Concentrated Growth Factor as an alternative membrane material in periodontal regeneration: A case report

Nur Zety Mohd Noh; Nurul Qamar Salehuddin; Sharul Nisha Ali; Ikhwan Hakimi Mohamad; Farha Ariffin

doi:10.31436/ijohs.v4i1.165

Authors

Nur Zety Mohd Noh Department of Restorative Dentistry (Periodontics Unit), Kulliyyah of Dentistry, International Islamic University Malaysia, Kuantan Campus, Jalan Sultan Ahmad Shah, Bandar Indera Mahkota, 25200 Kuantan, Pahang, Malaysia.
Nurul Qamar Salehuddin Centre of Periodontology Studies, Faculty of Dentistry, Universiti Teknologi MARA, Jalan Hospital, Sungai Buloh Campus, 47000 Sungai Buloh, Selangor, Malaysia.
Sharul Nisha Ali Centre of Periodontology Studies, Faculty of Dentistry, Universiti Teknologi MARA, Jalan Hospital, Sungai Buloh Campus, 47000 Sungai Buloh, Selangor, Malaysia.
Ikhwan Hakimi Mohamad School of Dental Sciences, Health Campus, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan.
Farha Ariffin Centre of Periodontology Studies, Faculty of Dentistry, Universiti Teknologi MARA, Jalan Hospital, Sungai Buloh Campus, 47000 Sungai Buloh, Selangor, Malaysia.

DOI:

https://doi.org/10.31436/ijohs.v4i1.165

Keywords:

Concentrated Growth Factor, guided tissue regeneration, membrane, periodontitis, xenograft

Abstract

The risk of further periodontal breakdown increases with a deep intrabony defect. Non-surgical periodontal therapy could pose a challenge and surgical intervention is mainly required to manage the defect. Autologous platelet concentrates such as concentrated growth factor (CGF) may improve surgical outcome due to its enrichment with growth factors. Nevertheless, the outcomes of using CGF as a biomaterial in periodontal regenerative therapy is inconclusive. This case report describes the regenerative management of an intrabony defect on all the first molars of a 24-year-old Malay lady diagnosed with Generalised Periodontitis, Stage III, Grade C. A guided tissue regeneration strategy was utilised on all the first molars except on tooth 46, which was treated with xenografts and a biologic adjunct of CGF. Patient was recalled regularly every week up to two months following the procedure, followed by a three-month interval review. The results showed promising outcomes with an average of 4 mm probing pocket depth reduction and 79.1% radiographic bone fill for both regenerative strategies. The utilisation of biologic adjuncts such as CGF, could offer a viable alternative to collagen membrane in periodontal regeneration without compromising clinical results.

References

Becker, W., Becker, B. E. (1993). Treatment of mandibular 3-wall intrabony defects by flap debridement and expanded polytetrafluoroethylene barrier membranes. Long-term evaluation of 32 treated patients. Journal of Periodontology, 64(11s), 1138–1144.

Borsani, E., Bonazza, V., Buffoli, B. (2015). Biological characterization and in vitro effects of human concentrated growth factor preparation: An innovative approach to tissue regeneration. Biology and Medicine, 7(5), 1 - 15.

Bosshardt, D. D. (2008). Biological mediators and periodontal regeneration: A review of enamel matrix proteins at the cellular and molecular levels. Journal of Clinical Periodontology, 35(S8), 87–105.

Chen, J., Jiang, H. (2020). a comprehensive review of concentrated growth factors and their novel applications in facial reconstructive and regenerative medicine. Aesthetic Plastic Surgery, 44(3), 1047–1057.

Cieplik, F., Ihlenfeld, I., Hiller, K. A., Pummer, A., Schmalz, G., Buchalla, W. et al. (2020). Tooth survival and clinical outcomes up to 26 years after guided tissue regeneration therapy in deep intrabony defects: Follow-up investigation of three randomized clinical trials. Journal of Clinical Periodontology, 47(7), 863–874.

Cortellini, P., Tonetti, M. S. (2000). Focus on intrabony defects: Guided tissue regeneration.Periodontology 2000, 22, 104–132.

Cortellini, P., Pini Prato, G., Tonetti, M. S. (1995). The modified papilla preservation technique. A new surgical approach for interproximal regenerative procedures. Journal of Periodontology, 66(4), 261–266.

Cortellini, P., Pini Prato, G., Tonetti, M. S. (1999). The simplified papilla preservation flap. A novel surgical approach for the management of soft tissues in regenerative procedures. International Journal of Periodontics and Restorative Dentistry, 19(6), 589–599.

Cortellini, P., Tonetti, M. S. (2004). Long-term tooth survival following regenerative treatment of intrabony defects. Journal of Periodontology, 75(5), 672–678.

Cortellini, P., Prato, G. P., Tonetti, M. S. (1993). Periodontal regeneration of human infrabony defects. II. Clinical measures. Journal of Periodontology, 64(4), 261–268.

Durmuslar, M. C., Balli, U., Dede, F. O., Misir, A. F., Baris, E., Kurkcu, M. et al. (2016). Histological evaluation of the effect of concentrated growth factor on bone healing. Journal of Craniofacial Surgery, 27(6), 1494–1497.

Graziani, F., Karapetsa, D., Alonso, B., Herrera, D. (2017). Nonsurgical and surgical treatment of periodontitis: how many options for one disease? Periodontology 2000, 75(1), 152–188.

Jepsen, S., Deschner, J., Braun, A., Schwarz, F., Eberhard, J. (2011). Calculus removal and the prevention of its formation. Periodontology 2000, 55(1), 167–188.

Jepsen, S., Gennai, S., Hirschfeld, J., Kalemaj, Z., Buti, J., Graziani, F. (2020). Regenerative surgical treatment of furcation defects: A systematic review and Bayesian network meta-analysis of randomized clinical trials. Journal of Clinical Periodontology, 47(S22), 352–374.

Kamal, A., Salman, B., Abdul Razak, N. H., Qabbani, A. Al, Samsudin, A. R. (2020). The efficacy of concentrated growth factor in the healing of alveolar osteitis: A clinical study. International Journal of Dentistry, 2020, 1–9.

Kamal, A., Salman, B., Razak, N. H. A., Samsudin, A. R. (2020). A comparative clinical study between concentrated growth factor and low-level laser therapy in the management of dry socket. European Journal of Dentistry, 14(4), 613–620.

Kim, T. H., Kim, S. H., Sádor, G. K., Kim, Y. D. (2014). Comparison of platelet-rich plasma (PRP), platelet-rich fibrin (PRF), and concentrated growth factor (CGF) in rabbit-skull defect healing. Archives of Oral Biology, 59(5), 550–558.

Lei, L., Yu, Y., Han, J., Shi, D., Sun, W., Zhang, D. et al. (2020). Quantification of growth factors in advanced platelet-rich fibrin and concentrated growth factors and their clinical efficacy as adjunctive to the GTR procedure in periodontal intrabony defects. Journal of Periodontology, 91(4), 462–472.

Mijiritsky, E., Assaf, H. D., Peleg, O., Shacham, M., Cerroni, L., Mangani, L. (2021). Use of PRP, PRF and CGF in periodontal regeneration and facial rejuvenation-a narrative review. Biology, 10(4), 1–23.

Nibali, L., Koidou, V. P., Nieri, M., Barbato, L., Pagliaro, U., Cairo, F. (2020). Regenerative surgery versus access flap for the treatment of intra-bony periodontal defects: A systematic review and metaanalysis. Journal of Clinical Periodontology, 47(S22), 320–351.

Qiao, J, Duan, J., Chu, Y., Sun, S. (2017). Effect of concentrated growth factors on the treatment of degree II furcation involvements of mandibular molars. Journal of Peking University. Health Sciences, 49(1), 36–42.

Qiao, Jing, Duan, J., Zhang, Y., Chu, Y., Sun, C. (2016). The effect of concentrated growth factors in the treatment of periodontal intrabony defects. Future Science OA, 2(4), 1–12.

Rodella, L. F., Favero, G., Boninsegna, R., Buffoli, B., Labanca, M., Scarì, G. et al. (2011). Growth factors, CD34 positive cells, and fibrin network analysis in concentrated growth factors fraction. Microscopy Research and Technique, 74(8), 772–777.

Sanz, M., Herrera, D., Kebschull, M., Chapple, I., Jepsen, S., Berglundh, T. et al. (2020). Treatment of stage I–III periodontitis—The EFP S3 level clinical practice guideline. Journal of Clinical Periodontology, 47(S22), 4–60.

Suárez-López Del Amo, F., Monje, A., Padial-Molina, M., Tang, Z. H., Wang, H. L. (2015). Biologic agents for periodontal regeneration and implant site development. BioMed Research International, 2015, 1–11.

Takeda, Y., Katsutoshi, K., Matsuzaka, K., Inoue, T. (2015). The effect of concentrated growth factor on rat bone marrow cells in vitro and on calvarial bone healing in vivo. The International Journal of Oral & Maxillofacial Implants, 30(5), 1187–1196.

Takei, H., Han, T., Carranza, F., Kenney, E., Lekovic, V. (1985). Flap technique for periodontal bone implants: Papilla preservation technique. Journal of Periodontology, 56(4), 204–210.

Tonetti, M. S., Greenwell, H., Kornman, K. S. (2018). Staging and grading of periodontitis: Framework and proposal of a new classification and case definition. Journal of Clinical Periodontology, 89 (S1), S159–S172.

Xu, Y., Qiu, J., Sun, Q., Yan, S., Wang, W., Yang, P. et al. (2019). One-year results evaluating the effects of concentrated growth factors on the healing of intrabony defects treated with or without bone substitute in chronic periodontitis. Medical Science Monitor, 25, 4384–4389.