Concentrated Growth Factors for Periodontal Regeneration in Severe Periodontitis: Clinical Efficacy and Inflammatory Modulation
-
Yue Cui
,
Hong Mu
,
Shuang Cai
,
Xuewen Jiao
Abstract
To evaluate the efficacy of concentrated growth factors (CGF) combined with guided tissue regeneration (GTR) in patients with severe periodontitis.
This retrospective study included 220 patients with severe periodontitis undergoing periodontal regenerative surgery. After propensity score matching, 85 patients treated with CGF plus GTR and 85 treated with GTR alone were analyzed. Overall clinical response, postoperative pain, gingival thickness, alveolar bone parameters, and gingival crevicular fluid levels of IL-17, IL-23, and IL-10 were assessed.
The CGF group showed a significantly higher overall response rate than the GTR-alone group (94.12% vs 75.29%). Pain scores were significantly lower in the CGF group on postoperative day 1, with no significant differences on days 3 and 7. At 3 months, improvements in gingival thickness, alveolar bone height, width, and gray values were greater in the CGF group, although differences were not significant at 6 months. CGF treatment reduced IL-17 and IL-23 levels and increased IL-10 levels; these changes correlated with improvements in gingival and bone regeneration.
CGF combined with GTR may enhance early periodontal tissue regeneration, reduce immediate postoperative pain, and modulate local inflammation in severe periodontitis. Further randomized controlled trials are needed to establish long-term benefits.
1. Sanz M, Herrera D, Kebschull M, Chapple I, Jepsen S, Beglundh T, et al. Treatment of stage I-III periodontitis: The EFP S3 level clinical practice guideline. J Clin Periodontol. 2020;47(Suppl 22):4–60.
2. Haas AN, Furlaneto F, Gaio EJ, Rösing CK, Oballe HJR, Susin C, et al. New tendencies in non-surgical periodontal therapy. Braz Oral Res. 2021;35(Suppl 2):e095.
3. Bee SL, Hamid ZAA. Asymmetric resorbable-based dental barrier membrane for periodontal guided tissue regeneration and guided bone regeneration: A review. J Biomed Mater Res B Appl Biomater. 2022;110(9):2157–2182.
4. Rosen E, Tsesis I, Kavalerchik E, Levin L, et al. Effect of guided tissue regeneration on the success of surgical endodontic treatment of teeth with endodontic-periodontal lesions: A systematic review. Int Endod J. 2023;56(8):910–921.
5. Ashfaq R, Kovács A, Berkó S, Katona G, Soós M, Csóka I, et al. Developments in alloplastic bone grafts and barrier membrane biomaterials for periodontal guided tissue and bone regeneration therapy. Int J Mol Sci. 2024;25(14):7746.
6. Trindade D, Carvalho R, Machado V, Botelho J, Mendes JJ, Delgado AS, et al. Prevalence of periodontitis in dentate people between 2011 and 2020: A systematic review and meta-analysis of epidemiological studies. J Clin Periodontol. 2023;50(5):604–626.
7. Huang S, Li Q, Li X, Wang Y, Zhang J, Liu H, et al. Recent research progress of wound healing biomaterials containing platelet-rich plasma. Int J Nanomedicine. 2025;20:3961–3976.
8. Yang F, Zhang R, Xu J, Liu Y, Zhao Y, Chen Z, et al. Comparative effects of concentrated growth factors on the biological characteristics of periodontal ligament cells and stem cells from apical papilla. J Endod. 2022;48(8):1029–1037.
9. Qi L, Liu L, Hu Y, Zhang Y, Wu Y, Yang S, et al. Concentrated growth factor promotes gingival regeneration through the AKT/Wnt/β-catenin and YAP signaling pathways. Artif Cells Nanomed Biotechnol. 2020;48(1):920–932.
10. Xu C, Pei Y, Wang Y, Zhang X, Liu H, Chen J, et al. Progress in the application of auto-concentrated growth factor (CGF) in wound repair. J Biomater Appl. 2025;39(8):819–827.
11. Iao S, Ouyang X, Huang Y, Liu J, Liu W. Concentrated growth factor with guided tissue regeneration for shallow infrabony defects: A one-year prospective study. J Periodontol. 2025 May 19.
12. Aboelela SAA, Atef M, Shawky M, Soliman S, et al. Ridge augmentation using autologous concentrated growth factors enriched bone graft matrix versus guided bone regeneration using native collagen membrane in horizontally deficient maxilla: A randomized clinical trial. Clin Implant Dent Relat Res. 2022;24(5):569–579.
13. Bunte K, Beikler T. TH17 cells and the IL-23/IL-17 axis in the pathogenesis of periodontitis and immune-mediated inflammatory diseases. Int J Mol Sci. 2019;20(14):3394.
14. Herrera D, Sanz M, Kebschull M, Jepsen S, Sculean A, Berglundh T, et al. Treatment of stage IV periodontitis: The EFP S3 level clinical practice guideline. J Clin Periodontol. 2022;49(Suppl 24):4–71.
15. Kwon T, Lamster IB, Levin L. Current concepts in the management of periodontitis. Int Dent J. 2021;71(6):462–476.
16. Pippi R. Post-surgical clinical monitoring of soft tissue wound healing in periodontal and implant surgery. Int J Med Sci. 2017;14(8):721–728.
17. Jepsen K, Sculean A, Jepsen S. Complications and treatment errors related to regenerative periodontal surgery. Periodontol 2000. 2023;92(1):120–134.
18. Wu Z, He D, Zhao S, Wang H, Li Y, Liu J, et al. IL-17A/IL-17RA promotes invasion and activates MMP-2 and MMP-9 expression via p38 MAPK signaling pathway in non-small cell lung cancer. Mol Cell Biochem. 2019;455(1-2):195–206.
19. He W, Zhu H, Liu C. Profiles of inflammation factors and inflammatory pathways around the peri-miniscrew implant. Histol Histopathol. 2021;36(9):899–906.
20. Yoo KH, Thapa N, Chwae YJ, Park HJ, Kim JH, Lee SH, et al. Transforming growth factor-β family and stem cell-derived exosome therapeutic treatment in osteoarthritis (review). Int J Mol Med. 2022;49(5):62.
21. Bunte K, Beikler T. TH17 cellsand the IL-23/IL-17 axis in the pathogenesis of periodontitis and immune-mediated inflammatory diseases. Int J Mol Sci. 2019;20(14):3394.
22. Rzeszotarska E, Sowinska A, Stypinska B, Olesinska M, Walczyk M, Kwiatkowska B, et al. IL-1β, IL-10, and TNF-α polymorphisms may affect systemic lupus erythematosus risk and phenotype. Clin Exp Rheumatol. 2022;40(9):1708–1717.
23. Carvalho Vasconcelos R, Ferreira C, de Araújo EM, Sousa FB, de Almeida PC, de Castro Brito GA, et al. Zirconia/hydroxyapatite (80/20) scaffold repair in critical size calvarial defect increased FGF-2, osteocalcin, and OPG immunostaining and IL-10 levels. Am J Transl Res. 2020;12(6):2439–2450.
24. Xu F, Qiao L, Zhao Y, Chen W, Hong S, Pan J, et al. The potential application of concentrated growth factor in pulp regeneration: an in vitro and in vivo study. Stem Cell Res Ther. 2019;10(1):134.
25. Tsubosaka M, Maruyama M, Huang EE, Akita S, Arai Y, Tsuchiya H, et al. Effect on osteogenic differentiation of genetically modified IL4 or PDGF-BB over-expressing and IL4-PDGF-BB co-over-expressing bone marrow-derived mesenchymal stromal cells in vitro. Bioengineering (Basel). 2021;8(11):165.
26. Liu XH, Pan JP, Bauman WA, Cardozo CP, Qin W, et al. Myostatin inhibits insulin-like growth factor 1-dependent citrate secretion and osteogenesis via nicotinamide adenine dinucleotide phosphate oxidase-4 in a mouse mesenchymal stem cell line. Ann N Y Acad Sci. 2022;1517(1):203–212.
27. Luo X, Chen O, Wang Z, Bang S, Ji J, Lee SH, et al. IL-23/IL-17A/TRPV1 axis produces mechanical pain via macrophage-sensory neuron crosstalk in female mice. Neuron. 2021;109(17):2691–2706.e5.
28. Terui H, Yamasaki K, Wada-Irimada M, Tanaka A, Kajita A, Kubo A, et al. Staphylococcus aureus skin colonization promotes SLE-like autoimmune inflammation via neutrophil activation and the IL-23/IL-17 axis. Sci Immunol. 2022;7(76):eabm9811.
29. Liu X, Zhou J, Chen M, Zhang Y, Wang Y, Li H, et al. 3D-printed biomimetic bone scaffold loaded with lyophilized concentrated growth factors promotes bone defect repair by regulating the VEGFR2/PI3K/AKT signaling pathway. Int J Biol Macromol. 2024;282(Pt 2):136938.
30. Everts PA, Lana JF, Alexander RW, Mautner K, Borrione P, Marx RE, et al. Profound properties of protein-rich, platelet-rich plasma matrices as novel, multi-purpose biological platforms in tissue repair, regeneration, and wound healing. Int J Mol Sci. 2024;25(14):7914.
31. Arıcan G, Özmeriç A, Fırat A, Karakuzu C, Atlıhan D, Bozkurt HH, et al. Micro-CT findings of concentrated growth factors (CGF) on bone healing in Masquelet's technique: an experimental study in rabbits. Arch Orthop Trauma Surg. 2022;142(1):83–90.
2. Haas AN, Furlaneto F, Gaio EJ, Rösing CK, Oballe HJR, Susin C, et al. New tendencies in non-surgical periodontal therapy. Braz Oral Res. 2021;35(Suppl 2):e095.
3. Bee SL, Hamid ZAA. Asymmetric resorbable-based dental barrier membrane for periodontal guided tissue regeneration and guided bone regeneration: A review. J Biomed Mater Res B Appl Biomater. 2022;110(9):2157–2182.
4. Rosen E, Tsesis I, Kavalerchik E, Levin L, et al. Effect of guided tissue regeneration on the success of surgical endodontic treatment of teeth with endodontic-periodontal lesions: A systematic review. Int Endod J. 2023;56(8):910–921.
5. Ashfaq R, Kovács A, Berkó S, Katona G, Soós M, Csóka I, et al. Developments in alloplastic bone grafts and barrier membrane biomaterials for periodontal guided tissue and bone regeneration therapy. Int J Mol Sci. 2024;25(14):7746.
6. Trindade D, Carvalho R, Machado V, Botelho J, Mendes JJ, Delgado AS, et al. Prevalence of periodontitis in dentate people between 2011 and 2020: A systematic review and meta-analysis of epidemiological studies. J Clin Periodontol. 2023;50(5):604–626.
7. Huang S, Li Q, Li X, Wang Y, Zhang J, Liu H, et al. Recent research progress of wound healing biomaterials containing platelet-rich plasma. Int J Nanomedicine. 2025;20:3961–3976.
8. Yang F, Zhang R, Xu J, Liu Y, Zhao Y, Chen Z, et al. Comparative effects of concentrated growth factors on the biological characteristics of periodontal ligament cells and stem cells from apical papilla. J Endod. 2022;48(8):1029–1037.
9. Qi L, Liu L, Hu Y, Zhang Y, Wu Y, Yang S, et al. Concentrated growth factor promotes gingival regeneration through the AKT/Wnt/β-catenin and YAP signaling pathways. Artif Cells Nanomed Biotechnol. 2020;48(1):920–932.
10. Xu C, Pei Y, Wang Y, Zhang X, Liu H, Chen J, et al. Progress in the application of auto-concentrated growth factor (CGF) in wound repair. J Biomater Appl. 2025;39(8):819–827.
11. Iao S, Ouyang X, Huang Y, Liu J, Liu W. Concentrated growth factor with guided tissue regeneration for shallow infrabony defects: A one-year prospective study. J Periodontol. 2025 May 19.
12. Aboelela SAA, Atef M, Shawky M, Soliman S, et al. Ridge augmentation using autologous concentrated growth factors enriched bone graft matrix versus guided bone regeneration using native collagen membrane in horizontally deficient maxilla: A randomized clinical trial. Clin Implant Dent Relat Res. 2022;24(5):569–579.
13. Bunte K, Beikler T. TH17 cells and the IL-23/IL-17 axis in the pathogenesis of periodontitis and immune-mediated inflammatory diseases. Int J Mol Sci. 2019;20(14):3394.
14. Herrera D, Sanz M, Kebschull M, Jepsen S, Sculean A, Berglundh T, et al. Treatment of stage IV periodontitis: The EFP S3 level clinical practice guideline. J Clin Periodontol. 2022;49(Suppl 24):4–71.
15. Kwon T, Lamster IB, Levin L. Current concepts in the management of periodontitis. Int Dent J. 2021;71(6):462–476.
16. Pippi R. Post-surgical clinical monitoring of soft tissue wound healing in periodontal and implant surgery. Int J Med Sci. 2017;14(8):721–728.
17. Jepsen K, Sculean A, Jepsen S. Complications and treatment errors related to regenerative periodontal surgery. Periodontol 2000. 2023;92(1):120–134.
18. Wu Z, He D, Zhao S, Wang H, Li Y, Liu J, et al. IL-17A/IL-17RA promotes invasion and activates MMP-2 and MMP-9 expression via p38 MAPK signaling pathway in non-small cell lung cancer. Mol Cell Biochem. 2019;455(1-2):195–206.
19. He W, Zhu H, Liu C. Profiles of inflammation factors and inflammatory pathways around the peri-miniscrew implant. Histol Histopathol. 2021;36(9):899–906.
20. Yoo KH, Thapa N, Chwae YJ, Park HJ, Kim JH, Lee SH, et al. Transforming growth factor-β family and stem cell-derived exosome therapeutic treatment in osteoarthritis (review). Int J Mol Med. 2022;49(5):62.
21. Bunte K, Beikler T. TH17 cellsand the IL-23/IL-17 axis in the pathogenesis of periodontitis and immune-mediated inflammatory diseases. Int J Mol Sci. 2019;20(14):3394.
22. Rzeszotarska E, Sowinska A, Stypinska B, Olesinska M, Walczyk M, Kwiatkowska B, et al. IL-1β, IL-10, and TNF-α polymorphisms may affect systemic lupus erythematosus risk and phenotype. Clin Exp Rheumatol. 2022;40(9):1708–1717.
23. Carvalho Vasconcelos R, Ferreira C, de Araújo EM, Sousa FB, de Almeida PC, de Castro Brito GA, et al. Zirconia/hydroxyapatite (80/20) scaffold repair in critical size calvarial defect increased FGF-2, osteocalcin, and OPG immunostaining and IL-10 levels. Am J Transl Res. 2020;12(6):2439–2450.
24. Xu F, Qiao L, Zhao Y, Chen W, Hong S, Pan J, et al. The potential application of concentrated growth factor in pulp regeneration: an in vitro and in vivo study. Stem Cell Res Ther. 2019;10(1):134.
25. Tsubosaka M, Maruyama M, Huang EE, Akita S, Arai Y, Tsuchiya H, et al. Effect on osteogenic differentiation of genetically modified IL4 or PDGF-BB over-expressing and IL4-PDGF-BB co-over-expressing bone marrow-derived mesenchymal stromal cells in vitro. Bioengineering (Basel). 2021;8(11):165.
26. Liu XH, Pan JP, Bauman WA, Cardozo CP, Qin W, et al. Myostatin inhibits insulin-like growth factor 1-dependent citrate secretion and osteogenesis via nicotinamide adenine dinucleotide phosphate oxidase-4 in a mouse mesenchymal stem cell line. Ann N Y Acad Sci. 2022;1517(1):203–212.
27. Luo X, Chen O, Wang Z, Bang S, Ji J, Lee SH, et al. IL-23/IL-17A/TRPV1 axis produces mechanical pain via macrophage-sensory neuron crosstalk in female mice. Neuron. 2021;109(17):2691–2706.e5.
28. Terui H, Yamasaki K, Wada-Irimada M, Tanaka A, Kajita A, Kubo A, et al. Staphylococcus aureus skin colonization promotes SLE-like autoimmune inflammation via neutrophil activation and the IL-23/IL-17 axis. Sci Immunol. 2022;7(76):eabm9811.
29. Liu X, Zhou J, Chen M, Zhang Y, Wang Y, Li H, et al. 3D-printed biomimetic bone scaffold loaded with lyophilized concentrated growth factors promotes bone defect repair by regulating the VEGFR2/PI3K/AKT signaling pathway. Int J Biol Macromol. 2024;282(Pt 2):136938.
30. Everts PA, Lana JF, Alexander RW, Mautner K, Borrione P, Marx RE, et al. Profound properties of protein-rich, platelet-rich plasma matrices as novel, multi-purpose biological platforms in tissue repair, regeneration, and wound healing. Int J Mol Sci. 2024;25(14):7914.
31. Arıcan G, Özmeriç A, Fırat A, Karakuzu C, Atlıhan D, Bozkurt HH, et al. Micro-CT findings of concentrated growth factors (CGF) on bone healing in Masquelet's technique: an experimental study in rabbits. Arch Orthop Trauma Surg. 2022;142(1):83–90.
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| Issue | Articles in Press | |
| Section | Original Article(s) | |
| Keywords | ||
| Cytokines Gingival crevicular fluid Guided tissue regeneration Periodontitis Platelet-rich fibrin Wound healing | ||
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How to Cite
1.
Cui Y, Mu H, Cai S, Jiao X. Concentrated Growth Factors for Periodontal Regeneration in Severe Periodontitis: Clinical Efficacy and Inflammatory Modulation. Iran J Allergy Asthma Immunol. 2026;:1-9.
