The use of bioactive factors to enhance bone regeneration. A narrative review.

Abstract

AimThis reviewcritically appraisesthe available knowledge on the pre-clinical and clinical use of bioactive factorsfor bone regeneration in the cranial and maxillo-facial area.Materials and MethodsThe use of growth factors, amelogenins and autologous platelet concentrates (APCs) for bone regeneration wasreviewedin a systematic manner. More specifically,preclinical and clinical studies on ridge preservation, alveolar ridge augmentation, regeneration of peri-implant defects and sinus augmentation models were considered.ResultsAmongst different bioactive factors, the highest pre-clinical and clinical evidence of a positive effect on bone formation is associated with BMP-2 and the lowest with amelogenins. While APCs seem to accelerate clinical healing and reduce postoperative discomfort, there is insufficient and contrasting evidence of a significant effect on hard tissue regenerationfor the different clinical applications.ConclusionsAlthough there is increasing evidence that bioactive factors might enhance the bone regeneration process, the great heterogeneity of the available studies and the limited number of RCTs do not allow to draw robust conclusions. Issues that still need to be investigated include the optimal carriersfor bioactive agents (direct vs. indirect), the dosage, the timing of administration, as well as the possibility of combining different agents to promote synergistic effects.