Twenty-five years of recombinant human growth factors rhPDGF-BB and rhBMP-2 in oral hard and soft tissue regeneration.

Contemporary oral tissue engineering strategies involve recombinant human growth factor approaches to stimulate diverse cellular processes including cell differentiation, migration, recruitment, and proliferation at grafted areas. Recombinant human growth factor applications in oral hard and soft tissue regeneration have been progressively researched over the last 25 years. Growth factor-mediated surgical approaches aim to accelerate healing, tissue reconstruction, and patient recovery. Thus, regenerative approaches involving growth factors such as recombinant human platelet-derived growth factor-BB (rhPDGF-BB) and recombinant human bone morphogenetic proteins (rhBMPs) have shown certain advantages over invasive traditional surgical approaches in severe hard and soft tissue defects. Several clinical studies assessed the outcomes of rhBMP-2 in diverse clinical applications for implant site development and bone augmentation. Current evidence regarding the clinical benefits of rhBMP-2 compared to conventional therapies is inconclusive. Nevertheless, it seems that rhBMP-2 can promote faster wound healing processes and enhance de novo bone formation, which may be particularly favorable in patients with compromised bone healing capacity or limited donor sites. rhPDGF-BB has been extensively applied for periodontal regenerative procedures and for the treatment of gingival recessions, showing consistent and positive outcomes. Nevertheless, current evidence regarding its benefits at implant and edentulous sites is limited. The present review explores and depicts the current applications, outcomes, and evidence-based clinical recommendations of rhPDGF-BB and rhBMPs for oral tissue regeneration

Platelet‐Derived Growth Factor Promotes Periodontal Regeneration in Localized Osseous Defects: 36‐Month Extension Results From a Randomized, Controlled, Double‐Masked Clinical Trial

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141092/1/jper0456.pd

Platelet‐Derived Growth Factor Stimulates Bone Fill and Rate of Attachment Level Gain: Results of a Large Multicenter Randomized Controlled Trial

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141430/1/jper2205.pd

A Novel Surgical Approach to Modify the Periodontal Phenotype for the Prevention of Mucogingival Complications Related to Orthodontic Treatment.

Certain bone morphologies and soft tissue thickness (ie, phenotype) are considered to be risk factors for the development of gingival recessions following orthodontic tooth movement. Preoperative evaluation of the periodontal phenotype, in the frame of orthodontic treatment plan, identify teeth at high risk for mucogingival complications related to orthodontic therapy. The new surgical technique is illustrated in a clinical case. A patient with a thin phenotype without visible gingival recession had bone dehiscences in the anterior mandible. Prior to orthodontic treatment, simultaneous bone and soft tissue augmentation was performed using the combination of a highly cross-linked ribose porcine type I collagen membrane and a subepithelial palatal connective tissue graft. Two years after augmentation surgery and initiation of orthodontic treatment, a thick buccal tissue with a wide band of attached gingiva was observed without any clinical signs of root prominences, indicating a substantial change in periodontal phenotype. The clinical findings were corroborated by the 3D analysis, demonstrating substantial bone apposition on the buccal aspect of all roots in the treated area. The described surgical technique offers a valuable approach for regenerating hard and soft tissues in deficient areas prior to orthodontic therapy, thus preventing the development of gingival recessions

Clinical outcomes of maxillary anterior postextraction socket implants with immediate provisional restorations using a novel macro-hybrid implant design: an 18-to 24-month single-cohort prospective study

Extraction and immediate implant placement/restoration in the esthetic zone is clinically challenging; benefits include fewer surgical appointments and maintenance of peri-implant soft tissues throughout the treatment period, and limitations include gingival recession and bone dehiscence during surgery. Macrohybrid implants (large-diameter apical/narrow-diameter occlusal) were placed in 19 patients immediately following the extraction of hopeless maxillary anterior teeth. Immediate restorations were fabricated without occlusal contacts. Pre- and postplacement cone beam computed tomography (CBCT) scans were taken. Nineteen implants were available for recall 13 to 25 months postoperatively. The overall implant cumulative survival rate was 100% (range: 13 to 25 months, mean: 19 months), and mean insertion torque value was 65 Ncm. Mean Pink Esthetic Score was 12.63 at 6 months, and was 13 at the 18- to 24-month follow-up. Mean mesial and distal tooth-to-implant distances immediately after implant placement were 2.55 +/- 1.29 mm and 2.29 +/- 0.82 mm, respectively. Interproximal bone crest width, distance, and height were maintained at implant platforms, mesially and distally, 18 to 24 months postoperative. The results of this study indicated that the macro-hybrid implant geometry for this immediate surgical/restorative protocol provided excellent and stable 2-year results relative to implant survival (100%), labial plate thickness via CBCT evaluations, tooth-to-implant distances immediately post-implant placement, PES, and interproximal bone crest width, distance, and heights, which were maintained at the implant platforms

Impact of supportive periodontal therapy and implant surface roughness on implant outcome in patients with a history of periodontitis

Objective: This review searched for a relationship between susceptibility to periodontitis and peri-implantitis, with implant outcome as the primary outcome variable and supportive periodontal therapy (SPT) and implant surface roughness as confounding factors.status: publishe

Tissue Integration of a Volume-Stable Collagen Matrix in an Experimental Soft Tissue Augmentation Model.

Reducing the need for a connective tissue graft by using an efficacious biomaterial is an important task for dental professionals and patients. This experimental study aimed to test the soft tissue response to a volume-stable new collagen matrix. The device demonstrated good stability during six different time points ranging from 0 to 90 days of healing with no alteration of the wound-healing processes. The 90-day histologic specimen demonstrates eventual replacement of most of the matrix with new connective tissue fibers

Minimally Invasive Management of Implant-Supported Rehabilitation in the Posterior Maxilla, Part I. Sinus Floor Elevation: Biologic Principles and Materials

Alveolar bone resorption and maxillary sinus pneumatization occurring after dental extraction in the posterior region of the maxilla may be problematic when planning implant-supported rehabilitation. Various regenerative options are available, including guided bone regeneration, bone block grafts, and lateral sinus augmentation. These procedures are associated with significant complication rates, high morbidity, increased therapy duration, and high cost. Less invasive approaches, such as transcrestal sinus floor elevation, and using short implants have been proposed in an attempt to reduce these drawbacks. The aim of this study is to analyze available evidence to suggest predictable options and identify minimally invasive management of implant-supported rehabilitation in the posterior maxilla. This article concerns biologic mechanisms regulating new bone formation after maxillary sinus augmentation and examines characteristics of available implants and grafting materials to help the clinician select the most rational and convenient surgical approach according to specific situations

Minimally Invasive Management of Implant-Supported Rehabilitation in the Posterior Maxilla, Part II. Surgical Techniques and Decision Tree

Insufficient crestal bone is a common feature encountered in the edentulous posterior maxilla due to atrophy of the alveolar ridge and maxillary sinus pneumatization. Numerous surgical techniques, grafting materials, and timing protocols have been proposed for implant-supported rehabilitation of posterior maxillae with limited bone height. In the majority of potential implant sites, residual bone height is less than 8 mm and the clinician has to select either a lateral or transcrestal sinus-elevation technique or placing short implants as the correct surgical option. Nevertheless, guidelines for selecting the best option remains mostly based on the personal experience and skills of the surgeon. The role of sinus anatomy in healing and graft remodeling after sinus floor augmentation is crucial. In addition to the evaluation of residual bone height, the clinician should consider that histologic and clinical outcomes are also influenced by the buccal-palatal bone wall distance. Therefore, three main clinical scenarios may be identified and treated with either a lateral or transcrestal sinus-elevation technique or short implants. This article introduces a new decision tree for a minimally invasive approach based on current evidence to help the clinician safely and predictably manage implant-supported treatment of the atrophic posterior maxilla