Periodontitis is an infectious disease of the supporting structures of the teeth in which changes occurring within the alveolar bone are very crucial because the destruction of the bone is responsible for mobility and tooth loss. The resorption process of bone is usually interfered by various factors such as severe gingival inflammation, changes within the bacterial plaque composition, continuous or repeated trauma to the tooth by occlusal discrepancies and systemic diseases. One way of determining whether an inflammatory gingival lesion has spread into the underlying periodontal structures is by radiographic evidence of crestal alveolar bone loss and associated pocket formation. It is often characterized by formation of intra-bony defects and the treatment of these defects still remains a challenge to the clinician. Several regenerative procedures have been described in the literature.
Graft material used for periodontal regeneration are categorized as autografts, allografts, xenografts. Autografts and DFDBA have histologic evidence of pdl regeneration in humans. Harvesting intraoral autogenous bone for pdl grafting is often an unattractive option due to the limited quantity of bone available as well as potential need for second surgical site. where as Decalcified freeze-dried bone allograft (DFDBA) contains bone morphogenetic proteins (BMPs) that aid in mesenchymal cell migration, attachment and osteogenesis have both osteoinductive as well as osteoconductive activity and the ability to create and maintain the space. DFDBA has been proposed as an effective regenerative material for osseous defects.
Later on, research efforts shifted toward platelet concentrates because of the acceleration of wound healing and stimulation of adjacent cells for the
restoration of the lost periodontium. Platelet concentrates are way ahead of other biomaterials due to constant release of growth factors over a time period, which are crucial for stimulation of adjacent progenitor cells, leading to periodontal regeneration and tissue healing.5 These platelet concentrates also have leucocytes, vitronectin, fibronectin, bone morphogenetic proteins (BMPs), and cytokines that contribute to different stages of the wound healing process.6 Initially, platelet- rich plasma (PRP) was used alone or with bone graft in the treatment of intra- bony defects. Although the results were reasonable, due to the risk of antigenicity as a result of the addition of bovine anti-thrombin, leucocyte- platelet-rich fibrin (L-PRF) was introduced, which does not require any kind of anticoagulant. |