Platelet‐Derived Growth Factor‐BB Release Profile in Gingival Crevicular Fluid After Use of Marginal Periosteal Pedicle Graft as an Autogenous Guided Tissue Membrane to Treat Localized Intrabony Defects

Background: The aim of this study is to evaluate levels of platelet‐derived growth factor‐BB (PDGF‐BB) in gingival crevicular fluid (GCF) during the early stages of healing for sites treated by marginal periosteal pedicle (MPP) graft as an autogenous guided tissue membrane compared to that of the control open flap debridement (OFD). Methods: Fifteen non‐smoking patients (13 males and 2 females) with severe chronic periodontitis participated in this prospective, controlled, masked trial. Each subject contributed matched pairs of 2‐ or 3‐walled intrabony interproximal defects in premolar or molar teeth. Interproximal contralateral defects were randomly assigned to either the MPP group 1 or control OFD group 2. GCF samples were collected at 1, 3, 7, 14, and 30 days after surgery. PDGF‐BB in the GCF samples was measured using a human PDGF‐BB enzyme‐linked immunosorbent assay kit. Results: In both MPP and OFD, PDGF‐BB concentrations peaked in the samples obtained during the early postoperative days (days 2 and 3) and decreased sharply in the samples obtained 7, 14, and 30 days post‐surgery. Conclusion: Periosteal coverage of periodontal defects is not associated with a significant increase in PDGF‐BB levels.     

Advantages of Autologous Platelet‐Rich Fibrin Membrane on Gingival Crevicular Fluid Growth Factor Levels and Periodontal Healing: A Randomized Split‐Mouth Clinical Study

Background: This study evaluates contributions of platelet‐rich fibrin (PRF) combined with conventional flap surgery on growth factor levels in gingival crevicular fluid (GCF) and periodontal healing. Methods: Twenty‐six patients (52 sites) with chronic periodontitis were treated either with autologous PRF with open flap debridement (OFD+PRF) or OFD alone. Growth factor levels in GCF at baseline and 2, 4, and 6 weeks after surgery were analyzed, and clinical parameters such as probing depth (PD), relative clinical attachment level (rCAL), and gingival margin level (GML) at baseline and 9 months after surgery were measured. Results: Mean PD reduction and rCAL gain were significantly greater in OFD+PRF sites than in OFD sites. Mean GML change was ?0.38 + 0.10 mm in OFD sites and 0.11 + 0.08 mm in the test group; difference between the two groups was statistically significant (P <0.05). Both groups demonstrated increased expression levels of fibroblast growth factor‐2, transforming growth factor‐β1, and platelet‐derived growth factor‐BB at 2 weeks compared with baseline, followed by reductions at 4 and 6 weeks. The OFD+PRF group showed significantly higher growth factor levels compared with the OFD group at 2 and 4 weeks. Conclusion: PRF membrane combined with OFD provides significantly higher GCF concentrations of angiogenic biomarkers for ≈2 to 4 weeks and better periodontal healing in terms of conventional flap sites.     

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

Lekovic V, Milinkovic I, Aleksic Z, Jankovic S, Stankovic P, Kenney EB, Camargo PM. Platelet‐rich fibrin and bovine porous bone mineral vs. platelet‐rich fibrin in the treatment of intrabony periodontal defects. J Periodont Res 2012; 47: 409–417. © 2011 John Wiley & Sons A/S Background and Objective: Bovine porous bone mineral (BPBM) is a xenograft that has been successfully utilized in periodontal regeneration. Platelet‐rich fibrin (PRF) is a leukocyte and platelet preparation that concentrates various polypeptide growth factors and therefore has the potential to be used as regenerative treatment for periodontal defects. The purpose of this study was to examine the suitability of autologous PRF as regenerative treatment for periodontal intrabony defects in humans and to examine the ability of BPBM to augment the regenerative effects exerted by PRF. Material and Methods: Using a split‐mouth design, 17 paired intrabony defects were randomly treated either with PRF or with PRF–BPBM combination. Re‐entry surgeries were performed at 6 mo. Primary study outcomes were changes in pocket depth, attachment level and defect fill. Results: Preoperative pocket depths, attachment levels and transoperative bone measurements were similar for the PRF and PRF–BPBM groups. Postsurgical measurements revealed a significantly greater reduction in pocket depth in the PRF–BPBM group (4.47 ± 0.78 mm on buccal and 4.29 ± 0.82 mm on lingual sites) when compared with the PRF group (3.35 ± 0.68 mm on buccal and 3.24 ± 0.73 mm on lingual sites). The PRF–BPBM group presented with significantly greater attachment gain (3.82 ± 0.78 mm on buccal and 3.71 ± 0.75 mm on lingual sites) than the PRF group (2.24 ± 0.73 mm on buccal and 2.12 ± 0.68 mm on lingual sites). Defect fill was also greater in the PRF–BPBM group (4.06 ± 0.87 mm on buccal and 3.94 ± 0.73 mm on lingual sites) than in the PRF group (2.21 ± 0.68 mm on buccal and 2.06 ± 0.64 mm on lingual sites). Conclusion: The results of this study indicate that PRF can improve clinical parameters associated with human intrabony periodontal defects, and BPBM has the ability to augment the effects of PRF in reducing pocket depth, improving clinical attachment levels and promoting defect fill.     

Platelet‐Rich Fibrin Combined With 1.2% Atorvastatin for Treatment of Intrabony Defects in Chronic Periodontitis: A Randomized Controlled Clinical Trial

Background: Platelet‐rich fibrin (PRF), a second‐generation platelet concentrate, and atorvastatin (ATV), a potent member of the statin group, are known to promote tissue regeneration. The current study is designed to evaluate combined efficacy of PRF and 1.2% ATV gel with open flap debridement (OFD) in treatment of intrabony defects (IBDs) in individuals with chronic periodontitis (CP). Methods: Ninety‐six individuals with single defects were categorized into three groups: 1) OFD with PRF; 2) OFD with PRF + 1.2% ATV; and 3) OFD alone. Clinical parameters: 1) site‐specific plaque index; 2) modified sulcus bleeding index; 3) probing depth (PD); 4) relative clinical attachment level (rCAL); and 5) gingival marginal level were recorded at baseline before surgery and 9 months postoperatively. Percentage radiographic IBD depth reduction was evaluated at baseline and 9 months. Results: PRF + 1.2% ATV and PRF alone showed significantly greater PD reduction and rCAL gain compared with OFD alone at 9 months. Furthermore, PRF + 1.2% ATV showed a similar percentage radiographic defect depth reduction (50.96% ± 4.88%) compared with PRF alone (47.91% ± 4.79%), and a greater reduction compared with OFD alone (5.54% ± 1.71%) at 9 months. Conclusions: PRF + 1.2% ATV showed similar improvements in clinical parameters with a greater percentage radiographic defect depth reduction compared with PRF alone in treatment of IBDs in individuals with CP. Thus, 1.2% ATV failed to augment the regenerative potential of PRF alone in periodontal IBDs.     

Optimized Platelet‐Rich Fibrin With the Low‐Speed Concept: Growth Factor Release,Biocompatibility, and Cellular Response

Background: Over the past decade, use of leukocyte platelet‐rich fibrin (L‐PRF) has gained tremendous momentum in regenerative dentistry as a low‐cost fibrin matrix used for tissue regeneration. This study characterizes how centrifugation speed (G‐force) along with centrifugation time influence growth factor release from fibrin clots, as well as the cellular activity of gingival fibroblasts exposed to each PRF matrix. Methods: Standard L‐PRF served as a control (2,700 revolutions per minute [rpm]‐12 minutes). Two test groups using low‐speed (1,300 rpm‐14 minutes, termed advanced PRF [A‐PRF]) and low‐speed + time (1,300 rpm‐8 minutes; A‐PRF+) were investigated. Each PRF matrix was tested for growth factor release up to 10 days (eight donor samples) as well as biocompatibility and cellular activity. Results: The low‐speed concept (A‐PRF, A‐PRF+) demonstrated a significant increase in growth factor release of platelet‐derived growth factor (PDGF), transforming growth factor (TGF)‐β1, epidermal growth factor, and insulin‐like growth factor, with A‐PRF+ being highest of all groups. Although all PRF formulations were extremely biocompatible due to their autogenous sources, both A‐PRF and A‐PRF+ demonstrated significantly higher levels of human fibroblast migration and proliferation compared with L‐PRF. Furthermore, gingival fibroblasts cultured with A‐PRF+ demonstrated significantly higher messenger RNA (mRNA) levels of PDGF, TGF‐β, and collagen1 at either 3 or 7 days. Conclusions: The findings from the present study demonstrate modifications to centrifugation speed and time with the low‐speed concept favor an increase in growth factor release from PRF clots. This, in turn, may directly influence tissue regeneration by increasing fibroblast migration, proliferation, and collagen mRNA levels. Future animal and clinical studies are now necessary.     

Platelet‐Rich Fibrin With 1% Metformin for the Treatment of Intrabony Defects in Chronic Periodontitis: A Randomized Controlled Clinical Trial

Background: Platelet‐rich fibrin (PRF) is a second‐generation platelet concentrate that releases various growth factors that promote tissue regeneration. Metformin (MF), a member of the biguanide group, has been shown to facilitate osteoblast differentiation and thus may exhibit a favorable effect on alveolar bone. The current study is designed to evaluate the efficacy of open‐flap debridement (OFD) combined with PRF, 1% MF gel, and PRF + 1% MF gel in the treatment of intrabony defects (IBDs) in patients with chronic periodontitis (CP). Methods: One hundred twenty patients with single defects were categorized into four treatment groups: OFD alone, OFD with PRF, OFD with 1% MF, and OFD with PRF plus 1% MF. Clinical parameters such as site‐specific plaque index (PI), modified sulcus bleeding index (mSBI), probing depth (PD), relative attachment level (RAL), and gingival marginal level (GML) were recorded at baseline (before surgery) and 9 months postoperatively. Percentage radiographic IBD depth reduction was evaluated using computer‐aided software at baseline and 9 months. Results: PRF, 1% MF, and PRF + 1% MF groups showed significantly more PD reduction and RAL gain than the OFD‐only group. Mean PD reduction and mean RAL gain were found to be greater in the PRF + 1% MF group compared to just PRF or MF at 9 months. Furthermore, PRF + 1% MF group sites showed a significantly greater percentage of radiographic defect depth reduction (52.65% ± 0.031%) compared to MF (48.69% ± 0.026%), PRF (48% ± 0.029%), and OFD alone (9.14% ± 0.04%) at 9 months. Conclusion: The PRF + 1% MF group showed greater improvements in clinical parameters, with greater percentage radiographic defect depth reduction compared to MF, PRF, or OFD alone in treatment of IBDs in patients with CP.     

Rosuvastatin 1.2 mg In Situ Gel Combined With 1:1 Mixture of Autologous Platelet‐Rich Fibrin and Porous Hydroxyapatite Bone Graft in Surgical Treatment of Mandibular Class II Furcation Defects: A Randomized Clinical Control Trial

Background: A wide range of regenerative materials have been tried and tested in the treatment of furcation defects. Rosuvastatin (RSV) is a new synthetic, second‐generation, sulfur‐containing, hydrophilic statin with potent anti‐inflammatory and osseodifferentiation mechanisms of action. Platelet‐rich fibrin (PRF) is a platelet concentrate having sustained release of various growth factors with regenerative potential to treat periodontal defects. Porous hydroxyapatite (HA) bone grafting material has a clinically satisfactory response when used to fill periodontal intrabony defects. This double‐masked randomized study is designed to evaluate the potency of a combination of 1.2 mg RSV in situ gel with a 1:1 mixture of autologous PRF and HA bone graft in the surgical treatment of mandibular Class II furcation defects compared with autologous PRF and HA bone graft placed after open‐flap debridement (OFD). Methods: One hundred five mandibular furcation defects were treated with OFD + placebo gel (group 1), PRF + HA with OFD (group 2), or 1.2 mg RSV gel + PRF + HA with OFD (group 3). Clinical and radiologic parameters (i.e., probing depth [PD], relative vertical and relative horizontal clinical attachment level [rvCAL and rhCAL], intrabony defect depth, and percentage of defect fill) were recorded at baseline and 9 months postoperatively. Results: Mean PD reduction was greater in group 2 (3.68 ± 1.07 mm) and group 3 (4.62 ± 1.03 mm) than group 1 (2.11 ± 1.25 mm), and mean rvCAL and rhCAL gain were greater in group 2 (3.31 ± 0.52 and 2.97 ± 0.56 mm, respectively) and group 3 (4.17 ± 0.70 and 4.05 ± 0.76 mm) compared with group 1 (1.82 ± 0.78 and 1.62 ± 0.64 mm). A significantly greater percentage of mean bone fill was found in group 2 (54.69% ± 1.93%) and group 3 (61.94% ± 3.54%) compared with group 1 (10.09% ± 4.28%). Conclusions: Treatment of furcation defects with 1.2 mg RSV in situ gel combined with autologous PRF and porous HA bone graft results in significant improvements of clinical and radiographic parameters compared with OFD alone. These results imply that the combination of RSV, PRF, and HA has synergistic effects, explaining their role as a regenerative material in the treatment of furcation defects.     

Comparative Evaluation of Autologous Platelet‐Rich Fibrin and Platelet‐Rich Plasma in the Treatment of 3‐Wall Intrabony Defects in Chronic Periodontitis: A Randomized Controlled Clinical Trial

Background: The topical use of platelet concentrates is recent, and its efficiency remains controversial. The present study aims to explore the clinical and radiographic effectiveness of autologous platelet‐rich fibrin (PRF) and platelet‐rich plasma (PRP) in the treatment of intrabony defects in patients with chronic periodontitis. Methods: Ninety intrabony defects were treated with either autologous PRF with open‐flap debridement or autologous PRP with open‐flap debridement or open‐flap debridement alone. Clinical and radiologic parameters, such as probing depth (PD), clinical attachment level (CAL), intrabony defect depth, and percentage defect fill, were recorded at baseline and 9 months postoperatively. Results: Mean PD reduction and CAL gain were greater in PRF (3.77 ± 1.19 and 3.17 ± 1.29 mm) and PRP (3.77 ± 1.07 and 2.93 ± 1.08 mm) groups than the control group (2.97 ± 0.93 and 2.83 ± 0.91 mm). Furthermore, significantly greater percentage of mean bone fill was found in the PRF (55.41% ± 11.39%) and PRP (56.85% ± 14.01%) groups compared with the control (1.56% ± 15.12%) group. Conclusions: Within the limit of the present study, there was similar PD reduction, CAL gain, and bone fill at sites treated with PRF or PRP with conventional open‐flap debridement. Because PRF is less time consuming and less technique sensitive, it may seem a better treatment option than PRP. However, long‐term, multicenter randomized, controlled clinical trials will be required to know their clinical and radiographic effects on bone regeneration.     

Growth Factor Measurement and Histological Analysis in Platelet Rich Fibrin: A Pilot Study

Objective

The aim of this study was to compare growth factor amount contained in platelet rich fibrin (PRF) and compare with that in platelet rich plasma (PRP), and in whole blood. And also to investigate distribution of growth factors and cellular components in PRF.

Materials and Methods

PRF and PRP were obtained from the same sample of peripheral blood. Extraction of proteins were done with lysis buffer, accompanied by freeze and thaw procedures. Concentration of two representative growth factors in platelets: platelet derived growth factor (PDGF) and transforming growth factor beta (TGF-β), were measured with enzyme-linked immunosorbent assay (ELISA). PRF was cut into three parts: (top, middle and bottom), and growth factor concentration was measured respectively. Paraffin embedded section of PRF was observed with Giemsa stain. Immuno-histochemical analysis with anti-PDGF and anti-TGF-β antibodies was also conducted.

Results

The growth factor levels in PRF was higher than in peripheral blood and comparable to those in PRP. Growth factor levels in bottom part of PRF was much higher than in top and middle part. Microscopically, platelets and mono-nucleated cells were concentrated just above the yellow–red interface. Poly-nucleated cells were concentrated below the interface.

Conclusion

The growth factors were surely concentrated in PRF. This result can support basis of good clinical outcomes. For effective application of PRF, the knowledge that growth factors and cells are not equally distributed in PRF should be utilized.     

Platelet-derived growth factor-B gene delivery sustains gingival fibroblast signal transduction

Background and Objective: Platelet‐derived growth factor‐BB is a potent mediator of tooth‐supporting periodontal tissue repair and regeneration. A limitation of the effects of topical platelet‐derived growth factor‐BB application is its short half‐life in vivo. Gene therapy has shown strong promise for the long‐term delivery of platelet‐derived growth factor in both skin ulcer healing and periodontal tissue engineering. However, little is known regarding the extended effects of platelet‐derived growth factor‐B on cell signaling via gene delivery, especially at the level of phosphorylation of intracellular kinases. This study sought to evaluate the effect of gene transfer by Ad‐PDGF‐B on human gingival fibroblasts (HGFs) and the subsequent regulation of genes and cell‐surface proteins associated with cellular signaling. Material and Methods: HGFs from human subjects were treated by adenoviral PDGF‐B, PDGF‐1308 (a dominant negative mutant of PDGF) and recombinant human platelet‐derived growth factor‐BB, and then incubated in serum‐free conditions for various time points and harvested at 1, 6, 12, 24, 48, 72 and 96 h. Exogenous PDGF‐B was measured by RT‐PCR and Western blot. Cell proliferation was evaluated by [methyl‐³H]thymidine incorporation assay. We used proteomic arrays to explore phosphorylation patterns of 23 different intracellular kinases after PDGF‐B gene transfer. The expression of α and β PDGFR and Akt were measured by Western blot analysis. Results: Sustained in vitro expression of PDGF‐B in HGFs by Ad‐PDGF‐B transduction was seen at both the mRNA and protein levels. Compared to rhPDGF‐BB and Ad‐PDGF‐1308, Ad‐PDGF‐B maintained cell growth in serum‐free conditions, with robust increases in DNA synthesis. Gene delivery of PDGF‐B also prolonged downregulation of the growth arrest specific gene (gas) PDGFαR. Of the 23 intracellular kinases that we tested in proteomic arrays, Akt revealed the most notable long‐term cell signaling effect as a result of the over‐expression of Ad‐PDGF‐B, compared with pulse recombinant human platelet‐derived growth factor BB. Prolonged Akt phosphorylation was induced by treatment with Ad‐PDGF‐B, for at least up to 96 h. Conclusion: These findings further demonstrate that gene delivery of PDGF‐B displays sustained signal transduction effects in human gingival fibroblasts that are higher than those conveyed by treatment with recombinant human platelet‐derived growth factor‐BB protein. These data on platelet‐derived growth factor gene delivery contribute to an improved understanding of these pathways that are likely to play a role in the control of clinical outcomes of periodontal regenerative therapy.     

Platelet‐Rich Fibrin Combined With a Porous Hydroxyapatite Graft for the Treatment of 3‐Wall Intrabony Defects in Chronic Periodontitis: A Randomized Controlled Clinical Trial

Background: Porous hydroxyapatite (HA) bone grafting material has been used to fill periodontal intrabony defects (IBDs), resulting in clinically acceptable responses. Platelet‐rich fibrin (PRF) is a leukocyte and platelet preparation that concentrates various polypeptide growth factors and, therefore, has the potential for use as regenerative treatment for periodontal defects. The present study aims to explore the clinical and radiographic effectiveness of autologous PRF versus PRF + HA in treatment of IBDs in patients with chronic periodontitis. Methods: Ninety IBDs were treated with autologous PRF with open‐flap debridement (OFD), PRF + HA with OFD, or OFD (controls) alone. Clinical and radiologic parameters, including probing depth (PD), clinical attachment level (CAL), IBD depth, and percentage defect fill were recorded at baseline and 9 months postoperatively. Results: Mean PD reduction was greater in PRF (3.90 ± 1.09 mm) and PRF + HA (4.27 ± 0.98 mm) groups than the control group (2.97 ± 0.93 mm), and mean CAL gain was greater in PRF (3.03 ± 1.16 mm) and PRF + HA (3.67 ± 1.03 mm) compared to controls (2.67 ± 1.09 mm). Furthermore, significantly greater percentage of mean bone fill was found in the PRF (56.46% ± 9.26%) and PRF + HA (63.39% ± 16.52%) groups compared to controls (15.96% ± 13.91%). Conclusions: Treatment of IBD with PRF results in significant improvements of clinical parameters compared to baseline. When added to PRF, HA increases the regenerative effects observed with PRF in the treatment of 3‐wall IBDs.     

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

Background: The purpose of this study is to assess the healing outcomes of intrabony defects after treatment with platelet‐rich plasma (PRP) versus platelet‐poor plasma (PPP) combined with bovine‐derived xenograft (BDX). Methods: Using a split‐mouth design, a total of 79 intrabony defects with an intrabony component of ≥3 mm in 20 patients were treated either with PRP/BDX (group 1) or PPP/BDX (group 2). At baseline and 12 months after surgery, plaque and sulcus bleeding indices, probing depth (PD), relative attachment level, recession, and probing and radiographic bone levels were recorded. Results: After 12 months, groups 1 and 2 presented a mean PD reduction of 3.87 ± 0.86 and 3.76 ± 0.80 mm, recession of 1.35 ± 0.68 and 1.58 ± 0.54 mm, attachment gain of 2.51 ± 0.97 and 2.18 ± 0.87 mm, clinical bone gain of 2.18 ± 0.86 and 2.09 ± 0.89 mm, and radiographic bone gain of 2.11 ± 0.87 and 2.19 ± 0.96 mm, respectively. Intergroup differences were found to be insignificant. Conclusions: Within its limits, these results suggest that the outcomes of the treatment after PRP/BDX and PPP/BDX applications in intrabony defects are similar. When the platelet counts are taken into consideration, PPP seems to demonstrate similar clinical efficacy as the PRP.     

Platelet‐Poor and Platelet‐Rich Plasma Stimulate Bone Lineage Differentiation in Periodontal Ligament Stem Cells

Background: Plasma‐derived fractions have been used as an autologous source of growth factors; however, limited knowledge concerning their biologic effects has hampered their clinical application. In this study, the authors analyze the content and specific effect of both platelet‐rich plasma (PRP) and platelet‐poor plasma (PPP) on osteoblastic differentiation using primary cultures of human periodontal ligament stem cells (HPLSCs). Methods: The authors evaluated the growth factor content of PRP and PPP using a proteome profiler array and enzyme‐linked immunosorbent assay. HPLSCs were characterized by flow cytometry and differentiation assays. The effect of PRP and PPP on HPLSC bone differentiation was analyzed by quantifying calcium deposition after 14 and 21 days of treatment. Results: Albeit at different concentrations, the two fractions had similar profiles of growth factors, the most representative being platelet‐derived growth factor (PDGF) isoforms (PDGF‐AA, ‐BB, and ‐AB), insulin‐like growth factor binding protein (IGFBP)‐2, and IGFBP‐6. Both formulations exerted a comparable stimulus on osteoblastic differentiation even at low doses (2.5%), increasing calcium deposits in HPLSCs. Conclusions: PRP and PPP showed a similar protein profile and exerted comparable effects on bone differentiation. Further studies are needed to characterize and compare the effects of PPP and PRP on bone healing in vivo.     

Growth factors and cytokines in autologous platelet concentrate and their correlation to periodontal regeneration outcomes

AIM: To determine the concentration of naturally available biologic mediators in autologous platelet concentrates and their correlation with periodontal regeneration outcomes. MATERIAL AND METHODS: In 25 patients with two intra-bony defects each, an autologous platelet concentrate (APC) was prepared by a laboratory thrombocyte apheresis technique pre-operatively. Both defects were treated using a bioresorbable guided tissue regeneration-membrane in combination with tricalciumphosphate (TCP). In the test defect, APC was additionally applied. In the APC, platelets were counted and the levels of growth factors and cytokines were determined by ELISA. Correlations between the platelet counts or the growth factor/cytokine levels and the potential clinical and radiographic regeneration outcomes due to APC were calculated after 3, 6, and 12 months. RESULTS: The APC contained 2.2 x 10(6) platelets/mul, which was 7.9 times more than in the venous blood. Transforming growth factor-beta1 (TGF-beta1), insulin-like growth factor-I (IGF-I), platelet-derived growth factor-AB (PDGF-AB), PDGF-BB, vascular endothelial growth factor (VEGF), and epidermal growth factor (EGF) were found in the APC, whereas interleukin-1beta (IL-1beta), IL-6, tumor necrosis factor alpha (TNFalpha), IL-4, and IL-10 were not detectable. The regression analysis showed a weak correlation between the platelet counts or the growth factor levels and the clinical and radiographic regeneration outcomes (r2相似文献   

Platelet‐Rich Fibrin in Regeneration of Intrabony Defects: A Randomized Controlled Trial

Background: Platelet‐rich fibrin (PRF) is an autologous non‐transfusional hemo‐component with a high concentration of platelets. It incorporates leukocytes, platelets, and growth factors within the dense fibrin matrix and can be used as healing biomaterial. This study assesses the adjunctive use of PRF in regenerative management of intrabony defects in comparison with open flap debridement (OFD). Methods: Twenty‐six bilateral defects (13 per group) in 13 patients were randomized as either PRF (test group) or OFD alone (control group) sites. Probing depth (PD), clinical attachment level (CAL), and bone PD were recorded. Reduction in defect depth and percentage of bone fill was assessed radiographically. Primary outcomes assessed were changes in PD, CAL, and percentage of bone fill, and they were assessed at 6, 9, and 12 months. Secondary outcome was assessment of wound healing using a wound healing index (WHI). Results: The PRF group showed significant improvement in clinical parameters compared with the control group at 6, 9, and 12 months. The PRF group showed a bone fill of 45.18% ± 7.57%, which was statistically significant compared with 21.6% ± 9.3% seen in the control group at the end of the study period. The PRF group also showed significant soft tissue healing and reduction in PD. WHI also showed significant advantages for the PRF group. Conclusion: The adjunctive use of PRF to conventional OFD may be potentially used in the treatment of intrabony defects.     

Additive Effect of Plasma Rich in Growth Factors With Guided Tissue Regeneration in Treatment of Intrabony Defects in Patients With Chronic Periodontitis: A Split‐Mouth Randomized Controlled Clinical Trial

Background: Periodontal regeneration can be defined as complete restoration of lost periodontal tissues to their original architecture and function. A variety of treatment modalities have been proposed to achieve it. Plasma rich in growth factors (PRGF) is a concentrated suspension of growth factors that promotes restoration of lost periodontal tissues. The objective of the present study is to assess the effect of PRGF associated with guided tissue regeneration (GTR) versus GTR only in the treatment of intrabony defects (IBDs) in patients with chronic periodontitis (CP). Methods: Patients with CP (n = 14) with 42 contralateral 2‐ and 3‐walled defects were randomly assigned to test (PRGF+GTR) and control (GTR alone) treatment groups. Clinical and radiographic assessments performed at baseline and after 6 months were: 1) gingival index (GI), 2) probing depth (PD), 3) clinical attachment level (CAL), 4) radiologic defect depth, and 5) bone fill. Results: Comparison of parameters measured at baseline and after 6 months showed mean PD reduction of 3.37 ± 1.62 mm in the control group (P <0.001) and 4.13 ± 1.59 mm in the test group (P <0.001). There was a significant difference in mean change in CAL (P <0.001) in the control group (5.42 ± 1.99) and the test group (5.99 ± 1.77). Mean change in GI was 1.89 ± 0.32 and 1.68 ± 0.58 in the control group and test group, respectively, and the difference was statistically significant (P <0.001). When compared between groups, clinical parameters did not show any statistically significant variations. Mean radiographic bone fill was 1.06 ± 0.81 and 1.0 ± 0.97 in the control group and test group, respectively. However, the difference was not statistically significant. Conclusions: PRGF with GTR, as well as GTR alone, was effective in improving clinical and radiographic parameters of patients with CP at the 6‐month follow‐up. There was no additive effect of PRGF when used along with GTR in the treatment of IBDs in patients with CP in terms of both clinical and radiologic outcomes.     

Clinical and Radiographic Evaluation of Demineralized Freeze‐Dried Bone Allograft Versus Platelet‐Rich Fibrin for the Treatment of Periodontal Intrabony Defects in Humans

Background: A wide variety of materials have been proposed for treatment of periodontal intrabony defects (IBDs); recently, platelet‐rich fibrin (PRF) has been suggested as a grafting material. The aim of this study is to report changes in clinical attachment level (CAL) and bone fill of periodontal IBDs treated with demineralized freeze‐dried bone allograft (DFDBA) compared with PRF in humans. Methods: Thirty‐six patients completed the study protocol. Each patient contributed a single IBD, which was randomized to receive either DFDBA or PRF. Clinical and standardized radiographic data were collected at baseline and 6 months after treatment. Primary outcome measures included: 1) radiographic bone fill as measured from the cemento‐enamel junction to base of bony defect and 2) change in CAL. Results: Both treatment groups had significant gains in CAL as well as bone fill, with no significant differences in outcomes between groups. DFDBA had a mean CAL gain of 1.16 ± 1.33 mm, mean clinical bone fill of 1.53 ± 1.64 mm, and mean radiographic bone fill of 1.14 ± 0.88 mm. PRF had a mean CAL gain of 1.03 ± 0.86 mm, mean clinical bone fill of 1.35 ± 1.60 mm, and mean radiographic bone fill of 1.10 ± 1.01 mm. Conclusion: Treatment of IBDs with either DFDBA or PRF resulted in a significant gain in CAL as well as bone fill after 6 months of healing, with no significant difference between materials.     

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

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

Platelet‐Rich Fibrin With 1.2% Rosuvastatin for Treatment of Intrabony Defects in Chronic Periodontitis: A Randomized Controlled Clinical Trial

Background: Regenerative periodontal therapy encompasses use of various bioactive agents that are not only inflammomodulatory but also osteoclast‐inhibitory or, rather, osteostimulative. Hypolipidemic statin drugs, particularly rosuvastatin (RSV), are known to be associated with alveolar bone formation and periodontal improvements. Platelet analogs such as platelet‐rich fibrin (PRF), being rich sources of growth factors, have also come into widespread periodontal regenerative use. The aim of this study is to evaluate and compare efficacy of open flap debridement (OFD) with or without PRF or PRF + 1.2% RSV gel in treatment of intrabony defects (IBDs) in patients with chronic periodontitis (CP). Methods: Ninety individuals with a total of 90 IBDs were randomly assigned to one of three treatment groups: 1) OFD alone; 2) OFD + PRF; and 3) OFD + PRF + 1.2% RSV gel placement. Measurements recorded at baseline and 9 months after surgery were: 1) plaque index (PI); 2) modified sulcus bleeding index (mSBI); 3) probing depth (PD); 4) clinical attachment level (CAL); and 5) IBD depth. Results: Significant PI and mSBI reductions were observed in all three groups. PRF placement significantly enhanced improvements in periodontal parameters compared with OFD alone. Addition of 1.2% RSV gel to PRF resulted in significantly greater CAL gain and PD and IBD depth reductions over 9 months compared with other groups. Conclusion: OFD with RSV (1.2%) and PRF results in significantly greater periodontal benefits compared with OFD alone or with PRF.     

Treatment of 3-wall intrabony defects in patients with chronic periodontitis with autologous platelet-rich fibrin: a randomized controlled clinical trial

Background: Platelet‐rich fibrin (PRF) is considered a second‐generation platelet concentrate that is widely used in osseous regeneration. The present study aims to explore the clinical and radiographic effectiveness of autologous PRF in the treatment of intrabony defects in patients with chronic periodontitis. Methods: Fifty‐six intrabony defects were treated with either autologous PRF with open‐flap debridement or open‐flap debridement alone. Clinical parameters such as the probing depth (PD) and periodontal attachment level (PAL) were recorded at baseline and 9 months postoperatively. The defect fill at baseline and 9 months was calculated on standardized radiographs by using image‐analysis software. Results: The mean PD reduction was greater in the test group (4.55 ± 1.87 mm) than in the control group (3.21 ± 1.64 mm), whereas the mean PAL gain was also greater in the test group (3.31 ± 1.76) compared to the control group (2.77 ± 1.44 mm). Furthermore, a significantly greater percentage of mean bone fill was found in the test group (48.26% ± 5.72%) compared to the control group (1.80% ± 1.56%). Conclusions: Within the limits of the present study, there was greater PD reduction, PAL gain, and bone fill at sites treated with PRF with conventional open‐flap debridement compared to conventional open‐flap debridement alone. However, a long‐term, multicentered randomized controlled clinical trial is required to know the clinical and radiographic effects of PRF on bone regeneration.