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Miron RJ, Moraschini V, Estrin N, Shibli JA, Cosgarea R, Jepsen K, Jervøe-Storm PM, Wang HL, Sculean A, Jepsen S. Autogenous platelet concentrates for treatment of intrabony defects-A systematic review with meta-analysis. Periodontol 2000 2024. [PMID: 39425513 DOI: 10.1111/prd.12598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 06/21/2024] [Accepted: 07/16/2024] [Indexed: 10/21/2024]
Abstract
To provide an overview of the use of autogenous platelet concentrates (APCs) in periodontal regeneration and to conduct a systematic review (SR) of the treatment outcomes of periodontal intrabony defects by using platelet-rich fibrin (PRF) compared with other commonly utilized modalities. The eligibility criteria comprised randomized controlled trials (RCTs) comparing the clinical outcomes of PRF with that of other modalities. Studies were classified into 21 categories and into five different groups as follows: Group I (1) open flap debridement (OFD) alone versus OFD/PRF, (2) OFD versus Titanium-PRF (T-PRF) Group II, (3) Comparative PRF protocols (PRF vs. T-PRF), Group III (Comparative Studies to PRF): (4) OFD/PRP versus OFD/PRF, (5) OFD/bone graft(BG)/PRGF versus OFD/BG/PRF, (6) OFD/EMD versus OFD/PRF, (7) OFD/BG/EMD versus OFD/BG/PRF, (8) OFD/collagen membrane (CM) versus OFD/PRF, (9) OFD/BG/BM versus OFD/BG/PRF, (10) OFD/BG versus OFD/PRF, Group IV (Addition of PRF to treatment groups) (11) OFD/BG versus OFD/BG/PRF, (12) OFD/GTR versus OFD/GTR + PRF (13) OFD/EMD versus OFD/EMD/PRF (14) OFD/BG/BM versus OFD/BG/BM/PRF, Group V (Addition of Biomaterial/Biomolecule to PRF): OFD/PRF versus … (15) OFD/PRF/BG, (16) OFD/PRF/antibiotic, (17) OFD/PRF/Metformin, (18) OFD/PRF/Bisphosphonates, (19) OFD/PRF/Statins, (20) OFD/BG/PRF versus OFD/BG/PRF/Statins, and (21) OFD/PRF/low-level laser therapy (LLLT). Weighted means and forest plots were calculated for probing pocket depth (PPD), clinical attachment level (CAL), and radiographic bone fill (RBF). From 596 records identified, 55 RCTs were included. Group I: The use of OFD/PRF statistically significantly reduced PPD and improved CAL and RBF when compared to OFD. Group II: A significant difference between various PRF protocols was only observed for PPD. Group III: No significant advantage was found when comparing OFD/PRF to the following groups: OFD/PRP, OFD/EMD, OFD/BM, or OFD/BG. Group IV: The addition of PRF to OFD/BG led to significant improvements in PPD, CAL and RBF compared with OFD/BG alone. Group V: The addition of either a BG as well as three of the following biomolecules (metformin, bisphosphonates, and statins) to OFD/PRF led to statistically significant improvements in PPD, CAL, and/or RBF when compared to OFD/PRF alone. The use of PRF significantly improved clinical outcomes in intrabony defects when compared to OFD alone. Similar results were observed when OFD/PRF was compared with OFD/BG, OFD/EMD, OFD/PRP, and OFD/BM. The addition of PRF to a bone grafting material as well as the addition of various small biomolecules to PRF may offer additional clinical advantages, thus warranting further investigations. Future research investigating various protocols of PRF, longer-term outcomes, as well as PRF at the human histological level remains needed.
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Affiliation(s)
- Richard J Miron
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - Vittorio Moraschini
- Department of Oral Surgery, School of Dentistry, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | - Nathan Estrin
- School of Dental Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, Florida, USA
| | - Jamil Awad Shibli
- Department of Implant Dentistry, School of Dentistry, Guarulhos University, Guarulhos, Brazil
| | - Raluca Cosgarea
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany
- Department of Periodontology, University of Marburg, Germany
- Faculty of Dentistry, University Iuliu Hatieganu Cluj-Napoca, Romania
| | - Karin Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany
| | - Pia-Merete Jervøe-Storm
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Anton Sculean
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - Søren Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany
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Miron RJ, Moraschini V, Estrin NE, Shibli JA, Cosgarea R, Jepsen K, Jervøe-Storm PM, Sculean A, Jepsen S. Periodontal regeneration using platelet-rich fibrin. Furcation defects: A systematic review with meta-analysis. Periodontol 2000 2024. [PMID: 39324633 DOI: 10.1111/prd.12583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 05/19/2024] [Accepted: 05/27/2024] [Indexed: 09/27/2024]
Abstract
The objective of the study was to compare the treatment outcomes of periodontal furcation defects by using platelet-rich fibrin (PRF) with other commonly utilized modalities. The eligibility criteria comprised randomized controlled trials (RCTs) comparing the clinical outcomes of PRF with those of other modalities for the treatment of furcation defects. Studies were classified into 11 categories in 3 different groups as follows: Group I (addition of PRF): (1) open flap debridement (OFD) alone versus OFD/PRF, (2) OFD/bone graft (OFD/BG) versus OFD/BG/PRF; Group II (comparative studies to PRF): (3) OFD/BG versus OFD/PRF, (4) OFD/collagen membrane versus OFD/PRF, (5) OFD/PRP versus OFD/PRF, (6) OFD/rhBMP2 versus OFD/PRF; and Group III (addition of biomaterial/biomolecule to PRF): OFD/PRF versus … (7) OFD/PRF/BG, (8) OFD/PRF/amniotic membrane (AM), (9) OFD/PRF/metformin, (10) OFD/PRF/bisphosphonates, (11) OFD/PRF/statins. Weighted means and forest plots were calculated for the reduction of probing pocket depth (PPD), gain of vertical and horizontal clinical attachment levels (VCAL and HCAL), gain in vertical and horizontal bone levels (VBL, HBL), and radiographic bone fill (RBF). From 45 articles identified, 21 RCTs reporting on class II furcations were included. The use of OFD/PRF and OFD/BG/PRF statistically significantly reduced PPD and improved VCAL and HCAL when compared to OFD or OFD/BG, respectively. The comparison between OFD/PRF alone versus OFD/BG, OFD/CM, OFD/PRP, or OFD/rhBMP2 led to similar outcomes for all investigated parameters, including a reduction in PPD, VCAL/HCAL gain, and RBF. The additional incorporation of a BG to OFD/PRF only mildly improved outcomes, whereas the addition of AM improved clinical outcomes. The addition of small biomolecules such as metformin, bisphosphonates, or statins all led to significant improvements in PPD, VCAL, and HCAL when compared to OFD/PRF alone. Noteworthy, a very high heterogeneity was found in the investigated studies. The use of PRF significantly improved clinical outcomes in class II furcation defects when compared to OFD alone, with similar levels being observed between OFD/PRF and/or OFD/BG, OFD/CM, OFD/PRP, or OFD/rhBMP2. Future research geared toward better understanding potential ways to enhance the regenerative properties of PRF with various small biomolecules may prove valuable for future clinical applications. Future histological research investigating PRF in human furcation defects is largely needed. The use of PRF in conjunction with OFD statistically significantly improved PPD, VCAL, and HCAL values, yielding comparable outcomes to commonly used biomaterials. The combination of PRF to bone grafts or the addition of small biomolecules may offer additional clinical benefits, thus warranting future investigation.
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Affiliation(s)
- Richard J Miron
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - Vittorio Moraschini
- Department of Oral Surgery, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | - Nathan E Estrin
- School of Dental Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, Florida, USA
| | - Jamil Awad Shibli
- Department of Implant Dentistry, School of Dentistry, Guarulhos University, Guarulhos, São Paulo, Brazil
| | - Raluca Cosgarea
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany
- Clinic of Periodontology and Peri-implant Diseases, University of Marburg, Marburg, Germany
- Faculty of Dentistry, University Iuliu Hatieganu, Cluj-Napoca, Romania
| | - Karin Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany
| | - Pia-Merete Jervøe-Storm
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany
| | - Anton Sculean
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - Søren Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany
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Ren J, Li Z, Liu W, Fan Y, Qi L, Li S, Kong C, Zou H, Liu Z. Demineralized bone matrix for repair and regeneration of maxillofacial defects: A narrative review. J Dent 2024; 143:104899. [PMID: 38428719 DOI: 10.1016/j.jdent.2024.104899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/14/2024] [Accepted: 02/23/2024] [Indexed: 03/03/2024] Open
Abstract
OBJECTIVES Demineralized bone matrix (DBM) is a well-established bone graft material widely accepted by dentists and the public for its favorable osteoconductivity and osteoinductive potential. This article aimed to provide a narrative review of the current therapeutic applications and limitations of DBM in maxillofacial bone defects. STUDY SELECTION, DATA, AND SOURCES Randomized controlled trials, prospective or retrospective clinical studies, case series and reports, and systematic reviews. MEDLINE, PubMed, and Google Scholar were searched using keywords. CONCLUSIONS Some evidence supported the therapeutic application of DBM in periodontal intrabony defects, maxillary sinus lifts, ridge preservation, ridge augmentation, alveolar cleft repair, orthognathic surgery, and other regional maxillofacial bone defects. However, the limitations of DBM should be considered when using it, including potential low immunogenicity, instability of osteoinductive potential, handling of the graft material, and patient acceptance. CLINICAL SIGNIFICANCE With the increasing demand for the treatment of maxillofacial bone defects, DBM is likely to play a greater role as a promising bone graft material. Safe and effective combination treatment strategies and how to maintain a stable osteoinductive potential will be the future challenges of DBM research.
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Affiliation(s)
- Jiwei Ren
- Hospital of Stomatology, Jilin University, China
| | - Zhiwei Li
- Hospital of Stomatology, Jilin University, China
| | - Wantong Liu
- Hospital of Stomatology, Jilin University, China
| | - Yixin Fan
- Hospital of Stomatology, Jilin University, China
| | - Le Qi
- Hospital of Stomatology, Jilin University, China
| | - Sining Li
- Hospital of Stomatology, Jilin University, China
| | - Chen Kong
- Hospital of Stomatology, Jilin University, China
| | - He Zou
- Hospital of Stomatology, Jilin University, China
| | - Zhihui Liu
- Hospital of Stomatology, Jilin University, China.
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Salem S, Dhawan S, Sharma E, Dhawan R, Mukherjee A, Sivaraman SM. Comparative evaluation of regenerative potential of injectable platelet-rich fibrin and platelet-rich fibrin with demineralized freeze-dried bone allograft in the treatment of intrabony defects: A randomized controlled clinical study. Natl J Maxillofac Surg 2023; 14:399-405. [PMID: 38273925 PMCID: PMC10806309 DOI: 10.4103/njms.njms_39_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 11/16/2022] [Accepted: 03/13/2023] [Indexed: 01/27/2024] Open
Abstract
Background Injectable platelet-rich fibrin (i-PRF) being in liquid form keeps graft particles clumped together forming agglutinated steak of bone graft. It has been shown to contain more platelets and long-term deliverance of growth factors in comparison with platelet-rich fibrin (PRF). Aim The aim of the present study was to assess regenerative potential of i-PRF and comparing it with PRF, along with demineralized freeze-dried bone allograft (DFDBA) in the treatment of intrabony alveolar defects. Materials and Method Thirty defect sites in 15 patients with bilateral intrabony defects were assigned randomly into two groups (Group I (Control group)- DFDBA + PRF and Group II (Test group)-DFDBA + i-PRF). Gingival index (GI), plaque index (PI), pocket probing depth (PPD), and relative attachment level (RAL) were recorded at baseline, 3 months, and 6 months. Linear bone growth (LBG) was recorded radiographically at baseline and 6 months. Statistical Analysis ANOVA test and post hoc Tukey test were used to assess intragroup comparison of clinical parameters. Paired t-test was used to assess intragroup comparison of the radiographic parameter. Unpaired t-test was used to assess intergroup variations in all the clinical as well as radiographic parameters. Results Statistically significant PPD reduction (P = 0.005) and RAL gain (P = 0.003) were found in Group II than in Group I, and no significant difference was found in other parameters. Percentage LBG was higher in Group II than Group I but the difference was not statistically significant. Conclusion i-PRF with DFDBA showed more favorable results as compared to PRF with DFDBA in the management of intrabony periodontal defects.
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Affiliation(s)
- Saba Salem
- Department of Periodontics, Maharishi Markandeshwar College of Dental Sciences and Research (Maharishi Markandeshwar Deemed to be University, Mullana), Ambala, Punjab, India
| | - Shivani Dhawan
- Department of Periodontics, Maharishi Markandeshwar College of Dental Sciences and Research (Maharishi Markandeshwar Deemed to be University, Mullana), Ambala, Punjab, India
| | - Ena Sharma
- Department of Periodontics, Rayat Bahra Dental College, Mohali, Punjab, India
| | - Rajan Dhawan
- Department of Periodontics, Maharishi Markandeshwar College of Dental Sciences and Research (Maharishi Markandeshwar Deemed to be University, Mullana), Ambala, Punjab, India
| | - Abhilasha Mukherjee
- Department of Periodontics, Maharishi Markandeshwar College of Dental Sciences and Research (Maharishi Markandeshwar Deemed to be University, Mullana), Ambala, Punjab, India
| | - S M Sivaraman
- Department of Periodontics, Maharishi Markandeshwar College of Dental Sciences and Research (Maharishi Markandeshwar Deemed to be University, Mullana), Ambala, Punjab, India
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Patel B, Joshi S, Nagrani T, Girdhar GA, Patel H, Sinha S, Haque M, Kumar S, Haq MA. Clinical and Radiographic Evaluation of Autologous Platelet-Rich Fibrin With or Without Demineralized Bone Matrix in the Treatment of Grade II Furcation Defects. Cureus 2023; 15:e44394. [PMID: 37654905 PMCID: PMC10468150 DOI: 10.7759/cureus.44394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2023] [Indexed: 09/02/2023] Open
Abstract
Introduction This study aims to differentiate the employment of demineralized bone matrix (DMBM; Osseograft, Advanced Biotech Products (P) Ltd, Chennai, India) and platelet-rich fibrin (PRF) alone to a composite graft consisting of both materials in the surgical actions toward the anomalies of the human periodontal furcation imperfection. Methods In a split-mouth study, 30 patients with mandibular molars affected by the furcation were allocated without conscious choice to test (PRF + DMBM, n = 30) or control (PRF, n = 30) categories. At the starting point, three months after surgery, and six months later, the following modifiable factors were evaluated: probing pocket depth (PPD), full-mouth plaque scores, full-mouth gingival scores, radiographic defect depth, relative vertical clinical attachment level (RVCAL), and relative horizontal clinical attachment level (RHCAL). Results Results at three and six months demonstrated substantial differences between baseline values for both treatment methods in clinical and X-ray imaging appraisal. Nonetheless, the PRF/DMBM group manifests statistically significantly soaring changes observed in comparison to the PRF group. Overall, the probing depth (PD) in the test site was significantly lower than that in the control site, showing a reduction of 68% (95% CI=41%, 95%, p<0.001). Conclusion Clinical indications significantly improved with PRF and DMBM combined instead of PRF alone. On radiographs, the test group also showed higher bone fill.
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Affiliation(s)
- Bhavin Patel
- Periodontology, Karnavati School of Dentistry, Karnavati University, Gandhinagar, IND
| | - Surabhi Joshi
- Periodontology, Karnavati School of Dentistry, Karnavati University, Gandhinagar, IND
| | - Tanya Nagrani
- Periodontology, Karnavati School of Dentistry, Karnavati University, Gandhinagar, IND
| | - Gaurav A Girdhar
- Periodontology, Karnavati School of Dentistry, Karnavati University, Gandhinagar, IND
| | - Heli Patel
- Periodontology, Karnavati School of Dentistry, Karnavati University, Gandhinagar, IND
| | - Susmita Sinha
- Physiology, Khulna City Medical College Hospital, Khulna, BGD
| | - Mainul Haque
- Karnavati Scientific Research Center, Karnavati School of Dentistry, Karnavati University, Gandhinagar, IND
- Pharmacology and Therapeutics, National Defence University of Malaysia, Kuala Lumpur, MYS
| | - Santosh Kumar
- Periodontology, Karnavati School of Dentistry, Karnavati University, Gandhinagar, IND
| | - Md Ahsanul Haq
- Biostatistics, Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDRB), Dhaka, BGD
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Ardila CM, Pertuz M, Vivares-Builes AM. Clinical Efficacy of Platelet Derivatives in Periodontal Tissue Regeneration: An Umbrella Review. Int J Dent 2023; 2023:1099013. [PMID: 37435111 PMCID: PMC10332916 DOI: 10.1155/2023/1099013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/19/2023] [Accepted: 06/21/2023] [Indexed: 07/13/2023] Open
Abstract
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.
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Affiliation(s)
- Carlos M. Ardila
- Biomedical Stomatology Research Group, Universidad de Antioquia UdeA, Medellín, Colombia
| | - María Pertuz
- Fundación Universitaria Visión de Las Américas, Medellín, Colombia
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Brodzikowska A, Górski B, Szerszeń M, Sanz M. Efficacy of Guided Tissue Regeneration Using Frozen Radiation-Sterilized Allogenic Bone Graft as Bone Replacement Graft Compared with Deproteinized Bovine Bone Mineral in the Treatment of Periodontal Intra-Bony Defects: Randomized Controlled Trial. J Clin Med 2023; 12:jcm12041396. [PMID: 36835930 PMCID: PMC9964170 DOI: 10.3390/jcm12041396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 02/07/2023] [Accepted: 02/08/2023] [Indexed: 02/12/2023] Open
Abstract
(1) Background: The aim of this study was to compare the clinical and radiographic outcomes of guided tissue regeneration (GTR) using two biomaterials as bone replacement grafts in the treatment of periodontal intra-bony defects. (2) Methods: Using a split-mouth design, 30 periodontal intra-bony defects were treated with either frozen radiation-sterilized allogenic bone grafts (FRSABG tests) or deproteinized bovine bone mineral (DBBM, controls) combined with a bioabsorbable collagen membrane in 15 patients. Clinical attachment level gains (CAL-G), probing pocket depth reductions (PPD-R), and radiographic changes in linear defect fill (LDF) were evaluated 12 months postoperatively. (3) Results: The CAL, PPD, and LDF values improved significantly in both groups 12 months after the surgery. However, in the test group, the PPD-R and LDF values were significantly higher compared to the controls (PPD-R 4.66 mm versus 3.57 mm, p = 0.0429; LDF 5.22 mm versus 4.33, p = 0.0478, respectively). Regression analysis showed that baseline CAL was a significant predictor for PPD-R (p = 0.0434), while the baseline radiographic angle was a predictor for CAL-G (p = 0.0026) and LDF (p = 0.064). (4) Conclusions: Both replacement grafts when used for GTR with a bioabsorbable collagen membrane yielded successful clinical benefits in teeth with deep intra-bony defects 12 months postoperatively. The use of FRSABG significantly enhanced PPD reduction and LDF.
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Affiliation(s)
- Aniela Brodzikowska
- Department of Conservative Dentistry, Medical University of Warsaw, 02-097 Warsaw, Poland
- Correspondence: ; Tel.: +48-501019990
| | - Bartłomiej Górski
- Department of Periodontal and Oral Mucosa Diseases, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Marcin Szerszeń
- Department of Prosthodontics, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Mariano Sanz
- ETEP Research Group, Department of Dental Clinical Specialties, Faculty of Odontology, University Complutense of Madrid, 28040 Madrid, Spain
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Tavelli L, Chen CYJ, Barootchi S, Kim DM. Efficacy of biologics for the treatment of periodontal infrabony defects: An American Academy of Periodontology best evidence systematic review and network meta-analysis. J Periodontol 2022; 93:1803-1826. [PMID: 36279121 DOI: 10.1002/jper.22-0120] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/05/2022] [Accepted: 04/05/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND A large variety of biomaterials, biologics and membranes have been utilized in the past 40 years for the regenerative treatment of periodontal infrabony defects. Biologic agents have progressively gained popularity among clinicians and are routinely used for periodontal regeneration. In alignment with the goals of the American Academy of Periodontology (AAP) Best Evidence Consensus (BEC) on the use of biologic mediators in contemporary clinical practice, the aim of this sytematic review was to evaluate the effect of biologic agents, specifically autogenous blood-dervied products (ABPs), enamel matrix derivative (EMD) and recombinant human platelet-derived growth factor-BB (rhPDGF-BB), on the regenerative outcomes of infrabony defects. METHODS A detailed systematic search was conducted to identify eligible randomized control trials (RCTs) reporting the outcomes of periodontal regenerative therapy using biologics for the treatment of infrabony defects. A frequentist mixed-modeling approach to network meta-analysis (NMA), characterized by the assessment of three individual components for the treatment of an infrabony defect (the bone graft material [BG], the biologic agent, the application of a barrier membrane) was performed to evaluate and compare the relative efficacy of the different components, on the outcomes of different therapeutic modalities of periodontal regeneration. RESULTS A total of 153 eligible RCTs were included, with 150 studies contributing to the NMA. The quantitative analysis showed that the addition of biologic agents to bone graft significantly improves the clinical and radiographic outcomes, as compared to BG and flap procedures alone. Barrier membranes enhanced the regenerative outcomes of BG but did not provide further benefits in combination with biologics. The type of BG (autogenous, allogeneic, xenogeneic or alloplastic) and the biologic agent (EMD, platelet-rich fibrin [PRF], platelet-rich plasma [PRP] or rhPDGF-BB) played a significant role on the final outcomes of infrabony defects. Allogeneic and xenogeneic BGs exhibited statistically significantly superior clinical gain than synthetic and autogenous BGs (p < 0.05 in all the comparisons), while rhPDGF-BB and PRF demonstrated significantly higher stability of the gingival margin (p < 0.01) and radiographic bone fill/gain (p < 0.05), together with greater, although not statistically significant, clinical attachment level gain and pocket depth reduction, than EMD and PRP. Overall, rhPDGF-BB exhibited the largest effect size for most parameters, including clinical attachment level gain, pocket depth reduction, less gingival recession and radiographic linear bone gain. Considering the relatively high number of trials presenting an unclear or high risk of bias, the strength of recommendation supporting the use of PRP was judged weak, while the recommendation for EMD, PRF and rhPDGF-BB was deemed in favor. CONCLUSIONS Biologics enhance the outcomes of periodontal regenerative therapy. Combination therapies involving BGs + biologics or BGs + barrier membrane demonstrated to be superior to monotherapies. The choice of the type of BG and biologic agent seems to have significant impact on the clinical and radiographic outcomes of infrabony defects.
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Affiliation(s)
- Lorenzo Tavelli
- Department of Oral Medicine, Infection, and Immunity, Division of Periodontology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Chia-Yu Jennifer Chen
- Department of Oral Medicine, Infection, and Immunity, Division of Periodontology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Shayan Barootchi
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - David M Kim
- Department of Oral Medicine, Infection, and Immunity, Division of Periodontology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
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Varghese J, Rajagopal A, Shanmugasundaram S. Role of Biomaterials Used for Periodontal Tissue Regeneration-A Concise Evidence-Based Review. Polymers (Basel) 2022; 14:3038. [PMID: 35956553 PMCID: PMC9370319 DOI: 10.3390/polym14153038] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/04/2022] [Accepted: 07/06/2022] [Indexed: 12/14/2022] Open
Abstract
Periodontal infections are noncommunicable chronic inflammatory diseases of multifactorial origin that can induce destruction of both soft and hard tissues of the periodontium. The standard remedial modalities for periodontal regeneration include nonsurgical followed by surgical therapy with the adjunctive use of various biomaterials to achieve restoration of the lost tissues. Lately, there has been substantial development in the field of biomaterial, which includes the sole or combined use of osseous grafts, barrier membranes, growth factors and autogenic substitutes to achieve tissue and bone regeneration. Of these, bone replacement grafts have been widely explored for their osteogenic potential with varied outcomes. Osseous grafts are derived from either human, bovine or synthetic sources. Though the biologic response from autogenic biomaterials may be better, the use of bone replacement synthetic substitutes could be practical for clinical practice. This comprehensive review focuses initially on bone graft replacement substitutes, namely ceramic-based (calcium phosphate derivatives, bioactive glass) and autologous platelet concentrates, which assist in alveolar bone regeneration. Further literature compilations emphasize the innovations of biomaterials used as bone substitutes, barrier membranes and complex scaffold fabrication techniques that can mimic the histologically vital tissues required for the regeneration of periodontal apparatus.
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Affiliation(s)
- Jothi Varghese
- Department of Periodontology, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Manipal 576104, India; (A.R.); (S.S.)
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Taufik S A, Wiweko A, Yudhanto D, Rizki M, Habib P, Dirja BT, Rosyidi RM. Treatment of bone defects with bovine hydroxyapatite xenograft and platelet rich fibrin (PRF) to accelerate bone healing. Int J Surg Case Rep 2022; 97:107370. [PMID: 35841757 PMCID: PMC9403016 DOI: 10.1016/j.ijscr.2022.107370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 06/25/2022] [Accepted: 06/25/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION The autograft treatment has become a gold standard therapy for bone defects, although it has its drawbacks and a side effect of donor site morbidity. Furthermore, the bovine hydroxyapatite xenograft due to its excellent osteoconduction characteristic combined with platelet-rich fibrin (PRF), which is a source of growth factor, makes both utilized as therapeutic measures. Therefore, this study examines the potential use of bovine hydroxyapatite xenograft and platelet-rich fibrin in the treatment of bone defects. METHOD The report on three cases of bone defects that were treated using a combination of bovine hydroxyapatite xenograft and platelet-rich fibrin (PRF) for internal fixation and grafting was used for this investigation. The study showed that delayed and non-union fractures of the femur, humerus, and tibia may cause bone deformities. RESULT The outcome revealed a positive clinical and radiological finding about using the combination of bovine hydroxyapatite xenograft and platelet-rich fibrin (PRF) in the repair of bone defects and acceleration of healing processes. CONCLUSION The use of a combination of bovine hydroxyapatite xenograft and platelet-rich fibrin (PRF) in the repair of bone defects shows more effective and accelerated healing. Future studies with a bigger sample size may be carried out and are expected to yield optimal results.
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Affiliation(s)
- Ahmad Taufik S
- Faculty of Medicine Mataram University, Indonesia,Stem Cell and Regenerative Medicine Center, Mataram University Teaching Hospital, Indonesia,Doctorate Program, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia,Corresponding author at: Jl Majapahit no 62, Mataram, West Nusa Tenggara, Indonesia.
| | - Adnanto Wiweko
- Faculty of Medicine Mataram University, Indonesia,Stem Cell and Regenerative Medicine Center, Mataram University Teaching Hospital, Indonesia
| | - Didit Yudhanto
- Faculty of Medicine Mataram University, Indonesia,Stem Cell and Regenerative Medicine Center, Mataram University Teaching Hospital, Indonesia,Doctorate Program, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Mohammad Rizki
- Faculty of Medicine Mataram University, Indonesia,Stem Cell and Regenerative Medicine Center, Mataram University Teaching Hospital, Indonesia
| | - Philip Habib
- Faculty of Medicine Mataram University, Indonesia
| | - Bayu Tirta Dirja
- Faculty of Medicine Mataram University, Indonesia,Stem Cell and Regenerative Medicine Center, Mataram University Teaching Hospital, Indonesia
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Wickramasinghe ML, Dias GJ, Premadasa KMGP. A novel classification of bone graft materials. J Biomed Mater Res B Appl Biomater 2022; 110:1724-1749. [DOI: 10.1002/jbm.b.35029] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 01/20/2022] [Accepted: 01/21/2022] [Indexed: 12/19/2022]
Affiliation(s)
- Maduni L. Wickramasinghe
- Department of Biomedical Engineering General Sir John Kotelawala Defense University Ratmalana Sri Lanka
| | - George J. Dias
- Department of Anatomy, School of Medical Sciences University of Otago Dunedin New Zealand
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Reshma A, Varghese S, Pampadykandathil L. Comparison between the regenerative potential of different types of platelet concentrates in periodontal intrabony defect management: A systematic review. J Indian Soc Periodontol 2022; 26:425-433. [DOI: 10.4103/jisp.jisp_684_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/28/2021] [Accepted: 12/12/2021] [Indexed: 11/04/2022] Open
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Suthar N, Maknojia M, Rajbhoj S, Dere S, Shah A. Comparative evaluation of autologous platelet-rich fibrin versus platelet-rich fibrin combined with demineralized freeze-dried bone allograft in the treatment of periodontal intrabony defects: A clinical & radiographic study. J Int Oral Health 2022. [DOI: 10.4103/jioh.jioh_80_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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