Bone augmentation with Concentrated Growth Factors

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Posted on By Luca Mangani In Bone Grafting

In this case I performed a buccal bone augmentation using Concentrated Growth Factors and heterologous cortico-cancellous bone. I wanted to try not to split the bone.After 3 months I placed 2 implants:the hard and soft tissue quality was really great.




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10 Comments


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I have been hearing many clinicians use platelet concentrates with claims the growth factors improve ridge augmentation outcomes. There is a lack of good scientific evidence that shows this is the case. I compare the before and after photos in this case and in my opinion there is a very modest gain. This could have been accomplished without using a platelet concentrate. Some clinicians are using fibrin membranes in place of barrier membranes (collagen, PTFE). Fibrin membranes are not cell occlusive and do not maintain their integrity long enough to act as a barrier. I use platelet concentrates routinely for ridge augmentation but only because they improve particulate graft handling, maintain particulate graft contour and adhesion and possibly improve soft tissue healing. Claims that they improve outcomes are not substantiated in the literature (besides case reports, opinion papers).
Nice outcome but the title give the impression that growth factors played a significant role in the result.

compare


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I was anger to explain what I think about these observations. But the Author himself did an excellent answer.
With all my respect.


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Thank you dear Master for your comment. Following the scientific data, in my opinion the technique I used with Concentrated Growth Factors gives you a better bone quality before the implant placement and an incredible tissue healing. I'm only 31 and I'm analyzing all the features about old and modern biomaterials doing many different clinical cases. At this moment, I'm very happy of my personal results with Concentrated Growth Factors doing more than 130 surgeries.But I'd like to learn more and more so I'm looking forward to accept every suggestion and opinion from very expert mentors. Thank you!


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Like you I embrace new materials and techniques. I think much of the discussion on platelet derived growth factors is, “In my opinion” or “in my observations” – opinions and case reports are the lowest level of evidence in the scientific hierarchy of evidence. I also use platelet concentrates but my point is – don’t assume that the results of bone augmentation will be better. I use them mainly for improved clinical handling – not because the bone quantity or quality is improved. Excellent documentation and a well performed surgery on your part. I applaud your posting the work but encourage we acknowledge when we are doing something because we THINK it’s better as opposed to KNOWING it’s better. Thank your for sharing.
Regards,
Craig


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I agree with you Dr Misch. The best advantage I find from using platelet concentrates is the handling of the particulate . I do use them routinely for augmentation as a graft binder or in sinus lifts where they are particularly helpful. This results in a more stable clot and prevents particulates from moving about under the flap. The fibrin membranes may sometimes help in wound closure if you end up with a wound dehiscence postoperatively. Bone turnover may be slightly accelerated as well. But in the end I think if you create a tented space, stable clot, and provide necessary cells and scaffold then most augmentation procedures are comparable to each other. Regards, Naheed


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Craig, you're absolutely right..! I repeat every day that the growth factors are only one factor of the success team.
We can't trust only on fibrin and growth factors to achieve clinical success and long term stability.. thank you!


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Luca

Splendidi risultati. La risposta dell'osso pre e post è ovvia Linea di fondo biomateriale fa la differenza

Rocco


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Thank you for all your comments dear colleagues.
I work everyday following the EBD (Evidence Based Dentistry) but many mentors of mine taught me also the other EBD (Experience Based Dentistry).
Best regards to all of you!


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