Does Concentrated Growth Factor Used With Allografts in Maxillary Sinus Lifting Have Adjunctive Benefits?

Effect of Autologous Concentrated Growth Factor in Regenerative Dentistry: A Systematic Review and Meta-Analysis

INTRODUCTION

Concentrated growth factor (CGF), a novel autologous platelet concentrate, has gained substantial interest for its potential role in managing oral diseases. The objective of this study is to evaluate the effectiveness of CGF in regenerative dentistry.

METHODS

A systematic search was performed across MEDLINE, OVID, Scopus, Cochrane Library, Google Scholar, Web of Science, and Elsevier for publications between July 1, 2013, and July 1, 2023. Only randomized clinical trials were included. The quality of the methodology was assessed using the Cochrane Risk of Bias Tool. Data were analyzed using RevMan 5.4 software.

RESULTS

In 3 trials treating periodontal intrabony defects, CGF combined with bone grafts showed significant superiority over bone grafts alone (P < .00001), with a mean reduction of 1.41 mm in intrabony defect depth and a mean gain of 0.55 mm in clinical attachment level (P = 0.002). For gingival recession in 5 trials, CGF combined with coronally advanced flap (CAF) was more effective than CAF alone, resulting in a mean increase in keratinized tissue width of 0.41 mm and a mean increase in gingival thickness of 0.26 mm (P < 0.00001). However, CGF combined with CAF was less effective than connective tissue graft (CTG) combined with CAF, showing a mean difference in root coverage of -15.09% and a mean difference in gingival thickness of -0.50 mm (P < 0.0001). In alveolar ridge preservation, sinus elevation, guided bone regeneration, dental implant procedures, and postextraction healing, CGF gave better values in clinical practice.

CONCLUSIONS

CGF enhances regenerative surgery outcomes for periodontal intrabony defects. Combined with CAF, CGF improves therapeutic efficacy for gingival recession, although less so than CTG with CAF. CGF shows promise in various regenerative dentistry areas. However, the absence of meta-analysis and low-quality assessments in many studies necessitates further high-quality research.Knowledge Transfer Statement:The use of concentrated growth factors (CGFs) in regenerative dentistry, within the limitation of low-quality studies, shows promising benefits in treating periodontitis infrabony defects, gingival recession, guided bone regeneration, dental implant alveolar ridge preservation, sinus elevation, and third molar extraction. Future research should focus on high-quality studies and explore combining CGF with grafting materials to enhance therapeutic outcomes in oral surgery.

Efficacy of concentrated growth factor combined with coronally advanced flap in the treatment of gingival recession: a systematic review and meta-analysis

OBJECTIVES

This study aims to evaluate the efficacy of combining the coronally advanced flap (CAF) technique with concentrated growth factor (CGF) in the treatment of gingival recession (GR), and to compare this approach with other alternative treatments.

METHODS

This systematic review and meta-analysis included randomized controlled trials (RCTs) comparing CAF combined with CGF to other treatments for root coverage procedures. Included studies evaluated systemically healthy adults (> 18 years) with Miller Class I/II or Cairo RT1 gingival recessions. Primary outcomes were complete root coverage (CRC) and mean root coverage (MRC); secondary outcomes included changes in keratinized tissue width (KTW), gingival thickness (GT), clinical attachment level (CAL), recession width (RW), recession depth (RD), and probing depth (PD). A comprehensive search was conducted across multiple databases, including PubMed, Scopus, Cochrane Library, Web of Science, and Embase, up to November 9, 2024. The study protocol was prospectively registered in PROSPERO (CRD42024556815). Statistical analyses were performed using Review Manager 5.4.1.

RESULTS

Eight studies were included in the meta-analysis. Compared to CAF alone, the combination of CAF and CGF significantly improved CRC (OR = 1.79, P = 0.04), MRC (MD = 10.38%, P = 0.04), KTW (MD = 0.40 mm, P = 0.02), GT (MD = 0.26 mm, P < 0.00001), and CAL (MD = 0.36 mm, P = 0.03). CAF combined with connective tissue graft (CTG) showed superior efficacy for CRC compared to CAF + CGF (OR = 0.25, P = 0.009). However, no significant differences were found between CAF + CTG and CAF + CGF for MRC, CAL, KTW, RD, RW, or PD. Additionally, no significant differences were observed when comparing CAF + CGF with CAF + PRF across all clinical parameters (all P > 0.05).

CONCLUSIONS

The findings of this meta-analysis indicate that CAF/CGF improves clinical outcomes in treating GR compared to CAF alone, and CGF may be a viable alternative to CTG when CTG is not applicable. Further studies are needed to validate the efficacy of CAF/CGF in the treatment of GR.

CLINICAL SIGNIFICANCE

In cases where CTG is not applicable, CGF may serve as a viable alternative for the treatment of Miller class I and II GR.

Clinical, Radiological, and Histomorphometric Comparison of the Use of Deproteinized Bovine Bone Mineral and Titanium-Prepared Platelet-Rich Fibrin in Maxillary Sinus Augmentation: A Split-Mouth Randomized Controlled Clinical Study

BACKGROUND

Maxillary sinus augmentation (MSA) is a standard and predictable procedure to increase bone height in the atrophic posterior maxilla. Many biomaterials are employed in this technique; however, autologous platelet concentrates have been found to reduce clinical recovery time and improve bone gain in MSA.

PURPOSE

This study aimed to compare the radiographic, histomorphometric, and implant stability outcomes of titanium-prepared platelet-rich fibrin (T-PRF) and deproteinized bovine bone mineral (DBBM) in a two-stage MSA technique.

STUDY DESIGN, SETTING, SAMPLE

This randomized controlled split-mouth study included patients requiring bilateral two-stage MSA at the Periodontology Department of Kutahya Health Sciences University between March 2022 and April 2023. Patients with systemic comorbidities and residual bone height >5 mm in the bilateral posterior maxilla were excluded.

PREDICTOR VARIABLE

The predictor variable was the two-stage MSA technique. Each surgical site was randomly assigned to the T-PRF or DBBM group for two-stage MSA.

MAIN OUTCOME VARIABLES

The primary outcome was the histomorphometric evaluation of the percentage of new bone between the 2 groups. Secondary outcomes included radiographic evaluation of total bone height (ToBH), bone gain, bone density (BD), and graft volume (GV) on cone-beam computed tomography 6 months post-MSA, clinical assessment of primary implant stability at implant placement and secondary stability 3 months postplacement, and histomorphometric evaluation of the percentage of residual particles, percentage of connective tissue, and percentage of blood vessels from bone biopsy samples collected 6 months after MSA.

COVARIATES

Age, sex, periodontitis susceptibility, and smoking status were treated as covariates.

ANALYSES

The Wilcoxon signed-rank test was used for bivariate comparisons between 2 groups, and the Pearson or Spearman test was used to analyze correlations of variables within groups. A P value ≤ .05 was considered statistically significant.

RESULTS

The sample was composed of 10 patients with bilateral maxillary sinuses, 20 MSA regions, 8 (80%) males and 2 (20%) females with a mean age of 51.30 (9.06) year. The percentage of new bone was 19.48 ± 14.60 μm2 in the T-PRF group and 8.31 ± 5.47 μm2 in the DBBM group, and there was no statistically significant difference between the groups (P = .074). Radiographic measurements showed ToBH, GV, and BD values of 10.64 ± 3.96 mm, 989.89 ± 523.07 mm3, and 192.09 ± 127.90 hounsfield unit in the T-PRF group and 14.25 ± 1.65 mm, 1,519.39 ± 432.61 mm3, and 492.77 ± 117.35 hounsfield unit in the DBBM group, respectively. ToBH, GV, and BD values were statistically significant between the groups (P = .01 and P = .00). Primary and secondary implant stability in the T-PRF group were 71.11 ± 12.48 implant stability quotient (ISQ) and 68.03 ± 6.81 ISQ, respectively, compared with 67.94 ± 19.84 ISQ and 72.46 ± 11.21 ISQ in the DBBM group. The difference was not statistically significant between the groups (P = .41 and P = .33).

CONCLUSION AND RELEVANCE

Although T-PRF demonstrated inferior radiographic outcomes compared with DBBM during the initial6-month healing phase, both techniques yielded comparable results regarding new bone formation and implant stability. Further research is warranted to explore the efficacy of different T-PRF applications in MSA. This trial is registered at ClinicalTrials.gov (NCT05596084).

The effect of autologous platelet concentrates as solely grafting material or with bone graft materials in maxillary sinus augmentation: a meta-analysis of randomized controlled trials

OBJECTIVES

This study compared the effectiveness of adding autologous platelet concentrates (APCs(+)) and sole bone grafting procedures (APCs(-)) in maxillary sinus augmentation (MSA).

MATERIALS AND METHODS

A systematic search was performed to identify randomized controlled trials (RCTs) from electronic database and clinical registers published up to June 1, 2024. Six evaluation indices comprising percentage of new bone formation (NBF%), percentage of residual bone substitute (RBS%), percentage of fibrous tissue (FT%), implant stability quotient (ISQ), bone height (BH) and bone density (BD) were identified.

RESULTS

We analyzed 14 studies involving 268 lifted sinuses and 119 implants. Compared with the APCs(-) group, the APCs(+) group demonstrated a significant advantage regarding NBF% (weight mean difference (MD)= 4.80, 95% confidence interval (CI) (1.82,8.32), p=0.007) and RBS% (MD=-4.48, 95% CI (-6.01,2.96), p<0.01), with no evident superiority in FT% (MD=-0.11, 95% CI (-0.56,0.35), p=0.64), ISQ (MD=-1.68, 95% CI (-6.77,3.40), p=0.52) and BH (standard mean difference (SMD) =-0.11, 95% CI (-3.04,2.83), p=0.94). While APCs(-) group showed a significant benefit in BD compared to the APCs(+) group (MD=-28.34, 95% CI (-48.98,-7.71), p=0.01).

CONCLUSION

Compared with APCs(-), APCs(+) could be a better option for promoting NBF% and reducing RBS%, whereas we found no evident influence in FT% and ISQ under MSA. Concerning BD and BH results, there were no additional effects with the addition of APCs, which needs to be treated with caution due to the limited number of studies.

CLINICAL RELEVANCE

APCs(+) procedures show promising results, with a higher NBF% and lower RBS%, making them a potential routine MSA strategy.

APCs in sinus floor augmentation

After tooth loss in the posterior area of the maxilla, sinus floor elevation is often required to compensate the vertical bone loss due to sinus pneumatization. This narrative review reports on the potential benefits of autologous platelet concentrates (APCs) during this procedure. As for transcrestal approach, APCs have been used as "sole" substitute/graft. However, because of the low number of clinical trials available with PRGF, and even none for PRP, no definitive conclusions can be made regarding their efficacy. The number of studies on the use of L-PRF were outnumbered indicating good feasibility for vertical bone gain, with a high implant survival rate and a low degree of complications. PRP and PRGF have not been studied as a "single/sole" substitute for a one-stage lateral window approach, probably because of the weak physical characteristics of the membranes. L-PRF alone appears to be a predictable grafting material for lateral maxillary sinus grafting and a reduced RBH should not be considered as a risk factor. Compared to a "standard" bone substitute L-PRF shows slightly less vertical bone gain (consider enough membrane application and use of bony window as new sinus floor roof over the implant apices), enhanced early resorption (first 6 months after application), but a similar stable bone gain afterward. For a two-stage lateral window approach, APCs "alone" cannot be recommended, due to their weak withstand to the sinus pneumatization forces. APCs combined with bone substitutes seem to accelerate bone formation, without any additional benefits on the long-term new bone gain. The use of L-PRF membranes for the treatment of perforations appears to be an effective treatment option, but further clinical studies are needed to confirm this. Even though the abovementioned statements are based on large numbers of studies, additional RCTs comparing APCs with different types of grafting procedures for sinus elevation are needed.

CGF with Bio-Oss collagen as grafting materials for simultaneous implant placement after osteotome sinus floor elevation: a prospective study

BACKGROUND

Osteotome sinus floor elevation (OSFE) procedure with simultaneous implant placement is known to be an efficient procedure in the atrophic maxilla, where bone regeneration is required the most. The purpose of this study was to radiologically evaluate the efficacy of using Bio-Oss Collagen with Concentrated Growth Factor (CGF) as grafting materials for OSFE with simultaneous implant placement in the atrophic maxilla after one year of functional loading.

METHODS

A total of 126 implants were placed for 123 patients. Our inclusion criteria were patients with Residual Bone Height (RBH) ≤ 5 whom underwent OSFE procedure and simultaneous implant placement with different grafting materials: Group A with no grafting materials, Group B with Bio-Oss bone graft, and Group C with Bio-Oss Collagen with CGF. The Implants Survival Rate (ISR) was the primary outcome variable. Secondary outcome variables included radiographic measurements assessed at four follow-up time points, the Implant Stability Quotient (ISQ), and bone density (B). Indicators of bone formation were compared at different time points. Appropriate statistical analyses were conducted, with statistical significance set at a P value of 0.05 for all tests.

RESULTS

ISR was 96%. A significant positive relationship was found between RBH and ISR, [r (126) = .359, p = .000]. Endo sinus bone gain indictors increased in both grafted groups as compared to the non-grafted group. Total Bone Resorption (TBR1) and (TBR2) significantly decreased in both grafted groups compared to the non-grafted group (P = .004, P = .000). Graft size (D) was a positive predictor for ISR at three time points: D0 (odds ratio [OR] 8.06; 95% CI 1.59 to 38.24; P = .010); D1 (OR 96.58; 95% CI 1.69 to 5.52; P = .027); D2 (OR 4.97; 95% CI 1.29 to 19.19; P = .020). Visual Analog Scale (VAS) pain score significantly increased in Group B compared to Groups A and C (P = .000).

CONCLUSION

The combination of Bio-Oss Collagen with CGF as grafting material is a reliable protocol after OSFE with simultaneous implant placement in the atrophic maxilla. This approach is accompanied by high patient satisfaction.

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

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

Histomorphometric and Micro-CT Evaluation of Cerabone and Bio-Oss in Maxillary Sinus Lifting: A Randomized Clinical Trial

Background and Objectives: The loss of teeth in the posterior maxillary region often leads to significant alveolar bone resorption and maxillary sinus pneumatization, complicating dental implant placement. Maxillary sinus grafting, typically using autogenous bone, is a common solution. However, autogenous bone grafts require additional surgical procedures, leading to increased morbidity. This study aims to compare the efficacy of two xenografts, Bio-Oss and Cerabone, in promoting new bone formation in maxillary sinus grafting through histomorphometric analysis and micro-computed tomography (micro-CT). Materials and Methods: A total of 22 maxillary sinuses (12 right and 10 left) were grafted, with 12 using Cerabone and 10 using Bio-Oss. Six months post-grafting, biopsies were collected for histomorphometric analysis to measure new bone formation, connective tissue, and residual biomaterial. Additionally, micro-CT analysis was performed to assess bone volume fraction, trabecular thickness, number, and separation. Results: Histomorphometric analysis showed that the Cerabone group had a higher average new bone formation (25.94% ± 10.55) compared to the Bio-Oss group (17.29% ± 4.61), with a statistically significant difference (p = 0.02). Micro-CT analysis revealed that the bone volume fraction in the Cerabone group was significantly higher compared to the Bio-Oss group, with significant differences in trabecular thickness (p = 0.02) but not in trabecular number or separation. Conclusions: The study demonstrates that both xenografts are effective in promoting new bone formation in maxillary sinus grafting. However, Cerabone showed superior performance in terms of new bone formation and bone volume fraction, suggesting it may be a more effective option for maxillary sinus augmentation procedures.

Effectiveness of concentrated growth factors with or without grafting materials in maxillary sinus augmentation: a systematic review

Concentrated Growth Factor (CGF) is a highly effective biomaterial known for its ability to promote tissue regeneration. While it's been studied extensively in intraoral procedures and bone grafting, its benefits in maxillary sinus lifting lack substantial evidence. This review aimed to evaluate CGF's effectiveness in maxillary sinus augmentation, focusing on clinical, radiographic, and histological outcomes.A comprehensive literature search was conducted across PubMed, Scopus, Web of Science, Google Scholar, and Cochrane Library databases using specific mesh terms and keywords and adhered to PRISMA guidelines. Studies up to March 2024 involving transcrestal or lateral maxillary sinus floor elevation with CGF, either alone or in combination with grafting materials, were included.Out of 783 publications, 13 studies met the eligibility criteria. The review assessed CGF's role in minimizing postoperative complications, enhancing new bone formation, and improving implant survival. Despite data variability among studies, the majority reported that CGF positively influenced maxillary sinus augmentation outcomes.While more robust randomized clinical trials are required to draw definitive conclusions, initial results are promising, and the findings suggest that CGF utilization in maxillary sinus augmentation seems to enhance clinical outcomes by promoting vascularization and regeneration at the surgical sites and improving both the quality and quantity of newly formed sinus bone. Furthermore, it exhibits potential for improving postoperative sequelae and achieving high implant survival rates.

Assessment of the efficacy of autologous blood preparations in maxillary sinus floor elevation surgery: a systematic review and meta-analysis

OBJECTIVE

This study aimed to evaluate the efficacy of autologous blood preparations, namely Platelet-Rich Plasma (PRP), Platelet-Rich Fibrin (PRF), and Concentrated Growth Factor (CGF), in maxillary sinus floor elevation surgery. The focus was on their impact on new bone formation, maxillary sinus floor height, and soft tissue healing.

METHODS

A systematic search was conducted across PubMed/MEDLINE, Web of Science, Embase, and Scopus databases up to April 2024. This systematic review included both randomized clinical trials (RCTs) and controlled clinical trials (CCTs) that evaluated the efficacy of autologous blood preparations in maxillary sinus floor elevation surgery. The primary outcomes measured were the percentage of new bone formation, maxillary sinus floor height, and he percentage of soft tissue area. Data from the selected studies were extracted and analyzed to determine the impact of autologous blood preparations on these outcomes. The risk of bias was assessed using Cochrane's risk of bias tool and ROBINS-I, and meta-analyses were performed using Review Manager 5.4 software to calculate effect sizes and integrate results from multiple studies.

RESULTS

Among the 507 screened articles, 30 studies met the inclusion criteria. The results indicated that the application of PRP significantly increased new bone formation during maxillary sinus floor elevation surgery (primary outcome, MD = 4.40, CI = 0.37 to 8.44, P = 0.03), as well as improving maxillary sinus floor height elevation (secondary outcome, MD = 1.00, CI = 0.78 to 1.23, P < 0.00001). The absence of PRP during surgery had a statistically significant effect on the percentage of soft tissue area (secondary outcome, MD= -5.25, CI= -7.29 to 3.20, P < 0.00001). However, based on the research findings, PRF did not show significant effects on enhancing new bone formation, maxillary sinus floor height elevation, and promoting soft tissue regeneration.

CONCLUSIONS

PRP demonstrates efficacy in maxillary sinus floor elevation surgery by enhancing new bone formation and increasing sinus height. Further studies are needed to validate the outcomes of PRF and CGF.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Optimization of a concentrated growth factor/mesoporous bioactive glass composite scaffold and its application in rabbit mandible defect regeneration

Maxillofacial bone defect repair and regeneration remains a tremendous challenge in the field of stomatology. However, the limited osteoinductivity of artificial materials and the high cost of bioactive agents restrain their clinical translation. This study aimed to construct an economical and efficient concentrated growth factor/mesoporous bioactive glass (CGF/MBG) composite scaffold for bone regeneration. The biochemical composition and biological effects of different forms of CGFs were systematically compared, and the results showed that CGF-conditioned medium effectively promoted proliferation, migration and osteogenesis of allogenic BMSCs. Gel phase CGF (gpCGF) exhibited superior bioactivity and osteoinductivity to liquid phase CGF (lpCGF) and liquid/gel mixed phase CGF (lgpCGF), and was further applied to construct CGF/MBG scaffolds. In vitro studies demonstrated that co-culture with gpCGF-conditioned medium further enhanced the biocompatibility of MBG, increasing cell adhesion and proliferation on the scaffold. On this basis, two compositing approaches to construct the scaffold by fibrin gel formation (CGF/FG/MBG) and freeze-drying (fdCGF/MBG) were applied, and the biological efficacy of CGFs was compared in vivo. In a rabbit mandibular defect model, higher osteogenic efficiency in in situ bone regeneration of CGF/FG/MBG composite scaffolds was proved, compared with fdCGF/MBG. Taken together, the CGF/FG/MBG composite scaffold is expected to be an efficient bone repairing therapy for clinical translation, and the CGF-composited scaffold using gpCGF and the fibrin gel formation method is a promising way to enhance the bioactivity and osteoinductivity of current clinical bone repairing materials, providing new thoughts on the development of future orthopedic biomaterials.

Histological examination of the effect of concentrated growth factor (CGF) on healing outcomes after maxillary sinus floor augmentation surgery

A double-blind clinical trial was conducted to examine the effect of concentrated growth factor (CGF), a new generation of platelet derivatives, on the healing outcome of maxillary sinus floor augmentation during maxillary sinus lift surgery. The study included 9 patients referred to the Tabriz University, Faculty of Dentistry, aged 30-80 years, with bilateral posterior partial edentulous or edentulous maxilla who underwent the procedure using a split-mouth technique. After lifting the Schneiderian membrane, bovine xenograft was randomly applied on one side (for example, left maxillary sinus) and CGF on the other side (for example, right maxillary sinus). Results from alizarin red and hematoxylin-eosin staining methods showed that the percentage of bone formed in the CGF group (112.41±26.34% and 96.16±24.49%, respectively) was significantly higher than in the control group (64.99±24.96% and 60.16±16.39%, respectively) (P<0.05). In addition, after 6 months, the amount of residual graft material in the control group (xenograft) was significantly higher than in the CGF group (P<0.05). These findings demonstrate that the use of CGF during open sinus lift surgery is reliable for the placement of dental implants.

Emerging roles of platelet concentrates and platelet-derived extracellular vesicles in regenerative periodontology and implant dentistry

Platelet concentrates (PCs) are easily obtained from autogenous whole blood after centrifugation and have evolved through three generations of development to include platelet-rich plasma, platelet-rich fibrin, and concentrated growth factor. Currently, PCs are widely used for sinus floor elevation, alveolar ridge preservation, periodontal bone defects, guided bone regeneration, and treatment of gingival recession. More recently, PCs have been leveraged for tissue regeneration to promote oral soft and hard tissue regeneration in implant dentistry and regenerative periodontology. PCs are ideal for this purpose because they have a high concentration of platelets, growth factors, and cytokines. Platelets have been shown to release extracellular vesicles (P-EVs), which are thought to be essential for PC-induced tissue regeneration. This study reviewed the clinical application of PCs and P-EVs for implant surgery and periodontal tissue regeneration.

Treatment of multiple gingival recessions with concentrated growth factor membrane and coronally advanced tunnel technique via digital measurements: A randomized controlled clinical trial

BACKGROUND/PURPOSE

Research into biomaterial alternatives to connective tissue grafts (CTG) is a research hotspot. The purpose of this clinical trial was to compare the effectiveness of root coverage through tunnel technique with concentrated growth factor (CGF) vs CTG in treating multiple gingival recessions using digital measurements.

MATERIALS AND METHODS

Seventy Cairo Class I multiple gingival recessions (in 28 patients) were treated with either CGF or CTG combined with coronally advanced tunnel technique. Digital models were obtained at baseline, 2 weeks, 6 weeks, and 6 months post-op to compare the gain in gingival height, area, volume, and thickness. Tooth sensitivity, post-operative pain, and healing index were also recorded.

RESULTS

Complete root coverage at 6 months post-op were 47.06% in the CGF group and 77.78% in the CTG groups. Mean root coverages were 80.55% and 96.18%, respectively. No statistical difference was demonstrated between the two groups in terms of gingival area gain at 2 weeks post-op, but the CTG group had greater increases in gingival height, area, volume, and thickness in the period after 2 weeks post-op. Pain scores were statistically significantly lower in the CGF group. At 6 months post-op, sensitivity scores decreased more significantly in the CTG group.

CONCLUSION

Digital measurements revealed post-operative gingival shrinkage was more pronounced in the CGF group than in the CTG group when combined with coronally advanced tunnel technique. Despite the ease-of-use and minimal post-operative discomfort, it is difficult to achieve similar root coverage outcomes to CTG when using CGF alone in treating multiple gingival recessions.

Preliminary Novel Analysis on Antimicrobial Properties of Concentrated Growth Factor against Bacteria-Induced Oral Diseases

OBJECTIVE

 Concentrated growth factor (CGF) is particularly gaining acceptance and popularity in regenerative dentistry. Nonetheless, there are no available studies showing its effect against microorganisms of oral cavity particularly in chronic oral disease-induced biofilms. This in vitro research was conducted to determine the antimicrobial effects of CGF against Staphylococcus aureus sp. (S. aureus) and Streptococcus mutans sp. (S. mutans).

MATERIALS AND METHODS

 Blood samples were obtained from a healthy volunteer. CGF was then prepared using specialized centrifugation equipment (Medifuge, Silfradent, Santa Sofia FC, Italy) and protocol. Antimicrobial activity of the CGF was observed and recorded on standard strains of S. aureus and S. mutans using a well diffusion method to determine the inhibition zone, broth microdilution to determine minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC), and crystal violet assay for biofilm assessment, with chlorhexidine (CHX) 0.12% used as a positive control. Statistical analysis was then performed using one-way analysis of variance followed by Tukey Test post hoc analysis.

RESULTS

 It was observed that there was a presence of clear zones of inhibition around the CGF after 24 hours of incubation. The mean diameter of the inhibition zone was 1.26 ± 0.12 nm and 1.20 ± 0.06 nm for S. aureus and S. mutans, respectively, with significance difference (p < 0.05) against the control group CHX 0.12%. The MIC values of the CGF against S. aureus and S. mutans were 47.9% and 34.17%, respectively, and the MBC values of the CGF against S. aureus and S. mutans were 100%. The viability and the ability in inhibiting the biofilm formation of S. mutans and S. aureus following treatment with CGF showed a reduction in the concentration-dependent manner as compared with the control group.

CONCLUSION

 CGF possesses antimicrobial and antibiofilm activity against S. aureus and S. mutans.

The Ability and Mechanism of nHAC/CGF in Promoting Osteogenesis and Repairing Mandibular Defects

Nano-hydroxyapatite/collagen (nHAC) is a new type of bone tissue engineering scaffold material. To speed up the new bone formation of nHAC, this study used concentrated growth factor (CGF) and nHAC in combination to repair rabbit mandibular defects. nHAC/CGF and nHAC were implanted into rabbit mandibles, and X-ray, Micro-CT, HE and Masson staining, immunohistochemical staining and biomechanical testing were performed at 8, 16 and 24 weeks after surgery. The results showed that as the material degraded, the rate of new bone formation in the nHAC/CGF group was better than that in the nHAC group. The results of the HE and Masson staining showed that the bone continuity or maturity of the nHAC/CGF group was better than that of the nHAC group. Immunohistochemical staining showed that OCN expression gradually increased with time. The nHAC/CGF group showed significantly higher BMP2 than the nHAC group at 8 weeks and the difference gradually decreased with time. The biomechanical test showed that the compressive strength and elastic modulus of the nHAC/CGF group were higher than those of the nHAC group. The results suggest that nHAC/CGF materials can promote new bone formation, providing new ideas for the application of bone tissue engineering scaffold materials in oral clinics.

Application of concentrated growth factor to autotransplantation with inflammation in recipient area

OBJECTIVE

The purpose of this study was to apply concentrated growth factor (CGF) to the transplanted area with inflammation, to observe the clinical effects of CGF on the inflammation area assisted by 3D printing technology.

METHODS

A total of 52 compromised mandibular first or second molar with chronic periapical lesions were transplanted with mature third molars. The patients were divided into CGF group (n = 26) and control group (n = 26) and transplanted into fresh extraction sockets with or without CGF. All the patients underwent clinical and radiographic examinations during the follow-up.

RESULTS

Average surgery and extra-oral time were 39 min (± 7.8) and 42 s (± 10.2). The success rates of CGF group and control group were 100% and 92.3% respectively. Most of the periapical lesions in CGF group healed completely within 3 months, which was significantly faster than control group. The initial stability of CGF group was better than control group immediately after operation, and the degree of pain in CGF group was lower than control group on the 1st and 3rd day after operation.

CONCLUSIONS

The application of CGF in recipient site with chronic periapical lesions can accelerate the regeneration of alveolar bone and the healing of inflammation, greatly shorten the healing period. Meanwhile, CGF help to reduce postoperative pain and reaction at the early stage of healing and increase the success rate of autogenous tooth transplantation (ATT). Additionally, the use of 3D printing model can greatly reduce the extra-oral time of donor teeth.