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

A Comparative Evaluation of Advanced Platelet-Rich Fibrin Combined With Demineralized Freeze-Dried Bone Allograft and Demineralized Freeze-Dried Bone Allograft Alone in the Treatment of Periodontal Infrabony Defects: A Clinical and Radiographic Study

Aim Allografts, autografts, alloplast and xenografts are frequently used for periodontal regeneration. The aim of this study was to determine the efficacy of advanced platelet-rich fibrin (A-PRF) in combination with demineralized freeze-dried bone allograft (DFDBA) and DFDBA alone in periodontal infrabony defects. Methodology This was a split-mouth design study where 20 infrabony defects in 10 patients were included. Patients were randomly divided into two groups, where DFDBA allograft and A-PRF were used in the test group, while the DFDBA allograft alone was used in the control group. Furthermore, the results were evaluated at baseline, three, and nine months, respectively, in terms of clinical and radiographic parameters. Data were analysed with an unpaired t-test at the significance level of P < 0.05 (statistically significant). Results Both treatments showed reduced clinical and radiographic parameters from baseline to nine months. There was a non-significant difference in the plaque index (PI), bleeding on probing (BOP), clinical attachment level (CAL), and radiographic defect fill (RDF). In comparison to the control group (3.40 ± 0.516), the probing pocket depth (PPD) in the test group at nine months (3.22 ± 0.422) was statistically significant showing reduction in the PPD (P = 0.042). Conclusion Within its limitations, the study showed that A-PRF plus DFDBA and DFDBA alone treatment modalities reduced clinical and radiographic parameters from baseline, at 9 months; however, the inclusion of A-PRF did not substantially improve the treatment outcome when comparing both the groups, except for the probing pocket depth after nine months.

Clinical Efficacy of Platelet Derivatives in Periodontal Tissue Regeneration: An Umbrella Review

Objectives

This umbrella review aimed to consolidate the best available evidence regarding the clinical efficacy of platelet derivatives in the treatment of periodontal defects associated with periodontitis and in the management of mucogingival deformities.

Materials and Methods

The "umbrella review" strategy was used to identify systematic reviews and meta-analyses. The search was performed without language restrictions and updated at the end of February 2023. The PubMed and Scopus databases, together with gray literature, were included in the search.

Results

The search yielded 412 studies. Subsequently, 12 articles were selected for further examination based on relevance. Finally, eight systematic reviews and meta-analyses were assessed. Regarding intrabony defects, in terms of clinical attachment level (CAL) gain, platelet-rich fibrin (PRF) was observed to lead to a statistically significant attachment gain compared to surgical therapy alone. PRF was also found to show greater CAL gain compared to platelet-rich plasma (PRP) and other biomaterials. The parameter probing depth decreased significantly when PRF was used compared to surgical therapy alone (P < 0.05). Similar results were seen when leukocyte- and platelet-rich fibrin (L-PRF) was applied. In terms of radiographic bone fill, both PRF and PRP showed significantly greater bone fill compared to surgical therapy. Regarding the results of periodontal plastic surgery, PRF favored a slight root coverage compared to the coronally displaced flap. This result depended on the number of PRF and L-PRF membranes used, but Emdogain or connective tissue graft produced better results regardless. However, an improvement in the healing of periodontal tissues was reported.

Conclusions

Therapies with platelet derivatives applied to intrabony defects provided superior regenerative results compared to monotherapies, except in the case of root coverage.

Comparative evaluation of demineralized freeze-dried bone allograft with and without concentrated growth factor membrane in the treatment of periodontal intrabony defects: a randomized controlled clinical trial

BACKGROUND

The current study's aim was to evaluate and compare demineralized freeze-dried bone allograft (DFDBA) with and without concentrated growth factor (CGF) membrane in the treatment of periodontal intrabony defects on both a clinical and radiographic level.

METHODS

30 stage III grade B periodontitis patients with bilateral intrabony defects were involved in the split mouth randomized controlled trial, and they received either DFDBA alone (control group) or DFDBA plus CGF membrane treatment (test group). At baseline and 6 and 12 months, the gingival index (GI), plaque index (PI), probing pocket depth (PPD), clinical attachment level (CAL), and gingival recession (GR) were assessed, whereas cone beam computed tomography was used to assess the bone defect height (BDH), vertical bone loss (VBL), bone defect depth (BDD), mesio-distal bone defect width (MDBDW), bucco-lingual bone defect width (BLBDW), and bone defect volume (CBCT) at baseline and 12 months.

RESULTS

The radiographic measures BDH, BDD, MDBDW, BLBDW, and BDV in the test group likewise showed a higher reduction in PPD and gain in CAL than the control group. The results of the intergroup comparison showed that the test group had statistically significant differences in BDH, BDD, and MDBDW.

CONCLUSION

The data show that the test group achieved better results, with greater reductions in PPD, gains in CAL, and decreases in BDH, BDD, MDBDW, BLBDW, and BDV.

CLINICAL RELEVANCE

The use of concentrated growth factor in conjunction with demineralized freeze-dried bone allograft may be suggested for the treatment of periodontal intrabony defects.

Alveolar Ridge Preservation after Tooth Extraction Using Different Bone Graft Materials and Autologous Platelet Concentrates: a Systematic Review

Objectives

To review and assess the efficiency of different post extraction socket preservation techniques.

Material and Methods

An electronic literature search was performed on the MEDLINE and Embase databases. The review included human studies published between from January 1^st, 2007 to January 1^st, 2018, in English. Outcome measures included dimensional changes and/or histological evaluation of alveolar bone.

Results

Twenty-six full text articles were reviewed, 16 of which met the inclusion criteria and were selected for the study. Autogenous tooth graft prevented vertical resorption the most: -0.28 (SD 0.13) mm, observation period (OP): 4 months, while the least effective approach was beta tri-calcium phosphate (β-TCP): -1.72 (SD 0.56) mm, OP: 4 months. Estimating horizontal resorption, the most effective technique was biphasic calcium sulphate (BCS) with β-TCP and hydroxyapatite (HA) - BCS + TCP + HA: 0.03 (SD 2.32) mm, OP: 4 months, while β-TCP was the least efficient: -1.45 (SD 0.4) mm, OP: 4 months. Evaluating residual graft particles (RG) and newly formed bone (NFB) ratio the best results were achieved with demineralized freeze-dried bone allograft: RG: 8.88%, NFB: 38.42%, OP: 5 months, whereas magnesium-enriched hydroxyapatite was least effective: RG: 40.82%, NFB: 31.85%, OP: 4 months.

Conclusions

This review revealed that even though there are numerous types of biomaterials for socket preservation none of them can completely stop alveolar bone loss after tooth extraction. Furthermore, lack of information about qualitative evaluation of bone was noticed indicating that further studies regarding this topic are needed.

Does a combination of platelet-rich plasma and decalcified freeze-dried bone allograft offer advantages over decalcified freeze-dried bone allograft alone when using pocket depth and clinical attachment level as markers for periodontal healing? A literature review

The aim of the present study was to investigate whether a combination of platelet-rich plasma (PRP) and decalcified freeze-dried bone allograft (DFDBA) offers advantages over DFDBA and saline in infrabony defects. The objectives were to primarily evaluate changes in clinical attachment level (CAL) and secondarily changes in pocket depth (PD). A search was performed of electronic databases (Medline, PubMed, Embase, The Cochrane Central Register of Controlled Trials, and Web of Science), as well as hand searching and reference list searching. Only randomized, controlled trials published up until 30 March 2018 were included that had a follow-up period of at least 6 months. Four papers met the eligibility criteria and were critically appraised using the Consolidated Standards of Reporting Trials statement and put through the Cochrane Collaboration's tool for assessing risk of bias. In three of the four studies, clinically and significantly greater CAL gains and PD reductions were observed in patients who received PRP and DFDBA in comparison to those who received DFDBA and saline (P < 0.05). Methodological heterogeneity existed among the studies, especially in the preparation of PRP and the type of infrabony defect. This made it difficult to draw clear conclusions, but despite this, the studies could still be regarded, as significant as they showed a low risk of bias.

Efficacy of Adjunctive Bioactive Materials in the Treatment of Periodontal Intrabony Defects: A Systematic Review and Meta-Analysis

Objectives

Lots of bioactive materials have been additionally applied for the treatment of periodontal intrabony defect. However, there is dearth of studies to systematically evaluate the supplementary role of them in periodontal regeneration. The goal of this meta-analysis is to evaluate the adjunctive effects of bioactive materials such as platelet-rich plasma (PRP), platelet-rich fibrin (PRF), enamel matrix derivative (EMD), and amnion membrane (AM) on the outcomes of bone grafting treatment for periodontal intrabony defects.

Methods

Articles published before December 2017 were searched electronically in three databases (PubMed, Embase, and Cochrane Central), with no date or language limits. Randomized controlled trials (RCTs) on the assessment of effectiveness of the four biomaterials in conjunction with demineralized freeze-dried bone allografts (DFDBA) in the treatment of periodontal intrabony defects were enrolled in this meta-analysis. Data were analyzed with STATA 12.

Results

Nine studies were included. PRF and PRP significantly improved pocket depth (PD) reduction and clinical attachment loss (CAL) gain. Only PRF exhibited a positive result in recession reduction (RecRed). Only PRP showed a statistically significant increase in bone fill. AM merely gained more CAL. EMD did not improve any clinical outcome.

Conclusion

Our data suggest that PRF/PRP could be taken as a preferred adjunct to facilitate periodontal regeneration of intrabony defects.

[Decalcified freeze-dried bone allograft combined with rich platelet derivatives for the treatment of human periodontal intrabony defects: a Meta-analysis]

OBJECTIVE

This review aims to systematically evaluate the effect of decalcified freeze-dried bone allograft (DFDBA) combined with rich platelet derivatives on the treatment of human periodontal intrabony defects.

METHODS

A search in PubMed, Web of Science, Embase, Cochrane Library, CNKI, and other electronic databases was conducted to identify randomized controlled trials (RCT) of the use of DFDBA combined with rich platelet derivatives in the treatment of human periodontal intrabony defects, performed before May 2016. The quality of the RCTs was assessed. RevMan 5.3 software was applied for Meta-analysis.

RESULTS

A total of nine RCTs were included. A total of 194 patients and 303 defects were involved. Short-term (6 months) and long-term (12 to 18 months) groups were included. Meta-analysis results revealed that DFDBA combined with rich platelet derivatives was superior to DFDBA or rich platelet derivatives alone for probing depth reduction in the short-term [MD=0.75 mm, 95% confidence intervals (CI) (0.31 mm, 1.20 mm), P=0.001 0] and longterm groups [MD=0.87 mm, 95%CI (0.02 mm, 1.72 mm), P=0.04], clinical attachment level gain in the short-term [MD=
0.65 mm, 95%CI (0.08 mm, 1.22 mm), P=0.03] and long-term groups [MD=1.31 mm, 95%CI (0.60 mm, 2.01 mm), P<0.000 3], gingival recession reduction in the long-term group [MD=-0.58 mm, 95%CI (-0.78 mm, -0.38mm), P<0.000 01], bone fill gain in the short-term [MD=0.52 mm, 95%CI (0.03 mm, 1.00 mm), P=0.04] and long-term groups [MD=1.26 mm, 95%CI (0.65 mm, 1.86 mm), P<0.000 1].

CONCLUSIONS

DFDBA combined with platelet rich derivatives is probably effective in the treatment of human periodontal intrabony defects. It is probably superior to DFDBA or platelet rich derivatives alone. Considering the limitation of the included studies, high-quality and large-sample RCTs are required to evaluate the effect.

Natural graft tissues and synthetic biomaterials for periodontal and alveolar bone reconstructive applications: a review

Periodontal disease is categorized by the destruction of periodontal tissues. Over the years, there have been several clinical techniques and material options that been investigated for periodontal defect repair/regeneration. The development of improved biomaterials for periodontal tissue engineering has significantly improved the available treatment options and their clinical results. Bone replacement graft materials, barrier membranes, various growth factors and combination of these have been used. The available bone tissue replacement materials commonly used include autografts, allografts, xenografts and alloplasts. These graft materials mostly function as osteogenic, osteoinductive and/or osteoconductive scaffolds. Polymers (natural and synthetic) are more widely used as a barrier material in guided tissue regeneration (GTR) and guided bone regeneration (GBR) applications. They work on the principle of epithelial cell exclusion to allow periodontal ligament and alveolar bone cells to repopulate the defect before the normally faster epithelial cells. However, in an attempt to overcome complications related to the epithelial down-growth and/or collapse of the non-rigid barrier membrane and to maintain space, clinicians commonly use a combination of membranes with hard tissue grafts. This article aims to review various available natural tissues and biomaterial based bone replacement graft and membrane options used in periodontal regeneration applications.

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.

A comparative evaluation of extraction socket preservation with demineralized freeze-dried bone allograft alone and along with platelet-rich fibrin: A clinical and radiographic study

AIMS

To investigate clinically and radiographically, the bone fill in extraction sockets using demineralized freeze-dried bone allograft alone and along with platelet-rich fibrin (PRF).

MATERIALS AND METHODS

A randomized controlled clinical trial was carried out on 36 nonrestorable single-rooted teeth sites. Sites were randomized into demineralized freeze-dried bone allograft (DFDBA) combined with PRF - test and DFDBA - control groups using a coin toss method. After the placement of graft material, collagen membrane was used to cover it. The clinical parameters recorded were ridge width and ridge height. All the parameters were recorded at baseline and at 90 and 180 days.

STATISTICAL ANALYSIS USED

Independent t-test and paired t-test.

RESULTS

In both groups, there is significant reduction in loss of ridge width and ridge height from baseline to 90 days (P < 0.001), baseline to 180 days (P < 0.001), and 90-180 days (P < 0.001). However, when both the groups were compared the test group favored in the reduction of ridge width while there was no statistical difference in reduction of ridge height among at different intervals.

CONCLUSIONS

Although DFDBA is considered as an ideal graft material, PRF can be used as an adjunctive with DFDBA for socket preservation.

Effects of Plasma Rich in Growth Factors and Platelet-Rich Fibrin on Proliferation and Viability of Human Gingival Fibroblasts

OBJECTIVES

Platelet preparations are commonly used to enhance bone and soft tissue regeneration. Considering the existing controversies on the efficacy of platelet products for tissue regeneration, more in vitro studies are required. The aim of the present study was to compare the in vitro effects of plasma rich in growth factors (PRGF) and platelet-rich fibrin (PRF) on proliferation and viability of human gingival fibroblasts (HGFs).

MATERIALS AND METHODS

Anitua's PRGF and Choukran's PRF were prepared according to the standard protocols. After culture periods of 24, 48 and 72 hours, proliferation of HGFs was evaluated by the methyl thiazol tetrazolium assay. Statistical analysis was performed using one-way ANOVA followed by Tukey-Kramer's multiple comparisons and P-values<0.05 were considered statistically significant.

RESULTS

PRGF treatment induced statistically significant (P<0.001) proliferation of HGF cells compared to the negative control (100% viability) at 24, 48 and 72 hours in values of 123%±2.25%, 102%±2.8% and 101%±3.92%, respectively. The PRF membrane treatment of HGF cells had a statistically significant effect on cell proliferation (21%±1.73%, P<0.001) at 24 hours compared to the negative control. However, at 48 and 72 hours after treatment, PRF had a negative effect on HGF cell proliferation and caused 38% and 60% decrease in viability and proliferation compared to the negative control, respectively. The HGF cell proliferation was significantly higher in PRGF than in PRF group (P< 0.001).

CONCLUSION

This study demonstrated that PRGF had a strong stimulatory effect on HGF cell viability and proliferation compared to PRF.

Bone Replacement Materials and Techniques Used for Achieving Vertical Alveolar Bone Augmentation

Alveolar bone augmentation in vertical dimension remains the holy grail of periodontal tissue engineering. Successful dental implant placement for restoration of edentulous sites depends on the quality and quantity of alveolar bone available in all spatial dimensions. There are several surgical techniques used alone or in combination with natural or synthetic graft materials to achieve vertical alveolar bone augmentation. While continuously improving surgical techniques combined with the use of auto- or allografts provide the most predictable clinical outcomes, their success often depends on the status of recipient tissues. The morbidity associated with donor sites for auto-grafts makes these techniques less appealing to both patients and clinicians. New developments in material sciences offer a range of synthetic replacements for natural grafts to address the shortcoming of a second surgical site and relatively high resorption rates. This narrative review focuses on existing techniques, natural tissues and synthetic biomaterials commonly used to achieve vertical bone height gain in order to successfully restore edentulous ridges with implant-supported prostheses.