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      Use of PRP, PRF and CGF in Periodontal Regeneration and Facial Rejuvenation—A Narrative Review


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          Growth factors play a vital role in cell proliferation, migration, differentiation and angiogenesis. Autologous platelet concentrates which contain high levels of growth factors are used in many fields of dentistry. The current review is designed to provide clinical information regarding the use of three autologous platelet concentrates techniques in periodontal regeneration and facial rejuvenation: platelet-rich plasma, platelet-rich fibrin and concentrated growth factor techniques. The aim is to provide the clinician with an up-to-date overview of autologous platelet concentrates evolution over the past decade, clinical indications for use and advantages and limitations of each technique. This article was written in clinical orientation and is designed to provide clinicians with reliable and useful information applicable to their clinical work. Overall, platelet-rich plasma is mainly used in cases of hard and soft tissue procedures, while platelet-rich fibrin is used in gingival recession and treatment of furcation and intrabony defects; concentrated growth factor is mainly used in bone regeneration. In the field of facial rejuvenation, the use of platelet-rich plasma promotes tissue remodeling in aged skin and may be used as an adjuvant treatment to lasers; platelet-rich fibrin holds significant potential for stimulated dermal augmentation, and concentrated growth factor treatment could improve the survival and quality of fat grafts.


          Growth factors (GFs) play a vital role in cell proliferation, migration, differentiation and angiogenesis. Autologous platelet concentrates (APCs) which contain high levels of GFs make them especially suitable for periodontal regeneration and facial rejuvenation. The main generations of APCs presented are platelet-rich plasma (PRP), platelet-rich fibrin (PRF) and concentrated growth factor (CGF) techniques. The purpose of this review is to provide the clinician with an overview of APCs’ evolution over the past decade in order to give reliable and useful information to be used in clinical work. This review summarizes the most interesting and novel articles published between 1997 and 2020. Electronic and manual searches were conducted in the following databases: Pubmed, Scopus, Cochrane Library and Embase. The following keywords were used: growth factors, VEGF, TGF-b1, PRP, PRF, CGF and periodontal regeneration and/or facial rejuvenation. A total of 73 articles were finally included. The review then addresses the uses of the three different techniques in the two disciplines, as well as the advantages and limitations of each technique. Overall, PRP is mainly used in cases of hard and soft tissue procedures, while PRF is used in gingival recession and the treatment of furcation and intrabony defects; CGF is mainly used in bone regeneration.

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          Most cited references87

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          Postnatal human dental pulp stem cells (DPSCs) in vitro and in vivo.

          Dentinal repair in the postnatal organism occurs through the activity of specialized cells, odontoblasts, that are thought to be maintained by an as yet undefined precursor population associated with pulp tissue. In this study, we isolated a clonogenic, rapidly proliferative population of cells from adult human dental pulp. These DPSCs were then compared with human bone marrow stromal cells (BMSCs), known precursors of osteoblasts. Although they share a similar immunophenotype in vitro, functional studies showed that DPSCs produced only sporadic, but densely calcified nodules, and did not form adipocytes, whereas BMSCs routinely calcified throughout the adherent cell layer with clusters of lipid-laden adipocytes. When DPSCs were transplanted into immunocompromised mice, they generated a dentin-like structure lined with human odontoblast-like cells that surrounded a pulp-like interstitial tissue. In contrast, BMSCs formed lamellar bone containing osteocytes and surface-lining osteoblasts, surrounding a fibrous vascular tissue with active hematopoiesis and adipocytes. This study isolates postnatal human DPSCs that have the ability to form a dentin/pulp-like complex.
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            Investigation of multipotent postnatal stem cells from human periodontal ligament.

            Periodontal diseases that lead to the destruction of periodontal tissues--including periodontal ligament (PDL), cementum, and bone--are a major cause of tooth loss in adults and are a substantial public-health burden worldwide. PDL is a specialised connective tissue that connects cementum and alveolar bone to maintain and support teeth in situ and preserve tissue homoeostasis. We investigated the notion that human PDL contains stem cells that could be used to regenerate periodontal tissue. PDL tissue was obtained from 25 surgically extracted human third molars and used to isolate PDL stem cells (PDLSCs) by single-colony selection and magnetic activated cell sorting. Immunohistochemical staining, RT-PCR, and northern and western blot analyses were used to identify putative stem-cell markers. Human PDLSCs were transplanted into immunocompromised mice (n=12) and rats (n=6) to assess capacity for tissue regeneration and periodontal repair. Findings PDLSCs expressed the mesenchymal stem-cell markers STRO-1 and CD146/MUC18. Under defined culture conditions, PDLSCs differentiated into cementoblast-like cells, adipocytes, and collagen-forming cells. When transplanted into immunocompromised rodents, PDLSCs showed the capacity to generate a cementum/PDL-like structure and contribute to periodontal tissue repair. Our findings suggest that PDL contains stem cells that have the potential to generate cementum/PDL-like tissue in vivo. Transplantation of these cells, which can be obtained from an easily accessible tissue resource and expanded ex vivo, might hold promise as a therapeutic approach for reconstruction of tissues destroyed by periodontal diseases.
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              SHED: stem cells from human exfoliated deciduous teeth.

              To isolate high-quality human postnatal stem cells from accessible resources is an important goal for stem-cell research. In this study we found that exfoliated human deciduous tooth contains multipotent stem cells [stem cells from human exfoliated deciduous teeth (SHED)]. SHED were identified to be a population of highly proliferative, clonogenic cells capable of differentiating into a variety of cell types including neural cells, adipocytes, and odontoblasts. After in vivo transplantation, SHED were found to be able to induce bone formation, generate dentin, and survive in mouse brain along with expression of neural markers. Here we show that a naturally exfoliated human organ contains a population of stem cells that are completely different from previously identified stem cells. SHED are not only derived from a very accessible tissue resource but are also capable of providing enough cells for potential clinical application. Thus, exfoliated teeth may be an unexpected unique resource for stem-cell therapies including autologous stem-cell transplantation and tissue engineering.

                Author and article information

                Role: Academic Editor
                Biology (Basel)
                Biology (Basel)
                10 April 2021
                April 2021
                : 10
                : 4
                : 317
                [1 ]Department of Otolaryngology, Head and Neck and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv 6139001, Israel; mijiritsky@ 123456bezeqint.net (E.M.); orenpeleg@ 123456gmail.com (O.P.)
                [2 ]The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
                [3 ]Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem 9190401, Israel; Haya.assaf@ 123456mail.huji.ac.il
                [4 ]School of Social Work, Ariel University, Ariel 40700, Israel
                [5 ]Department of Translational Medicine and Clinical Science, University of Tor Vergata, 00133 Rome, Italy; cerroni@ 123456uniroma2.it (L.C.); manganiluca@ 123456yahoo.it (L.M.)
                Author notes
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                © 2021 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( https://creativecommons.org/licenses/by/4.0/).

                : 04 March 2021
                : 07 April 2021

                prp,prf,cgf,facial rejuvenation,autologous platelet concentrates,periodontal regeneration


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