Treatment of human infrabony periodontal defects by grafting human cultured periosteum sheets combined with platelet-rich plasma and porous hydroxyapatite granules: case series.

In a previous publication from our research group we reported that a combination of platelet-rich plasma (PRP) and hydroxyapatite (HA) granules resulted in a significantly favorable clinical result in treating osseous defects. The aim of this study is to evaluate the clinical response of human cultured periosteum (HCP) sheets in combination with autologous PRP and HA granules used as a tissue-engineered grafting material for the treatment of infrabony defects in three female patients. Periosteum cell specimens were harvested from the mandible of each patient and cultured for six weeks until HCP sheets were formed. The periodontal surgery fully exposed the osseous defects and debridement and root planing were carried out. The coagulated PRP and HA mixture were placed into the osseous defects, and then they were covered with autologous HCP sheets. Six months post-surgery there were gains in clinical attachment and radiographic evidence of infrabony osseous fill. It may be concluded that HCP sheets combined with PRP and HA granules showed significant promise for treating human periodontal infrabony defects. A factor contributing to these favorable clinical results would be the presence of osteogenic cells in the HCP sheets, which provided greater regeneration potential.