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I see an increasing number of patients with multiple risk factors for poor bone healing leading that are medication/patient health issue induced, I certainly am seeing SSRI's and PPI's causing bone ineffective bone healing when they have used the meds for years. SSRI's cause a 3.2% degradation in mineral bone quality per year of use. I am wondering if other surgeons are using PDGF or BMP in their treatments to avoid implant failure or osteonecrosis. Do you add L-PRF when you use these recombinant growth factors? Comments, observations and suggestions are very welcome.