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Title Combined PDGF And Beta-TCP Is Superior To Beta-TCP Alone In Treatment Of Osseous Defects
Clinical Question For a patient being treated for an osseous defect, does the combination of recombinant human platelet-derived growth factor (rhPDGF-BB) and beta-tricalcium phosphate (beta-TCP) matrix improve bone fill as compared to beta-tricalcium phosphate matrix alone?
Clinical Bottom Line "Treatment with rhPDGF-BB and beta-TCP stimulated significant increases in the rate of clinical attachment level gain and improved bone fill as compared to beta-TCP alone." (See Comments on the CAT below)
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 16332231Nevins/2005180 subjects, each requiring surgical treatment of a 4 mm or greater intrabony periodontal defect and meeting all inclusion and exclusion criteria.Randomized Controlled Trial
Key resultsAuthors’ conclusion: “CAL gain was significantly greater at 3 months for group 1 (rhPDGF 0.3 mg/ml) compared to group 3 (beta-TCP + buffer) (3.8 versus 3.3 mm; P = 0.032), although by 6 months, this finding was not statistically significant (P = 0.11). This early acceleration of CAL gain led to group 1 exhibiting a significantly greater rate of CAL gain between baseline and 6 months than group 3 as assessed by the AUC (68.4- versus 60.1-mm weeks; P = 0.033). rhPDGF (0.3 mg/ml)-treated sites also had significantly greater linear bone gain (2.6 versus 0.9 mm, respectively; P < 0.001) and percent defect fill (57% versus 18%, respectively; P < 0.001) than the sites receiving the bone substitute with buffer at 6 months. There was less GR at 3 months in group 1 compared to group 3 (P = 0.04); at 6 months, GR for group 1 remained unchanged, whereas there was a slight gain in gingival height for group 3 resulting in comparable GR. There were no serious adverse events attributable to any of the treatments.”
#2) 21133980Jayakumar/201154 patients with periodontal osseous defects Randomized Controlled Trial
Key resultsAuthors’ conclusion: “Among the outcome measures, the extent of linear bone growth (p<0.01) and per cent bone fill (p<0.004) at the sixth month over baseline were significantly higher in the rhPDGF-BB+β-TCP group when compared with the β-TCP group.”
Evidence Search Platelet-Derived Growth Factor"[Mesh]) AND "Alveolar Bone Loss"[Mesh]) AND "Bone Regeneration"[Mesh] AND "beta-tricalcium phosphate" [Supplementary Concept]
Comments on
The Evidence
Both articles are randomized control studies. It is unclear if there are any bias or competing interests.
Applicability Nevins restricted patients to adults requiring surgical treatment of a 4 mm or greater intrabony periodontal defect.
Specialty/Discipline (Oral Surgery) (Periodontics)
Keywords Osseous defect, intrabony periodontal defect, Bone Graft, Guided tissue regeneration, beta-tricalcium phosphate, Beta-TCP,recombinant human platelet-derived growth factor, rhPDGF-BB
ID# 2065
Date of submission: 06/14/2011spacer
E-mail Hoedebecke@livemail.uthscsa.edu
Author Blake Hoedebecke
Co-author(s) e-mail
Faculty mentor/Co-author David Lasho, DDS, MSD
Faculty mentor/Co-author e-mail lasho@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
Comments and Evidence-Based Updates on the CAT
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by Dr. Peter Gakunga (San Antonio, Texas) on 08/28/2012
Biological basis: PDGF-BB is a broad acting growth factor with mitogenic (cell proliferation) and chemotactic (cell recruitment) effects on osteoblasts, cementoblasts and periodontal ligament cells. Beta-tricalcium phosphate (beta-TCP) functions as an osteoinductive agent. On human osteoblasts beta-TCP induces the up regulation of osteogenic. It also serves as a scaffold for factors including PDGF-BB When used together, PDGF-BB is released from the β-TCP matrix into the environment where it binds to specific cell surface receptors and initiates a cascade of intracellular signaling pathways. These events lead to cell migration, chemotaxis and cell proliferation or of osteoblasts, periodontal ligament fibroblasts and cementoblasts. This results in increased matrix synthesis, and subsequently the formation of resulting in formation of bone, periodontal ligament and cementum. The 2 factors would have additive biological effects as compared to the biological effect of one of them.

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