Revitalizing Periodontal Therapy: Unveiling the Power of  Growth Factor Enhanced Matrix 21s in Clinical Practice – A Literature Review

Gayathri Priyadharshini Elangovan; Pradeepa M; Praveena K; Priya Dharshini K; Puvisha S

doi:10.25259/DJIGIMS_39_2024

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10.25259/DJIGIMS_39_2024

Revitalizing Periodontal Therapy: Unveiling the Power of Growth Factor Enhanced Matrix 21s in Clinical Practice – A Literature Review

Gayathri Priyadharshini Elangovan^1,, Pradeepa M^1,, Praveena K^1,, Priya Dharshini K^1,, Puvisha S^1,

1Department of Periodontology, Vivekanandha Dental College For Women, Tiruchengode, India.

* Corresponding author: Dr. Gayathri Priyadharshini Elangovan, MDS, Department of Periodontology, Vivekanandha Dental College For Women, Tiruchengode, India. gayathriaelangovan@gmail.com

Received: 2024-12-15, Accepted: 2025-04-05, Epub ahead of print: 2025-05-03,

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This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Elangovan GP, M P, K P, K PD, S P. Revitalizing Periodontal Therapy: Unveiling the Power of Growth Factor Enhanced Matrix 21s in Clinical Practice – A Literature Review. Dent J Indira Gandhi Int Med Sci. doi: 10.25259/DJIGIMS_39_2024

Abstract

Periodontal regeneration therapy attempts to revive the lost structures of the periodontium, which includes the gingiva, periodontal ligament (PDL), cementum, and alveolar bone, which get affected due to periodontal disease. One innovative approach for periodontal regeneration therapy is to use growth factors, particularly recombinant human platelet-derived growth factor (rhPDGF). GEM 21S, a product that combines rhPDGF-BB with a collagen matrix, has shown significant potential in enhancing periodontal regeneration. GEM 21S enhances the proliferation of periodontal ligament (PDL) cells, stimulates the differentiation of osteoblast cells, and supports the regeneration of key periodontal tissues. Clinical studies suggest that GEM 21S contributes to increased bone formation, improved attachment levels, and better overall clinical outcomes in periodontal defect treatment. While the results are promising, long-term research is needed to establish the prolonged effectiveness and cost-benefit profile of GEM 21S as a regenerative treatment option for periodontal disease.

Keywords

GEM21S

Periodontal Regeneration

Growth factor enhanced matrix

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INTRODUCTION

Periodontal regeneration therapy attempts to revive the lost structures of the periodontium due to periodontal disease, which include the gingiva, periodontal ligament (PDL), cementum, and alveolar bone. Growth factors, such as transforming growth factors and platelet-derived growth factors, contained in the blood platelets that are released at the site of injury, have importance in normal healing.^[1]

Growth factors Enhanced Matrix (GEM 21S) has recently become an available agent, offering enhanced capabilities for wound healing and bone regeneration. Its advanced properties make it an attractive option for promoting optimal healing outcomes.^[1] GEM 21S is a bone graft that consists of recombinant human platelet-derived growth factor (rhPDGF-BB) and an osteoconductive matrix (bone scaffold), which is β-tricalcium phosphate.^[1]

FUNCTIONAL MECHANISM

When rhPDGF is unveiled from the β-TCP matrix, it binds to receptors on bone and soft tissue healing cells, resulting in activation of GEM 21S® to initiate bone and soft tissue regeneration.^[1,2] GEM 21S® attracts and stimulates cells necessary for tissue repair, enhancing their growth and accelerating healing. This leads to increased osteoblast, fibroblast, and cementoblast activity, as well as new blood vessel formation, promoting the revitalization of alveolar bone, PDL, and cementum. Over about six months, GEM 21S® is gradually replaced by the patient’s own tissue, resulting in improved bone and PDL regeneration.^[3]

CLINICAL IMPLICATIONS OF GEM21S:

Root coverage procedure

McGuire et al. conducted a split-mouth study where gingival recession defects were surgically created in teeth set for orthodontic extraction.^[2] After a 9-month follow-up, the rhPDGF-BB + β-TCP-treated sites showed true periodontal regeneration, with new bone, cementum, and PDL with perpendicularly oriented fibers. In contrast, sites treated with CTG only exhibited a limited healing response characterized by the formation of a long junctional epithelium (LJE) but lacking true periodontal regeneration.^[4] Thus, the GEM 21S has a promising effect in the management of gingival recession.

Furcation defect

Nevins and colleagues assessed rhPDGF-BB for treating Class II furcation defects in molars.^[5] The results showed successful revitalization of the periodontal attachment, including new cementum, bone, and PDL, with continuous cementum and well-organized PDL fibers attached to it.^[4]

Intrabony defect

Lynch et al.’s study on beagle dogs with periodontal disease found that open-flap debridement led to healing via a LJE. PDGF treatment promotes regeneration through enhanced cementogenic and osteogenic activity.^[6]

In another study, open flap debridement (OFD)-treated sites showed epithelial migration below the defect base and no new cementum formation after five weeks. In contrast, rhPDGF-BB-treated sites exhibited significant new bone formation with osteocytes. The meld of rhPDGF-BB and IGF-I notably enhanced bone height, density, and new cementum length compared to OFD.^[5]

Peri-implant regenerative therapy

Simon and colleagues assessed the use of rhPDGF for ridge augmentation around dental implants in a canine model. After 4 months, histological analysis revealed that demineralized bovine bone combined with a guided tissue regeneration (GTR) membrane resulted in limited bone regeneration. In contrast, demineralized bovine bone infused with rhPDGF-BB and a membrane showed considerable bone growth.^[7]

Guided bone regeneration

Nevins et al. conducted two studies on using rhPDGF-BB to enhance bone regeneration. The results of the animal study showed that the use of rhPDGF-BB combined with equine equine hydroxyapatite collagen (eHAC) showed increased vertical ridge augmentation.^[8] In the human Study,^[9] he investigated the therapeutic potential of rhPDGF-BB in combination with a bovine or equine matrix for treating bone defects. Eight patients were treated with either bovine or equine matrix mixed with rhPDGF-BB (0.3 mg/mL). Histological analysis after 5 months showed new bone growth integrated with graft particles.

Alveolar ridge preservation

Mendoza-Azpur et al. assessed the use of rhPDGF-BB combined with an organic bovine bone and collagen for ridge preservation in 20 patients. At 4 months, both groups showed similar bone cell counts and new tissue regeneration. However, the rhPDGF-BB group had notably more blood vessels and stem cells.^[10]

Sinus augmentation

Nevins and colleagues performed a histological study to evaluate the regenerative potential of rhPDGF in sinus augmentation, utilizing an organic bovine bone mineral combined with rhPDGF-BB in maxillary sinus augmentations. After 6 to 8 months, core biopsy analysis revealed the presence of vascularized lamellar bone and woven bone, with some graft particles resorbed and others remaining intact.^[11]

Soft tissue augmentation

Simion et al. demonstrated the effectiveness of rhPDGF with a guided tissue regeneration matrix in enhancing soft tissue around dental implants. After 4 months, results showed tissue regeneration similar to healthy gingiva with resorption of the guided tissue regeneration matrix. This treatment approach offers promising implications for improving aesthetics and soft tissue outcomes around dental implants.^[12]

CONCLUSION

GEM 21S, a synthetic bone graft containing rhPDGF-BB and beta-tricalcium phosphate, has demonstrated remarkable efficacy in various clinical applications. The cumulative evidence from multiple studies underscores the potential of GEM 21S to enhance periodontal regeneration, bone growth, and soft tissue augmentation.

Ethical approval

Institutional Review Board approval is not required.

Declaration of patient consent

Patient’s consent not required as there are no patients in this study.

Financial support and sponsorship

Nil

Conflicts of interest

There are no conflicts of interest.

Use of artificial intelligence (AI)-assisted technology for manuscript preparation

The authors confirm that there was no use of Artificial Intelligence (AI)-Assisted Technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.

REFERENCES

Singh P, Suresh DK. Clinical evaluation of GEM 21S® and a collagen membrane with a coronally advanced flap as a root coverage procedure in the treatment of gingival recession defects: A comparative study. J Indian Soc Periodontol. 2012;16:577-83.
[CrossRef] [PubMed] [Google Scholar]
McGuire MK, Scheyer ET, Schupbach P. Growth factor–mediated treatment of recession defects: a randomized controlled trial and histologic and microcomputed tomography examination. J Periodontol. 2009;80:550-64.
[CrossRef] [PubMed] [Google Scholar]
‐Lay Wang H, Pappert TD, Castelli WA, Chiego DJ, Shyr Y, Smith BA. The effect of platelet‐Derived growth factor on the cellular response of the periodontium: An autoradiographic study on dogs. J Periodontol. 1994;65:429-36.
[CrossRef] [PubMed] [Google Scholar]
Meghil MM, Mandil O, Nevins M, Saleh MHA, Wang HL. Histologic evidence of oral and periodontal regeneration using recombinant human platelet-derived growth factor. Medicina (Kaunas). 2023;59:676.
[CrossRef] [PubMed] [PubMed Central] [Google Scholar]
Nevins M, Camelo M, Nevins ML, Schenk RK, Lynch SE. Periodontal regeneration in humans using recombinant human platelet‐derived growth factor‐BB (rhPDGF‐BB) and allogenic bone. J Periodontol. 2003;74:1282-92.
[CrossRef] [PubMed] [Google Scholar]
Lynch SE, Castilla GRde, Williams RC, Kiritsy CP, Howell TH, Reddy MS, et al. The effects of short‐Term application of a combination of platelet‐Derived and insulin‐Like growth factors on periodontal wound healing. J Periodontol. 1991;62:458-67.
[CrossRef] [PubMed] [Google Scholar]
Simion M, Rocchietta I, Kim D, Nevins M, Fiorellini J. Vertical ridge augmentation by means of deproteinized bovine bone block and recombinant human platelet-derived growth factor-BB: A histologic study in a dog model. Int J Periodontics Restorative Dent. 2006;26
[Google Scholar]
Nevins M, Hezaimi KA, Schupbach P, Karimbux N, Kim DM. Vertical ridge augmentation using an equine bone and collagen block infused with recombinant human platelet‐derived growth factor‐BB: A randomized single‐masked histologic study in non‐human primates. J Periodontol. 2012;83:878-84.
[CrossRef] [PubMed] [Google Scholar]
Nevins ML, Reynolds MA, Camelo M, Schupbach P, Kim DM, Nevins M. Recombinant human platelet-derived growth factor BB for reconstruction of human large extraction site defects. Int J Periodontics Restorative Dent. 2014;34:157-63.
[CrossRef] [PubMed] [Google Scholar]
Mendoza-Azpur G, Cornejo H, Olaechea A, Padial-Molina M, O’Valle F, et al. Anorganic bovine bone plus recombinant human platelet-derived growth factor-BB in ridge preservation: A pilot study. Int J Oral Maxillofac Implants. 2022;37:356-64.
[CrossRef] [PubMed] [Google Scholar]
Nevins M, Garber D, Hanratty JJ, McAllister BS, Nevins ML, Salama M, et al. Human histologic evaluation of anorganic bovine bone mineral combined with recombinant human platelet-derived growth factor BB in maxillary sinus augmentation: Case series study. Int J Periodontics Restorative Dent. 2009;29:583-91.
[PubMed] [Google Scholar]
Simion M, Rocchietta I, Fontana F, Dellavia C. Evaluation of a resorbable collagen matrix infused with rhPDGF-BB in peri-implant soft tissue augmentation: a preliminary report with 3.5 years of observation. Int J Periodontics Restor Dent. 2012;32:273.
[Google Scholar]

INTRODUCTION

FUNCTIONAL MECHANISM

CLINICAL IMPLICATIONS OF GEM21S:

Root coverage procedure
Furcation defect
Intrabony defect
Peri-implant regenerative therapy
Alveolar ridge preservation
Sinus augmentation
Soft tissue augmentation

CONCLUSION

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[1] Singh P, Suresh DK. Clinical evaluation of GEM 21S® and a collagen membrane with a coronally advanced flap as a root coverage procedure in the treatment of gingival recession defects: A comparative study. J Indian Soc Periodontol. 2012;16:577-83.
[CrossRef] [PubMed] [Google Scholar]

[2] McGuire MK, Scheyer ET, Schupbach P. Growth factor–mediated treatment of recession defects: a randomized controlled trial and histologic and microcomputed tomography examination. J Periodontol. 2009;80:550-64.
[CrossRef] [PubMed] [Google Scholar]

[3] ‐Lay Wang H, Pappert TD, Castelli WA, Chiego DJ, Shyr Y, Smith BA. The effect of platelet‐Derived growth factor on the cellular response of the periodontium: An autoradiographic study on dogs. J Periodontol. 1994;65:429-36.
[CrossRef] [PubMed] [Google Scholar]

[4] Meghil MM, Mandil O, Nevins M, Saleh MHA, Wang HL. Histologic evidence of oral and periodontal regeneration using recombinant human platelet-derived growth factor. Medicina (Kaunas). 2023;59:676.
[CrossRef] [PubMed] [PubMed Central] [Google Scholar]

[5] Nevins M, Camelo M, Nevins ML, Schenk RK, Lynch SE. Periodontal regeneration in humans using recombinant human platelet‐derived growth factor‐BB (rhPDGF‐BB) and allogenic bone. J Periodontol. 2003;74:1282-92.
[CrossRef] [PubMed] [Google Scholar]

[6] Lynch SE, Castilla GRde, Williams RC, Kiritsy CP, Howell TH, Reddy MS, et al. The effects of short‐Term application of a combination of platelet‐Derived and insulin‐Like growth factors on periodontal wound healing. J Periodontol. 1991;62:458-67.
[CrossRef] [PubMed] [Google Scholar]

[7] Simion M, Rocchietta I, Kim D, Nevins M, Fiorellini J. Vertical ridge augmentation by means of deproteinized bovine bone block and recombinant human platelet-derived growth factor-BB: A histologic study in a dog model. Int J Periodontics Restorative Dent. 2006;26
[Google Scholar]

[8] Nevins M, Hezaimi KA, Schupbach P, Karimbux N, Kim DM. Vertical ridge augmentation using an equine bone and collagen block infused with recombinant human platelet‐derived growth factor‐BB: A randomized single‐masked histologic study in non‐human primates. J Periodontol. 2012;83:878-84.
[CrossRef] [PubMed] [Google Scholar]

[9] Nevins ML, Reynolds MA, Camelo M, Schupbach P, Kim DM, Nevins M. Recombinant human platelet-derived growth factor BB for reconstruction of human large extraction site defects. Int J Periodontics Restorative Dent. 2014;34:157-63.
[CrossRef] [PubMed] [Google Scholar]

[10] Mendoza-Azpur G, Cornejo H, Olaechea A, Padial-Molina M, O’Valle F, et al. Anorganic bovine bone plus recombinant human platelet-derived growth factor-BB in ridge preservation: A pilot study. Int J Oral Maxillofac Implants. 2022;37:356-64.
[CrossRef] [PubMed] [Google Scholar]

[11] Nevins M, Garber D, Hanratty JJ, McAllister BS, Nevins ML, Salama M, et al. Human histologic evaluation of anorganic bovine bone mineral combined with recombinant human platelet-derived growth factor BB in maxillary sinus augmentation: Case series study. Int J Periodontics Restorative Dent. 2009;29:583-91.
[PubMed] [Google Scholar]

[12] Simion M, Rocchietta I, Fontana F, Dellavia C. Evaluation of a resorbable collagen matrix infused with rhPDGF-BB in peri-implant soft tissue augmentation: a preliminary report with 3.5 years of observation. Int J Periodontics Restor Dent. 2012;32:273.
[Google Scholar]