Synergistic effects of the combined use of human‐cultured periosteal sheets and platelet‐rich fibrin on bone regeneration: An animal study

Abstract

A human‐cultured alveolar bone‐derived periosteal (hCP) sheet is an osteogenic grafting material used clinically in periodontal regenerative therapy, while platelet‐rich fibrin (PRF), a platelet concentrate with fibrin clot, is considered to augment the wound healing process. Therefore, whether the combined use of hCP‐PRF complex could facilitate bone regeneration synergistically was evaluated in animal models. Human periosteal segments (1 × 1 mm) were cultured initially on plastic dishes and formed an hCP sheet. The hCP sheet was implanted with freshly prepared human PRF into subcutaneous tissue (hCP: n = 4, hCP + PRF: n = 4) and 4 mm diameter calvarial bone defect models (hCP: n = 4, hCP + PRF: n = 4, control [defect‐only]: n = 4) that prepared in nude mice. At 4 weeks postimplantation, new bone formation was evaluated by using μCT. Cell growth and neovascularization were evaluated by histochemical and immunohistological methods. In the subcutaneous tissue, mineral deposit formation, collagen deposition, and number of vessels were higher in the hCP + PRF group than in the hCP alone group. In the calvarial defect models, new bone formation was significantly higher in the hCP + PRF group than in the hCP alone group and defect‐only control group. The numbers of vessels and PCNA‐positive cells in calvarial defects were also increased in the hCP + PRF group more than in the hCP alone group. Platelet‐rich fibrin preparations support the proliferation and the growth of periosteal cells to form well‐combined active biological materials. Platelet‐rich fibrin also stimulates the local angiogenesis in the implantation site. Therefore, the combined use of hCP and PRF could be clinically applicable in bone regeneration therapy.

Prevascularization promotes endogenous cell-mediated angiogenesis by upregulating the expression of fibrinogen and connective tissue growth factor in tissue-engineered bone grafts

“…Combining platelet-rich fibrin (PRF) with the synthetic material (the combination of hydroxyapatite and β-TCP) resulted in more cortical and subcortical bone formation [ 41 ]. Fibrin preparations can support the proliferation and growth of periosteal cells to form well-combined active biological materials [ 42 ]. Therefore, fibrin could be clinically applicable in bone regeneration therapy.…”

The use of bioactive factors to enhance bone regeneration: A narrative review

“…The combination of PRF with cell therapy has shown promising results. In particular, the addition of PRF to human‐cultured bone‐derived periosteal sheet (Horimizu, Kubota, Kawase, Nagata & Kobayashi, ) and the addition of PRF to sheets of MSCs or to a composite of MSCs and nanoscale HA (Wang et al., ; Wang, Li, Guo, et al., ) increased the amount of regenerated bone in calvarial CSDs. The combination of MSCs with an autologous platelet‐rich fibrin glue and GBR in dog mandibular defects was also associated with significant more bone regeneration in comparison to empty defects, defects treated with GBR or with a combination of MSCs and platelet‐rich fibrin glue at 16 weeks (Liao, Chen, Chen, Chen & Tsai, ).…”

Pedicle Periosteum as a Barrier for Guided Bone Regeneration in the Rabbit Frontal Bone

“…This is important for the healing and maintenance of the vital cambium layer, which has the potential to stimulate bone formation. Recently, the application of isolated periosteum cells (17) and periosteal sheets for bone regenerative therapy (18) has been a focus of research. Although these treatments have a high potential, the obtained osteogenic units are supposed to be transplanted as free grafts in both therapies.…”