The use of concentrated growth factors (CGF) in guided tissue regeneration (GTR) for implant dentistry

Many attempts have been made in the field of tissue regeneration with the aim of predictably repairing, regenerating, or restoring damaged and diseased tissues. To make regenerative medicine successful, three elements are required: stem cells, scaffolds, and growth factors. Translational research, which takes results from the laboratory and translates them to the clinics, and industry - academic collaborations also play important roles in making regenerative medicine suitable for practical use (Gurtner 2007). Guided Tissue Regeneration (GTR) is one of popular method to augment hard and soft defects developed by periodontal disease, tooth loss, trauma or infection. For successful gain procedure, primary wound closure, angiogenesis, space maintenance and clot stabilization are prerequisites (Coury 2016). The therapeutic method traditionally used in bone defect reconstruction is autologous bone grafting. The most common problems affecting this type of repair approach are bone absorption and donor trauma. Autogenous bone grafting or artificial materials can be used to reconstruct bone defects, but reducing bone absorption and enhancing new bone formation has remained problematic; the risk of infection and immunological rejection are high both for allogenic bone grafting and artificial materials. Tissue engineering technology may make bone defect reconstruction feasible. In some clinical studies, autologous materials acting as a biological scaffold were used to ensure graft stabilization; satisfactory long-term results were obtained. The requirement for successful osseointegration of dental implants is a sufficient quantity and quality of osseous tissue to ensure the stabilization of the implant and to allow for bone to implant contact of the entire surface intended for osseointegration. In cases of insufficient quantity of bone tissue at the site of implantation decreased implant success rates have been reported. Predictable formation of a direct bone to implant interface is a treatment goal in implant dentistry. For this purpose, the existence of appropriate bone quality and quantity is necessary and important. Loss of alveolar bone (Papapanou et al. 2000) may occur prior to tooth extraction because of periodontal disease, periapical pathology, or trauma to teeth and bone. Damage to the bone tissues during tooth extraction procedures may also result in bone loss. Finally, alveolar bone atrophy after tooth extraction is a well-known phenomenon. Sufficient alveolar bone volume and favorable architecture of the alveolar ridge are essential to obtain ideal functional and esthetic prosthetic reconstruction following implant therapy (Chiapasco 2006). Non-transfusional hemocomponents for surgical use are innovative tools of regenerative medicine and are widely used in clinical and surgical practices that require tissue regeneration. Blood is made of a cellular component: erythrocytes, leukocytes, platelets and a liquid extracellular matrix represented by plasma. It’s a further proposal as a biomaterial can be used for reconstructive techniques. The most important use in dentistry is dedicated totally to hard and soft tissue regeneration in association or not with other biomaterials. Their potential beneficial outcomes include local hemostasis and the acceleration of wound healing. Therefore, they are suitable for application in different medical fields as therapeutic options. Non-transfusional hemocomponents for surgical use are autogenous products prepared through the centrifugation of a blood sample from a patient. These preparations can be solutions or gels and can be injected or placed in a surgical site in order to regenerate the damaged tissues. Many studies about non-trasfusional hemocomponents have shown their ability to accelerate tissues regeneration and healing processes. Fibrin Glue was the first that was tested, then Platelet Rich Plasma (PRP), Plasma Rich in Growth Factors (PRGF), Platelet Rich Fibrin (PRF) and at last Concentrates Growth Factors (CGF).