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Perio Update

Growth Factors Redefine Implant Success

Recombinant human platelet-derived growth factor-BB is revolutionizing bone regeneration by enhancing cellular activity and accelerating tissue repair. This powerful biologic shows impressive results when paired with grafting materials, offering more predictable outcomes in challenging implant cases, especially in the esthetic zone.

By , , and
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The introduction of growth factors represents a new era in wound healing.1 The rationale behind the use of these natural biological mediators is to regulate crucial cellular events involved in tissue repair, including DNA synthesis, cell replication, chemotaxis, differentiation, matrix synthesis, and tissue vascularization.2 Several preclinical and clinical studies have documented the use of different bioactive factors in enhancing bone regeneration.3 These biologic materials may enhance the development of mature lamellar bone and lead to more predictable support for dental implants. One of the best-documented growth factors proven to have positive effects on a myriad of oral regenerative procedures is recombinant human platelet-derived growth factor-BB (rhPDGF-BB).

PDGF is derived and released from human platelets cells following tissue injury.4 Obtained with recombinant DNA processing, rh-PDGF has been shown to upregulate angiogenesis and promote guided bone regeneration in large horizontal ridge defects.5,6 The main effect of rhPDGF-BB is mitogenesis, angiogenesis, and chemotaxis for cells of mesenchymal origin, increasing the potential for regeneration.4,7-10 Animal and human histological studies revealed bone volume regeneration after implantation of rhPDGF-infused xenograft.11-14

A recent systematic review that assessed the clinical efficacy, safety, and benefits of rh-PDGF in hard and soft tissue regeneration reported that the combined use of the bone grafts substitutes (xenografts, allografts) and rh-PDGF demonstrated clinical benefits for periodontal regeneration, root coverage, alveolar ridge augmentation, and ridge preservation.1

Several case studies using combinations of autogenous bone, anorganoic bovine, bone-derived mineral, and rhPDGF have demonstrated a high success rate.14-16 However, the harvesting of autogenous bone involves an additional surgical procedure. Limited information regarding the use of rhPDGF in combination with composite graft materials for horizontal and vertical ridge augmentation in the esthetic zone is available. The following case report details the successful use of rhPDGF in conjunction with allograft/xenograft and a barrier membrane to reconstruct severe bone defects in the esthetic zone.

References

  1. Tavelli L, Ravida A, Barootchi S, Chambrone L, Giannobile WV. Recombinant human platelet-derived growth factor: a systematic review of clinical findings in oral regenerative procedures. JDR Clin Trans Res. 2021;6:161-173.
  2. Giannobile WV, Somerman MJ. Growth and amelogenin-like factors in periodontal wound healing. A systematic review. Ann Periodontol. 2003;8:193-204.
  3. Donos N, Dereka X, Calciolari E. The use of bioactive factors to enhance bone regeneration: A narrative review. J Clin Periodontol. 2019;46 Suppl 21:124-161.
  4. Yao W, Shah B, Chan HL, Wang HL, Lin GH. Bone quality and quantity alterations after socket augmentation with rhpdgf-bb or bmps: a systematic review. Int J Oral Maxillofac Implants. 2018;33:1255-1265.
  5. Snyder MB. Treatment of a large postextraction buccal wall defect with mineralized allograft, beta-TCP, and rhPDGF-BB: a growth factor-mediated bone regenerative approach. Int J Periodontics Restorative Dent. 2012;32:705-711.
  6. 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;35:231-237.
  7. Phipps MC, Xu Y, Bellis SL. Delivery of platelet-derived growth factor as a chemotactic factor for mesenchymal stem cells by bone-mimetic electrospun scaffolds. PLoS One. 2012;7:e40831.
  8. Nevins M, Giannobile WV, McGuire MK, 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;76:2205-2215.
  9. McGuire MK, Kao RT, Nevins M, Lynch SE. rhPDGF-BB promotes healing of periodontal defects: 24-month clinical and radiographic observations. Int J Periodontics Restorative Dent. 2006;26:223-231.
  10. Nevins M, Camelo M, Nevins ML, Schenk RK, Lynch SE. Periodontal regeneration in humans using recombinant human platelet-derived growth factor-BB (rhPDGF-BB) and allogenic bone. J Periodontol. 2003;74:1282-1292.
  11. Simion M, Nevins M, Rocchietta I, et al. Vertical ridge augmentation using an equine block infused with recombinant human platelet-derived growth factor-BB: a histologic study in a canine model. Int J Periodontics Restorative Dent. 2009;29:245-255.
  12. Nevins M, Garber D, Hanratty JJ, et al. Human histologic evaluation of anorganic bovine bone mineral combined with recombinant human platelet-derived growth factor BB in maxillary sinus augmentation: case series study. Int J Periodontics Restorative Dent. 2009;29:583-591.
  13. Nevins ML, Camelo M, Schupbach P, Kim DM, Camelo JM, Nevins M. Human histologic evaluation of mineralized collagen bone substitute and recombinant platelet-derived growth factor-BB to create bone for implant placement in extraction socket defects at 4 and 6 months: a case series. Int J Periodontics Restorative Dent. 2009;29:129-139.
  14. Simion M, Rocchietta I, Kim D, Nevins M, Fiorellini J. Vertical ridge augmentation by means of deproteinized bovine bone block and recombinant human platelet-derived growth factor-BB: a histologic study in a dog model. Int J Periodontics Restorative Dent. 2006;26:415-423.
  15. Simion M, Rocchietta I, Monforte M, Maschera E. Three-dimensional alveolar bone reconstruction with a combination of recombinant human platelet-derived growth factor BB and guided bone regeneration: a case report. Int J Periodontics Restorative Dent. 2008;28:239-243.
  16. Urban IA, Lozada JL, Jovanovic SA, Nagy K. Horizontal guided bone regeneration in the posterior maxilla using recombinant human platelet-derived growth factor: a case report. Int J Periodontics Restorative Dent. 2013;33:421-425.

This originally appeared in Boeriu S, Hottel TL, Chirla C, Chirla P. Achieving predictable bone regeneration without autogenous grafts. Decisions in Dentistry. 2025;11(2):36-39.

Sorin Boeriu, DDS, MsD, PhD, Dip Perio, FRCD(C), maintains a private practice limited to implant and periodontal surgery in Kitchener, Ontario, Canada. He has published articles on implant dentistry, soft tissue grafting, and periodontal/restorative treatment of carious and noncarious cervical lesions and presented numerous lectures. Furthermore, Boeriu is the author of two textbooks: Periodontics in the Tradition of Bissada and Clinical Periodontology and Implant Surgery.


Timothy L. Hottel, DDS, MS, DBA, FACD, is a clinical professor at the College of Dental Medicine, Case Western Reserve University in Cleveland. Previously, he served in a variety of key positions — including dean and director of Statewide Oral Health Initiatives — at the University of Tennessee College of Dentistry. With more than 100 published articles, Hottel is also coauthor of the textbook Dentistry for the Restorative Expanded Function Dental Auxiliary. A member of Decisions in Dentistry’s Peer Review Panel, he can be reached at: tlhottel@gmail.com.


Cristian Chirla, DDS, FMII, is in private practice in Akron, Ohio, and is a fellow of the Midwest Implant Institute.


Phillip Chirla, DMD, is in private practice in Akron, Ohio


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