Clinical Efficacy of Growth Factors to Enhance Tissue Repair in Oral and Maxillofacial Reconstruction: A Systematic Review

Abstract

Provide a comprehensive overview on the clinical use and the efficacy of growth factors in different reconstructive procedures in the oral maxillofacial area. A systematic review of the literature on the clinical use of human and human recombinant growth factors in oral maxillofacial reconstruction has been performed. The use of autogenous growth factors in platelet concentrates (PCs) has shown to be beneficial in the treatment of intrabony pockets at a reasonable level of evidence by improving probing depth and clinical attachment levels as well as linear bone fill within the limits of the observation periods. The application in conjunction with non-autogenous graft materials has been superior to the use of PCs only or grafting materials alone. No benefits have been shown for the use of PCs in recession treatment. When used in furcation treatment, probing depth, clinical attachment level and linear bone fill have been reported to improve significantly, however, without clinical benefit. No benefit for the final outcome could be shown for the use of PCs neither in sinus lift procedures nor in lateral / vertical crest augmentations. The use of human recombinant growth factors has been so far limited almost exclusively to rhPDGF-BB and rhBMPs (BMP-2, BMP-7 and GDF-5). The use of rhPDGF in the treatment of intrabony pockets has shown a reliable increase in linear bone fill but weaker evidence for permanent improvements of clinical attachment level. So far there is no evidence to support the use in recession treatment, sinus lift procedures and socket healing as well as lateral / vertical augmentations of the alveolar crest. rhBMPs have shown to be effective in enhancing bone formation in socket healing (rhBMP-2) and sinus lift procedures (rhBMP-2 and GDF-5). No controlled studies are available for the use in mandibular segmental repair. Successful reports on this application appear to be limited to primary reconstruction after ablative surgery for benign pathology with preservation of the periosteum. Evidence of clinical efficacy of growth factors in reconstructive procedures in the oral and maxillofacial area is limited.