ABSTRACT

CGF-“A miracle in regenerative dentistry ”. CGF- Concentrated Growth Factor is a new regeneration

platelet aggregate which is used widely in periodontal disorders and surgeries. It is adopted without the use

of chemicals which grades it more eco-friendly. It contains various growth factors which enhances its action

and promotes wound healing .CGF is currently used along with autologous bone particles to induce bone

regeneration and connective tissue attachment that shows excellent results .In future research can prove, that

CGF can be used as a sole regenerative material. It is an excellent biomaterial which showcases back to

normal periodontium with external finishing. This article focuses on the preparation, applications and

advantages of using CGF in the field of regeneration.

INTRODUCTION

In dentistry, recent research of growth factors recognized that the best tissue regenerative stimulus is

present amongst the autologous growth factors, which have clinically proven to induce regeneration

and tissue healing. Growth factors are bioactive proteins which control the process of wound healing.

Concentrated Growth Factors (CGF) is a relatively new technology within the area of regenerative
[1]
medicine. (CGF) was first developed by Sacco (2006) . It is a blood extract obtained with

differential continuous centrifugal technology, containing many kinds of growth factors and fibrins,

and able to facilitate the recovery of soft and hard tissues. CGF is different from the methods for

producing platelet-rich plasma (PRP) or platelet-rich fibrin (PRF) because no additives are added

during its production.

It is an advanced 2nd generation platelet concentrate. CGF has a difference in centrifugation speed

than the platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) which permits the isolation of much

larger and denser fibrin matrix richer in growth factors .

CGF is fibrin rich organic matrix which contains growth factors, platelets, leukocytes and CD34+ stem

cells which help in the process of regeneration and also has immunological cells that are effective in

regulating inflammation and minimizing the risk of infection. Concentrated Growth Factors (CGF) is a

biological inducing material which improves the quality of the formed bone, and facilitates the

formation of bones and the healing of tissues.

Preparation

CGF is an autologous preparation taken from patient’s venous blood of about 9 ml was collected

without anticoagulant solutions in sterile Vacuette tubes. The tubes are kept for centrifugation

(Medifuge,Silfradent,Sofia, Italy) with one step centrifugation protocol: 30sec -acceleration, 2min -

2700 rpm, 4min 2400 rpm, 4min - 2700 rpm, 3min - 3000 rpm, 36sec – deceleration and stop. This

results in 4 different phases [1].

Phases of CGF

1. Superior phase – Serum

2. Interim phase – Fibrin buffy coat

3. Liquid phase – Growth factors

4. Lower phase – Red blood cells

The CGF glue rich in growth factors is taken from the test tubes with tweezers and the two phases

were cut off with scissors where the center and bottom layers connected. When the CGF glue is

separated out, a quantity of growth factors are located on the interface between the CGF glue layer
and the erythrocyte layer. Therefore, a certain amount of erythrocytes has to be retained when doing

the separation in order to ensure the content of the growth factors. The CGF glue is pressed in

moulds, squeezing the liquid elements within it and obtaining the CGF membrane. The CGF glue and

the CGF membrane are put into sterile normal saline for future use [2].

Functions

CGF is a fibrin tissue adhesive with haemostatic and tissue sealing properties. It promotes wound

healing and accelerates osteogenesis. CGF improves the wound stability, which is required for the

establishment of a new connective tissue attachment to a root surface. It promotes epithelial,

endothelial and epidermal regeneration and decreases scarring. It has antimicrobial properties due to

high concentration of leukocytes. It acts as an anti-angiogenic agent on chronic non healing wounds.

It also provides a scaffold supporting cytokine attachment and cellular migration.

APPLICATIONS:

1. CGF in treatment of Gingival Recession :

CGF act as a membrane support in recession coverage as it constantly releases growth factors to
[3]
produce tissue regeneration. According to the study it proved that CGFs’ placement together with

CAF may enhance the healing of soft tissues. It can be used as a barrier membrane, along with

laterally displaced procedure, to facilitate soft tissue healing, which when combined with the root

coverage procedures like sliding flap technique, results in achieving the attached gingival width .
[4]
According to this procedure , patient’s venous blood of about 9 ml was collected

without anticoagulant and kept for centrifugation. After 12 minutes of centrifugation CGF was
 obtained and it was separated from the RBC layer and kept in between the compressing disc to get as

a membrane. Patient’s recipient site preparation was done .The deepithelialisation was done around

the root surface. Once the flap is ready to slide laterally onto the adjacent root ,the prepared CGF

membrane was placed first on the denuded root surface as a barrier membrane, above which the

lateral pedicle flaps was positioned and suturing done covering the CGF membrane and dressing

placed finally.

The advantage of sliding flap technique is that the flap has enough blood supply which

paves for better healing. CGF membrane provides dual coverage to the exposed root surface. CGF

membrane was exposed in certain areas for not achieving 100% root coverage. Healing was

accelerated without any complications in unexposed areas and increase in the width of attached

gingival was also achieved.

2. CGF in Treatment of Bone Defects :

Figure 2: (Pre- op Gingival
Figure 4 (CGF membrane and lateral
recessionOwing
in 31). to its stimulatory effect on angiogenesis and epithelialization, concentrated growth factor
pedicle flap).
(CGF) is an excellent material for enhancing bone healing. CGF is mixed with autologous bone

particles or biomaterials to fill the bone defects to induce bone regeneration. Its advantages over

platelet-rich plasma include ease of preparation, ease of application, minimal expense, and lack of

biochemical modification (no bovine thrombin or anticoagulant is required). It can also serve as a

resorbable interpositional membrane. The CGF layer avoids early invagination of the gingival

epithelium, thereby serving as barrier to epithelium migration. [ 5 ].

Mechanism of action of CGF on bone defects:

CGF contains a markedly higher concentration of fibrinogen, coagulation factors and CD34+ cells

and is considered as a new type of biological material. Vascular endothelial growth factor (VEGF) is

a key regulator of physiological angiogenesis, and has the ability to induce vascular leakage, promote

endothelial cell proliferation, and initiate vascular branch formation. VEGF induces vascularization

of the CGF membrane. EGF stimulates epidermal growth and keratinization, and also promotes

angiogenesis in the CGF membrane and causes changes in the gingiva .CGF prolongs the duration of

growth factor activity, which is conductive for growth factor synergy, and enhances cell proliferation

and osteogenic differentiation. CD34+ cells are capable of inducing neovascularization of the CGF

membrane, ensures sealing of soft tissue defects, which enhances the effect of guided bone

regeneration by promoting healing, improving wound stability which is essential for establishment of

a new connective tissue attachment to a root surface . The three-dimensional CGF membrane network

structure contains a high concentration of platelets and growth factors, which can be released and act

effectively over a prolonged period [6,7].

3. Effect of CGF on osseointegration

Osseointegration of dental implants is important for longterm success and stability. (CGF) increases

implant stability and accelerate osseointegration by increasing osteoblastic differentiation and

accelerates bone healing around the implant.

CGF contains fibroblast, platelets, leukocytes, and endothelial cell for angiogenesis and tissue

remodeling; and it provides matrix for cell migration. Platelets contain biologically active proteins at

high concentrations and support healing, growth, and cell morphogenesis. CGF increases FGF-β or
VEGF release, which plays an active role in angiogenesis, as well as enhancing neutrophil migration

by performing integrin release.

Implant cavities are covered with CGF membrane before implant placement. Greatest bone

formation was observed in the CGF-treated implant. CGF accelerated the implant osseointegration

process and affected the stabilization values positively. As CGF contains more growth factors than

other platelet preparations, it has favorable effects on implant healing period[8] .

CONCLUSION

CGF is a relatively new biotechnology autograft that evidently demonstrates significant stimulation

and acceleration of soft-tissue and bone, healing and formation. The efficacy of this therapy lies in

the local delivery of a wide range and high concentration of growth factors and proteins, mimicking

and supporting physiologic wound healing, reparative tissue process and local infiltration therapy,

taking the surgical practice of regenerative techniques to a higher level.

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