Effect of concentrated growth factors in guided tissue regeneration for the treatment of mandibular molar furcation lesions

Tissues loss due to periodontal disease is typically treated by a variety of regenerative treatment modalities, including bone grafts, guided tissue regeneration (GTR) and growth factors, to reform the supporting tissues of teeth. Concentrated growth factors (CGF) are produced by centrifuging blood samples at alternating and controlled speeds using a special centrifuge. The purpose of this study was to evaluate whether GTR could improve the effect of CGF combined with bone graft in the treatment of classII furcations of mandibular molars. In the present study, thirty-five classII furcation involvements were included and randomly divided into two groups. The experimental group (n=17) accepted GTR combined with CGF and bone graft therapy, and the controlled group (n=18) accepted CGF combined with bone graft therapy. The clinical examinations and cone beam computed tomography (CBCT) were performed at baseline and 1 year post-surgery. Comparisons of clinical and CBCT data before and after operation between the experimental group and the control group were made. The clinical and CBCT data of both groups were not statistically different at baseline (P>0.05). At the end of 1 year post-surgery, the clinical parameters of both groups were significantly improved (P<0.001). The probing depths of the experimental group were (4.81±1.95) mm and (3.56±1.94) mm, respectively, significantly higher than the changes of the control group (P<0.001). The vertical and horizontal attachment gains of the experimental group were (4.11±1.98) mm and (3.84±1.68) mm, respectively, significantly higher than the changes of the control group (P<0.001). At the end of 1 year post-surgery, the experimental group showed significantly higher bone gain at vertical and horizontal directions compared with those of the control group: (3.84±1.68) and (3.88±2.12) mm, respectively (P<0.001). Within the limitation of the present study, GTR showed positive role in the effect of CGF combined with bone graft in the treatment of classII furcation involvements of mandibular molars.

ObjectiveTo investigate the effect of concentrated growth factor (CGF) combined with sodium hyaluronate (SH) on temporomandibular joint osteoarthritis (TMJOA).MethodsSixty patients with TMJOA who were diagnosed by cone-beam computed tomography (CBCT) between March 2020 and March 2023 at the Stomatological Hospital of Xi’an Jiaotong University were randomly divided into a control group (n = 30) and an experimental group (n = 30). The patients in the experimental group were treated with CGF + SH, and those in the control group were treated with SH only. The visual analogue scale (VAS) score indicating pain in the temporomandibular joint (TMJ) area; the Helkimo Clinical Dysfunction Index (Di); and changes in condylar CBCT at the first visit and 2 weeks, 3 months and 6 months after treatment were recorded. The CBCT data of the patients in the experimental and control groups were collected, and the three-dimensional CBCT image sequences were imported into Mimics Medical 19.0 software in DICOM format for condylar reconstruction.ResultsThe VAS scores at 2 weeks, 3 months and 6 months after treatment were significantly lower in the experimental group than in the control group (P < 0.05), and the pain in the experimental group was significantly relieved. The Di was significantly lower in the experimental group than in the control group (P < 0.05), and the clinical function of the TMJ improved. After treatment, the CBCT score was significantly lower in the experimental group than in the control group (P < 0.05), and the condylar bone cortex was obviously repaired. Observation of the condylar bone cortex by three-dimensional reconstruction showed the same results as those obtained by CBCT.ConclusionCGF combined with SH is effective in the treatment of TMJOA and can improve muscle pain, TMJ pain, Impaired TMJ function, Impaired range of movement, Pain on movement of the mandible and promote bone repair.The registration number (TRN)ChiCTR2400082712.The date of registrationApril 5, 2024.

Background and aims Plasma rich in growth factors (PRGF) is a concentrated suspension of growth factors, which is used to promote periodontal tissue regeneration. The aim of this randomized, controlled, clinical trial was to evaluate of the treatment of grade II mandibular molar furcation involvement using autogenous bone graft with and without PRGF. Materials and methods In this double-blind clinical trial, thirty mandibular molars with grade II furcation involvement in 30 patients were selected. The test group received bone graft combined with PRGF, while the control group was treated with bone graft only. Clinical parameters included clinical probing depth (CPD), vertical clinical attachment level (V-CAL), horizontal clinical attachment level (H-CAL), location of gingival margin (LGM), surgically exposed horizontal probing depth of bony defect (E-HPD), vertical depth of bone crest (V-DBC), vertical depth of the base of bony defect (V-DBD), and length of the intrabony defect (LID). After six months, a re-entry surgery was performed. Data were analyzed by SPSS 14, using Kolmogorov, Mann-Whitney U, and paired t-test. Results After 6 months, both treatment methods led to significant improvement in V-CAL and H-CAL and significant decreases in CPD, E-HPD, V-DBD and LID; there was no significant difference in LGM and V-DBC in any of the treated groups compared to the baseline values. Also, none of the parameters showed significant differences between the study groups. Conclusion Although autogenous bone grafts, with or without PRGF, were successful in treating grade II furcation involvement, no differences between the study groups were observed.

To explore the effect of concentrated growth factors (CGF) on postoperative pain and swelling in patients with complex dental implants. A total of 28 patients with single maxillary anterior teeth loss and labial orbital bone defect were recruited randomly and divided into two groups. Each group included 14 patients. The experimental group was applied with CGF membrane to guide bone regeneration, whereas the control group was treated with collagen membrane to guide bone regeneration. The postoperative pain degree and swelling degree were compared, and data were analyzed with SPSS 23.0 software. Postoperative pain was measured by visual analogue scale (VAS), and the degree of swelling was divided into four grades according to swelling range. VAS scores of patients in experimental and control groups reached 35.1±22.5 and 47.0±20.3, respectively. The duration of postoperative pain in experimental and control groups totaled (2.1±1.5) and (2.8±1.0) days, respectively. No statistically significant difference was observed between the two groups (P>0.05). Percentages of non-swelling, mild swelling, moderate swelling, and severe swelling in experimental group reached 21.4%, 57.1%, 21.4%, and 0, respectively, and those in control group were 7.1%, 35.7%, 35.7%, and 21.4%. Swelling duration reached (2.4±1.4) and (4.2±2.2) days in the experimental and control groups, respectively. A statistically significant difference was observed in the swelling degree of experimental and control groups (P<0.05). The use of CGF can significantly reduce the degree of postoperative swelling and shorten swelling time but cause no significant effect on pain.

Objective: The objective of the present systematic review and meta-analysis was to compare treatment with membrane associated with bone grafting and treatment exclusively with membrane in the approach of Class II furcation defects in mandibular molars. Materials and Methods: The Preferred Reporting Items for Systematic Reviews and Meta-analyses statement was followed. Searches were conducted in five databases (PubMed, Web of Science, Scopus, Ovid, and Lilacs), in Septem-ber 2021, without restriction regarding publication year or language. Studies comparing membranes associated with bone grafting and membranes exclusively in the treatment of Class II furcation lesions were included. Cross-sectional, case-control studies, and reviews were excluded. Study selection, data extraction, and risk of bias assessment (MINORS) were performed by two review authors. The certainty of the evidence (GRADE) was evaluated and meta-analysis was performed. Mean difference (MD) and 95% confidence interval (CI) were provided. Results: Four hundred eighty-six references were iden-tified and four studies were included. Greater reduction in probing depth [MD = 0.32 (CI = 0.09, 0.56)] and greater clinical attachment level gain [MD = 0.41 (CI = 0.24, 0.57)] were observed when membrane and bone grafting were used. The risk of bias of included studies was low. Conclusions: This present systematic review and meta-analysis demonstrated that treatment of Class II furcation defects in mandibular molars using membrane and bone grafing is significantly more efficacious than treatment with the exclusive use of membrane. Keywords: Periodontitis; Bone grafting; Membranes; Guided tissue regeneration; Furcation defects; Systematic review

The purpose of this study was to evaluate the results after guided tissue regeneration (GTR) using a bioabsorbable membrane in Class II furcation defects in mandibular molars over a 24-month period. Nine patients with 2 comparable Class II furcation defects were included. The defects in each patient were randomly assigned to either test (GTR) or control (open flap debridement) group. Clinical measurements and standardized radiographs were taken at baseline, and at 6, 12, 18, and 24 months. The radiographs were analyzed by subtraction radiography. There were significant probing depth reductions for both test and control groups (P < 0.007, P < 0.0005, respectively); however the differences between groups were not significant at any examination. The intra-group and inter-group differences in the vertical clinical attachment level gain were not significant (P > 0.05). Over 24 months, a significant horizontal clinical attachment level gain was observed in the test group compared to control (P<0.03). In the test group, 2 sites showed complete closure, one was converted to Class I, and one tooth was lost due to root resorption. In the control group, 2 defects progressed to Class III over 24 months. At 6 months, the test group showed 0.14 mm of bone loss while the control group showed 0.86 mm of bone gain (P = 0.035). The inter-group differences were not significant at 12, 18, and 24 months. A significant bone height gain was observed in the test group at 24 months when compared to the values obtained after 6 months (P = 0.015). GTR may provide a greater horizontal clinical attachment level gain with the possibility of complete closure of some defects and stability over time.

Periodontitis is a prevalent chronic inflammatory disease characterized by progressive destruction of periodontal tissues, with alveolar bone defects posing significant challenges for clinical treatment. This research aimed to ascertain the clinical efficacy of minimally invasive bone grafting combined with concentrated growth factor (CGF) for treating periodontitis. Seventy-eight patients with periodontitis and bone defects were randomized into the control group (received guided tissue regeneration (GTR) combined with bone grafting treatment) and the test group (received GTR combined with minimally invasive bone grafting and CGF treatment). Postoperative pain at 1 day, 3 days, and 7 days postoperatively, mucosal healing at 7 days postoperatively, probing depth (PD), clinical attachment level (CAL), gingival recession depth (GRD), bleeding index (BI), gingival index (GI), and the alveolar bone defect depth preoperatively and at 6 months postoperatively were compared, changes in implant new bone thickness and density at 3 and 6 months postoperatively were tested by cone-beam computed tomography (CBCT), and implantation success rate and postoperative complications were compared. The test group exhibited lower pain scores at 3 and 7 days (P < 0.05), improved mucosal healing (P < 0.05), and superior periodontal indicators (PD, CAL, GRD, BI, GI) at 6 months (P < 0.05). CBCT revealed greater bone thickness/density in the test group (P < 0.05). Complication rates were lower in the test group (P < 0.05), with no significant difference in implantation success (P > 0.05). Minimally invasive bone grafting combined GTR with CGF improves periodontal conditions in patients with periodontitis complicated by bone defects, achieves good bone regeneration results, and reduces postoperative complications.

Context:Invasion of the bifurcation and trifurcation of the multi-rooted teeth resulting in furcation involvement is one of the serious complications of periodontitis.Aim:The purpose of the study was to evaluate the efficacy of combination therapy using anorganic bovine bone graft and resorbable guided tissue regeneration (GTR) membrane versus open flap debridement alone in the management of Grade II furcation defects in mandibular molars.Materials and Methods:The study included a total number of 20 sites in 10 patients with bilateral mandibular furcation defects, out of which 10 sites were treated as test group and 10 as control group. The test group was treated with combination therapy and the control group with open flap debridement alone. The parameters were recorded on 0 day (baseline), 90th day, and 180th day, which included vertical probing depth and horizontal probing depth of the furcation defect, clinical attachment level, and defect fill.Statistical Analysis Used:Mean and standard deviation were calculated for different variables in each study group at different time points. Mean values were compared by using Wilcoxon signed ranks test, after adjusting the P values for multiple comparison by using Bonferroni correction method.Results:Both the test and control groups showed a definitive improvement in clinical parameters, which was statistically significant. On comparison, the vertical probing depth showed significant reduction in the test group with a mean reduction of 3.1 ± 0.7 mm, when compared to the control group which showed a mean reduction of 1.5 ± 0.5 mm. The horizontal probing depth of furcation defects was also significantly reduced in the test group with a mean reduction of 2.2 ± 0.6 mm, when compared to the control group in which the mean reduction was 0.9 ± 0.3 mm. There was also significant gain in attachment level in the test group which showed a mean gain of 3.2 ± 0.6 mm, when compared to the control group which showed a gain of 1.2 ± 0.6 mm. Radiographic defect fill was found to be more in the test group with a mean gain of 2.0 ± 0.1 mm, when compared to the control group which showed a defect fill of 0.2 ± 0.1 mm.Conclusions:The results of this study demonstrated that the combined use of anorganic bovine bone graft and resorbable GTR membrane is effective than open flap debridement alone in the treatment of mandibular grade II furcation defects.

This study evaluated the efficacy of concentrated growth factor (CGF) sticky bone combined with guided tissue regeneration (GTR) in treating shallow infrabony defects and explored factors influencing clinical outcomes. Thirteen patients with 31 shallow defects (≤3mm) were treated using CGF sticky bone (CGF + deproteinized bovine bone mineral), covered with a collagen membrane and CGF membrane. Probing depth (PD), clinical attachment level (CAL), and gingival recession (REC) were examined at baseline and 1 year post surgery. The distance between the base of the defect and the cementoenamel junction (BD-CEJ) were measured on periapical radiographs. Gingival volume and thickness were assessed with digital intraoral scans. Linear regression identified factors influencing CAL gain, PD reduction, and bone gain (ΔBD-CEJ). One year post surgery, CAL increased by 2.48±1.72mm (p<0.001), PD reduced by 2.90±1.40mm (p<0.001), and bone gain was 2.46±1.71mm (p<0.001). REC remained stable (p=0.254), and the volume and thickness of gingival contour showed no significant changes (p=0.751 and p=0.915, respectively). Greater baseline attachment loss was associated with higher CAL gain (coefficient 0.436, p=0.001). Deeper preoperative PD predicted greater PD reduction (coefficient 0.573, p=0.029). Greater bone gain was correlated with lower baseline bone height (coefficient 0.305, p=0.018). CGF sticky bone combined with GTR demonstrates benefits in CAL gain, PD reduction, and bone gain while preventing REC and gingival contour collapse in the treatment of shallow infrabony defects with residual pockets after initial therapy. Chinese Clinical Trial Registry (ChiCTR2300069617). This study explored a novel approach to treating shallow bone defects around teeth using a combination of concentrated growth factor (CGF) sticky bone and guided tissue regeneration (GTR). The treatment involved using a specially prepared bone graft material (CGF sticky bone) along with a collagen membrane and a CGF membrane. The researchers tracked the changes in gum and bone health in 13 patients with 31 shallow defects over 1 year. The results showed significant improvements: Gum attachment levels increased by an average of 2.48mm, gum pockets reduced by 2.90mm, and bone growth averaged 2.46mm. Notably, gum recession and gingival contour remained stable, meaning the treatment did not compromise the appearance of the gums. The study also found that patients with worse gum or bone loss at the start of the treatment tended to experience the greatest improvements. These findings suggest that CGF sticky bone combined with GTR is a promising option for restoring shallow bone defects, particularly in cases where traditional therapy has left residual gum pockets.

Furcation involvements present one of the greatest challenges in periodontal therapy because furcation-involved molar teeth respond less favorably to conventional periodontal therapy compared with noninvolved molar or nonmolar teeth. Various regenerative procedures have been proposed and applied with the aim of eliminating the furcation defect or reducing the furcation depth. An abundance of studies and several systematic reviews have established the effectiveness of membrane therapy (guided tissue regeneration) for buccal Class II furcation involvement of mandibular and maxillary molars compared with open flap surgery. Bone grafts/substitutes may enhance the results of guided tissue regeneration. However, complete furcation closure is not a predictable outcome. Limited data and no meta-analyses are available on the effects of enamel matrix proteins for furcation regeneration. Enamel matrix protein therapy has demonstrated clinical improvements in the treatment of buccal Class II furcation defects in mandibular molars; however, complete closure of the furcation lesion is achieved only in a minority of cases. Neither guided tissue regeneration nor enamel matrix protein therapy have demonstrated predictable results for approximal Class II and for Class III furcations. Promising preclinical data from furcation regeneration studies in experimental animals is available for growth factor- and differentiation factor-based technologies, but very limited data are available from human clinical studies. Although cell-based therapies have received considerable attention in regenerative medicine, their experimental evaluation in the treatment of periodontal furcation lesions is at a very early stage of development. In summary, the indications and the limitations for currently available treatment modalities for furcation defects are well established. New regenerative treatments are clearly needed to improve the predictability of a complete resolution of furcation defects.

The present clinical trial was designed to evaluate the regenerative potential of the periodontal tissue in Class II furcation defects in mandibular molars using reconstructive surgery based on the guided tissue regeneration (GTR) technique versus the coronally positioned flap (CPF) technique. After the completion of the initial phase of therapy and four to six weeks healing period, 20 furcation-involved molars were examined for baseline data which included plaque index, gingival condition, probing depth (PD), probing attachment level (PAL-V, PAL-H) and radiographs. All parameters were reexamined after three, six and twelve months of healing, except PD, PAL-V and PAL-H which were not measured at three and six months. A nonparametric analysis was used. The study showed that there were no significant differences in the mean baseline measurements between the treatment groups. After 12 months following surgical treatment, both GTR and CPF procedures showed gains in new clinical attachment levels. When comparing parameters between the two surgical procedures, GTR molars showed significantly more improvement in probing depth as well as vertical and horizontal attachment level of the interradicular osseous defect than did the CPF molars (p < 0.05). About 80 per cent of the sites treated with the GTR technique showed complete clinical resolution of the furcation problem. CPF therapy reached the same Treatment goal in about 50 per cent of the cases which were treated. Guided tissue regeneration appeared to be more effective in promoting regeneration than the coronally positioned flap.

Amnion and chorion membranes possess unique inherited biological properties that enhance wound healing and may accelerate periodontal regeneration. The present study aims to evaluate and compare the efficacy of amnion and chorion membranes in the treatment of furcation defects. A total of 20 patients were selected and were randomly allocated to group I and group II with 10 subjects in each group. Amnion and chorion membranes are placental-derived membranes that accelerate regeneration by having natural growth factors with their antimicrobial and inflammation reduction properties. Group I was treated using bone grafting with decalcified freeze-dried bone allograft (DFDBA) and placement of amnion as a membrane for guided tissue regeneration (GTR) whereas group II was treated using bone grafting with DFDBA and placement of chorion as a membrane for GTR. The patients were followed for clinical and radiographic parameters and were evaluated between 3 and 6 months after surgery. In intragroup comparison, a significant difference was evident in both the groups for all the clinical and radiographic parameters within the groups. (p = 0.01) This means both amnion and chorion membranes showed statistically significant regenerative efficacy. In intergroup comparison, the results show that all the clinical parameters and radiographic parameters show no significant difference between the groups. The amnion and chorion membranes had similar regenerative efficacy in combination with DFDBA in patients with buccal degree II furcation defects in mandibular molars. The amnion and chorion membranes have shown significant improvement in clinical and radiographic parameters when used for the treatment of buccal degree II furcation defects in mandibular molars. How to cite this article: Mallapragda S, Gupta R, Gupta S, et al. Evaluation of Regenerative Efficacy of Amnion and Chorion Membrane in Treatment of Mandibular Molar Furcation Defects: A Clinico-radiographic Study. J Contemp Dent Pract 2024;25(2):160-167.

Selective serotonin reuptake inhibitors (SSRIs), one of the commonly used anti-anxiety drugs, may have impacts on bone metabolism and potentially lead to drug-induced osteoporosis. The traditional approach of oral implantation in individuals with both anxiety disorder and drug-induced osteoporosis poses a significant challenge. To address this issue, concentrated growth factor (CGF) has been utilized in patients undergoing concurrent alveolar ridge augmentation during oral implantation, resulting in favorable clinical outcomes. Consequently, combining CGF with guided bone regeneration (GBR) in alveolar bone increment may represent a promising new surgical approach for such patients. In this report, we present a case study of a 25-year-old male with anxiety disorder and drug-induced osteoporosis, in who CGF combined with GBR was employed in alveolar bone increment. This article reports the case of a 25-year-old male who underwent cone beam computed tomography (CBCT) due to the absence of his right lower second molar for a period of six months. The CBCT scan revealed significant bone defects, which were attributed to the tooth loss and prolonged use of anti-anxiety drugs. Consequently, the patient sought medical assistance from our department. Based on the patient's self-report, he was diagnosed with an anxiety disorder. Additionally, the CBCT scan confirmed the loss of the right mandibular second molar and revealed the presence of dental irregularity and an alveolar bone defect. During the patient's course of treatment with anti-anxiety medication, a combination of CGF and GBR was employed for the simultaneous implantation of the missing right mandibular second molar, along with bone augmentation. The patient had a follow-up visit two weeks after the surgical procedure, and the wound in the operation area had healed satisfactorily. Six months later, CBCT images revealed excellent osseointegration. The buccal and lingual width of the alveolar bone measured 6.95mm, which was an increase of 1.35mm compared to the pre-implantation stage. This article presents a case study in which CGF combined with GBR were utilized to address alveolar bone augmentation during the implantation phase in patients taking anti-anxiety medication. The results demonstrated that CGF combined with GBR, as a cutting-edge platelet concentrate technique, could effectively stimulate bone tissue proliferation in individuals who have been on long-term anti-anxiety medication, specifically in oral implant areas. This approach can help prevent poor osseointegration, promote higher osseointegration rates, and facilitate wound healing.

This study compared clinical and radiographic findings for the treatment of Class II furcation defects in human mandibular molars using anorganic bovine-derived hydroxyapatite matrix (ABM)/cell-binding peptide (P-15) or open flap debridement (OFD). Twelve subjects showing two comparable Class II furcation defects in their mandibular molars were enrolled. The defects in each subject were assigned randomly to the test (ABM/P-15) or the control (OFD) group. Clinical measurements and standardized radiographs were taken at baseline and 6 to 7 months after surgery. There were no statistically significant differences between the test and control groups for any clinical or radiographic parameter (P >0.05). On comparing the baseline and final measurements, the gain in horizontal clinical attachment level and reduction in gingival recession were significant only in the test group (P < or =0.02), whereas the gain in the vertical clinical attachment level was significant in both groups (P < or =0.04). In the test group, four of 12 sites showed complete closure, and five showed partial closure; in the control group, three defects showed complete closure, and four showed partial closure (P = 0.42). Subtraction radiography revealed similar gains in bone height and increases in mean bone density with both treatments (P >0.05). ABM/P-15 yielded favorable results in the treatment of Class II furcation defects over a 6-month evaluation period; however, there was no difference compared to OFD. Further studies using a larger sample size are needed to confirm the present findings.

Aim of study: The aim of this study was to compare the effect of Xenograft alone or in combination with Platelet rich fibrin (PRF) in the treatment of mandibular furcation grade II defects.Patients and methods: Twenty patients with a total number of 40 grade II furcation defects in split mouth design determined clinically and radiographically were selected for the study. The selected sites were treated with open flap surgery and divided into two groups: Group I was treated with Xenograft (cerabone®) only and Group II treated with Xenograft (cerabone®) plus PRF membrane. The clinical and radiographic evaluation occurred at baseline (before surgery) and 6 month post-operative. Clinical parameters include: plaque index (PI), gingival index (GI), vertical clinical attachment level (VCAL) and Horizontal clinical attachment level (HCAL). Cone-beam Computed Tomography (CBCT) was performed to measure furcation height (FH), width (FW), and depth (FD) defects of mandibular molars at baseline (before surgery) and 6 month post-operative.Results: Both groups showed statistically significant reduction in all clinical and radiographic parameters within groups from baseline to 6 months post-operative. HCAL, FH, FW and FD were significantly increased in G II compared to G I at 6 months post-operative.Conclusion: Treatment of furcation grade II defects with xenograft (cerabone®) plus PRF led to significant improvement more than xenograft (cerabone®) alone.