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ePaper created 2017-12-04, 09:17:08 | version 1.38.0
I case study_ implant surface The synergetic effect: L-PRF and OSSEAN implant surface Author_ Robert J. Miller, MA, DDS, FACD _Clinical outcomes in implant dentistry are dependent on a host of factors that are well docu- mented. The evolution of our dis- cipline has involved the physical manipulation of the site and mate- rials used but now also includes the shaping of the biologic response. Speed of healing and the qual- ity of the tissue regenerated are now considered two of the most important attributes as it relates to surgical success. As clinical out- comes are dependent on the types of biomaterials used, one of the strategies we now employ is using the synergetic effect of a combina- tion of these materials to ensure When OSSEAN surface implants the best clinical outcomes. are placed in the presence of autologous biologics (L-PRF), something remarkable occurs: synergy. (Photos/Provided by Intra-Lock) == Our capacity to shorten treatment time for pa- tients and still achieve successful function and es- thetics requires compression of the wound response. Starting 20 years ago, the initial use of autologous growth factors, in the form of platelet-rich plasma (PRP), enabled us to speed up the regeneration of soft tissue. As it had very little effect on hard tissue, researchers developed recombinant human growth factors in the form of platelet derived growth factor (rhPDGF) and bone morphogenic protein (rhBMP) to address this inadequacy. While there was success in speeding up the process of regenerating hard tissue, the bone was relatively immature unless the clinician waited longer before placing implants. A decade ago, a second-generation autologous material in the form of leucocyte containing platelet rich plasma (L-PRF®) became available. The introduc- tion of an FDA-cleared medical device for the produc- tion of L-PRF, IntraSpin™, has opened a new world and has enhanced healing possibilities for our patients. The entire range of growth factors necessary for 10 I implants 2_2017 regeneration of both hard and soft tissue, in concen- trated form, now enables us to predictably compress treatment time while creating a tissue envelope that normally would be seen following a much longer period of healing.1 But if it is true that a paradigm is only as good as the weakest link, the choice of implant architecture and surface must also be considered. One of the most exciting developments in implant surface design has been the incorporation of calcium phosphate into the titanium oxide layer in a surface treatment called OSSEAN.® It is a fractal nano-rough structure and is ideal for fibrin attachment and platelet deposition. It has receptor sites that further encourage cell growth, which hastens early osse- ointegration. It creates a calcium-rich environment, potentiating osteoblastic cell activity by altering gene expression and produces a higher percentage of vital bone at an earlier stage of healing. This rapid bone bonding is a requirement for early loading of implants.2 However, when the OSSEAN surface implants are placed in the presence of autologous biologics (L-PRF), something remarkable occurs: synergy. In its simplest form, a synergetic effect is the creation of a whole that is greater than the sum of its parts. The benefit of this effect is that it serves only to add, never subtract. The clinical outcomes that we observe far outweigh those that we see when these materials are used independently. This “synergy” of two different materials now enables us to compress the wound response in ways we could not have im- agined just a few years ago. Recently published advances in these two in- dividual biotechnologies led a group of scientists to investigate just such a scenario.3 They reasoned that if an implant with an osteoinductive, bioactive surface (OSSEAN) was immersed into a super blood clot (L-PRF) obtained with the IntraSpin system, bone should naturally grow in an extraction site defect between the bone and implant surface, even in the