, ferritin, and creatinine levels correlated significantly with the Plaque Index (p < 0.001, p < 0.001, p = 0.015, p = 0.018, and p = 0.03). While the Ferritin level showed significant correlations with both the Plaque Index and Miller Classes (r = 0.281, p = 0.018 and r = 0.258, p = 0.031), respectively. The Calcium level showed a significant correlation with the Gingival Index (r = 0.266, p = 0.027). Cystatin C level was statistically correlated with mobility (r = 0.258, p = 0.031). Also, the result showed a significant correlation between Creatinine levels and Periodontitis (r = 0.26, p = 0.03).

CONCLUSION

This study provides evidence of a strong association between periodontal disease and chronic kidney disease in Yemeni haemodialysis patients. The findings emphasize the significance of maintaining good oral health in the care of haemodialysis patients.

Effect of concentrated growth factor on wound healing, side effects, and postoperative complications following third molar surgery

BACKGROUND

Third molar surgery often results in postoperative complications such as pain, trismus, and facial swelling due to surgical trauma. Concentrated Growth Factor (CGF), a third-generation platelet concentrate, is believed to enhance wound healing due to its rich content of growth factors and fibrin.

METHODS

This systematic review followed PRISMA guidelines and included a search of PubMed, Embase, and Cochrane Library up to April 18, 2024. Randomized controlled trials involving CGF-treated versus non-CGF-treated patients undergoing third molar surgery were included. Risk of bias was assessed using the Cochrane Collaboration RoB 2.0.

RESULTS

Ten studies were included. CGF significantly improved wound healing, with enhanced soft and hard tissue recovery. Pain relief was notable on postoperative days 3 and 7, although results varied. CGF reduced facial swelling significantly on days 3 and 7 post-surgery. Trismus outcomes were mixed, with some studies reporting significant alleviation and others showing no advantage. CGF showed potential in reducing dry socket incidence, though evidence was not robust.

CONCLUSIONS

CGF appears to promote wound healing and reduce postoperative complications such as pain and swelling after third molar surgery. However, its effects on trismus and dry socket incidence remain controversial. Further research with standardized measures is needed to confirm these findings.

A comparative study of the effects of advanced platelet-rich fibrin and resorbable collagen membrane in the treatment of gingival recession: a split-mouth, randomized clinical trial

AIM

This study aimed to assess the effectiveness of advanced platelet-rich fibrin (A-PRF) combined with the pinhole surgical technique (PST) for enhancing root coverage (RC) in individuals with Miller class I or II gingival recessions (GR). Additionally, it compared the clinical effect of A-PRF and resorbable collagen membrane (RCM).

MATERIALS AND METHODS

A total of 18 patients, encompassing 36 treatment sides of 18 Miller class I or II, were randomly assigned to the PST + A-PRF side (18 sides) and the PST + RCM side (18 sides). Clinical assessments of various parameters, including plaque index (PI), clinical attachment level (CAL), keratinized tissue width (KTW), recession depth (RD), recession width (RW), and gingival thickness (GT) were conducted at baseline and three months after the surgical procedure. A numeric rating scale (NRS) was also evaluated during the 1st, 2nd, 3rd and 4th days. This study was formally recorded under the TCTR identification number TCTR20230613005 in the Thai Clinical Trials Register-Medical Research Foundation of Thailand (MRF) on 13/06/2023. Furthermore, it was ethically approved by Sana'a University's Ethical Committee for Medical Research.

RESULTS

When comparing the values of 3 months follow-up with the baseline values, intra-side comparison of the PST + A-PRF group showed significant improvements in PI (P = 0.02), CAL (P = 0.01), and RD (P = 0.04), and GT values (P < 0.01). The improvements in the PST + A-PRF group were through the reduction of baseline values of PI, CAL, and RD; the mean reductions in PI, CAL, and RD were 0.44 ± 0.71, 0.33 ± 0.45, and 0.22 ± 0.43 respectively, and a significant increase in GT value (0.44 ± 0.24). While there was an insignificant increase in KTW value with no change in RW values (4.50 ± 0.71, P = 1). In contrast, intra- side comparison of PST + RCM side showed only a significant reduction in PI value (0.44 ± 0.71, P = 0.02) and a significant increase in GT value (0.42 ± 0.26, P = < 0.01). Meanwhile, there were insignificant improvements in CAL (2.89 ± 0.95), KTW (3.97 ± 0.74), and RD (1.94 ± 0.87) values. Regarding inter-side comparison, there were no statistically significant among all variables (p > 0.05). The pain scores of the numeric rating scale were significantly lower on the PST + A-PRF sides compared with the PST + RCM sides, especially on the 1st, 2nd, and 3rd days (P < 0.001).

CONCLUSION

Both A-PRF and RCM showed not wholly satisfactory outcomes in gingival recession treatment. Interestingly, the combination of PST with A-PRF has proven more effective than combining PST with RCM. Additionally, the localized application of A-PRF has been shown to reduce post-operative pain following the pinhole surgical technique.

Efficacy of Platelet-Rich Fibrin in Preserving Alveolar Ridge Volume and Reducing Postoperative Pain in Site Preservation of Post-Extracted Sockets

Background and Objectives: In socket preservation, the goal is to minimize bone resorption after tooth extraction to maintain the volume and contour of the alveolar ridge. The use of PRF in post extraction sites may reduce ridge resorption by encouraging the growth of new bone and acting as a scaffold for tissue. In addition, PRF may enhance healing and minimize postoperative pain. The aim of this study was to evaluate the effectiveness of platelet-rich fibrin (PRF) in maintaining the ridges' dimensions at the extraction site, in the maxilla and mandible, as well as its impact on post-extraction discomfort. Methods: The study was conducted on 60 patients presenting for extraction of posterior teeth and was randomly divided into three groups: group I PRF (n = 20), group II PRF + collagen (n = 20), and group III control (n = 20). Sockets were filled with PRF (group I) and PRF + collagen (group II). At baseline and follow-up after 3 months, CBCT was used to assess the bone dimensions. The postoperative pain evaluations were performed at 24 h, 3 days, and 7 days after the tooth extraction. The pain rate was evaluated using a numerical rating scale from the British Pain Society. Results: The study examined the effects of platelet-rich fibrin (PRF) and PRF combined with collagen on the height and width of the ridges, as well as the pain experienced by the patients following alveolar ridge preservation surgery. ANOVA and t-tests were used to evaluate and compare the ridge dimensions. Comparing the results to the control group, there were no significant differences in the height or width of the ridges. However, both the PRF and PRF + Collaplug® treatments effectively reduced the short-term postoperative pain. Conclusions: The study findings suggest that platelet-rich fibrin (PRF) and PRF combined with collagen do not exert significant effects on ridge width and height compared to the standard treatment following alveolar ridge preservation. However, it is noteworthy that both the PRF and PRF + collagen treatments demonstrated efficacy in reducing postoperative pain in the short term, offering a potential advantage over standard treatment protocols.

Application of concentrated growth factor in mandibular third molar extraction: A protocol for systematic review and meta-analysis

OBJECTIVE

We will perform the systematic review to evaluate the effect of applying concentrated growth factor (CGF) on relieving postoperative complications and promoting wound healing following mandibular third molar extraction.

METHODS

The PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Database, China Biology Medicine Disc (CBM), and VIP Databases will be comprehensively searched up to May 31, 2024. Randomized controlled trials (RCTs) examining the application of CGF after mandibular third molar extraction will be included. The protocol was registered in PROSPERO, and the registration ID was CRD42023463234. Two reviewers will conduct the literature search, eligible study selection, data extraction, and bias risk assessment (using the Cochrane Risk of Bias 2.0 tool). Data analysis will be performed with RevMan software (version 5.4).

RESULTS

The results of this study will be available in a peer-reviewed journal.

CONCLUSION

Our study will provide scientific evidence regarding the efficacy of applying CGF in mandibular third molar extraction.

From Basic Science to Clinical Practice: A Review of Current Periodontal/Mucogingival Regenerative Biomaterials

Periodontitis is a dysbiosis-driven inflammatory disease affecting the tooth-supporting tissues, characterized by their progressive resorption, which can ultimately lead to tooth loss. A step-wise therapeutic approach is employed for periodontitis. After an initial behavioral and non-surgical phase, intra-bony or furcation defects may be amenable to regenerative procedures. This review discusses the regenerative technologies employed for periodontal regeneration, highlighting the current limitations and future research areas. The search, performed on the MEDLINE database, has identified the available biomaterials, including biologicals (autologous platelet concentrates, hydrogels), bone grafts (pure or putty), and membranes. Biologicals and bone grafts have been critically analyzed in terms of composition, mechanism of action, and clinical applications. Although a certain degree of periodontal regeneration is predictable in intra-bony and class II furcation defects, complete defect closure is hardly achieved. Moreover, treating class III furcation defects remains challenging. The key properties required for functional regeneration are discussed, and none of the commercially available biomaterials possess all the ideal characteristics. Therefore, research is needed to promote the advancement of more effective and targeted regenerative therapies for periodontitis. Lastly, improving the design and reporting of clinical studies is suggested by strictly adhering to the Consolidated Standards of Reporting Trials (CONSORT) 2010 statement.

Advancements in alveolar bone grafting and ridge preservation: a narrative review on materials, techniques, and clinical outcomes

This narrative review systematically explores the progression of materials and techniques in alveolar ridge preservation (ARP). We commence by delineating the evolution from traditional ARP methods to cutting-edge alternatives, including platelet-rich fibrin, injectable bone repair materials, and hydrogel systems. Critical examination of various studies reveals these innovative approaches not only accelerate bone healing but also significantly improve patient-reported outcomes, such as satisfaction, pain perception, and overall quality of life. Emphasis is placed on the correlation between advanced ARP techniques and enhanced patient comfort and clinical efficacy, underscoring their transformative potential in dental implantology. Highlighting the effectiveness of ARP, the implant survival rate over a span of 5 to 7 years was high, showcasing the reliability and success of these methods. Further, patients expressed high aesthetic satisfaction with the soft tissue outcome, evidenced by an average visual analog scale (VAS) score of 94. This positive aesthetic appraisal is linked to the clinical health of implants, potentially due to the employment of tooth-supported surgical guides. The economic analysis reveals a varied cost range for bone graft substitutes ($46.2 to $140) and socket sealing materials ($12 to $189), with a noteworthy correlation between the investment in barrier membranes and the diminished horizontal and vertical ridge resorption. This suggests that membrane usage significantly contributes to preserving ridge dimensions, offering a cost-effective strategy for enhancing ARP outcomes. In conclusion, this review illuminates the significant advancements in ARP, highlighting the shift towards innovative materials and techniques that not only promise enhanced bone regeneration and reduced healing times but also improve patient satisfaction and aesthetic outcomes. The documented high implant survival rate and the beneficial economic implications of membrane use further validate the effectiveness of contemporary ARP strategies, paving the way for their broader adoption in dental implantology.

A graftless maxillary sinus lifting approach with simultaneous dental implant placement: a prospective clinical study

PURPOSE

This study aimed to introduce a graftless sinus lifting approach with simultaneous dental implant placement in the alveolus of the posterior maxilla and compare this approach's outcomes in freshly extracted sockets versus healed sockets.

MATERIALS AND METHODS

A prospective study was conducted on 60 patients aged between 27 and 59 years old, requiring dental implants in the posterior maxilla, and diagnosed with reduced vertical bone height (30 with freshly extracted sockets (group A) and the remaining 30 with healed sockets (group B). Before the sinus lifting approach, a cone beam computed tomography (CBCT) was taken, followed by another CBCT at least one-year post-sinus lifting (range: 12-36 months). Biological and mechanical complications were assessed, and the primary implant stability was measured using the Implant Stability Quotient (ISQ). Parametric data were analyzed using an independent t-test for intergroup comparisons, with significance set at P < 0.05.

RESULTS

No significant differences were found among groups concerning gender, placement side, and follow-up. All dental implants demonstrated high survival rates with no observed biological or mechanical complications. Moreover, the primary implant stability was satisfactory, and there was no statistically significant difference (P = 0.38). In terms of new intrasinus bone formation, both groups exhibited satisfactory and successful outcomes, with increased new bone formation in group A. However, there was no statistically significant difference (P = 0.26). Regarding the vertical sinus floor elevation without new bone formation, group B showed (0.11 ± 0.64) mm of intrasinus implant height without bone formation, while group A showed an increment of bone formation above the intrasinus implant (0.22 ± 0.33) mm, with no statistically significant difference between both groups (P = 0.30).

CONCLUSION

Our approach proves to be predictable, low-cost, and efficient option for sinus lift procedures, demonstrating high survival rates with acceptable primary implant stability. Moreover, it yields satisfactory outcomes in terms of new intrasinus bone formation, both in freshly extracted and healed sockets. Consequently, our approach holds promise as a reliable procedure for sinus lifting with simultaneous dental implant placement.

The role and mechanism of platelet-rich fibrin in alveolar bone regeneration

Platelet-rich fibrin (PRF), as an autologous blood preparation, has been receiving increasing attention in recent years and has been successfully applied in various clinical treatments for alveolar bone regeneration in the oral field. This review focuses on analyzing and summarizing the role and mechanism of PRF in alveolar bone regeneration. We first provide a brief introduction to PRF, then summarize the mechanisms by which PRF promotes alveolar bone regeneration from three aspects: osteogenesis mechanism, bone induction mechanism, and bone conduction mechanism, involving multiple signaling pathways such as Smad, ERK1/2, PI3K/Akt, and Wnt/β-catenin. We also explore the various roles of PRF as a scaffold, filler, and in combination with bone graft materials, detailing how PRF promotes alveolar bone regeneration and provides a wealth of experimental evidence. Finally, we summarize the current applications of PRF in various oral fields. The role of PRF in alveolar bone regeneration is becoming increasingly important, and its role and mechanism are receiving more and more research and understanding. This article will provide a reference of significant value for research in related fields. The exploration of the role and mechanism of PRF in alveolar bone regeneration may lead to the discovery of new therapeutic targets and the development of more effective and efficient treatment strategies.

Efficacy of autogenous particulated dentin graft for alveolar ridge preservation: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Autogenous particulate dentin (APD) has been used as a bone graft material for bone augmentation, but the specifics of its effect on alveolar ridge preservation (ARP) are uncertain. The aim of this study was to investigate the clinical and histomorphometric performance of APD compared with blood clot healing or other grafted materials in ARP.

METHODS

MEDLINE, Embase, Web of Science, Scopus and the Cochrane Library and citation databases were searched until August 2, 2023 to identify randomized controlled trials that employed APD for ARP. Two independent meta-analyses were performed based on the different control groups (Group I: blood clot healing; Group II: other grafted materials). Weighted or mean differences (MDs) and corresponding 95% confidence intervals (CIs) were calculated. The protocol was prospectively registered with PROSPERO (CRD42023409339).

RESULTS

A total of 238 records were identified, of which ten studies with 182 participants were included. The meta-analysis indicated that APD resulted in fewer changes in horizontal ridge width (Group I: MD = 1.61, 95% CI 0.76-2.46; Group II: MD = 1.28, 95% CI 1.08-1.48) and labial bone height (Group I: MD = 1.75, 95% CI 0.56-2.94; Group II: P < .05) than the control treatments. Regarding histomorphometry, APD yielded a satisfactory proportion of vital bone area (MD = 10.51, 95% CI 4.70-16.32) and residual material area (MD = -8.76, 95% CI -12.81 to -4.71) in Group II, while there was no significant difference in Group I. Moreover, none of the secondary outcomes were significantly differed between groups.

CONCLUSION

Within this study limitations, APD effectively maintained the horizontal and vertical dimensions of the extraction sockets and exhibited favorable osteogenic properties and degradation capacity. Further well-designed randomized controlled trials with larger samples and longer follow-up periods are needed to evaluate whether APD is superior to other substitutes for ARP.

Efficacy of concentrated growth factor (CGF) in the surgical treatment of oral diseases: a systematic review and meta-analysis

BACKGROUND

Concentrated growth factor (CGF), a new autologous platelet concentrate, has been widely investigated to the adjunctive treatment of oral diseases. This study aims to evaluate the efficacy of CGF in the surgical treatment of oral diseases.

METHODS

MEDLINE, Web of Science, Scopus, Cochrane, and EMBASE databases were searched up to July 2023. Only randomized clinical trials were included. The methodologic quality was evaluated by the Cochrane Risk of Bias Tool. RevMan 5.4 software was used for data analysis.

RESULTS

In the treatment of periodontal intrabony defects, bone graft combined with CGF was significantly superior to bone graft (P < 0.01), with mean intrabony defect depth reduction of 1.41 mm and mean clinical attachment level gain of 0.55 mm. In the regenerative surgery of furcation defects, the effect of CGF group was significantly better than control group (P < 0.0001), with mean probing depth reduction of 0.99 mm, vertical bone gain of 0.25 mm, and horizontal bone gain of 0.34 mm. CGF combined with coronally advanced flap (CAF) was more effective than CAF alone (mean keratinized tissue width increase of 0.41 mm, mean gingival thickness increase of 0.26 mm, P < 0.00001), but less effective than connective tissue graft (CTG) combined with CAF (mean root coverage difference of -15.1%, mean gingival thickness difference of -0.5 mm, P < 0.0001). In the alveolar ridge preservation, additional use of CGF reduced horizontal bone resorption by 1.41 mm and buccal vertical bone resorption by 1.01 mm compared to control group (P < 0.0001). The VAS score of CGF group was significantly lower than that of the control group at the 1st and 7th day after oral surgery (P < 0.0001).

CONCLUSIONS

CGF can exert a positive adjunctive effect for the regenerative surgery of periodontal intrabony defects, furcation defects, and alveolar ridge preservation procedure. CGF combined with CAF has a better therapeutic effect on gingival recession compared to CAF alone, although it is not as effective as CTG combined with CAF. CGF could promote postoperative healing and pain relief in oral surgery within a week. There is currently not enough evidence to support the clinical benefits of CGF in other oral surgeries.