Enhancing Generative and Regenerative Implant Treatments

The treatment of bony defects has been challenging clinicians for many years. After tooth extraction, trauma or periodontal disease, it can occur that sites associated with bony defects will not heal completely or properly. In that instance, additional reconstructive surgery is indicated. Different surgical approaches have been proposed for the treatment of such bony defects,  such as Guided Bone Regeneration (GBR). GBR is used to induce the growth of new bone at sites with insufficient volumes or dimensions of hard and soft tissues for proper function and esthetics. GBR is applied to induce new bone growth especially in procedures combined with dental implants. Regenerative procedures in implant surgery are predominantly done with regenerative materials, like bone substitutes and membranes. In the presence of extended bone defects autograft or combinations of autograft and xenograft are preferred.

The main purposes of regenerative materials are: 1. favor angiogenesis to provide necessary blood supply and undifferentiated mesenchymal cells; 2. create and maintain space to facilitate clot formation and bone in-growth; 3. improve stability of the wound to allow uneventful healing.

The use of biomaterials has proven to be of great support to wound healing. Biomaterials can be derived either from nature or synthesized in the laboratory using a variety of chemical approaches. Many products have been reported to improve healing. Countless efforts have been done to find new bioactive additives that may be used during surgery to promote and accelerate healing and to regulate inflammation.

However, it should be underlined that our body also contains powerful biological resources in the blood stream. Blood contains plasma, red and white blood cells and platelets. The healing of hard and soft tissues is regulated by numerous intra- and extracellular events controlled by signalling proteins. The key role played by platelets in many of these processes, especially in the haemostasis and wound healing, has been shown in several studies. By facilitating recruitment, proliferation, and maturation of cells participating in regeneration, platelet concentrates, like Leukocyte- and platelet rich fibrin (L-PRF), improve wound healing.

The advantages of using L-PRF are several: it is of autologous nature, of simple collection, easy chairside preparation, and its clinical application does not entail risks associated with allogenic products. L-PRF is able to stimulate osteogenesis, in addition to angiogenesis. Furthermore, it provides a scaffold that allows cell migration, and these are certainly the fundamental aspects for the process of bone regeneration.

In other words, the application of L-PRF, alone or in combination with other regenerative materials, in the treatment of bony defects might improve regeneration. Proving that this treatment approach provides superior outcomes with respect to a negative control or other regenerative approaches might be of great help to clinicians and patients.