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

Abstract

Aim This review critically appraises the available knowledge on the pre‐clinical and clinical use of bioactive factors for bone regeneration in the cranial and maxillofacial area. Materials and Methods The use of growth factors, amelogenins and autologous platelet concentrates (APCs) for bone regeneration was reviewed in a systematic manner. More specifically, pre‐clinical and clinical studies on ridge preservation, alveolar ridge augmentation, regeneration of peri‐implant defects and sinus augmentation models were considered. Results Amongst different bioactive factors, the highest pre‐clinical and clinical evidence of a positive effect on bone formation is associated with rhBMP‐2 and the lowest with amelogenins. While APCs seem to accelerate clinical healing and reduce postoperative discomfort, there is insufficient and contrasting evidence of a significant effect on hard tissue regeneration for the different clinical applications. Conclusions Although there is increasing evidence that bioactive factors might enhance the bone regeneration process, the great heterogeneity of the available studies and the limited number of RCTs do not allow to draw robust conclusions. Issues that still need to be investigated include the optimal carriers for bioactive agents (direct vs. indirect), the dosage, the timing of administration, as well as the possibility of combining different agents to promote synergistic effects.

Red and Yellow Injectable Platelet-Rich Fibrin Demonstrated Differential Effects on Periodontal Ligament Stem Cell Proliferation, Migration, and Osteogenic Differentiation

“…Growth factors are crucial for promoting osteogenesis and neo-angiogenesis by recruiting mesenchymal stem cells and inducing cell differentiation. The growth factors previously found in i-PRF are VEGF, PDGF, and TGF-β1, which can either directly induce new bone formation or indirectly promote bone healing [ 15 , 20 ]. The bone-morphogenic protein-2 release profile from i-PRF was inferior compared with a natural blood clot, but exhibited a better correlation between protein level and mineralization [ 21 ].…”

Management of the extraction socket and timing of implant placement: Consensus report and clinical recommendations of group 3 of the XV European Workshop in Periodontology

“…Based on strong pre‐clinical evidence (Haugen, Lyngstadaas, Rossi, & Perale, ; Donos, Dereka, & Calciolari, ; Omar, Elgali, Dahlin, & Thomsen, ), five different approaches that have been documented to a different degree in clinical studies are illustrated in Figure . The evidence pertains mostly to single tooth replacement, and thus, extrapolation to other scenarios may not apply.…”

Histological comparison of DBBM and platelet rich fibrin for guided bone regeneration in a rabbit model

“…24 A recent review concluded that there is insufficient evidence to show that autologous platelet concentrates provide an additional benefit in the regeneration of hard tissues, beyond their benefit in soft tissues and post-surgical discomfort reduction in oral surgery. 25 Regarding connective tissue percentage, there was only a significant difference between the DBBM + L-PRF and the control group, showing the latter more connective tissue at 3 weeks. There were no significant differences between groups with regards to this parameter at other time intervals, but nevertheless, there was a trend of less connective tissue percentage in both groups that used DBBM, combined or not with L-PRF.…”