Biologic Agents for Periodontal Regeneration and Implant Site Development

Table 1

Summary of growth factors.

(a)

Agent	rhPDGF-BB	EMD	PRP/PRF	FGF-2
Origin	Blood platelets	Hertwig’s epithelial root sheath	Platelet alpha granules	Fibroblast growth factors family
Composition	Protein	90% Amelogenin	PDGF, I-LGF, VEGF, TGF-	Protein
MOA	Mainly chemotaxis and mitogenesis	Precise MOA still unknown	Combination of different MOA of different growth factors contained with the platelet concentrates	Proliferation PDL cells; Migration PDL cells; Differentiation PDL cells; ECM production
Indications/common uses	(i) Intrabony defects; (ii) Furcations; (iii) Gingival recession defects; (iv) Often used in combination with allograft or xenograft	(i) Intrabony defect; (ii) Class II furcation defects; (iii) Recession coverage procedures	(i) Recession coverage procedures; (ii) Barrier membrane	(i) Peri-implant defects; (ii) Intrabony defects
FDA approval	(i) Intrabony defects; (ii) Furcations; (iii) Gingival recession	(i) Intrabony defects; (ii) Optimize tissue height in esthetic zone	Not regulated	Not yet approved
Manufacturer	GEM 21S (Osteohealth)	Emdogain (Straumann)	Multiple machines for platelet concentrates fabrications are available	Not yet commercially available

(b)

Agent	BMP-2	BMP-7	GDF-5	Teriparatide
Origin	Recombinant DNA biotechnology using mammalian cells	Recombinant DNA biotechnology using mammalian cells	Recombinant DNA process using bacterial expression followed by in vitro refolding	Recombinant DNA
Composition	Bone Morphogenic Protein-2	Bone Morphogenic Protein-7	Growth Differential Factor-5	Parathyroid hormone’s (PTH) first 34 amino acids
MOA	Increased proliferation, mineralization, and expression of alkaline phosphatase and osteocalcin	Increased proliferation, mineralization, and expression of alkaline phosphatase and osteocalcin	Increased early differentiation and matrix production	Modify proliferation of mineralized markers
Indications/common uses	(i) Systemic or anatomic condition where successful bone regeneration cannot be achieved with conventional grafts; (ii) No with demineralized bovine bone	(i) Systemic or anatomic condition where successful bone regeneration cannot be achieved with conventional grafts; (ii) No with demineralized bovine bone	Systemic or anatomic condition where successful bone regeneration cannot be achieved with conventional grafts	Bone metabolism disease that can jeopardize implant stability and osseointegration process
FDA approval	Sinus augmentation; Socket preservation	Sinus augmentation; Socket preservation	Sinus augmentation; Socket preservation	—
Manufacturer	Infuse Bone Graft (Medtronic Inc.)	Osigraft (Stryker Biotech Inc.)	Scil Technology Inc.	Forteo (Eli Lilly Inc.)

MOA: mechanism of action; FDA: Food and Drug Administration.