TARRSON FAMILY ENDOWED CHAIR IN PERIODONTICS
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TARRSON FAMILY ENDOWED CHAIR IN PERIODONTICS. UCLA SCHOOL OF DENTISTRY. Presents. Presents. Dr. E. Barrie Kenney Professor & Chairman Section of Periodontics. E. Barrie Kenney B.D.Sc., D.D.S., M.S., F.R.A.C.D.S. Tarrson Family Endowed Chair in Periodontics.

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TARRSON FAMILY ENDOWED CHAIR IN PERIODONTICS

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Tarrson family endowed chair in periodontics

TARRSON FAMILY ENDOWED CHAIR IN PERIODONTICS


Tarrson family endowed chair in periodontics

UCLA SCHOOL OF DENTISTRY


Tarrson family endowed chair in periodontics

Presents

Presents

Dr. E. Barrie KenneyProfessor & ChairmanSection of Periodontics


Tarrson family endowed chair in periodontics

E. Barrie Kenney B.D.Sc., D.D.S., M.S., F.R.A.C.D.S.

Tarrson Family Endowed Chair in Periodontics.

Professor and Chairman Division of Associated Clinical Specialties UCLA School of Dentistry


Platelet rich plasma gel

Platelet Rich Plasma –PRP

is obtained by sequestering and concentrating platelets by gradient density centrifugation

Platelet Rich Plasma Gel


Tarrson family endowed chair in periodontics

Platelet rich plasma gel is an autologous modification of fibrin glue made by mixing platelets and fibrinogen centrifuged from whole blood with thrombin and calcium chloride. Increase platelet concentration in wound by more than 300 percent.

The PRP is then mixed with calcium chloride and bovine thrombin to form clot that binds bone graft material. Bovine thrombin has been used in cardiovascular surgery and there are 32 reported cases of bleeding disorders due to cross reactivity of bovine factor V causing antibodies to human factor V. No cases seen in bone grafting use of PRP. Can substitute human recombinant thrombin or patient’s own thrombin separated out in a separate protocol or extra purified bovine thrombin.


Tarrson family endowed chair in periodontics

Preparation of Platelet Rich Plasma (P.R.P.)

Use of general purpose centrifuges

  • 450 ml blood in citrate – phosphate anticoagulant placed in centrifuge at 5,600 rpm to get buffy coat of platelets plus leukocytes

  • Slow centrifugation of buffy coat at 2,400 rpm to obtain 30 ml of platelet rich plasma.

    Takes 30 minutes and should be used within 6 hours


Tarrson family endowed chair in periodontics

PDGF – Group of polypeptides that stimulate protein synthesis in bone and also stimulate bone resorption, stimulates collagen and matrix production and angiogenesis.TGF betaβ GROUP of at least 3 polypeptides. Stimulates angiogenesis and production of collagen, ground substance, fibronectin. Inhibits osteoclasts and stimulates osteoblasts to divide.

PDEGFStimulates proliferation of keratinocytes and fibroblastsPDAFStimulates new blood vessel production


Tarrson family endowed chair in periodontics

PRP mainly used in sinus lifts with autogenous bone, DFDBA or bovine bone. Case reports suggest increased rate of bone formation. However, in studies by FROUM et al using PRP – Bio-Oss no difference seen in bone in sinus lifts.

IGF-1Stimulates cartilage growth, bone matrix production and replication of osteogenic stem cellsPF-4Chemoattractant for fibroblasts and PMNS


Tarrson family endowed chair in periodontics

Platelet enriched plasma

Autologous thrombin


Platelet rich plasma plus bio oss plus biogide versus platelet rich plasma and bio oss

Comparison of Platelet Rich Plasma, Bovine Porous Bone Mineral and Guided Tissue Regeneration versus Platelet Rich Plasma and Bovine Porous Bone Mineral in the treatment of Intrabony defects:

a Re-entry Study

Lekovic V, Camargo PM, Weinlaender M, Vasilic N, Kenney EB

J. Periodontol 2002, 73:198

21 Paired Defects

6 Males, 15 Females

9 smokers 12 non-smokers

Mean age 40 years

6 month clinical and re-entry data

Platelet Rich Plasma plus Bio-Oss plus Biogide versus Platelet Rich Plasma and Bio-Oss


Tarrson family endowed chair in periodontics

Pocket Depth (in mm)


Platelet rich plasma plus bio oss plus atrisorb versus atrisorb alone

Platelet Rich Plasma and Bovine Porous Mineral combined with guided tissue regeneration in the treatment of intrabony defects in humans.

Camargo PM, Lekovic V, Weinlaender M, Vasilic N, Madzarevic M, Kenney EB

J Periodont. Res 2002, 37:300

18 paired defects

10 males 8 females

6 smokers 12 non-smokers

Mean age 39 years

6 month clinical and re-entry data

Platelet Rich Plasma plus Bio-Oss plus Atrisorb versus Atrisorb alone

Atrisorb-Polylactide in n methyl 2 pyrrolidine.


Tarrson family endowed chair in periodontics

Pocket Depth (mm)


Bio oss plus bio gide plus platelet rich plasma versus flap debridement

A Re-entry study on use of Bovine Porous bone mineral guided tissue regeneration and Platelet Rich Plasma in the treatment of intrabony defects in humans.

Camargo PM, Lekovic V, Weinlaender M, Vasilic N, Madzarevic M, Kenney EB

Int. J. Periodont. Rest. Dent. 2005, 25:49

28 Paired Defects

12 Females 16 Males

Mean age 41.0 years

12 Smokers 16 Non-smokers

Clinical and re-entry data

at 6 months

Bio-Oss plus Bio-Gide plus Platelet Rich Plasma versus Flap Debridement


Tarrson family endowed chair in periodontics

Pocket Depth


Platelet rich plasma

Comparison between

Bio-Oss/Bio-Gide/PRP

and

Bio-Oss/Bio-Gide

Preparing for publication

23 patients

Interproximal defects

Mean age 38

9 smokers, 14 non-smokers

Re-entry 6 months

Platelet Rich Plasma


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Pocket Depth (mm)

NO STATISTICALLY SIGNIFICANT DIFFERENCE


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HIGHLY PURIFIED RECOMBINANT PLATELET DERIVED GROWTH FACTOR


Recombinant human platelet derived graft factor with dfdba

Periodontal Regeneration in Human Class II Furcations using Purified Recombinant Human Platelet Derived Growth Factor – BB (rhPDGF-BB) with Bone Allograft

Camelo M et al

Int J Periodont Rest Dent 2003, 23:213

3 mandibular molars, 1 maxillary

2 got 0.5mg/ml PDGF+DFDBA

2 got 1.0mg/ml PDGF+DFDBA

9-month results

Block sections

Recombinant Human Platelet Derived Graft Factor with DFDBA


Tarrson family endowed chair in periodontics

Results at 9 months (in mm)

  • Histology shows

  • regeneration coronal

  • to notch

  • Bone and cementum

  • fill furcas

  • One case had

  • cementum formed over

  • enamel projection


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.


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THE END


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THE END


Tarrson family endowed chair in periodontics

TRI CALCIUM PHOSPHATE

PORES 1-500 MICRONS

PARTICLES 0.25 -1.00 MM.


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USE OF T.C.P WITH 0.3 mg/ml P.D.G.F. AND TETRACYCLINE ROOT CONDITIONING.


Tarrson family endowed chair in periodontics

6 months

post surgery

few re-entries done


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1 week post surgery


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6 months post surgery


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THE END


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Tarrson family endowed chair in periodontics

Genetically engineered human Bone Morphogenetic Proteins increase the amount and purity . Osteogenin is another name for B.M. P. Most osteogenins are bound to a carrier of bovine type I collagen sponge or other carrier.

Bone Morphogenetic Proteins

First isolated in acid extracts of human bone by URIST in 1965. Are part of superfamily of 43 transforming growth factor beta group. At least 16 different proteins isolated. BMP1 not part of superfamily is a procollagen protease. BMPs secreted by osteoblasts induce formation of osteoprogenitor cells and stimulate new bone formation.


Tarrson family endowed chair in periodontics

URIST at UCLA first identified BMP in 1965.This native BMP is present in minuteamounts (1mg per kg of bone), soneed large amounts of bone to produce. Therefore, recombinantBMPs have been developed.

BMPs 2, 4, 5, 6, 7 needed forregulation of osseous tissue andfor repair. Some are more osteoconductive, e.g., BMP2 and BMP7 more active than BMP5.


Tarrson family endowed chair in periodontics

Recombinant BMPs

require up to 10 times

more than native BMPs

to give the same

osteogenic activity.

BMPsare assayed by

intramuscular injection

into rodents and so

initiate osteogenesis.


Tarrson family endowed chair in periodontics

  • Carriers:

  • Demineralized Bone Matrix

  • Collagen

  • Resorbable polymers

  • Calcium phosphate materials

BMPsneed carrier to get effective bone initiation.

Ideal carrier still not found.


Tarrson family endowed chair in periodontics

Used human BMP (osteogenin) Collaplug and DFDBA, in humans. Took 36 block sections from 8 subjects with submerged roots and 50 non-submerged defects in 6 patients. Used calculus as a baseline measurement of regeneration.

Histologic comparison of Regeneration in Human Intrabony defects when Osteogenin is combined with Demineralized Freeze-Dried Bone Allograft with purified bovine collagen.

Bowers G. et al

J Periodontol. 1991, 62:690


Tarrson family endowed chair in periodontics

50 Non-Submerged Defects

36 Submerged Defects

*DFDBA+BMP significantly better than all other groups Bowers

No significant difference between DFDBA and DFDBA+BMP


Tarrson family endowed chair in periodontics

--1 sinus with BMP-7 had good bone--1 sinus no bone but cyst like mass--2 sinuses had small amount of bone insufficient for implants--All 5 autogenous sinus grafts had good bone

Recombined human Bone Morphogenetic Protein-7 in maxillary sinus floor elevation surgery in 3 patients compared to autogenous bone grafts.

Van den Bergh JPA. et al

J. Clinical Periodontol. 2000, 27:627


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  • 6 patients3 got BMP-7 in collagen in 4 sinus lifts3 got autogenous iliac bone in 5 sinus liftsAt 6 months took out bone cores.

A feasibility study evaluating rhBMP-2 absorbable collagen sponge for maxillary sinus floor augmentation.

Boyne P. et al

Int. J. Perio. Res. Dent. 1997, 17:11


Tarrson family endowed chair in periodontics

Got good bone in cores

One patient had mucus retention cyst on CT at 16 weeks

Got mean bone height increase of 8.51 mm to 15.73 mm

8 to 11 patients had sufficient bone for implant placement.

2 biopsies at 19 weeks had moderate amount of bone

10 biopsies at 24 to 27 weeks had moderate to large amounts of bone.

Collagen sponge bovine type 1 collagen 12 patients with sinus lifts evaluated with CT scans at 16 weeks and bone biopsies (7 cases) at 14 weeks to 27 weeks.


This bovine protein extract neo osteo sulzer contained bone morphogenetic proteins 2 3 4 6 7 12 13

This Bovine protein extract (Neo osteo, Sulzer) contained Bone Morphogenetic Proteins 2, 3, 4, 6, 7, 12, 13.

Bovine derived bone protein extract in the treatment of mandibular class II furcations.

Camargo PM, Wolinsky LE, Burgess AJ, Wagner WR, Paluk SF, Kenney EB.

Compend. Cont. Edu. Dent. 2002, 23:1023


Tarrson family endowed chair in periodontics

6 Month Clinical results using DFDBA plus Bovine Derived Protein

25 patients with grade II furcations in lower molars. Five with BMP

Group 1 0.00 control DFDBA alone.

Group 23.13 micrograms per mg of DFDBA

Group 36.25 micrograms per mg of DFDBA

Group 412.50 micrograms per mg of DFDB

Group 525.0 micrograms per mg of DFDBA

Evaluated at 6 months no re-entry


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Highest concentrations of BMP gave best clinical results


Tarrson family endowed chair in periodontics

THE END


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