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5 Future of Growth Factors in Implant Dentistry

5 Future of Growth Factors in Implant Dentistry

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6  Growth Factors for Site Preparation: Current Science, Indications, and Practice



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with the existing bone in beagle dogs. They evaluated bone-implant interface at 4,

8, and 12 weeks and found that FGF-2 significantly promoted bone formation at

4 weeks and increased the ISQ value by about ten compared to control. However,

the increase in ISQ value peaked at 4 weeks and remained fairly constant even at

12  weeks for both the FGF-2-impregnated implants and control, suggesting that

FGF-2 accelerates bone formation but does not alter it over a longer timeframe.

Notably, FGF-2 was most remarkable in improving bone formation in areas delayed

by gaps between implant and bone [95]. Several studies demonstrated that the use

of FGF increased the amount of bone-to-implant contact, for improved osseointegration. In 2001, McCracken et al. found that addition of FGF in an activated fibrinogen matrix on titanium-aluminum-vanadium implants significantly increased the

amount of bone-to-implant contact (p < 0.05) compared to controls. This study also

demonstrated a greater percentage volume of bone deposition adjacent to the

implants, which supported the hypothesis that FGF could increase bone formation

around implants in a rat model [96].



6.5.2 Nell-1

NELL-1 is a potent pro-osteogenic protein, first discovered in locations of excessive

bone growth in calvarial sutures of patients with craniosynostosis [97]. To date,

NELL-1 has demonstrated induction of the bone in several preclinical models

including increased bone deposition in osteoporotic mice, distraction osteogenesis,

and increased rates of spinal fusion in various animal models. In 2006, Cowan et al.

studied NELL-1 in the craniofacial complex through administration on distracted

intermaxillary sutures in mice, demonstrating that NELL-1 induced bone formation

at rates similar to BMP-2 and accelerated chondrocyte hypertrophy and endochondral bone formation [98]. The ability of NELL-1 to induce bone formation in the

palatal suture demonstrates potential for usage in palatal defect healing. According

to a study by Cowan et al., NELL-1 has potential to synergistically enhance osteogenic differentiation of mesenchymal stem cells when used with BMP-2. This study

confirmed the osteochondral specificity of NELL-1 signaling, and potential for

enhanced therapeutic BMP-2 bone regeneration [99, 100]. NELL-1 is currently

being studied for clinical applications including vertebral compression fractures,

osteoporosis, as well as potential to promote development of cartilage. While there

is currently no existing literature on the application of NELL-1  in patients or to

implant dentistry, the characterization of NELL-1 as an osteogenic protein posits

NELL-1 as an important factor for consideration in future studies.



6.6



Allografts with Viable Cells



Alternative methods of enhancing bone regeneration include usage of mesenchymal

stem cells with bone allograft material. Autograft bone, harvested most commonly

from the patient’s iliac crest, is the gold standard for bone augmentation because it



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is histocompatible and non-immunogenic. Furthermore, autograft bone provides the

three pillars of bone growth: osteoconductive scaffold, osteoinductive factors, and

osteogenic cells [101]. However, the process of harvesting autogenous bone presents many clinical downfalls, such as donor site morbidity, increased surgical time,

risk of infection, and limited availability [102].

A new approach being investigated is the use of bone allograft combined with

bone marrow mesenchymal stem cells (BMSCs) to maintain osteoconductivity,

osteoinductivity, and osteogenicity. Since their discovery in 1966, mesenchymal

stem cells (MSCs) have been characterized with ability for self-renewal as well as

multipotential to differentiate into bone, cartilage, fat, nerve, muscle, and tendon,

depending on external cues in the local environment [103]. For MSC’s to be directed

to a particular lineage of differentiation, they require appropriate density, spatial

organization, and local factors [104]. Furthermore, MSCs are part of the bony repair

callus and differentiates into bone or cartilage based on stability. Vasculature and

angiogenesis are additional requirements for osteogenic differentiation. Current

growth factor systems rely on the body’s inherent local cells, including MSC’s and

osteoprogenitor cells, to help regenerate bone.

Several new products are now on the market that combine various formulations

of endogenous bone forming cells with osteoinductive growth factors (Trinity®

Evolution™, Osteocel® Plus, and Osiris BIO4™). Trinity® Evolution™ (TE) is a

cryopreserved allograft consisting of viable cancellous bone matrix and demineralized cortical bone matrix, with mesenchymal stem cells, osteoprogenitors, and

osteoinductive proteins, and osteoconductive matrix [105]. In 2016, a prospective

clinical study was performed, which observed the usage of TE in anterior cervical

discectomy and fusion. Degree of fusion was assessed based on radiographic

appearance, function, and residual pain, performed with a series of clinical tests by

examiners. This study reported fusion rates of 94% with TE, similar to previously

reported fusion rates of autografts in similar conditions. Overall, the study concluded that TE had a high rate of single-level cervical fusion with no serious adverse

events. Though inconclusive, current data of bone allografts with MSCs are favorable and offer an alternative to autografts, allografts, and growth factors. Clinical

trials are currently being conducted, with usage of MSCs with allograft in transforaminal lumbar body fusion, anterior cervical discectomy and fusion, and foot and

ankle fusion [101, 106, 107]. Favorable results of allograft and MSC usage include

new bone formation at site of implantation, with satisfactory clinical and radiographic success in situations of stable internal or external skeletal fixation. In

implant dentistry, although generally favorable, few case series are available to support the use of MSC/allograft technology [108].

Conclusions



What is the future of growth factors in implant dentistry? This is a question that

is posed by patients, clinicians, researchers, and industry. Much work has been

done in the last few decades, but in many situations, the clinical relevance, predictability, and protocols have not been fully understood. It is unclear whether all

patients will require or benefit from growth factors to assist with wound healing



6  Growth Factors for Site Preparation: Current Science, Indications, and Practice

Table 6.4  Growth factor

uses



131



Growth factor uses

All patients

Compromised wounds

Complex hard/soft tissue defects

Previously failed surgeries

Medically compromised patients



and augmentation or if they are only relevant in medically compromised patients

and those with previously failed procedures (Table 6.4). What is clear is that the

field is looking for materials and methods to enhance bone and soft tissue healing, allowing treatment of more complex patients and wounds. Growth factors,

and possibly stem cells, are a plausible answer to current limitations. However,

much more research, both basic and clinical, needs to be done to improve current

technologies, develop predictable protocols, and evaluate long-term results.



References

1. Suarez-Lopez Del Amo F, et al. Biologic agents for periodontal regeneration and implant site

development. Biomed Res Int. 2015;2015:957518.

2.Higginbottom FL.  Implants as an option in the esthetic zone. J Oral Maxillofac Surg.

2005;63(9 Suppl 2):33–44.

3.Aghaloo TL, Moy PK.  Which hard tissue augmentation techniques are the most successful in furnishing bony support for implant placement? Int J Oral Maxillofac Implants.

2007;22(Suppl):49–70.

4. Schliephake H. Clinical efficacy of growth factors to enhance tissue repair in oral and maxillofacial reconstruction: a systematic review. Clin Implant Dent Relat Res. 2015;17(2):247–73.

5.Miyazaki M, et  al. An update on bone substitutes for spinal fusion. Eur Spine J.

2009;18(6):783–99.

6.Reddi AH. Morphogenesis and tissue engineering of bone and cartilage: inductive signals,

stem cells, and biomimetic biomaterials. Tissue Eng. 2000;6(4):351–9.

7. Urist MR. Bone: formation by autoinduction. Science. 1965;150(3698):893–9.

8.Lavery K, et al. BMP-2/4 and BMP-6/7 differentially utilize cell surface receptors to induce

osteoblastic differentiation of human bone marrow-derived mesenchymal stem cells. J Biol

Chem. 2008;283(30):20948–58.

9.Poon B, et  al. Bone morphogenetic protein-2 and bone therapy: successes and pitfalls. J

Pharm Pharmacol. 2016;68(2):139–47.

10.Wozney JM. Overview of bone morphogenetic proteins. Spine (Phila Pa 1976). 2002;27(16

Suppl 1):S2–8.

11.Yamaguchi A, Komori T, Suda T. Regulation of osteoblast differentiation mediated by bone

morphogenetic proteins, hedgehogs, and Cbfa1. Endocr Rev. 2000;21(4):393–411.

12. Valdes MA, et al. Recombinant bone morphogenic protein-2 in orthopaedic surgery: a review.

Arch Orthop Trauma Surg. 2009;129(12):1651–7.

13. Carreira AC, et al. Bone morphogenetic proteins: structure, biological function and therapeutic applications. Arch Biochem Biophys. 2014;561:64–73.

14.Boyne PJ, et  al. De novo bone induction by recombinant human bone morphogenetic

protein-2 (rhBMP-2) in maxillary sinus floor augmentation. J Oral Maxillofac Surg.

2005;63(12):1693–707.

15.Triplett RG, et al. Pivotal, randomized, parallel evaluation of recombinant human bone morphogenetic protein-2/absorbable collagen sponge and autogenous bone graft for maxillary

sinus floor augmentation. J Oral Maxillofac Surg. 2009;67(9):1947–60.



132



T. Aghaloo and R. Lim



16.Fiorellini JP, et al. Randomized study evaluating recombinant human bone morphogenetic

protein-2 for extraction socket augmentation. J Periodontol. 2005;76(4):605–13.

17.Carter TG, et  al. Off-label use of recombinant human bone morphogenetic protein-2

(rhBMP-2) for reconstruction of mandibular bone defects in humans. J Oral Maxillofac Surg.

2008;66(7):1417–25.

18.Herford AS, Boyne PJ. Reconstruction of mandibular continuity defects with bone morphogenetic protein-2 (rhBMP-2). J Oral Maxillofac Surg. 2008;66(4):616–24.

19.Herford AS. rhBMP-2 as an option for reconstructing mandibular continuity defects. J Oral

Maxillofac Surg. 2009;67(12):2679–84.

20.Fallucco MA, Carstens MH.  Primary reconstruction of alveolar clefts using recombinant

human bone morphogenic protein-2: clinical and radiographic outcomes. J Craniofac Surg.

2009;20(Suppl 2):1759–64.

21. Chin M, et al. Repair of alveolar clefts with recombinant human bone morphogenetic protein

(rhBMP-2) in patients with clefts. J Craniofac Surg. 2005;16(5):778–89.

22.Herford AS, et  al. Bone morphogenetic protein-induced repair of the premaxillary cleft. J

Oral Maxillofac Surg. 2007;65(11):2136–41.

23. Canan LW Jr, et al. Human bone morphogenetic protein-2 use for maxillary reconstruction in

cleft lip and palate patients. J Craniofac Surg. 2012;23(6):1627–33.

24.Cicciu M, et al. Recombinant human bone morphogenetic protein type 2 application for a

possible treatment of bisphosphonates-related osteonecrosis of the jaw. J Craniofac Surg.

2012;23(3):784–8.

25.Alonso N, et  al. Evaluation of maxillary alveolar reconstruction using a resorbable collagen sponge with recombinant human bone morphogenetic protein-2 in cleft lip and palate

patients. Tissue Eng Part C Methods. 2010;16(5):1183–9.

26.Edmunds RK, et al. Maxillary anterior ridge augmentation with recombinant human bone

morphogenetic protein 2. Int J Periodontics Restorative Dent. 2014;34(4):551–7.

27. Misch CM, et al. Vertical bone augmentation using recombinant bone morphogenetic protein,

mineralized bone allograft, and titanium mesh: a retrospective cone beam computed tomography study. Int J Oral Maxillofac Implants. 2015;30(1):202–7.

28. Tarnow DP, et al. Maxillary sinus augmentation using recombinant bone morphogenetic protein-2/acellular collagen sponge in combination with a mineralized bone replacement graft: a

report of three cases. Int J Periodontics Restorative Dent. 2010;30(2):139–49.

29.Jung RE, et  al. A randomized-controlled clinical trial evaluating clinical and radiological

outcomes after 3 and 5 years of dental implants placed in bone regenerated by means of

GBR techniques with or without the addition of BMP-2. Clin Oral Implants Res. 2009;20(7):

660–6.

30.Jensen OT, et  al. BMP-2/ACS/allograft for combined maxillary alveolar split/sinus floor

grafting with and without simultaneous dental implant placement: report of 21 implants

placed into 7 alveolar split sites followed for up to 3 years. Int J Oral Maxillofac Implants.

2014;29(1):e81–94.

31.Butura CC, Galindo DF. Implant placement in alveolar composite defects regenerated with

rhBMP-2, anorganic bovine bone, and titanium mesh: a report of eight reconstructed sites. Int

J Oral Maxillofac Implants. 2014;29(1):e139–46.

32.Bowler D, Dym H. Bone morphogenic protein: application in implant dentistry. Dent Clin

North Am. 2015;59(2):493–503.

33.Chan DS, et  al. Wound complications associated with bone morphogenetic protein-2  in

orthopaedic trauma surgery. J Orthop Trauma. 2014;28(10):599–604.

34.Garrett MP, et  al. Formation of painful seroma and edema after the use of recombinant

human bone morphogenetic protein-2 in posterolateral lumbar spine fusions. Neurosurgery.

2010;66(6):1044–9. discussion 1049.

35.Hustedt JW, Blizzard DJ. The controversy surrounding bone morphogenetic proteins in the

spine: a review of current research. Yale J Biol Med. 2014;87(4):549–61.

36. James AW, et al. A review of the clinical side effects of bone morphogenetic protein-2. Tissue

Eng Part B Rev. 2016;22(4):284–97.



6  Growth Factors for Site Preparation: Current Science, Indications, and Practice



133



37.Lebl DR.  Bone morphogenetic protein in complex cervical spine surgery: a safe biologic

adjunct? World J Orthop. 2013;4(2):53–7.

38.Neovius E, et  al. Alveolar bone healing accompanied by severe swelling in cleft children

treated with bone morphogenetic protein-2 delivered by hydrogel. J Plast Reconstr Aesthet

Surg. 2013;66(1):37–42.

39.Woo EJ. Adverse events reported after the use of recombinant human bone morphogenetic

protein 2. J Oral Maxillofac Surg. 2012;70(4):765–7.

40.Zetola A, et al. Recombinant human bone morphogenetic protein-2 (rhBMP-2) in the treatment of mandibular sequelae after tumor resection. Oral Maxillofac Surg. 2011;15(3):169–74.

41. Herford AS, Miller M, Signorino F. Maxillofacial defects and the use of growth factors. Oral

Maxillofac Surg Clin North Am. 2017;29(1):75–88.

42.Lynch SE, et al. A combination of platelet-derived and insulin-like growth factors enhances

periodontal regeneration. J Clin Periodontol. 1989;16(8):545–8.

43.Canalis E, McCarthy T, Centrella M. Growth factors and the regulation of bone remodeling.

J Clin Invest. 1988;81(2):277–81.

44.Hauschka PV, et al. Growth factors in bone matrix. Isolation of multiple types by affinity

chromatography on heparin-Sepharose. J Biol Chem. 1986;261(27):12665–74.

45.Heldin CH, Westermark B. Mechanism of action and in vivo role of platelet-derived growth

factor. Physiol Rev. 1999;79(4):1283–316.

46. Grotendorst GR, et al. Stimulation of granulation tissue formation by platelet-derived growth

factor in normal and diabetic rats. J Clin Invest. 1985;76(6):2323–9.

47.Howell TH, et al. A phase I/II clinical trial to evaluate a combination of recombinant human

platelet-derived growth factor-BB and recombinant human insulin-like growth factor-I in

patients with periodontal disease. J Periodontol. 1997;68(12):1186–93.

48.Nevins M, et  al. Platelet-derived growth factor stimulates bone fill and rate of attachment level gain: results of a large multicenter randomized controlled trial. J Periodontol.

2005;76(12):2205–15.

49.Nevins ML, Reynolds MA.  Tissue engineering with recombinant human platelet-derived

growth factor BB for implant site development. Compend Contin Educ Dent. 2011;32(2):18–

20-7. quiz 28, 40.

50. Nevins ML, et al. Recombinant human platelet-derived growth factor BB for reconstruction of

human large extraction site defects. Int J Periodontics Restorative Dent. 2014;34(2):157–63.

51.Froum SJ, et  al. A histomorphometric comparison of Bio-Oss alone versus Bio-Oss and

platelet-derived growth factor for sinus augmentation: a postsurgical assessment. Int J

Periodontics Restorative Dent. 2013;33(3):269–79.

52.Simion M, Rocchietta I, Dellavia C. Three-dimensional ridge augmentation with xenograft

and recombinant human platelet-derived growth factor-BB in humans: report of two cases.

Int J Periodontics Restorative Dent. 2007;27(2):109–15.

53.De Angelis N, De Lorenzi M, Benedicenti S.  Surgical combined approach for alveolar

ridge augmentation with titanium mesh and rhPDGF-BB: a 3-year clinical case series. Int J

Periodontics Restorative Dent. 2015;35(2):231–7.

54.Chiang T, et al. Reconstruction of the narrow ridge using combined ridge split and guided

bone regeneration with rhPDGF-BB growth factor-enhanced allograft. Int J Periodontics

Restorative Dent. 2014;34(1):123–30.

55.Wallace SC, Snyder MB, Prasad H.  Postextraction ridge preservation and augmentation

with mineralized allograft with or without recombinant human platelet-derived growth

factor BB (rhPDGF-BB): a consecutive case series. Int J Periodontics Restorative Dent.

2013;33(5):599–609.

56.Funato A, et al. A novel combined surgical approach to vertical alveolar ridge augmentation

with titanium mesh, resorbable membrane, and rhPDGF-BB: a retrospective consecutive case

series. Int J Periodontics Restorative Dent. 2013;33(4):437–45.

57. Urban IA, et al. Horizontal guided bone regeneration in the posterior maxilla using recombinant human platelet-derived growth factor: a case report. Int J Periodontics Restorative Dent.

2013;33(4):421–5.



134



T. Aghaloo and R. Lim



58.Steed DL. Clinical evaluation of recombinant human platelet-derived growth factor for the

treatment of lower extremity ulcers. Plast Reconstr Surg. 2006;117(7 Suppl):143S–9S. discussion 150S-151S.

59.Antoniades HN.  Human platelet-derived growth factor (PDGF): purification of PDGF-I

and PDGF-II and separation of their reduced subunits. Proc Natl Acad Sci U S A.

1981;78(12):7314–7.

60.Andrae J, Gallini R, Betsholtz C. Role of platelet-derived growth factors in physiology and

medicine. Genes Dev. 2008;22(10):1276–312.

61.Steed DL.  Clinical evaluation of recombinant human platelet-derived growth factor for

the treatment of lower extremity diabetic ulcers. Diabetic Ulcer Study Group. J Vasc Surg.

1995;21(1):71–8. discussion 79-81.

62.Dohan DM, et al. Platelet-rich fibrin (PRF): a second-generation platelet concentrate. Part

II: platelet-related biologic features. Oral Surg Oral Med Oral Pathol Oral Radiol Endod.

2006;101(3):e45–50.

63. Bielecki T, Gazdzik TS, Szczepanski T. Re: “The effects of local platelet rich plasma delivery

on diabetic fracture healing”. What do we use: platelet-rich plasma or platelet-rich gel? Bone.

2006;39(6):1388. author reply 1389.

64.Kaigler D, et al. Platelet-derived growth factor applications in periodontal and peri-implant

bone regeneration. Expert Opin Biol Ther. 2011;11(3):375–85.

65.Marx RE, et al. Platelet-rich plasma: growth factor enhancement for bone grafts. Oral Surg

Oral Med Oral Pathol Oral Radiol Endod. 1998;85(6):638–46.

66.Weibrich G, et al. Growth factor levels in platelet-rich plasma and correlations with donor

age, sex, and platelet count. J Craniomaxillofac Surg. 2002;30(2):97–102.

67. Dugrillon A, et al. Autologous concentrated platelet-rich plasma (cPRP) for local application

in bone regeneration. Int J Oral Maxillofac Surg. 2002;31(6):615–9.

68. Khairy NM, et al. Effect of platelet rich plasma on bone regeneration in maxillary sinus augmentation (randomized clinical trial). Int J Oral Maxillofac Surg. 2013;42(2):249–55.

69.Kutkut A, et al. Extraction socket preservation graft before implant placement with calcium

sulfate hemihydrate and platelet-rich plasma: a clinical and histomorphometric study in

humans. J Periodontol. 2012;83(4):401–9.

70. Geurs N, et al. Using growth factors in human extraction sockets: a histologic and histomorphometric evaluation of short-term healing. Int J Oral Maxillofac Implants. 2014;29(2):485–96.

71. Roffi A, et al. Does PRP enhance bone integration with grafts, graft substitutes, or implants?

A systematic review. BMC Musculoskelet Disord. 2013;14:330.

72. Eskan MA, et al. Platelet-rich plasma-assisted guided bone regeneration for ridge augmentation: a randomized, controlled clinical trial. J Periodontol. 2014;85(5):661–8.

73. Torres J, et al. Effect of platelet-rich plasma on sinus lifting: a randomized-controlled clinical

trial. J Clin Periodontol. 2009;36(8):677–87.

74.Tonelli P, et  al. Counting of platelet derived growth factor and transforming growth

factor-beta in platelet-rich-plasma used in jaw bone regeneration. Minerva Stomatol.

2005;54(1-2):23–34.

75.Antonello Gde M, et al. Evaluation of the effects of the use of platelet-rich plasma (PRP)

on alveolar bone repair following extraction of impacted third molars: prospective study. J

Craniomaxillofac Surg. 2013;41(4):e70–5.

76.Kassolis JD, Reynolds MA. Evaluation of the adjunctive benefits of platelet-rich plasma in

subantral sinus augmentation. J Craniofac Surg. 2005;16(2):280–7.

77.Raghoebar GM, et  al. Does platelet-rich plasma promote remodeling of autologous

bone grafts used for augmentation of the maxillary sinus floor? Clin Oral Implants Res.

2005;16(3):349–56.

78.Torres J, et  al. Platelet-rich plasma may prevent titanium-mesh exposure in alveolar ridge

augmentation with anorganic bovine bone. J Clin Periodontol. 2010;37(10):943–51.

79.Moy P, et  al. Hard and soft tissue augmentation. In: Moy P, Pozzi A, Beumer J, editors.

Fundmentals of implant dentistry. Chicago: Quintessence; 2016. p. 205–58.



6  Growth Factors for Site Preparation: Current Science, Indications, and Practice



135



80.Dohan DM, et al. Platelet-rich fibrin (PRF): a second-generation platelet concentrate. Part I:

technological concepts and evolution. Oral Surg Oral Med Oral Pathol Oral Radiol Endod.

2006;101(3):e37–44.

81.Davis VL, et al. Platelet-rich preparations to improve healing. Part I: workable options for

every size practice. J Oral Implantol. 2014;40(4):500–10.

82. Khorshidi H, et al. Comparison of the mechanical properties of early leukocyte- and plateletrich fibrin versus PRGF/Endoret membranes. Int J Dent. 2016;2016:1849207.

83.Schar MO, et al. Platelet-rich concentrates differentially release growth factors and induce

cell migration in vitro. Clin Orthop Relat Res. 2015;473(5):1635–43.

84. Suttapreyasri S, Leepong N. Influence of platelet-rich fibrin on alveolar ridge preservation. J

Craniofac Surg. 2013;24(4):1088–94.

85.Mazor Z, et  al. Sinus floor augmentation with simultaneous implant placement using

Choukroun’s platelet-rich fibrin as the sole grafting material: a radiologic and histologic

study at 6 months. J Periodontol. 2009;80(12):2056–64.

86.Moussa M, El-Dahab OA, El Nahass H.  Anterior maxilla augmentation using palatal bone block with platelet-rich fibrin: a controlled trial. Int J Oral Maxillofac Implants.

2016;31(3):708–15.

87.Yoon JS, Lee SH, Yoon HJ. The influence of platelet-rich fibrin on angiogenesis in guided

bone regeneration using xenogenic bone substitutes: a study of rabbit cranial defects. J

Craniomaxillofac Surg. 2014;42(7):1071–7.

88.Cieslik-Bielecka A, et al. L-PRP/L-PRF in esthetic plastic surgery, regenerative medicine of

the skin and chronic wounds. Curr Pharm Biotechnol. 2012;13(7):1266–77.

89. Ghanaati S, et al. Advanced platelet-rich fibrin: a new concept for cell-based tissue engineering by means of inflammatory cells. J Oral Implantol. 2014;40(6):679–89.

90.Simonpieri A, et al. Simultaneous sinus-lift and implantation using microthreaded implants

and leukocyte- and platelet-rich fibrin as sole grafting material: a six-year experience. Implant

Dent. 2011;20(1):2–12.

91.Dohan Ehrenfest DM, et al. Do the fibrin architecture and leukocyte content influence the

growth factor release of platelet concentrates? An evidence-based answer comparing a pure

platelet-rich plasma (P-PRP) gel and a leukocyte- and platelet-rich fibrin (L-PRF). Curr

Pharm Biotechnol. 2012;13(7):1145–52.

92.Shibli JA, et al. Composition of supra- and subgingival biofilm of subjects with healthy and

diseased implants. Clin Oral Implants Res. 2008;19(10):975–82.

93.Ornitz DM, Itoh N. The fibroblast growth factor signaling pathway. Wiley Interdiscip Rev

Dev Biol. 2015;4(3):215–66.

94.Kigami R, et al. FGF-2 angiogenesis in bone regeneration within critical-sized bone defects

in rat calvaria. Implant Dent. 2013;22(4):422–7.

95.Nagayasu-Tanaka T, et al. FGF-2 promotes initial osseointegration and enhances stability of

implants with low primary stability. Clin Oral Implants Res. 2016;28(3):291–7.

96.McCracken M, Lemons JE, Zinn K. Analysis of Ti-6Al-4V implants placed with fibroblast

growth factor 1 in rat tibiae. Int J Oral Maxillofac Implants. 2001;16(4):495–502.

97. Ting K, et al. Human NELL-1 expressed in unilateral coronal synostosis. J Bone Miner Res.

1999;14(1):80–9.

98. Cowan CM, et al. Nell-1 induced bone formation within the distracted intermaxillary suture.

Bone. 2006;38(1):48–58.

99.Cowan CM, et al. Synergistic effects of Nell-1 and BMP-2 on the osteogenic differentiation

of myoblasts. J Bone Miner Res. 2007;22(6):918–30.

100.Aghaloo T, et al. The effect of NELL1 and bone morphogenetic protein-2 on calvarial bone

regeneration. J Oral Maxillofac Surg. 2010;68(2):300–8.

101.Grabowski G, Cornett CA. Bone graft and bone graft substitutes in spine surgery: current

concepts and controversies. J Am Acad Orthop Surg. 2013;21(1):51–60.

102.Arrington ED, et al. Complications of iliac crest bone graft harvesting. Clin Orthop Relat

Res. 1996;329:300–9.



136



T. Aghaloo and R. Lim



103.Bruder SP, et  al. Bone regeneration by implantation of purified, culture-expanded human

mesenchymal stem cells. J Orthop Res. 1998;16(2):155–62.

104.Bruder SP, Fink DJ, Caplan AI. Mesenchymal stem cells in bone development, bone repair,

and skeletal regeneration therapy. J Cell Biochem. 1994;56(3):283–94.

105. Rush SM. Trinity evolution. Foot Ankle Spec. 2010;3(3):144–7.

106.Vanichkachorn J, et al. A prospective clinical and radiographic 12-month outcome study of

patients undergoing single-level anterior cervical discectomy and fusion for symptomatic

cervical degenerative disc disease utilizing a novel viable allogeneic, cancellous, bone matrix

(trinity evolution) with a comparison to historical controls. Eur Spine J. 2016;25(7):2233–8.

107. Eastlack RK, et al. Osteocel plus cellular allograft in anterior cervical discectomy and fusion:

evaluation of clinical and radiographic outcomes from a prospective multicenter study. Spine

(Phila Pa 1976). 2014;39(22):E1331–7.

108. Gonshor A, et al. Histologic and histomorphometric evaluation of an allograft stem cell-based

matrix sinus augmentation procedure. Int J Oral Maxillofac Implants. 2011;26(1):123–31.



Part III

Immediate Implant Placement and Immediate

Provisional Restoration



7



Advanced Grafting Techniques

for Implant Placement in Compromised

Sites

Bach Le and Joan Pi-Anfruns



Abstract



The loss of teeth can result in up to 50% of alveolar ridge width shrinkage within

the first 1–3 years [1]. This bone loss is exacerbated if there are preexisting endodontic pathologies and/or periodontal disease or if the tooth is loss due to

trauma. Since prosthetically driven implant placement is only possible when

there is an adequate amount of the bone, the presence of significant resorption

can pose a considerable clinical challenge. Bone augmentation is often required

to create ideal gingival contours and aesthetics.



7.1



Introduction



The loss of teeth can result in up to 50% of alveolar ridge width shrinkage within

the first 1–3 years [1]. This bone loss is exacerbated if there are preexisting endodontic pathologies and/or periodontal disease or if the tooth is loss due to trauma.

Since prosthetically driven implant placement is only possible when there is an

adequate amount of the bone, the presence of significant resorption can pose a considerable clinical challenge. Bone augmentation is often required to create ideal

gingival contours and aesthetics.



B. Le (*)

Department of Oral and Maxillofacial Surgery,

Herman Ostrow School of Dentistry at USC, Los Angeles, CA, USA

Private Practice, Whittier, CA, USA

J. Pi-Anfruns

Division of Diagnostic and Surgical Sciences, Division of Regenerative and Constitutive

Sciences, Dental Implant Center, UCLA School of Dentistry, Los Angeles, CA, USA

© Springer International Publishing AG, part of Springer Nature 2019

Todd R. Schoenbaum (ed.), Implants in the Aesthetic Zone,

https://doi.org/10.1007/978-3-319-72601-4_7



139



140



B. Le and J. Pi-Anfruns



The high predictability and success of osseointegration have led to a shift in the

focus toward achieving ideal long-term aesthetics with peri-implant bone and tissue

architecture. Increasing patient demand for natural aesthetic outcomes has redefined

the definition of success. Implant success is no longer solely equated with implant

survival, yet most studies on implants fail to include criteria for aesthetic success. It

is reported that up to 16% of single implant restorations in the aesthetic zone fail for

aesthetic reasons [2–4] due to tissue loss or a failure to adequately restore this lost

volume [5]. Achieving an ideal aesthetic result in the compromised site is often

elusive and, in many cases, not yet possible [6]. The potential for unexpected complications which can compromise the final result always exists with any surgical

procedure and should be a part of the initial discussion on expectations. With proper

treatment planning and execution, poor outcomes can be avoided.



7.1.1 A

 esthetic Risk Assessment in Compromised Sites: FATTT

Assessment

Even procedures with a high level of predictability will have aesthetic failures

defined by significant tissue recession, long clinical crowns, open gingival embrasures, and/or exposure of the abutment margin. Given the complexity of hard and

soft tissue reconstruction, the authors recommend using the following five simple

guidelines (FATTT) to help clinicians decrease the risk of an unaesthetic outcome

with hard and soft tissue reconstruction (Table 7.1).



7.1.2 Favorable Gingival Level (F)

Because gingival recession is common after prosthetic delivery [7–9], it is critical to

assess the preoperative gingival margin height of the tooth or implant site. This

margin is usually dictated by the underlying facial bone level. A free gingival margin that lies coronal to the planned restorative margin offers some insurance against

recession and is considered more favorable (Fig. 7.1). Ideally, the implant platform

should be placed 3 mm below the planned gingival margin with an abundance of

soft tissue height for prosthetic sculpting to achieve a harmonious gingival margin

with the adjacent teeth (Fig. 7.2a–d). In clinical cases where the gingival margin is



Table 7.1  Aesthetic risk assessment (FATTT)

FATTT criteria

Favorable gingival

level

Attachment on

adjacent tooth

Thick/thin biotype

Thick/thin labial

bone

Tooth shape



Favorable

Free gingival margin >1 mm coronal

to anticipated level

<5 mm from anticipated contact

point

No translucency on probing

>2 mm of residual labial bone



Non-favorable

Free gingival margin at or apical

to anticipated level

>5 mm from anticipated contact

point

Probe visible through gingiva

<1 mm of residual labial bone



Square



Triangular



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