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Title Combined Use of rhPDGF-BB with Bone Graft in Treating Periodontal Intrabony Defects Improves Healing Outcomes Compared to Bone Grafting Alone
Clinical Question In treatment of periodontal intrabony defects, does the use of rhPDGF-BB in conjunction with bone grafts improve healing outcomes compared to bone grafting alone?
Clinical Bottom Line When treating intrabony defects, combining recombinant human platelet derived growth factor BB homodimer (rhPDGF-BB) with bone graft can lead to better periodontal regeneration compared to bone grafting alone. There is strong evidence that suggests healing outcomes are improved and regeneration may occur more quickly when rhPDGF-BB is used.
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) 32392438 Tavelli / 2020564 patients (642 defects) in 16 studiesSystematic review of randomized trials
Key resultsThe use of rhPDGF-BB with allogenic and xenogeneic bone graft resulted in greater clinical attachment level (CAL) gain, 5.9 ± 1.8 mm and 5.5 ± 1.7 mm respectively, compared to other bone graft materials. Two clinical studies included histological findings and showed that intrabony defects treated with rhPDGF-BB and bone graft resulted in either complete regeneration of the periodontal ligament, cementum and alveolar bone or long junctional epithelium in cases where regeneration did not occur. All clinical trials included in this review showed that using bone graft material alone (control) to treat intrabony defects resulted in worse healing outcomes.
#2) 16332231Nevins / 2005180 patients with >4mm intrabony defects requiring periodontal surgeryRandomized Controlled Trial
Key resultsIntrabony defects treated with rhPDGF-BB and beta-TCP bone graft showed significantly greater CAL gain compared to beta-TCP bone graft alone at the 3-month follow up (3.8 mm and 3.3 mm respectively; p=0.032). However, at the 6-month follow up, the difference in CAL gain was not statistically significant (p=0.11). The linear bone gain (LBG) and percent defect fill (%DF) radiographically was significantly greater in rhPDGF-treated sites at 6 months (LBG: 2.6mm and 0.9mm respectively; p<0.001) (%DF: 57% and 18% respectively; p<0.001), and there was statistically less recession compared to sites that received beta-TCP alone (p=0.04).
#3) 25411740Maroo / 201415 patients (30 intrabony defects) with bilateral intrabony defectsRandomized Controlled Trial
Key resultsThis split mouth design study showed that sites treated with rhPDGF and beta-TCP resulted in significant reduction in probing depth (PD), gain in CAL and radiographic bone fill compared to beta-TCP alone at both the 6-month (PD: 4.73 mm and 3.40 mm, CAL gain: 4.66 mm and 2.93 mm, %DF: 80.12% and 57.54% respectively) and 9-month follow-up (PD: 5.33 mm and 4.13 mm, CAL gain: 5.33 mm and 3.67 mm, %DF: 94.30% and 67.99% respectively). These measurements comparing the test vs. control sites were all statistically significant (p<0.05).
Evidence Search PubMed search: (((periodontal regeneration) AND (rhPDGF-BB)) AND (intrabony defect))
Comments on
The Evidence
The Tavelli systematic review included 63 articles to cover a variety of periodontal surgeries where rhPDGF-BB may be utilized. Articles were chosen from MEDLINE, Embase, Cochrane library and manual searching. In vitro and animal studies were excluded. 18 studies consisting of 12 RCTs, 3 prospective case series and 2 retrospective studies were included in the intrabony defect section. Due to the heterogeneity of the studies, a meta-analysis could not be performed. Nevin’s randomized control trial had a test and control group that were not statistically different at baseline. Only two out of the 180 patients were lost at follow-up, and one patient was disqualified from the study due to an endodontic infection. This study was triple-blinded. However, the radiographs to assess % bone fill were not standardized. The control and test groups in the Maroo RCT were not statistically different at baseline. They had no patients lost at follow-up. This study was a single-blind clinical trial. A split-mouth design was used to eliminate individual variability.
Applicability The use of biologics in periodontal regeneration is becoming more popular. Due to the contained nature of some intrabony defects, periodontal regeneration would be an excellent surgical treatment. The evidence shows that in these procedures, the application of rhPDGF-BB to enhance and speed up healing can be very useful. Of course, using rhPDGF will result in a more costly treatment, so that should be considered on an individual patient basis.
Specialty/Discipline (Periodontics)
Keywords Periodontal regeneration, rhPDGF-BB, biologics, intrabony defect
ID# 3535
Date of submission: 10/17/2023spacer
E-mail banson@uthscsa.edu
Author Camille Banson, DMD
Co-author(s) Kathryn Gabel, DDS
Co-author(s) e-mail gabelk@uthscsa.edu
Faculty mentor/Co-author David Deas, DMD MS
Faculty mentor/Co-author e-mail deasd@uthscsa.edu
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