PDGF-BB: Thoughts on this Material?

The material is called GEM21S and it is a mixture of an alloplast with the growth factor. The combination is used for regeneration of lost bone structure around teeth. I'm not sure if FDA has given an OK for sinus use but one could argue... On an other note, BMP has also been recently introduced into the alveolar ridge grafting and it has shown some very promising results. One draw back - $$$. The material is extremely expensive and the sinus lift procedure needs to become twice as expensive when compare to a regular bone graft. What you do get is bone much sooner than you would with allograft/xenograft. For those patients that time is an issue, the extra expense is worth it.

I traveled to Vitoria,Spain this past summer and observed Dr. Eduardo Anitua. He developed PRGF which he calls Plasma Rich in Growth Factors. Essentially you draw 20 - 80cc of the patients blood and centrifuge it. The 25% of plasme just above the White Blood Cells is the Plasma Rich in Growth Factors. You pipette off this layer and you can activate it with CaCl and form a fibrin clot. This is place in the surgical site with or without human bone, harvested bone, or bovine bone. He has research showing that by placing the PRGF in extaction sites, the alvoeolar bone is regenerated in 3 months without any bone graft material. He also uses it in all implant placement, extractions, sinus lifts, ridge splits and, block grafts. He is the owner of BTI implants. You can read more about it at BTI-implant.us. One of the smartest and best clinicians I have observed. He is a MD, DDS, PhD. Very bright man. Brad Bynum Valdosta GA

There are references in german and european articles to pdgf since the mid 80´s. The technique is great for soft tissue and since late 90´s it has had more support in the hard tissue area. For me it works but is very expensive for the patient, the kits and centrifuge , etc are also expensive.If the main concern is time, then yes, if not then definitively no, no need.

Dr. Bynum, is PRGF the same process I have seen for PRP (Platet Rich Plasma)? These materials seem to dramatically improve predictability of bone grafting. Would it help with periodontal grafting too? I wonder about advantages and disadvantages of laboratory-grown vs in-office "autograft" PRP.

PRGF is purely from the patients blood other than a few drops of CaCl. The cost is about 8 dollars per patient. I have seen PRP demonstrated, however I do not know enough to discuss it thoroughly. It did cost around 175 per patient use and involved bovine products from my memory. My unserstanding is that PRGF has all the human growth factors and enhances all tissue to regenerate. It is activated by the cells it comes in contact with to release the growth factor for that cell. There is no bovine thrombin or any other hemoderivative. PRGF eliminates inflammatory interleukines because leukocytes are excluded. Google PRGF and read about it. There is a 44 page adobe file on PRGF, its easy to find.

I know about teh procedure with PRP, but my question is moren about rh- PDGF-BB. This could be injected in for instance a Bio-gide block and gives the same good results as the normal bone block augmentation, but with the difference of the lack of a secondary operation at the donorsite, which its problems and complications. So it would be more patient friendly to use this, instead of fore instance grafing bone in the chin or hip. I have seen a new procedure for a split osteotomy for vertical augementation of the ridge and putting a bio-gide bone block inbetween with good results. But since this is a scaffold with only a osteoconductive property With the injection of rhPDGF-BB ( recombinant PDGF) we would get also an osteopromotion with probably better results. If GEM 21 S is the product can one buy this product in Europ?

GEM21s is about 300 usd/box. It is is 10 to 100 times stronger than prp. Is it worth it? Yes - in some cases. I like to keep a few boxes in the office at all times.

is it possible to assemble pdgf and bone graft material separately instead of using GEM21s. and if yes then how to reconstitute it. please help if anybody has ny idea about this.