Concentrated Growth Factor Membrane Research Articles

Concentrated growth factor and collagen as barrier materials in alveolar ridge preservation for posterior teeth: a prospective cohort study with one-year follow-up.

This study aims to evaluate the efficacy of concentrated growth factor (CGF) membrane and collagen as barrier materials in sealing the alveolar socket in alveolar ridge preservation (ARP) in the posterior region during a one-year follow-up. A total of 24 patients who underwent ARP in the posterior region were selected for inclusion and randomly assigned to the CGF group (12 cases) and Collagen group (12 cases). The patients in both groups underwent extraction of posterior teeth. The extraction sockets were filled with a bone substitute to the level of the pre-extraction buccal and lingual or palatal alveolar bone plates. The wounds in the CGF group were closed with a fabricated CGF overlaying the upper edge of the bone substitute material, whereas those in the Collagen group were closed with Bio-Oss Collagen. The implants were placed after 6 months. The evaluation was based on implant retention, re-grafting rate, and vertical and horizontal alveolar ridge bone volume changes measured by cone beam computed tomography (CBCT). Data were statistically analyzed using SPSS 28.0 software. No patient withdrew throughout the follow-up period. No implant failure and no severe peri-implant or mucosal soft tissue complications were observed. Six months after the operation, the degree of vertical alveolar ridge height resorption in the CGF group was lower than that in the Collagen group (P<0.05). There were no statistically difference between the groups at 1 year after the operation (P>0.05). The amount of bone reduction in horizontal alveolar ridge width showed no difference between the groups at 6 months and 1 year after surgery (P>0.05). CGF membrane and Bio-Oss Collagen as barrier materials for posterior ARP inhibited reduction in alveolar ridge bone mass.

Comparative evaluation of the effectiveness of concentrated growth factor alone and in combination with diode laser application in the treatment of intrabony periodontal defects: A clinical and radiographic split-mouth study.

Applying autologous growth factors and diode laser in periodontal therapy enhances fibroblast-mediated new attachment and osteoblastic differentiation. Hence, this study compared and evaluated the effectiveness of concentrated growth factor (CGF) alone and with diode laser application in managing intrabony periodontal defects. Ten patients with stage III periodontitis were included in this study. All the patients underwent an open flap debridement (OFD) procedure followed by CGF membrane placement in the intrabony defect in site A, whereas, in site B, after OFD, all the patients underwent diode laser irradiation before CGF membrane placement. Plaque and gingival bleeding index (PI & GBI), PPD, and clinical attachment level (CAL) were evaluated at baseline and 3 and 6 months later. Bone fill (BF), BF%, bone crest changes (BCC), and BCC% were assessed radiographically at six months postoperatively. Significant reductions in PI and GBI scores, probing pocket depth (PPD), and CAL gain were observed at both sites 3 and 6 months from baseline. A significant reduction in PPD and CAL gain was noted between sites, which were higher in site B than in site A with a mean difference of 0.70±0.05 mm and 1.30±0.18 mm, 0.90±1.89 mm at 3 and 6 months, respectively. Radiographic measurement showed better BF, BF%, BCC, and BCC% at both sites at six months, which were higher at site B than at site A but statistically insignificant. The combination of CGF and diode laser application has demonstrated successful and promising results in terms of regeneration, improving the clinical and radiographic parameters.

Clinical and radiographic outcomes of a combined surgery approach to treat peri-implantitis

Peri-implant infra-bony defects are difficult to treat, and data on the management of peri-implantitis are lacking. The aim of this study was to evaluate the effect of a combined surgical approach to manage peri-implantitis: implantoplasty with xenogeneic bone grafting and a concentrated growth factor membrane. Two independent examiners analysed the medical records and radiographs taken before surgery and at the last follow-up. Data were analysed at the implant level; some patient-level data (age, sex, smoking habit) were also considered. Linear regression analysis with generalized estimating equations (GEE) was used to explore the effect of variables of interest (including marginal bone level (MBL)) on implantitis treatment success and resolution rates. The effect of the prosthesis type on postoperative clinical and radiographic parameters was also explored by GEE, with adjustment for age, sex, tooth site, location, follow-up duration, and implant length (model IV including all). Thirty patients with 72 implants were investigated. The implant survival rate was 100% over a mean observation period of 3.3 years (range 2–11 years). The treatment success rate (bone loss <0.5 mm, no bleeding on probing (BOP), no suppuration, probing depth (PD) < 5 mm) was higher in females than males (50% vs 19.0%; P = 0.008). At the last postoperative follow-up, the MBL (1.51 ± 1.07 vs 4.01 ± 1.13 mm), PD (3.61 ± 0.84 vs 6.54 ± 1.01 mm), and BOP (23.38 ± 23.18% vs 79.17 ± 15.51%) were significantly reduced when compared to pre-surgery values (all P < 0.001). Furthermore, a significantly higher PD reduction (β = −1.10 mm, 95% confidence interval −1.97 to −0.23 mm, P = 0.014) was observed for implants with a single crown than a full-arch prosthesis (GEE model IV). Preliminary clinical and radiographic data indicate that implantoplasty in combination with surgery could be an effective treatment option for peri-implantitis.

A novel concentrated growth factor (CGF) and bio-oss based strategy for second molar protection after impacted mandibular third molar extraction: a randomized controlled clinical study

BackgroundThe extraction of impacted mandibular third molars might cause large bone defects in the distal area of second molars. A new strategy was innovatively employed here combining autologous bone, Bio-Oss, concentrated growth factors (CGF) gel and CGF membrane for bone repair, and the present study aimed at exploring safety as well as short- and long-term efficacy of this new protocol clinically.Materials and methodsA total of 66 participants were enrolled in this randomized single-blind clinical trial, and randomly allocated to control group (only blood clots), test A group (autogenous bone, Bio-Oss with barrier membrane) and test B group (autogenous bone, Bio-Oss, CGF gel with CGF membrane). The postoperative outcomes including PoSSe scale, periodontal probing depth (PD), degree of gingival recession and computed tomography measurements were assessed at 3rd, 6th, 12th month. A p-value < 0.05 was considered statistically significant.ResultsIn PoSSe scale, no significant difference was observed except a significant alleviation of early-stage pain perception in test B group (p < 0.05). Also, test B group exhibited better effect on periodontal healing and gingival recession reduction after 6 months (p < 0.05). Both two test groups showed more new bone formation than the control group (p < 0.05). It is noteworthy that the bone repair of test B group was significantly better than that of test A at 3rd and 6th month (p < 0.05), yet no difference was observed at 12th month (p > 0.05).ConclusionBoth two test groups could achieve stable long-term efficacy on bone defect repair. The use of CGF gel and CGF membrane could accelerate early-stage bone repair, alleviate short-term pain after surgery, reduce long-term probing depth and relieve economic cost for patients. This new bone repair protocol is worthy of promoting by clinicians.Trial registrationThis study was registered with the identification number ChiCTR2300068466 on 20/02/2023 at Chinese Clinical Trial Registry. Also, it was ethically approved from the institutional ethics committee at the Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (No:2023-010-01), and has been conducted in accordance to the guidelines of the declaration of Helsinki. Written informed consent was obtained from all participants in the study.

Concentrated growth factor combined with iRoot BP Plus promotes inflamed pulp repair: an in vitro and in vivo study

BackgroundPlatelet concentrates combined with calcium silicate cements may promote reparative dentin formation. However, few studies have reported their effect on dental pulp inflammation. This study aimed to evaluate the effects of concentrated growth factor (CGF) combined with iRoot BP Plus on inflammatory human dental pulp stem cells (hDPSCs) in vitro and inflamed pulp in rats in vivo.MethodsThe proliferation of LPS-stimulated hDPSCs treated with 50% CGF with/without 25% iRoot BP Plus was evaluated using Cell Counting Kit-8 on days 1, 4 and 7. The expression of genes associated with inflammation on day 1 and differentiation on day 14 was analysed by real-time polymerase chain reaction. The exposed pulp of rat maxillary molars was injected with 10 mg/mL LPS and directly capped with CGF membrane with/without iRoot BP Plus extract for 1, 7 and 28 days. The teeth were subjected to histologic analyses and immunohistochemistry.ResultsThe proliferation rates of the inflammatory hDPSCs after the combination treatment were significantly higher than those after the other treatments on days 4 and 7 (P < 0.05). IL-1β, IL-6, and TNF-α levels were increased in inflammatory hDPSCs but decreased after treatment with CGF combined with iRoot BP Plus extract, whereas IL-4 and IL-10 showed the opposite expression patterns. Expression of the odontogenesis-related genes OCN, Runx2, and ALP was dramatically enhanced by combined treatment with CGF and iRoot BP Plus extract. In rat pulp, the average inflammation scores of the CGF and CGF-iRoot BP Plus groups significantly decreased in comparison with those of the LPS group (P < 0.05), and the CGF-iRoot BP Plus group had more reparative dentin than the CGF and BP groups. Immunohistochemical staining showed fewer M1 macrophages on day 1 and more M2 macrophages on day 7 in the CGF-iRoot BP Plus group than in the other groups.ConclusionsThe combination of CGF and iRoot BP Plus showed a synergistic effect on anti-inflammatory potential and promoted greater pulp healing than CGF or iRoot BP Plus alone.

Evaluation of the effects of concentrated growth factors membrane on wound healing following gingivectomy and gingivoplasty operations: a randomized controlled clinical trial

Aim This study aims to evaluate the effects of concentrated growth factors (CGF) membrane application on initial wound healing after gingivectomy and gingivoplasty surgeries. Methods and materials 20 patients with gingival enlargement who need gingivectomy or gingivoplasty surgery were selected to participate in this study. They were randomly divided into two groups of 10 patients each. Group-1 (Control group): where the gingivectomy sites were covered by a non-eugenol periodontal pack. Group-2 (Test group): were covered by the CGF membrane under the non-eugenol periodontal pack, postoperatively. Assessment of postoperative pain for both groups was recorded using the Visual Analog Scale for a period of 7 days. Laundry healing index, papillary bleeding index, and gingival index (GI) were also assessed at 7, 14, 21, and 28 days postoperatively. Results All patients experienced a decrease in postoperative pain throughout the study evaluation period, with no statistically significant differences between the two groups (P &gt; 0.05), except for days 3 and 4, where there were statistically significant differences in favor of the test group (P &lt; 0.05). On days 7 and 21, there was no difference in the healing index, but on days 14 and 28, there was a statistically significant difference (P &lt; 0.05). The Papillary bleeding index (PBI) and gingival index of the two analyzed groups improved during the research period. At 21 days, the intergroup comparison showed a significant difference in PBI between the two studied groups (P &gt; 0.05) in favor of the study group. Conclusion CGF membrane improved wound healing and reduced postoperative pain following gingivectomy or gingivoplasty surgery.

Preoperative CBCT Guided Bone Regeneration Combined with Concentrated Growth Factor Applied in the Implantation of Maxillary Teeth with Insufficient Bone Mass.

It was to explore the application effect of cone beam computed tomography (CBCT) guided bone regeneration (GBR) combined with concentrated growth factor (CGF) in the implantation of maxillary teeth with insufficient bone mass. 78 patients with single maxillary anterior tooth loss and labial alveolar defects in Dazhong Stomatological Hospital were retrospectively analyzed and randomly divided into groups A and B. Both groups were treated with surgical methods of GBR at the same time of implantation. Group A: CGF fibrin fluid and Bio-Oss bone powder, covered with CGF membrane on the surface to guide bone regeneration. Group B: Bio-Oss bone powder was implanted and covered with Heal All collagen biofilm. The horizontal bone width, keratinized gingival width, bone plate thickness, implant margin results, and alveolar ridge width were analyzed at 3 and 6 months before and after the operation in both groups. 6 months after the operation, the difference in the indexes between the two groups was evident; and in group A, the indexes had an obvious difference in contrast with those before operation; the healing rate of soft tissue was 100% in group A and 80% in group B, which was significantly different (P < 0.05). Preoperative CBCT GBR combined with CGF can promote the bone formation content of guided regeneration of bone defects in the maxillary teeth region.

Comparative evaluation of demineralized freeze-dried bone allograft with and without concentrated growth factor membrane in the treatment of periodontal intrabony defects: a randomized controlled clinical trial.

The current study's aim was to evaluate and compare demineralized freeze-dried bone allograft (DFDBA) with and without concentrated growth factor (CGF) membrane in the treatment of periodontal intrabony defects on both a clinical and radiographic level. 30 stage III grade B periodontitis patients with bilateral intrabony defects were involved in the split mouth randomized controlled trial, and they received either DFDBA alone (control group) or DFDBA plus CGF membrane treatment (test group). At baseline and 6 and 12months, the gingival index (GI), plaque index (PI), probing pocket depth (PPD), clinical attachment level (CAL), and gingival recession (GR) were assessed, whereas cone beam computed tomography was used to assess the bone defect height (BDH), vertical bone loss (VBL), bone defect depth (BDD), mesio-distal bone defect width (MDBDW), bucco-lingual bone defect width (BLBDW), and bone defect volume (CBCT) at baseline and 12months. The radiographic measures BDH, BDD, MDBDW, BLBDW, and BDV in the test group likewise showed a higher reduction in PPD and gain in CAL than the control group. The results of the intergroup comparison showed that the test group had statistically significant differences in BDH, BDD, and MDBDW. The data show that the test group achieved better results, with greater reductions in PPD, gains in CAL, and decreases in BDH, BDD, MDBDW, BLBDW, and BDV. The use of concentrated growth factor in conjunction with demineralized freeze-dried bone allograft may be suggested for the treatment of periodontal intrabony defects.

Ridge augmentation using autologous concentrated growth factors enriched bone graft matrix versus guided bone regeneration using native collagen membrane in horizontally deficient maxilla: A randomized clinical trial.

Facial resorption of maxillary alveolar ridges is a challenging situation for implant rehabilitation, which mandates a preparatory surgery of bone augmentation. Guided bone regeneration using a 1:1 mixture of autogenous particulate and anorganic bovine bone mineral (ABBM) showed reliable outcomes in treating horizontally deficient ridges. Twenty-eight patients were randomly assigned into two groups; in the control group, the 1:1 mixture of particulate autogenous bone and ABBM was covered with native collagen membrane, while in the study group, it was mixed with autologous fibrin glue (AFG) to make a sticky bone that was covered by concentrated growth factor (CGF) membrane. For each proposed implant site, the average bone width gain was calculated preoperatively, immediately after augmentation and after 6 months. Implants were placed after 6 months and the implant stability quotient (ISQ) was measured after insertion and after 6 more months. The graft consolidation period went uneventful in both groups; however, two cases in the sticky bone group showed total resorption of the graft upon re-entry. The mean horizontal bone width after 6months was 9 mm ± 0.71 in the guided bone regeneration (GBR) group which was higher than 7.9 mm ± 0.92 for the sticky bone group. The mean primary stability was higher in the GBR group; 67.19 ± 2.23 compared to 66.7± 3.22 for the sticky bone group, while the mean secondary stability was higher in the sticky bone group; 72 ± 2.15 compared to 71.7± 2.27 for the GBR group. Results of Shapiro-Wilk's for bone width data and model residuals were both statistically not significant (p> 0.05). Comparing CGF membrane versus native collagen membrane as barriers for GBR showed no statistically significant difference regarding bone gain. However, from a clinical point of view, CGF membrane is not a predictable barrier for guided bone regeneration.

Radiographic outcomes of lateral sinus floor elevation with and without bone window repositioning: one-year results of a randomized controlled trial

The objective of this study was to perform a comparative evaluation of the radiographic outcomes of lateral sinus floor elevation with and without bone window repositioning (BLSFE and LSFE, respectively) when applied concomitantly with implant placement. A randomized controlled clinical trial was conducted between February 1, 2016 and May 1, 2017 including 26 individuals with at least one missing tooth. Participants were randomized 1:1 to undergo BLSFE (10 participants, 16 implants) or LSFE (13 participants, 19 implants). Bovine-derived xenograft was used in both groups and the implants were inserted concomitantly. In the BLSFE group, the antrostomy was covered with a repositioned bone window and then with a concentrated growth factors (CGF) membrane. In the LSFE group, the antrostomy was covered with a CGF membrane. Panoramic radiographs were taken before surgery (T0), immediately postoperative (T1), and at 12 months postoperative (6 months after loading) (T2). Marginal bone loss (MBL), apical bone gain, augmented alveolar bone height, and intra-sinus bone augmentation were evaluated on panoramic radiographs at T2. A linear regression analysis with generalized estimating equation models was performed. The implant survival rate was 100% at 1 year after implant surgery. The residual alveolar bone height at T0 was comparable in the BLSFE and LSFE groups (3.58 ± 1.49 mm vs 4.12 ± 1.61, P = 0.32), as was the alveolar bone height at T1 (13.61 ± 1.82 mm vs 12.38 ± 1.82 mm, P = 0.06). At T2, significantly higher alveolar bone height, intra-sinus bone augmentation, and apical bone gain, and lower distal MBL were observed in the BLSFE group when compared to the LSFE group, with adjusting for covariates (β = 2.44, 95% CI 1.42–3.46, P < 0.0001; β = 2.38, 95% CI 1.35–3.41, P < 0.0001; β = 2.33, 95% CI 1.23–3.42, P < 0.0001; and β = −0.43, 95% CI −0.83 to −0.02, P = 0.038, respectively). No significant difference was observed for mesial MBL or apical bone resorption at T2. Lateral sinus floor elevation with bone window repositioning may result in higher bone augmentation after 1 year than the traditional approach. Further research is needed to elucidate the effect of lateral sinus floor elevation with bone window repositioning.

Effect of Concentrated Growth Factor on Distraction Osteogenesis of Dental Implant Distractors

The periosteum of bone segments can be destroyed during the installation of a dental implant distractor (DID) device, resulting in bone defects on the exposed side of the distraction gap. The purpose of this animal experiment is to explore the application of concentrated growth factor (CGF) in DID surgery, which can induce angiogenesis and osteogenesis and improve osteogenesis defects caused by periosteum loss on the exposed side of bone segments. CGF is the latest generation of platelet concentrate. Twenty-four DID devices inserted into the tibias of 8 goats were evenly divided into the CGF and control groups. Following 10days of distraction and a 12-week consolidation period, all 8 animals were euthanized to retrieve their tibias. The distraction gap between each segment was measured at 5 points, and the average value was taken as the computed tomography (CT) value of the distraction gap at 4, 8, and 12weeks after distraction. The vascular density and trabecular bone volume of each DID distraction gap were determined and statistically compared between the 2 groups. The CT value of the distraction gap increased gradually in control groups at 4, 8, and 12weeks after distraction to 319.3±14.6, 449.3±34.4, and 614.0±15.6 HU in the control group and 368.3±8.8, 544.5±12.3, and 661.0±8.1 HU in the CGF group. The trabecular bone volume was 281.7±16.5 and 209.7±21.6μm2 in the CGF group and control group. The vascular density was 17.7±2.1 and 11.7±1.9 in the CGF group and control group. Statistically significant differences were observed in the CT value (P=.002), vascular density (P=.023), and trabecular bone volume (P=.010) between the CGF and control groups. The application of an autogenous CGF membrane in DID surgery repaired bone defects caused by osteolysis around osteotomy segments.

Evaluation of the efficacy of sticky bone and concentrated growth factor membrane along with a coronally advanced flap as compared to coronally advanced flap alone in the treatment of Miller's Class I and Class II gingival recession defects.

Gingival recessions are commonly seen in the dentally cognizant population as well as those with limited access to dental attention. When root coverage is planned, the ultimate goal is to obtain complete root coverage, thus restoring the lost gingival unit covering the root. To determine the efficacy of sticky bone and concentrated growth factor (CGF) membrane along with a coronally advanced flap (CAF) as compared to CAF alone in treating Miller's Class I and Class II gingival recessions (Cairo RT1). The current study was a randomized double-blind controlled trial on 15 subjects using a split-mouth design. Fifteen subjects who were systemically healthy and had recession sites (30 sites) were randomly assigned to two groups: Group A (test group = CAF + CGF + sticky bone) and Group B (control group = CAF alone). Clinical outcome was assessed with parameters such as recession depth, recession width, keratinized gingival width, gingival mucosal thickness, and relative attachment level (RAL), and these were assessed at baseline and 1, 3, and 6 months. A distinct improvement was observed in the depth and width of recession, RAL, keratinized gingival width, and mucosal thickness of the gingiva in the two groups from baseline to 6 months. Statistical significance was not seen on intergroup comparisons. Thus, clinical outcomes revealed noticeable improvement for both the groups. However, statistically, the efficacy of CGF and sticky bone was not perceived to be superior to that of CAF alone.

Clinical applications of concentrated growth factors combined with bone substitutes for alveolar ridge preservation in maxillary molar area: a randomized controlled trial

PurposeTo evaluate the clinical effects of concentrated growth factors (CGFs) combined with bone substitutes for alveolar ridge preservation (ARP) in the maxillary molar area.MethodsThirty-six patients who underwent extraction of the upper molars were recruited and randomly divided into three groups: 1. Grafted with CGFs combined with deproteinized bovine bone mineral (DBBM) and covered with CGFs membrane (CGFs/DBBM group), 2. Grafted with DBBM alone and covered with collagen membrane (DBBM group), 3. Control group spontaneous healing. The area of the alveolar bone in center (C-), mesial (M-) and distal (D-) section was compared with preoperative in radiography. Bone cores were obtained for histopathology observation and comparison.ResultsIn C-, M- and D-section, the alveolar ridge area in all three groups was significantly reduced at 8 months postoperatively compared to the baseline (P < 0.05). The alveolar ridge area declines in the CGFs/DBBM group (C-12.75 ± 2.22 mm2, M-14.69 ± 2.82 mm2, D-16.95 ± 4.17 mm2) and DBBM group (C-14.08 ± 2.51 mm2, M-15.42 ± 3.47 mm2, D-16.09 ± 3.97 mm2) were non-significant differences. They were significantly less than the decline in the control group (C-45.04 ± 8.38 mm2 M-31.98 ± 8.34 mm2, D-31.85 ± 8.52 mm2) (P < 0.05). The percentage of newly formed bone in the CGFs/DBBM group (41.99 ± 12.99%) was significantly greater than that in DBBM group (30.68 ± 10.95%) (P < 0.05). The percentage of residual materials in the CGFs/DBBM group (16.19 ± 6.63%) was significantly less than that in the DBBM group (28.35 ± 11.70%) (P < 0.05).ConclusionCombined application of CGFs and DBBM effectively reduced the resorption of alveolar ridge and resulted in more newly formed bone than the use of DBBM with collagen membranes.

Short-Term Evaluation of Guided Bone Reconstruction with Titanium Mesh Membranes and CGF Membranes in Immediate Implantation of Anterior Maxillary Tooth.

Purpose The aim of the present prospective study was to evaluate the effect of titanium mesh and concentrated growth factor (CGF) membranes in reconstructing severe labial bone defects during immediate implantation of anterior maxillary tooth. Methods Patients with severe defects presenting on the anterior labial bone plate of maxillary were enrolled in this study. During immediate implantation, the titanium mesh was used to maintain the space of bone graft, collagen membrane, and xenograft bone that were used to guide bone regeneration (GBR). Cone beam computed tomography (CBCT) was used to measure the height and the labial bone thickness around the implant at the time of the second stage surgery, 6 months, 1 year, and 2 years after restoration. The pink esthetic score (PES) was used to evaluate the esthetic outcomes after restoration. Results 18 patients were enrolled in this study. The survival rate of implants was 100%, and no complication was observed, except for 1 case of titanium mesh exposure which did not affect osteogenesis. In the second stage of surgery, the labial bone was completely reconstructed, and the top of the implant was covered with a small amount of new bone. The thickness of the labial bone was 3.01 mm (±0.23), 2.96 mm (±0.21), 2.93 mm (±0.19), and 2.92 mm (±0.16) at the time of the second stage surgery, 6 months, 1 year, and 2 years after restoration, respectively. The height of the marginal bone around implants was above the top of implant at the time of the second stage surgery and then reduced 0.72 mm (±0.07), 0.91 mm (±0.08), and 0.90 mm (±0.07) at the time point of 6 months, 1 year, and 2 years after restoration, respectively. The changes of bone thickness and height were statistically significant within one year, but stable after one year. The PES values showed the same tendency. Conclusions With the limitation of the present prospective study, the combination of titanium mesh and CGF membrane could provide space maintenance for bone augmentation of alveolar bone defects and improve the bone regeneration in patients with severe labial bone defect when immediate implant of anterior maxillary.

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

Background/purposeResearch 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 methodsSeventy 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. ResultsComplete 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. ConclusionDigital 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.

Mechanical Properties of Human Concentrated Growth Factor (CGF) Membrane and the CGF Graft with Bone Morphogenetic Protein-2 (BMP-2) onto Periosteum of the Skull of Nude Mice.

Concentrated growth factor (CGF) is 100% blood-derived, cross-linked fibrin glue with platelets and growth factors. Human CGF clot is transformed into membrane by a compression device, which has been widely used clinically. However, the mechanical properties of the CGF membranes have not been well characterized. The aims of this study were to measure the tensile strength of human CGF membrane and observe its behavior as a scaffold of BMP-2 in ectopic site over the skull. The tensile test of the full length was performed at the speed of 2mm/min. The CGF membrane (5 × 5 × 2 mm3) or the CGF/BMP-2 (1.0 μg) membrane was grafted onto the skull periosteum of nude mice (5-week-old, male), and harvested at 14 days after the graft. The appearance and size of the CGF membranes were almost same for 7 days by soaking at 4 °C in saline. The average values of the tensile strength at 0 day and 7 days were 0.24 MPa and 0.26 MPa, respectively. No significant differences of both the tensile strength and the elastic modulus were found among 0, 1, 3, and 7 days. Supra-periosteal bone induction was found at 14 days in the CGF/BMP-2, while the CGF alone did not induce bone. These results demonstrated that human CGF membrane could become a short-term, sticky fibrin scaffold for BMP-2, and might be preserved as auto-membranes for wound protection after the surgery.

CGF Membrane Promotes Periodontal Tissue Regeneration Mediated by hUCMSCs through Upregulating TAZ and Osteogenic Differentiation Genes.

Concentrated growth factor (CGF) membranes are widely used in basic and clinical research of soft and hard tissue regeneration, but its effect on periodontal tissue regeneration is less studied. This study explored the role of CGF membranes in periodontal tissue regeneration mediated by human umbilical cord mesenchymal stem cells (hUCMSCs). HUCMSCs and human periodontal ligament fibroblasts (HPLFs) were extracted and identified by microscope and flow cytometry. The effects of the extracted CGF membrane on cell viability, osteogenic differentiation ability, osteopontin (OPN) expression, alkaline phosphatase (ALP) content, and osteogenic differentiation-related genes (Runt-related transcription factor 2 (RUNX2); osteocalcin (OCN); ALP), Tafazzin (TAZ) expression, and nuclear transfer were examined by MTT assay, alizarin red staining, immunofluorescence, enzyme-linked immunosorbent assay (ELISA), quantitative real-time polymerase chain reaction (qRT-PCR), and Western blot. Rescue experiments were performed to examine the effects of TAZ transfection and cell coculture. In the identified hUCMSCs (positive expressions of CD29, CD44, CD146, and CD105), overexpressed TAZ (pc-TAZ) enhanced the promotive effect of CGF membrane on cell viability, cell cycle, mineralization, ALP content and expressions of OPN, TAZ and osteogenic differentiation-related genes, and nuclear transfer. However, silencing TAZ showed opposite effects. The coculture of hUCMSCs and HPLFs further promoted the basic biological functions of HPLFs by upregulating osteogenic differentiation-related genes and COL-1 but downregulated MMP1 expression. Pc-TAZ could enhance the effect of CGF membrane on promoting periodontal tissue regeneration. CGF membrane promoted periodontal tissue regeneration through upregulating TAZ and osteogenic differentiation-related genes.

Application of Concentrated Growth Factors Membrane for Human Umbilical Cord Wharton’s Jelly Mesenchymal Stem Cell Differentiation towards Keratinocytes

Concentrated growth factors are extracted from platelet-rich plasma obtained from healthy adult veins by physical gradient centrifugation, and the activated platelets release various growth factors and cytokines, which can be further converted into concentrated growth factors liquid or gel preparations by different centrifuge tubes. These preparations are widely used in clinical treatments in various fields, such as dentistry, dermatology and surgery. In this article, concentrated growth factors gel and platelet-poor plasma gel obtained from six healthy adults were pressed into a concentrated growth factors membrane and platelet-poor plasma membrane. We examined whether the 3D fibrin mesh and the various concentrated growth factors within the concentrated growth factors membrane could be used as a bioscaffold for the human Wharton’s jelly umbilical cord stem cell line or the HaCaT cell line to attach, proliferate and form epidermal-like tissue. We also aimed to implant umbilical cord stem cells on the concentrated growth factors membrane or platelet-poor plasma membrane, and further compare the characteristics of similar tissues after 4 weeks in in vitro culture. The results showed that human Wharton’s jelly umbilical cord mesenchymal stem cells, implanted on the upper surface of the concentrated growth factors membrane, showed subsequent cell attachment and proliferation. After 4 weeks of ex vivo tissue culture, a multi-layer epidermal-like tissue formed on the upper surface of the membrane containing concentrated growth factors. This tissue had a minimum thickness of 89.91 µm to a maximum of 204.19 µm, mean ± SD = 144.36 µm ± 43.14 µm. Sections of these multi-layer epidermal-like tissues were used for immunohistochemical staining. We found that 79.8% ± 7.2% of the cells expressed the pancytokeratin marker, 29.5% ± 9.4% of the cells expressed the P63 marker, and 71.7% ± 3.9% of the cells expressed the vimentin marker. After the same 4 weeks in the in vitro culture, the HaCaT cells could attach to the concentrated growth factors membrane and proliferate to form a multi-layer tissue, The tissue had a minimum thickness of 63.17 µm to a maximum of 100.26 µm, mean ± SD = 74.05 µm ± 13.44 µm. We found that 88.1% ± 4.9% of the cells expressed the pancytokeratin marker, 63.6% ± 11.4% of the cells expressed the P63 marker, and 79% ± 9.9% of the cells expressed the vimentin marker. Also, after 4 weeks in the in vitro culture, it showed that umbilical cord stem cells could attach to the platelet-poor plasma membrane, proliferate and distribute in the whole-tissue sections. We found that 9.7% ± 2.4% of the cells expressed the pancytokeratin marker, 7.45% ± 1.9% of the cells expressed the P63 maker, and 95.9% ± 3.7% of the cells expressed the vimentin marker. In terms of the percentage of umbilical cord stem cells expressing pancytokeratin, P63, or vimentin cell markers, there was a significant difference between cultivating in the concentrated growth factors membrane scaffold and the platelet-poor plasma membrane scaffolds. In terms of the percentage of umbilical cord stem cells or HaCaT cells (cultivating in the concentrated growth factors membrane) expressing pancytokeratin, P63, or vimentin cell markers, there was no significant difference. These results suggested that umbilical cord Wharton’s jelly mesenchymal stem cells can use the concentrated growth factors membrane (composed of 3D fibrin mesh, and various growth factors and cytokines) as an effective and self-contained bioscaffold to differentiate towards keratinocytes-like cells. In the future, donors’ own concentrated growth factors membrane can be applied as an auxiliary tool for autologous tissue regeneration.

Human Fresh Fibrin Membrane with Bone Morphogenetic Protein-2 (BMP-2) Induces Bone Formation in the Subcutaneous Tissues of Nude Mice.

Autologous blood-derived fibrin glue with platelets, called the concentrated growth factor (CGF), can be prepared immediately by only the decided centrifuge without the addition of coagulation factors. Collagen materials combined with recombinant human BMP-2 have been commercially available for clinical use. The fresh CGF is auto-clot with wettability and elasticity, while most collagen membranes are derived from the cow or pig. The fresh CGF has wettability and elasticity, while collagen membranes are dry materials without elasticity. The aim of this study was to observe the microstructures of human CGF membrane and evaluate its behavior as a delivery scaffold of rhBMP-2 in the subcutaneous tissues of nude mice. Twenty-four nude mice (5-week-old, male) were used for the assessment of in vivo ectopic bone formation. Mice were received the CGF membrane as the controls and the CGF/rhBMP-2 membrane as the experimental group in the subcutaneous tissues, and harvested at 7, 10, and 14 days after the graft. Harvested samples were evaluated for the histological examination and the histomorphometric measurement was conducted to compare the residue of the CGF, as well as the new bone. Mature fibrin fibers assembled from multiple fibrillary elements and platelets with the rhBMP-2 membrane induced several bony islands and cartilage without residues of CGF at 14 days, while the CGF membrane alone was almost absorbed at 10 days and failed to induce bone formation at 14 days. These results demonstrated that the fresh, human CGF membrane could contribute to a short-term, sticky fibrin matrix for the delivery of rhBMP-2.

Gingival recession treatment with concentrated growth factor membrane: a comparative clinical trial.

Objective This clinical trial sought to evaluate the clinical effectiveness of concentrated growth factor (CGF) and compare it with connective tissue graft (CTG) with coronally advanced flap (CAF) in the treatment of Miller Class I gingival recessions (GR).Methodology This split-mouth study included 74 Miller Class I isolated (24 teeth) or multiple (50 teeth) GRs in 23 jaws of 19 patients. GRs were randomly treated using CGF (test group: 37 teeth; 12 teeth in isolated GRs, 25 teeth in multiple GRs) or CTG with CAF (control group: 37 teeth;12 teeth isolated GRs, 25 teeth in multiple GRs). Clinical variables, plaque index (PI), gingival index (GI), probing depth (PD), recession depth (RD), recession width (RW), clinical attachment level (CAL), keratinized tissue thickness (KTT), keratinized tissue width (KTW), and root coverage (RC) were assessed at the baseline as well as at three and six months post-surgery. Healing index (HI) were obtained in the second and third weeks post-surgery. Postoperative pain was assessed for the first seven days using a horizontal visual analog scale (VAS).Results No significant change was observed in PI, GI, or PD values in either the intergroup or the intragroup comparisons. A statistically significant decrease was observed in CAL, RD, and RW, and KTT increased in all groups at three and six months compared with the baseline. The control group had greater increases in KTW, KTT, and RC at three and six months. No significant difference was found in CAL or RD at the third and sixth months between the two groups. Healing was found to be similar for both groups in the second and third weeks post-surgery. The VAS values in the control group were higher than in the test group, especially at the second, fourth, fifth, and seventh days postoperatively.Conclusions CTG is superior to CGF with CAF for increasing KTT, KTW, and RC. CGF may be preferable due to decreased postoperative pain.