The Effect of Implant Surface Bioactivation with PRGF on Cell Attachment in the Presence of Cigarette Smoke Extract PHILLIP LIP CRUM, DDS LSU SCHOO OOL L OF OF D DENTIST ISTRY RY DEPAR ARTM TMENT ENT OF PERIODO DONT NTICS ICS
Effect Ef ct on Pe Perio iodonta tal l Effect Ef ct on De Dental l Impla lants nts Structu St ctures res and Na Natural l Teeth Cigarette Smoking • Increased incidence of periodontal disease (Bergström, 1991) • Implants in smokers 2.5x more likely to fail (Bain and • Increased levels of periodontal pathogens (Haffajee and Socransky, Moy,1993) • Increased incidence of peri-implant mucositis and 2001) • Poor healing results (Tonetti, 1998) peri-implantitis (Renvert, 2015) • Poorer long term prognosis (Tonetti, 1998)
How do Cigarettes Effect Dental Implant Success PATI TIENT ENT LEVEL VEL CELLULA ELLULAR R LEVEL VEL SUR URGE GEON ON LEVEL VEL
How ow Doe oes s Sm Smok oking ing Af Affec ect t Cel ells ls Used ed in in thi his Cel ells ls? St Stud udy PDL DL fi fibrob roblast last att ttachmen chment t Human man gingival ingival and d differen fferentia tiation tion fi fibro robla blasts sts obtain tained ed fr from m 13 year ar old ld male le patie tient nt Gi Gingival ngival fi fibro roblast blast att ttach chment ment at t LSU CELLULA ELLULAR R LEVEL VEL and d differen fferentia tiation tion Os Oste teob oblast last att ttachmen achment t and d differen fferentiatio tiation
Wh What at is is it it? How ow was as it it us used? ed? CSE is a solution A dilution of 1.5% CSE prepared by drawing the solution was used in smoke from a lit the current study. Cigarette Smoke Extract (CSE) cigarette through 10ml of MEMα media over 60 This level reflects the seconds salivary levels of CSE of resting saliva in an Used in research to average smoker mimic the effect of 100% CSE smoking on cells
How ow is is it it ac achieved? hieved? Wh What at is is it it? Coating a dental BMPs implant surface in a PRGF GF, PRP, PRF bioactive material in the Implant Surface Bioactivation hopes of improving the TGF biological compatibility of the dental implant Peptides Extracellular matrices
Plasma Rich in Growth Factors 100% Autologous pure platelet-rich plasma (P-PRP) product Does not contain leukocytes - avoiding their pro-inflammatory activity PRGF releases growth factors and proteins that are involved in wound healing - Platelet derived growth factor (PDGF) - Insulin like growth factor (IGF) - Transforming growth factor β( TGF- β) - Vascular endothelial growth factor (VEGF)
Blood Draw PRGF Preparation Implant placed in PRGF After centrifugation Collect fractions Fraction 2=PRGF for 5 mins Centrifuge for 8 mins
Cur urrent rent Stu tudy dy Ob Objectives ectives Pu Purpose: This study was designed to examine the effect of implant surface bioactivation with PRGF in the presence of CSE on the attachment of gingival fibroblasts to four different dental implant surfaces Hypo pothesi thesis: Surface bioactivation of dental implants with PRGF will enhance the attachment of gingival fibroblasts to the dental implant surface in the presence of CSE.
Study Design Phase ase 1: : +/- PRGF GF Implant Im lant Bran rands ds Used ed Control: Uncoated Implants (n=4 per surface) Su Surface ce 1: Osseoti otite te Test: Implants coated in PRGF (n=4 per surface) Surface Su ce 2: TiU iUnit ite Phase ase 2: : +/- PRGF GF in n th the pres resen ence ce of f CSE SE Control: Uncoated Implants in presence of CSE (n=4 per surface) Surface Su ce 3: SL SLA Test: Implants coated in PRGF in presence of CSE Surface Su ce 4: MTX (n=4 per surface)
Study Methods -Cells frozen Fluorescence Microplate Reader -Cells vortexed to release used to quantify PRGF Group soaked -Gingival fibroblasts, CSE and RNA cellular attachment for 5 mins dental implants plated -Cy-QUANT fluorescent -Placed in fresh well at 24 hours dye added and incubated for 48 hours
RESULTS Ph Phase I: Ce Cell ll A Attach chme ment nt to dental l im impla lants s wi with and wit without PR PRGF Su Surface ce Bi Bioactiv ivati ation Implan plant t Surfac rface Mean ean Cellul llular ar Attachm achment ent Control ontrol Group oup (SD) D) PRGF GF Group oup (SD) D) 3i 26,908 (+10,873.9) 21,610 (+3,126.03) Nobel 28,768 (+9,708.53) 22,032 (+7,800.79) Straumann 23,106 (+5,047.50) 26,983(+2,318.63) Zimmer 31,509 (+8,938.61) 27,859(+8,938.61) **NSSD between implant brands in either group
RESULTS Ph Phase II: I: Ce Cell ll At Attach chment ent to dental l im impla lants wi with and wit without PR PRGF Su Surface ce Bi Bioactiva ivati tion on in in t the Pr Presence of CS CSE Implan plant t Surfac rface Mean ean Cellul llular ar Attachm achment ent CSE Alon one Gro Group up (SD) D) CSE + PR PRGF GF Gr Grou oup (SD) D) 3i 12,034 (+3,624.77) 11,594 (+2,321.38) Nobel 5,872 (+1,506.55) 13,319 (+4,159.53) Straumann 5,682 (+1,999.37) 13,662 (+3,773.63) Zimmer 10,968 (+2,374.82) 11,890 (+3,036.68) **SS reduction in cellular attachment to Nobel and Straumann implants in the presence of CSE, PRGF helped rescue this reduction
RESULTS **The addition of PRGF in the presence of CSE lead to a SS increase in attachment of gingival fibroblasts to Nobel and Straumann Implants
RESULTS CSE Control PRGF CSE + PRGF
CONCLUSIONS This study demonstrated that in the presence of cigarette smoke extract; the overall attachment of gingival fibroblasts was reduced to various implant surfaces. When implants were placed in PRGF for 5 minutes prior to cell exposure, this reduction in cellular attachment was corrected. Within the limitations of this study, this provides a proof of concept for additional, large-scale studies to evaluate the true efficacy of implant surface bioactivation with PRGF.
FUTURE RESEARCH Larger studies are needed to evaluate the true impact of PRGF surface bioactivation on cellular attachment, including evaluation of PDL fibroblasts and osteoblasts Future clinical studies for implant survival and incidence of peri-implant diseases
THANK YOU Dr. Thomas as Lalli lier er Dr. Pooja ja Maney Dr. Jess ssic ica a Ow Owens Dr. Angela ela Palaiol aiologo ogou-Gal Gallis lis Perio io Dental tal Assista istants nts
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