TARRSON FAMILY ENDOWED CHAIR IN PERIODONTICS

1. TARRSON FAMILY ENDOWED CHAIR IN PERIODONTICS

2. UCLA SCHOOL OF DENTISTRY

3. Presents Presents Dr. E. Barrie KenneyProfessor & ChairmanSection of Periodontics

4. 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

5. Platelet Rich Plasma –PRP is obtained by sequestering and concentrating platelets by gradient density centrifugation Platelet Rich Plasma Gel

6. 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.

7. 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

8. 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

9. 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

10. Platelet enriched plasma Autologous thrombin

11. 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

12. Pocket Depth (in mm)

17. 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.

18. Pocket Depth (mm)

19. 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

20. Pocket Depth

26. 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

27. Pocket Depth (mm) NO STATISTICALLY SIGNIFICANT DIFFERENCE

28. HIGHLY PURIFIED RECOMBINANT PLATELET DERIVED GROWTH FACTOR

29. 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

30. 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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34. TRI CALCIUM PHOSPHATE PORES 1-500 MICRONS PARTICLES 0.25 -1.00 MM.

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

40. 6 months post surgery few re-entries done

46. 1 week post surgery

47. 6 months post surgery

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