Biologics‐based regenerative technologies for periodontal soft tissue engineering

Tavelli, Lorenzo; McGuire, Michael K.; Zucchelli, Giovanni; Rasperini, Giulio; Feinberg, Stephen E.; Wang, Hom‐Lay; Giannobile, William V.

doi:10.1002/jper.19-0352

Cited by 35 publications

(57 citation statements)

References 64 publications

(128 reference statements)

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“…Therefore, given the evidence supporting CTG as the gold standard treatment in terms of amount of root coverage (Cairo et al., 2014; Graziani et al., 2014, Tavelli, Ravida et al, 2019), it is not surprising that CTG achieved significantly higher overall RES and GM compared to XCM, EMD and flap alone. Similarly, other techniques, such as ADM, EMD, PRF and TEC, showed superior scores for GM compared with flap, which is due to higher root coverage outcomes that these treatments can achieve when CAF or TUN are combined with a scaffold material or a biologic agent (Cairo et al., 2014; Tavelli et al., 2020a, 2020b).…”

Section: Discussionmentioning

confidence: 99%

Aesthetic‐And patient‐related outcomes following root coverage procedures: A systematic review and network meta‐analysis

Cairo

Barootchi

Tavelli

et al. 2020

J Clinic Periodontology

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Background: Aim of this systematic review (SR) of randomized controlled trials (RCTs) was to evaluate effect of different flap designs and graft materials for root coverage, in terms of aesthetics, patient satisfaction and self-reported morbidity (post-operative pain/discomfort). Material and Methods: A comprehensive literature search was performed. A mixedmodelling approach to network meta-analysis was utilized to formulate direct and indirect comparisons among treatments for Root Coverage Esthetic Score (RES), with its individual components, and for subjective patient-reported satisfaction and postoperative pain/discomfort (visual analogue scale (VAS) of 100). Results: Twenty-six RCTs with a total of 867 treated patients (1708 recessions) were included. Coronally Advanced Flap (CAF) + Connective Tissue Graft (CTG) (0.74 (95% CI [0.24, 1.26], p = .005)), Tunnel (TUN) + CTG (0.84 (95% CI [0.15, 1.53]), p = .01) and CAF + Graft substitutes (GS) (0.55 (95% CI [0.006, 1.094], p = .04)) were significantly associated with higher RES than CAF. No significant difference between CAF + CTG and TUN + CTG was detected (0.09 (95% CI [−0.54, 0.72], p = .77)). Addition of CTG resulted in less natural tissue texture (−0.21 (95% CI [−0.34, −0.08]), p = .003) and gingival colour (−0.06 (95% CI [−0.12, −0.03], p = .03)) than CAF. CTG techniques were associated with increased morbidity. Conclusions: Connective tissue graft procedures showed highest overall aesthetic performance for root coverage, although graft integration might impair soft tissue colour and appearance. Additionally, CTG-based techniques were also correlated with a greater patient satisfaction and morbidity.

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Section: Discussionmentioning

confidence: 99%

Aesthetic‐And patient‐related outcomes following root coverage procedures: A systematic review and network meta‐analysis

Cairo

Barootchi

Tavelli

et al. 2020

J Clinic Periodontology

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“…[15][16][17][18]. Moreover, although these materials showed superior patient-related outcomes (pain perception and discomfort) than CTG-based treatments, their clinical results were still inferior to the autogenous graft [6,16,19].…”

Section: Introductionmentioning

confidence: 99%

Platelet-Rich Fibrin in Single and Multiple Coronally Advanced Flap for Type 1 Recession: An Updated Systematic Review and Meta-Analysis

et al. 2021

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Background and Objectives: The aim of the present systematic review and meta-analysis was to investigate the efficacy of leukocyte–platelet-rich fibrin (L-PRF) in addition to coronally advanced flap (CAF) for the treatment of both single and multiple gingival recessions (GRs) compared to the CAF alone and to the adjunct of connective tissue graft (CTG). Root coverage outcomes using platelet concentrates have gained increased interest. In particular, it has been suggested that adding L-PRF to CAF may provide further benefits in the treatment of GRs. Materials and Methods: An electronic and manual literature search was conducted to identify randomized controlled trials (RTCs) investigating root coverage outcomes with CAF + L-PRF. The outcomes of interest included mean root coverage (mRC), recession reduction, keratinized tissue width (KTW) gain, gingival thickness (GT) gain, and patient-reported outcome measures (PROms) such as pain perception and discomfort. Results: A total of 275 patients and 611 surgical sites were analyzed. L-PRF in adjunct to single CAF seems to show statistically significant results regarding clinical attachment level (CAL) with a weighted means (WM) 0.43 95% CI (−0.04,0.91), p < 0.0001, GT (WM 0.17 95% CI (−0.02,0.36), p < 0.0001, and mRC (WM 13.95 95% CI (−1.99,29.88) p < 0.0001, compared to single CAF alone. Interesting results were obtained from the adjunct of PRF to multiple CAF with respect to multiple CAF alone with an increase in the mRC WM 0.07 95% CI (−30.22,30.35), p = 0.0001, and PPD change WM 0.26 95% CI (−0.06,0.58), p < 00001. On the other hand, no statistically significant data were obtained when L-PRF was added to single or multiple CAF combined with CTG according to the included outcomes such as mRC (p = 0.03 overall). Conclusions: L-PRF is a valid alternative to CAF alone. L-PRF compared to CTG in single and multiple CAF showed statistically significant results regarding pain perception and discomfort PROms (p < 0.0001). However, CTG remains the gold standard for treating gingival recession.

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“…Several soft tissue graft materials have been used as alternatives to the gold standard CTG to reduce patient morbidity (Tavelli, Barootchi, Cairo, et al 2019; Tavelli, Barootchi, Di Gianfilippo, et al 2019; McGuire et al 2020). In particular, achieving periodontal regeneration while treating GRs has largely been attempted with guided tissue regeneration or the use of enamel matrix derivative (Tavelli, Barootchi, Cairo, et al 2019; Tavelli et al 2020a). Therefore, it is not surprising that rhPDGF has been investigated as a CTG alternative for root coverage purposes (McGuire et al 2009; McGuire et al 2014).…”

Section: Discussionmentioning

confidence: 99%

“…However, a greater keratinized tissue width was found for CTG, supporting the speculation that the induction of keratinization of the overlying epithelium is a property of CTG only (Tavelli et al 2020b; Zucchelli et al 2020). While further studies are advocated to better evaluate all of the benefits of rhPDGF in root coverage procedures, the current evidence supports the use of rhPDGF when the aim is to treat GRs while promoting periodontal regeneration (Tavelli et al 2020a).…”

Section: Discussionmentioning

confidence: 99%

Recombinant Human Platelet–Derived Growth Factor: A Systematic Review of Clinical Findings in Oral Regenerative Procedures

Tavelli

Ravidà

Barootchi

et al. 2020

JDR Clinical & Translational Research

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Aim: The use of recombinant human platelet-derived growth factor–BB (rhPDGF) has received Food and Drug Administration approval for the treatment of periodontal and orthopedic bone defects and dermal wound healing. Many studies have investigated its regenerative potential in a variety of other oral clinical indications. The aim of this systematic review was to assess the efficacy, safety, and clinical benefit of recombinant human platelet-derived growth factor (rhPDGF) use for alveolar bone and/or soft tissue regeneration. Material and Methods: Comprehensive electronic and manual literature searches according to the PRISMA guidelines were performed to identify interventional and observational studies evaluating the regenerative applications of rhPDGF-BB. The primary outcomes were the safety, efficacy, and overall clinical benefit of rhPDGF use in oral regenerative procedures. Results: Sixty-three human clinical studies (mean ± SD follow-up period of 10.7 ± 3.3 mo) were included in the qualitative analysis. No serious adverse effects were reported in any of the 63 studies, aside from the postoperative complications routinely associated with surgical therapy. Use of rhPDGF was shown to be beneficial when combined with allografts, xenografts, and alloplasts (the latter tricalcium phosphate [β-TCP]) for the treatment of periodontal defects and gingival recession. The use of rhPDGF also led to favorable clinical outcomes when combined with allografts or xenografts for guided bone regeneration (GBR) and alveolar ridge preservation. While favorable clinical results support the use of the combination of rhPDGF plus allograft or xenograft for GBR, ARP, and sinus floor augmentation, current data support the use of rhPDGF and alloplasts (e.g., β-TCP) only in periodontal defects and gingival recession. Conclusions: Based on the clinical evidence, rhPDGF is safe and provides clinical benefits when used in combination with bone allografts, xenograft, or β-TCP for the treatment of intrabony and furcation periodontal defects and gingival recession or when used with allografts or xenograft for GBR and ARP (PROSPERO CRD42020142446). Knowledge Transfer Statement: Clinicians should be aware that rhPDGF is a safe and effective approach for the treatment of intrabony and furcation periodontal defects and gingival recession or when used with allografts or xenograft for bone regeneration and alveolar ridge preservation. With consideration of cost and patient preference, this result could lead to more appropriate therapeutic decisions.

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Biologics‐based regenerative technologies for periodontal soft tissue engineering

Cited by 35 publications

References 64 publications

Aesthetic‐And patient‐related outcomes following root coverage procedures: A systematic review and network meta‐analysis

Aesthetic‐And patient‐related outcomes following root coverage procedures: A systematic review and network meta‐analysis

Platelet-Rich Fibrin in Single and Multiple Coronally Advanced Flap for Type 1 Recession: An Updated Systematic Review and Meta-Analysis

Recombinant Human Platelet–Derived Growth Factor: A Systematic Review of Clinical Findings in Oral Regenerative Procedures

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