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Title Topical Application of Fibroblast Growth Factor-2 May Promote Periodontal Regeneration in a Patient with Periodontitis
Clinical Question In a patient with periodontal disease, is topical application of fibroblast growth factor-2 in combination with scaling and root planning more effective in periodontal regeneration as compared to scaling and root planning alone?
Clinical Bottom Line The use of topical fibroblast growth factor-2 adjunct to scaling and root planning as compared to scaling and root planning alone, is more effective in increasing bone fill and rate of alveolar bone height in periodontal tissue regeneration in patients with periodontitis.
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) 18596969Kitamura/200874 patients displaying a 2-3 walled vertical bone defect as measured ≥ 3 mm apical to the bone crest.Randomized Controlled Trial
Key resultsThe 74 patients enrolled were randomly assigned to one of 4 groups. 19 patients were given 3% hydroxyproprylcellulose (HPC) with no FGF-2 (Group P); 19 patients were given HPC containing 0.03% FGF-2 (Group L); 19 patients were given HPC containing 0.1% FGF-2 (Group M); and 17 patients were given HPC containing 0.3% FGF-2 (Group H). Each patient received a full-mouth scaling and root planning before surgical treatment. Flap surgery was performed on each patient, and 200 μl of the appropriate investigated drug was administered to the bone defect region. Standard radiography and periodontal tissue inspection was performed before and at 12, 24 and 36 weeks following administration of the appropriate investigated drug. At 36 weeks, there was a significant difference in the rate of increase of alveolar bone height between group P (23.92%) and group H (58.62%). However, the difference in linear increase in alveolar bone height in group P (0.95 mm) and group H (1.85 mm) was not statistically significant (p=0.132). Regarding the clinical attachment loss regained, gingival recession, keratinized gingiva, tooth mobility, and plaque index, no significant differences existed between the 4 groups. Probing depth, gingival index, and bleeding on probing prevalence all decreased with time following periodontal surgical treatment in the 4 groups, however, no significant differences were noted between these groups. No serious adverse events attributable to the investigational drug were identified.
#2) 21059869Kitamura/2011253 patients with peiodontitisRandomized Controlled Trial
Key resultsPatients were randomly assigned to receive one of 4 treatments. 67 patients received 3% hydroxyproprylcellulose (HPC) with no FGF-2; 70 patients were given HPC containing 0.2% FGF-2; 65 patients were given HPC containing 0.3% FGF-2; and 65 patients were given HPC containing 0.4% FGF-2. Each patient underwent a modified Widman periodontal surgery and was administered 200 μl of the appropriate investigated drug to the bone defect region. Standard radiography and periodontal tissue inspection was performed before and at 12, 24 and 36 weeks following administration of the appropriate investigated drug. The percentage of bone fill at 36 weeks after administration was significantly higher (p<0.01) in each dose of FGF-2 than the 3% hydroxyproprylcellulose (HPC) with no FGF-2. After breaking of the blind, at 72 weeks after administration, both bone fill and clinical attachment loss regained at 72 weeks were retained at the 36-week level in all groups. All groups displayed a 2 mm regain in clinical attachment loss. The difference among groups in the clinical attachment regained, was not statistically significant. Regarding probing depth, bleeding on probing, gingival index, tooth mobility, gingival recession, plaque index, and width of keratinized gingivae, no significant differences were observed among the 4 groups. No clinical safety problems, including an abnormal increase in alveolar bone or ankylosis, were identified.
Evidence Search ("Fibroblast Growth Factor 2"[Mesh] AND "Regeneration"[Mesh]) AND "Periodontium"[Mesh]
Comments on
The Evidence
Both studies were double-blinded randomized controlled trials with groups similar at the start and were treated the same. No serious adverse effects were noted in all groups and FGF-2 administered topically did not enter the circulation and thus, there is little possibility of systemic adverse effects. Based on the studies done by Kitamura, FGF-2 can be effective in periodontal regeneration, but more evidence is needed to consider the use of FGF-2 as the standard of care for periodontal tissue regeneration.
Applicability The evidence is applicable to patients with loss of periodontal tissues due to periodontitis. At this time, there are limited data and clinical trials involving the use of FGF-2 in periodontal regeneration.
Specialty/Discipline (Periodontics)
Keywords Fibroblast Growth factor-2 (FGF2), periodontitis, periodontal regeneration
ID# 2886
Date of submission: 03/26/2015spacer
E-mail rakian@livemail.uthscsa.edu
Author Audrey Rakian
Co-author(s) e-mail
Faculty mentor/Co-author Cara Gonzales, DDS, PhD & Stephen Harris, PhD
Faculty mentor/Co-author e-mail gonzalesc5@uthscsa.edu; harris@uthscsa.edu
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