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Bienz SP, Gadzo N, Zuercher AN, Wiedemeier D, Jung RE, Thoma DS. Clinical and histological wound healing patterns of collagen-based substitutes: An experimental randomized controlled trial in standardized palatal defects in humans. J Clin Periodontol 2024; 51:319-329. [PMID: 38017650 DOI: 10.1111/jcpe.13903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 10/16/2023] [Accepted: 10/29/2023] [Indexed: 11/30/2023]
Abstract
AIM To evaluate the progression of wound healing of standardized palatal defects in groups using three different collagen-based wound dressings and a control group, in terms of wound closure, pain perception and descriptive histology. MATERIALS AND METHODS Twenty participants were enrolled in this experimental study, in whom four palatal defects were created. The defects (6 mm diameter, 3 mm depth) were randomly assigned to one of four treatment modalities: C (control), MG (Mucograft®), MD (mucoderm®) and FG (Fibro-Gide®). Photographs were taken, and pain assessment was performed before and after treatment and at 5, 7, 9, 12, 14 and 16 days after surgery. All participants wore a palatal splint for a duration of 16 days. RESULTS All groups achieved complete wound closure at 14 days. The percentage of the remaining open wound on day 7 amounted to 49.3% (C; interquartile range [IQR]: 22.6), 70.1% (FG; IQR: 20.7), 56.8% (MD; IQR: 26.3) and 62.2% (MG; IQR: 34.4). Statistically significant differences were found between FG and C (p =.01) and between MD and FG (p =.04). None of the participants rated pain higher than 4 out of 10 during the entire study period. CONCLUSIONS Collagen-based wound dressings provide coverage of open defects, albeit without acceleration of wound closure or reduction of pain. FG (which is not intended for open oral wounds) showed slower wound closure compared to C and MD.
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Affiliation(s)
- Stefan P Bienz
- Clinic of Reconstructive Dentistry, University of Zurich, Zurich, Switzerland
| | - Naida Gadzo
- Clinic of Reconstructive Dentistry, University of Zurich, Zurich, Switzerland
| | - Anina N Zuercher
- Clinic of Reconstructive Dentistry, University of Zurich, Zurich, Switzerland
| | - Daniel Wiedemeier
- Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Ronald E Jung
- Clinic of Reconstructive Dentistry, University of Zurich, Zurich, Switzerland
| | - Daniel S Thoma
- Clinic of Reconstructive Dentistry, University of Zurich, Zurich, Switzerland
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Wüster J, Sachse C, Sachse C, Rendenbach C, Wagendorf O, Vach K, Preissner S, Heiland M, Nelson K, Nahles S. Vestibuloplasty and its impact on the long-term survival and success of dental implants in irradiated and non-irradiated patients after head and neck tumor therapy: a retrospective study. Clin Oral Investig 2023; 27:4695-4703. [PMID: 37330421 PMCID: PMC10415447 DOI: 10.1007/s00784-023-05096-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/24/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVES This study aimed to evaluate the influence of vestibuloplasty on the clinical success and survival of dental implants in head and neck tumor patients. MATERIALS AND METHODS A retrospective single-center study was conducted. All patients received surgical therapy of a tumor in the head or neck and underwent surgical therapy and, if necessary, radiotherapy/radiochemotherapy. Patients with compromised soft tissue conditions received vestibuloplasty using a split thickness skin graft and an implant-retained splint. Implant survival and success and the influence of vestibuloplasty, gender, radiotherapy, and localizations were evaluated. RESULTS A total of 247 dental implants in 49 patients (18 women and 31 men; mean age of 63.6 years) were evaluated. During the observation period, 6 implants were lost. The cumulative survival rate was 99.1% after 1 year and 3 years and 93.1% after 5 years for patients without vestibuloplasty, compared to a survival and success rate of 100% after 5 years in patients with vestibuloplasty. Additionally, patients with vestibuloplasty showed significantly lower peri-implant bone resorption rates after 5 years (mesial: p = 0.003; distal: p = 0.001). CONCLUSION This study demonstrates a high cumulative survival and success rate of dental implants after 5 years in head and neck tumor patients, irrespective of irradiation. Patients with vestibuloplasty showed a significantly higher rate of implant survival and significantly lower peri-implant bone resorption after 5 years. CLINICAL RELEVANCE Vestibuloplasty should always be considered and applied if required by the anatomical situations to achieve high implant survival/success rates in head and neck tumor patients.
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Affiliation(s)
- Jonas Wüster
- Department of Oral and Maxillofacial Surgery, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin Hindenburgdamm 30, 12203, Berlin, Germany.
| | - Claudia Sachse
- Department of Oral and Maxillofacial Surgery, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin Hindenburgdamm 30, 12203, Berlin, Germany
| | - Christian Sachse
- Department of Oral and Maxillofacial Surgery, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin Hindenburgdamm 30, 12203, Berlin, Germany
| | - Carsten Rendenbach
- Department of Oral and Maxillofacial Surgery, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin Hindenburgdamm 30, 12203, Berlin, Germany
| | - Oliver Wagendorf
- Department of Oral and Maxillofacial Surgery, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin Hindenburgdamm 30, 12203, Berlin, Germany
| | - Kirstin Vach
- Institute of Medical Biometry and Statistics, Faculty of Medicine, University of Freiburg, Freiburg Im Breisgau , Baden-Württemberg, Germany
| | - Saskia Preissner
- Department of Oral and Maxillofacial Surgery, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin Hindenburgdamm 30, 12203, Berlin, Germany
| | - Max Heiland
- Department of Oral and Maxillofacial Surgery, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin Hindenburgdamm 30, 12203, Berlin, Germany
| | - Katja Nelson
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University Medical Center Freiburg, Albert Ludwig University of Freiburg, Freiburg Im Breisgau, Baden-Württemberg, Germany
| | - Susanne Nahles
- Department of Oral and Maxillofacial Surgery, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin Hindenburgdamm 30, 12203, Berlin, Germany
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Abstract
Collagen is commonly used as a regenerative biomaterial due to its excellent biocompatibility and wide distribution in tissues. Different kinds of hybridization or cross-links are favored to offer improvements to satisfy various needs of biomedical applications. Previous reviews have been made to introduce the sources and structures of collagen. In addition, biological and mechanical properties of collagen-based biomaterials, their modification and application forms, and their interactions with host tissues are pinpointed. However, there is still no review about collagen-based biomaterials for tissue engineering. Therefore, we aim to summarize and discuss the progress of collagen-based materials for tissue regeneration applications in this review. We focus on the utilization of collagen-based biomaterials for bones, cartilages, skin, dental, neuron, cornea, and urological applications and hope these experiences and outcomes can provide inspiration and practical techniques for the future development of collagen-based biomaterials in related application fields. Moreover, future improving directions and challenges for collagen-based biomaterials are proposed as well.
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Affiliation(s)
- Yiyu Wang
- Department of Prosthodontics, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310029, China
| | - Zhengke Wang
- MOE Key Laboratory of Macromolecular Synthesis and Functionalization, Department of Polymer Science and Engineering, Zhejiang University, Hangzhou 310027, China
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310029, China
| | - Yan Dong
- Department of Prosthodontics, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310029, China
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4
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Wearable and implantable devices for drug delivery: Applications and challenges. Biomaterials 2022; 283:121435. [DOI: 10.1016/j.biomaterials.2022.121435] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 01/26/2022] [Accepted: 02/17/2022] [Indexed: 12/19/2022]
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Sadeghi M, Ghavimi MA, Khorshidi R, Moini F, Ghoreishizadeh A. Evaluation of keratinized gingiva changes with buccal-based modified palatal flap in anterior maxillary implants. J Dent Res Dent Clin Dent Prospects 2022; 16:186-189. [PMID: 36704185 PMCID: PMC9871172 DOI: 10.34172/joddd.2022.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 07/22/2022] [Indexed: 01/20/2023] Open
Abstract
Background. Studies have shown a significant relationship between the width and thickness of keratinized gingiva around the implant and changes in marginal bone level, with a significant effect on the health and esthetic of tissues around the implant, especially in the anterior region of the maxilla, which is an esthetic area. Methods. Ten patients referring to the Faculty of Dentistry seeking implant placement in the anterior maxilla were included in the study. The connective tissue of the palatal gingiva of the surgical site was folded to the buccal aspect with the buccal base, and the thickness and width of keratinized gingiva around the buccal surface of each implant were measured in three time intervals, including before surgery and 6 and 12 weeks after surgery. Based on the results of the Kolmogorov-Smirnov test, Friedman test and repeated-measures ANOVA were used to analyze the data. Results. The intervention significantly affected changes in the gingival thickness. After the intervention, gingival thickness significantly increased compared to the baseline (P<0.05). The results also showed that the intervention did not significantly affect the width of keratinized gingiva. The width of keratinized gingiva at baseline was not significantly different from the two time intervals after intervention (P>0.05). Conclusion. Buccal-based modified palatal flap in anterior maxillary implants increased the thickness of keratinized gingiva, with no significant effect on the keratinized gingiva width.
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Affiliation(s)
- Mahdi Sadeghi
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohamad Ali Ghavimi
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran,Corresponding author: Mohamad Ali Ghavimi,
| | - Reza Khorshidi
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Faeze Moini
- Department of Periodontology, Faculty of Dentistry, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Arezou Ghoreishizadeh
- Department of Pediatric Dentistry, Faculty of Dentistry, Tabriz University of Medical Science, Tabriz, Iran
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6
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Al-Maawi S, Rother S, Halfter N, Fiebig KM, Moritz J, Moeller S, Schnabelrauch M, Kirkpatrick CJ, Sader R, Wiesmann HP, Scharnweber D, Hintze V, Ghanaati S. Covalent linkage of sulfated hyaluronan to the collagen scaffold Mucograft® enhances scaffold stability and reduces proinflammatory macrophage activation in vivo. Bioact Mater 2021; 8:420-434. [PMID: 34541411 PMCID: PMC8429620 DOI: 10.1016/j.bioactmat.2021.06.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 06/07/2021] [Accepted: 06/07/2021] [Indexed: 12/15/2022] Open
Abstract
Sulfated glycosaminoglycans (sGAG) show interaction with biological mediator proteins. Although collagen-based biomaterials are widely used in clinics, their combination with high-sulfated hyaluronan (sHA3) is unexplored. This study aims to functionalize a collagen-based scaffold (Mucograft®) with sHA3 via electrostatic (sHA3/PBS) or covalent binding to collagen fibrils (sHA3+EDC/NHS). Crosslinking without sHA3 was used as a control (EDC/NHS Ctrl). The properties of the sHA3-functionalized materials were characterized. In vitro growth factor and cytokine release after culturing with liquid platelet-rich fibrin was performed by means of ELISA. The cellular reaction to the biomaterials was analyzed in a subcutaneous rat model. The study revealed that covalent linking of sHA3 to collagen allowed only a marginal release of sHA3 over 28 days in contrast to electrostatically bound sHA3. sHA3+EDC/NHS scaffolds showed reduced vascular endothelial growth factor (VEGF), transforming growth factor beta 1 (TGF-β1) and enhanced interleukin-8 (IL-8) and epithelial growth factor (EGF) release in vitro compared to the other scaffolds. Both sHA3/PBS and EDC/NHS Ctrl scaffolds showed a high proinflammatory reaction (M1: CD-68+/CCR7+) and induced multinucleated giant cell (MNGC) formation in vivo. Only sHA3+EDC/NHS scaffolds reduced the proinflammatory macrophage M1 response and did not induce MNGC formation during the 30 days. SHA3+EDC/NHS scaffolds had a stable structure in vivo and showed sufficient integration into the implantation region after 30 days, whereas EDC/NHS Ctrl scaffolds underwent marked disintegration and lost their initial structure. In summary, functionalized collagen (sHA3+EDC/NHS) modulates the inflammatory response and is a promising biomaterial as a stable scaffold for full-thickness skin regeneration in the future. Covalent linking of high-sulfated hyaluronan (sHA3) to collagen allows a sustained release of sHA3. Covalent linking of sHA3 to collagen modulates the release of growth factor and cytokines in vitro. Covalent linking of sHA3 to collagen suppresses the induction of multinucleated giant cells in vivo. Covalent linking of sHA3 to collagen reduces the proinflammatory macrophage M1 response in vivo. Functionalized collagen with sHA3 is promising for full-thickness skin regeneration.
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Affiliation(s)
- Sarah Al-Maawi
- Clinic for Maxillofacial and Plastic Surgery, Goethe University, Frankfurt Am Main, Germany
| | - Sandra Rother
- Institute of Materials Science, Max Bergmann Center of Biomaterials, TU Dresden, Budapester Str. 27, 01069, Dresden, Germany.,Department of Cellular and Molecular Medicine, Glycobiology Research and Training Center, University of California, San Diego, La Jolla, CA, USA
| | - Norbert Halfter
- Institute of Materials Science, Max Bergmann Center of Biomaterials, TU Dresden, Budapester Str. 27, 01069, Dresden, Germany
| | - Karen M Fiebig
- Institute of Materials Science, Max Bergmann Center of Biomaterials, TU Dresden, Budapester Str. 27, 01069, Dresden, Germany
| | - Juliane Moritz
- Institute of Materials Science, Max Bergmann Center of Biomaterials, TU Dresden, Budapester Str. 27, 01069, Dresden, Germany
| | - Stephanie Moeller
- Biomaterials Department, INNOVENT e.V., Prüssingstr. 27B, 07745, Jena, Germany
| | | | | | - Robert Sader
- Clinic for Maxillofacial and Plastic Surgery, Goethe University, Frankfurt Am Main, Germany
| | - Hans-Peter Wiesmann
- Institute of Materials Science, Max Bergmann Center of Biomaterials, TU Dresden, Budapester Str. 27, 01069, Dresden, Germany
| | - Dieter Scharnweber
- Institute of Materials Science, Max Bergmann Center of Biomaterials, TU Dresden, Budapester Str. 27, 01069, Dresden, Germany
| | - Vera Hintze
- Institute of Materials Science, Max Bergmann Center of Biomaterials, TU Dresden, Budapester Str. 27, 01069, Dresden, Germany
| | - Shahram Ghanaati
- Clinic for Maxillofacial and Plastic Surgery, Goethe University, Frankfurt Am Main, Germany
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7
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Vacaras S, Baciut G, Gheban D, Bran S, Colosi H, Toader S, Opris D, Kretschmer W, Manea A, Armencea G, Baciut M, Opris H, Mitre I, Hedesiu M, Dinu C. Engaging a polylactide copolymer in oral tissue regeneration: first validation of Suprathel ® for guided epithelial and osseous healing. J Med Life 2021; 14:181-197. [PMID: 34104241 PMCID: PMC8169152 DOI: 10.25122/jml-2021-0083] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The present study investigated the capacity of Suprathel® (a copolymer membrane, so far validated for skin regeneration) to also regenerate oral tissue – mucosa and bone, by comparing this biomaterial, in a split-mouth rabbit model, to Mucoderm®, a xenogeneic collagen matrix certified for keratinized oral mucosa healing. The clinical reason behind this experimental animal model was to determine whether the benefits of this advanced skin regeneration product (Suprathel®) could be conveyed for future evaluation in clinical trials of oral tissue regeneration in humans. The outcomes of this study validated the use of Suprathel®, a terpolymer of polylactide with trimethylene carbonate and ε-caprolactone, for stimulation of oral epithelium and alveolar bone regeneration in rabbits. Both Suprathel® and Mucoderm® exhibited comparable results and the null hypothesis stating a comparable regenerating effect of these two materials could not be rejected.
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Affiliation(s)
- Sergiu Vacaras
- Department of Maxillofacial Surgery and Radiology, Division of Maxillofacial Surgery and Implantology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Grigore Baciut
- Department of Maxillofacial Surgery and Radiology, Division of Maxillofacial Surgery and Implantology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Dan Gheban
- Department of Morphological Sciences, Division of Pathoanatomy, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Simion Bran
- Department of Maxillofacial Surgery and Radiology, Division of Maxillofacial Surgery and Implantology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Horatiu Colosi
- Department of Medical Education, Division of Medical Informatics and Biostatistics, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Septimiu Toader
- Center for Experimental Surgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Daiana Opris
- Department of Maxillofacial Surgery and Radiology, Division of Maxillofacial Surgery and Implantology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Winfried Kretschmer
- Klinik fur Mund-, Kiefer- und Plastische Gesichtschirurgie, Alb Fils Kliniken GmbH, Goppingen, Baden-Wurttemberg, Germany
| | - Avram Manea
- Department of Maxillofacial Surgery and Radiology, Division of Maxillofacial Surgery and Implantology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Gabriel Armencea
- Department of Maxillofacial Surgery and Radiology, Division of Maxillofacial Surgery and Implantology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Mihaela Baciut
- Department of Maxillofacial Surgery and Radiology, Division of Maxillofacial Surgery and Implantology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Horia Opris
- Department of Maxillofacial Surgery and Radiology, Division of Maxillofacial Surgery and Implantology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ileana Mitre
- Department of Maxillofacial Surgery and Radiology, Division of Maxillofacial Surgery and Implantology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Mihaela Hedesiu
- Department of Maxillofacial Surgery and Radiology, Division of Maxillofacial Radiology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Cristian Dinu
- Department of Maxillofacial Surgery and Radiology, Division of Maxillofacial Surgery and Implantology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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8
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Naomi R, Ardhani R, Hafiyyah OA, Fauzi MB. Current Insight of Collagen Biomatrix for Gingival Recession: An Evidence-Based Systematic Review. Polymers (Basel) 2020; 12:E2081. [PMID: 32933133 PMCID: PMC7570157 DOI: 10.3390/polym12092081] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 08/09/2020] [Accepted: 08/13/2020] [Indexed: 12/17/2022] Open
Abstract
Collagen (Col) is a naturally available material and is widely used in the tissue engineering and medical field owing to its high biocompatibility and malleability. Promising results on the use of Col were observed in the periodontal application and many attempts have been carried out to inculcate Col for gingival recession (GR). Col is found to be an excellent provisional bioscaffold for the current treatment in GR. Therefore, the aim of this paper is to scrutinize an overview of the reported Col effect focusing on in vitro, in vivo, and clinical trials in GR application. A comprehensive literature search was performed using EBSCOhost, Science Direct, Springer Link, and Medline & Ovid databases to identify the potential articles on particular topics. The search query was accomplished based on the Boolean operators involving keywords such as (1) collagen OR scaffold OR hybrid scaffold OR biomaterial AND (2) gingiva recession OR tissue regeneration OR dental tissue OR healing mechanism OR gingiva. Only articles published from 2015 onwards were selected for further analysis. This review includes the physicochemical properties of Col scaffold and the outcome for GR. The comprehensive literature search retrieved a total of 3077 articles using the appropriate keywords. However, on the basis of the inclusion and exclusion criteria, only 15 articles were chosen for further review. The results from these articles indicated that Col promoted gingival tissue regeneration for GR healing. Therefore, this systematic review recapitulated that Col enhances regeneration of gingival tissue either through a slow or rapid process with no sign of cytotoxicity or adverse effect.
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Affiliation(s)
- Ruth Naomi
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur 56000, Malaysia;
| | - Retno Ardhani
- Department of Dental Biomedical Sciences, Faculty of Dentistry, Universitas Gadjah Mada, Jl Denta Sekip Utara, Yogyakarta 55281, Indonesia;
| | - Osa Amila Hafiyyah
- Department of Periodontics, Faculty of Dentistry, Universitas Gadjah Mada, Jl Denta Sekip Utara, Yogyakarta 55281, Indonesia;
| | - Mh Busra Fauzi
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur 56000, Malaysia;
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9
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Al-Maawi S, Rutkowski JL, Sader R, Kirkpatrick CJ, Ghanaati S. The Biomaterial-Induced Cellular Reaction Allows a Novel Classification System Regardless of the Biomaterials Origin. J ORAL IMPLANTOL 2020; 46:190-207. [PMID: 32068853 DOI: 10.1563/aaid-joi-d-19-00201] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Several different biomaterials are being introduced for clinical applications. However, no current material-specific systematic studies define parameters for evaluating these materials. The aim of this retrospective animal study is to classify biomaterials according to the in vivo induced cellular reaction and outline the clinical consequence of the biomaterial-specific cellular reaction for the regeneration process. A retrospective histologic analysis was performed for 13 polymeric biomaterials and 19 bone substitute materials (BSMs) (of various compositions and origins) that were previously implanted in a standardized subcutaneous model. Semiquantitative analyses were performed at days 3, 15, and 30 after implantation according to a standardized score for the induction of multinucleated giant cells (MNGCs) and vascularization rate. The induced cellular reaction in response to different polymeric materials allowed their classification according to the MNGC score in the following groups: class I induced no MNGCs at any time point, class II induced and maintained a constant number of MNGCs over 30 days, and class III induced MNGCs and provided an increasing number over 30 days. All BSMs induced MNGCs to varying extents. Therefore, the resultant BSM classifications are as follows: class I induced MNGCs with a decreasing number, class II induced and maintained constant MNGCs over 30 days, and class III induced MNGCs with increasing number over 30 days. These observations were mostly related to the biomaterial physicochemical properties and were independent of the biomaterial origin. Consequently, the induction of MNGCs and their increase over 30 days resulted in disintegration of the biomaterial. By contrast, the absence of MNGCs resulted in an integration of the biomaterial within the host tissue. This novel classification provides clinicians a tool to assess the capacity and suitability of biomaterials in the intended clinical indication for bone and soft tissue implantations.
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Affiliation(s)
- Sarah Al-Maawi
- FORM-Lab, Frankfurt Oral Regenerative Medicine, Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Medical Center of the Goethe University, Frankfurt, Germany
| | - James L Rutkowski
- Restorative Dentistry, School of Dental Medicine, State University of New York, Buffalo, NY
| | - Robert Sader
- FORM-Lab, Frankfurt Oral Regenerative Medicine, Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Medical Center of the Goethe University, Frankfurt, Germany
| | - C James Kirkpatrick
- FORM-Lab, Frankfurt Oral Regenerative Medicine, Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Medical Center of the Goethe University, Frankfurt, Germany
| | - Shahram Ghanaati
- FORM-Lab, Frankfurt Oral Regenerative Medicine, Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Medical Center of the Goethe University, Frankfurt, Germany
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10
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Tanneberger AM, Al-Maawi S, Herrera-Vizcaíno C, Orlowska A, Kubesch A, Sader R, Kirkpatrick CJ, Ghanaati S. Multinucleated giant cells within the in vivo implantation bed of a collagen-based biomaterial determine its degradation pattern. Clin Oral Investig 2020; 25:859-873. [PMID: 32514904 PMCID: PMC7878236 DOI: 10.1007/s00784-020-03373-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 05/25/2020] [Indexed: 12/21/2022]
Abstract
Objectives The aim of the present study was to characterize the cellular reaction to a xenogeneic resorbable collagen membrane of porcine origin using a subcutaneous implantation model in Wistar rats over 30 days. Materials and methods Ex vivo, liquid platelet-rich fibrin (PRF), a leukocyte and platelet-rich cell suspension, was used to evaluate the blood cell membrane interaction. The material was implanted subcutaneously in rats. Sham-operated rats without biomaterial displayed physiological wound healing (control group). Histological, immunohistological, and histomorphometric analyses were focused on the inflammatory pattern, vascularization rate, and degradation pattern. Results The membrane induced a large number of mononuclear cells over the observation period, including lymphocytes, macrophages, and fibroblasts. After 15 days, multinucleated giant cells (MNGCs) were observed on the biomaterial surface. Their number increased significantly, and they proceeded to the center of the biomaterial on day 30. These cells highly expressed CD-68, calcitonin receptor, and MMP-9, but not TRAP or integrin-ß3. Thus, the membrane lost its integrity and underwent disintegration as a consequence of the induction of MNGCs. The significant increase in MNGC number correlated with a high rate of vascularization, which was significantly higher than the control group. Physiological wound healing in the control group did not induce any MNGCs at any time point. Ex vivo blood cells from liquid-PRF did not penetrate the membrane. Conclusion The present study suggests a potential role for MNGCs in biomaterial degradation and questions whether it is beneficial to accept them in clinically approved biomaterials or focus on biomaterials that induce only mononuclear cells. Thus, further studies are necessary to identify the function of biomaterial-induced MNGCs. Clinical relevance Understanding the cellular reaction to biomaterials is essential to assess their suitability for specific clinical indications and outline the potential benefit of specific group of biomaterials in the respective clinical indications.
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Affiliation(s)
- Anna Maria Tanneberger
- Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, FORM (Frankfurt Orofacial Regenerative Medicine) Lab, University Hospital Frankfurt Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Sarah Al-Maawi
- Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, FORM (Frankfurt Orofacial Regenerative Medicine) Lab, University Hospital Frankfurt Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Carlos Herrera-Vizcaíno
- Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, FORM (Frankfurt Orofacial Regenerative Medicine) Lab, University Hospital Frankfurt Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Anna Orlowska
- Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, FORM (Frankfurt Orofacial Regenerative Medicine) Lab, University Hospital Frankfurt Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Alica Kubesch
- Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, FORM (Frankfurt Orofacial Regenerative Medicine) Lab, University Hospital Frankfurt Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Robert Sader
- Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, FORM (Frankfurt Orofacial Regenerative Medicine) Lab, University Hospital Frankfurt Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - C J Kirkpatrick
- Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, FORM (Frankfurt Orofacial Regenerative Medicine) Lab, University Hospital Frankfurt Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Shahram Ghanaati
- Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, FORM (Frankfurt Orofacial Regenerative Medicine) Lab, University Hospital Frankfurt Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
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Moraschini V, Guimarães HB, Cavalcante IC, Calasans-Maia MD. Clinical efficacy of xenogeneic collagen matrix in augmenting keratinized mucosa round dental implants: a systematic review and meta-analysis. Clin Oral Investig 2020; 24:2163-2174. [DOI: 10.1007/s00784-020-03321-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 05/01/2020] [Indexed: 12/13/2022]
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Biologization of Collagen-Based Biomaterials Using Liquid-Platelet-Rich Fibrin: New Insights into Clinically Applicable Tissue Engineering. MATERIALS 2019; 12:ma12233993. [PMID: 31810182 PMCID: PMC6926831 DOI: 10.3390/ma12233993] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 11/04/2019] [Accepted: 11/27/2019] [Indexed: 12/19/2022]
Abstract
Platelet-rich fibrin (PRF) is a blood concentrate derived from venous blood that is processed without anticoagulants by a one-step centrifugation process. This three-dimensional scaffold contains inflammatory cells and plasma proteins entrapped in a fibrin matrix. Liquid-PRF was developed based on the previously described low-speed centrifuge concept (LSCC), which allowed the introduction of a liquid-PRF formulation of fibrinogen and thrombin prior to its conversion to fibrin. Liquid-PRF was introduced to meet the clinical demand for combination with biomaterials in a clinically applicable and easy-to-use way. The aim of the present study was to evaluate, ex vivo, the interaction of the liquid-PRF constituents with five different collagen biomaterials by histological analyses. The results first demonstrated that large variability existed between the biomaterials investigated. Liquid-PRF was able to completely invade Mucograft® (MG; Geistlich Biomaterials, Wolhusen, Switzerland) and to partly invade Bio-Gide® (BG; Geistlich Biomaterials, Wolhusen, Switzerland) and Mucoderm® (MD; Botiss Biomaterials, Berlin, Germany), and Collprotect® (CP; Botiss Biomaterials, Berlin, Germany) showed only a superficial interaction. The BEGO® collagen membrane (BCM; BEGO Implant Systems) appeared to be completely free of liquid-PRF. These results were confirmed by the different cellular penetration and liquid-PRF absorption coefficient (PAC) values of the evaluated membranes. The present study demonstrates a system for loading biomaterials with a complex autologous cell system (liquid-PRF) in a relatively short period of time and in a clinically relevant manner. The combination of biomaterials with liquid-PRF may be clinically utilized to enhance the bioactivity of collagen-based biomaterials and may act as a biomaterial-based growth factor delivery system.
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Biomaterial-based bone regeneration and soft tissue management of the individualized 3D-titanium mesh: An alternative concept to autologous transplantation and flap mobilization. J Craniomaxillofac Surg 2019; 47:1633-1644. [PMID: 31420282 DOI: 10.1016/j.jcms.2019.07.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 05/11/2019] [Accepted: 07/14/2019] [Indexed: 12/14/2022] Open
Abstract
Three-dimensional augmentation in severely atrophic bone and after cancer resection is a challenging clinical indication that is mostly solved using autologous bone transplantation. The development of the digital technique along with the additive manufacturing and three-dimensional (3D) printing opened new avenues for reconstructive oral and maxillofacial surgery. Therefore, patient-specific titanium mesh is a novel means of stabilizing the augmentation region using particulate bone substitute materials (BSMs) combined with autologous bone as a minimally invasive concept. However, dehiscence is a frequently reported complication in this field. Therefore, the aim of the present case series was to introduce a biomaterial-based regenerative concept in terms of exposed open healing to overcome the dehiscence related to 3D-titanium meshes. Additionally, this case series presents a novel protocol using a combination of xenogeneic BSMs with an autologous blood concentrate system (platelet-rich fibrin [PRF]) and collagen matrices without any autologous transplantation. Seven patients with alveolar ridge atrophy with different etiologies (cancer resection, severe atrophy after tooth loss, aplasia, trauma, implant infections) were treated using the open-healing concept. Therefore, after 3D augmentation using the described biomaterials, the flap margins were approximated, and the gap between the flap margins was bridged using a collagen matrix loaded with liquid PRF that was then covered by either a PTFE-based membrane or sterile latex. No periosteum splitting was performed at any time point. After a healing period of 4-8 months, all patients received dental implants as virtually planned. Bone biopsies were performed during dental insertion for histological evaluation. The augmentation area displayed a vital and well-vascularized newly formed bone that incorporated the BSM granules to build a hybrid bone. Additionally, open healing resulted in newly formed soft tissue without any signs of scar formation or fibrosis. The regenerated soft tissue was used to build a new flap during implant insertion and showed good functional and aesthetic results after implant insertion. The open-healing concept of the regeneration of the soft tissue along with bone tissue to regenerate a harmonic implantation bed is a minimally invasive intervention without periosteum splitting or large flap mobilization. However, further controlled clinical studies are needed to evaluate this concept in a larger patient cohort to outline the potential clinical benefit.
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Al-Maawi S, Mota C, Kubesch A, James Kirkpatrick C, Moroni L, Ghanaati S. Multiwell three-dimensional systems enable in vivo screening of immune reactions to biomaterials: a new strategy toward translational biomaterial research. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2019; 30:61. [PMID: 31127377 DOI: 10.1007/s10856-019-6263-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 05/06/2019] [Indexed: 06/09/2023]
Abstract
In vivo experiments are accompanied by ethical issues, including sacrificing a large number of animals as well as large costs. A new in vivo 3D screening system was developed to reduce the number of required animals without compromising the results. The present pilot study examined a multiwell array system in combination with three different collagen-based biomaterials (A, B and C) using subcutaneous implantation for 10 days and histological and histomorphometrical evaluations. The tissue reaction towards the device itself was dominated by mononuclear cells. However, three independent biomaterial-specific tissue reactions were observed in three chambers. The results showed a mononuclear cell-based tissue reaction in one chamber (A) and foreign body reaction by multinucleated giant cells in the other two chambers (B and C). Statistical analysis showed a significantly higher number of multinucleated giant cells in cases B and C than in case A (A vs. B; ***P < 0.001), (A vs. C; P < 0.01). These outcomes were comparable to previously published observations with conventional biomaterial implantation. The present data lead to the conclusion that this 3D screening system could be an alternative tool to enhance the effectiveness of in vivo experiments, thus offering a more economic strategy to screen biomaterial-related cellular reactions, while saving animals, without influencing the final outcome.
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Affiliation(s)
- Sarah Al-Maawi
- FORM-lab, Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Medical Center of the Goethe University Frankfurt, Frankfurt, Germany
| | - Carlos Mota
- Maastricht University, MERLN Institute for Technology-Inspired Regenerative Medicine, Complex Tissue Regeneration Department, Maastricht, The Netherlands
| | - Alica Kubesch
- FORM-lab, Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Medical Center of the Goethe University Frankfurt, Frankfurt, Germany
| | - C James Kirkpatrick
- FORM-lab, Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Medical Center of the Goethe University Frankfurt, Frankfurt, Germany
| | - Lorenzo Moroni
- Maastricht University, MERLN Institute for Technology-Inspired Regenerative Medicine, Complex Tissue Regeneration Department, Maastricht, The Netherlands
| | - Shahram Ghanaati
- FORM-lab, Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Medical Center of the Goethe University Frankfurt, Frankfurt, Germany.
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Ghanaati S, Herrera-Vizcaino C, Al-Maawi S, Lorenz J, Miron RJ, Nelson K, Schwarz F, Choukroun J, Sader R. Fifteen Years of Platelet Rich Fibrin in Dentistry and Oromaxillofacial Surgery: How High is the Level of Scientific Evidence? J ORAL IMPLANTOL 2018; 44:471-492. [DOI: 10.1563/aaid-joi-d-17-00179] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Platelet-rich fibrin is a blood concentrate system used for soft tissue and bone tissue regeneration. In the last decade, platelet rich fibrin (PRF) has been widely used in different indication fields, particularly in oral and maxillofacial surgery. This review investigates the level of scientific evidence of published articles related to the use of PRF for bone and soft tissue regeneration in dentistry and maxillofacial surgery. An electronic literature research using the biomedical search engine “National Library of Medicine” (PubMed-MEDLINE) was performed in May 2017. A total of 392 articles were found, 72 of which were classified for each indication field. When comparing PRF with biomaterials vs biomaterial alone in sinus lift (5 studies; IIa), no statistically significant differences were detected. Socket preservation and ridge augmentation using PRF significantly enhanced new bone formation compared to healing without PRF (7 studies Ib, IIa, IIb). Reepithelialization and bone regeneration was achieved in 96 of 101 patients diagnosed with medication-related osteonecrosis of the jaw (5 studies, III). In periodontology, PRF alone (6 studies; Ib, IIa, IIb) or its combination with biomaterials (6 studies; Ib, IIa, IIb) significantly improved the pocket depth and attachment loss compared to a treatment without PRF. Over 70% of the patients were part of studies with a high level of scientific evidence (randomized and controlled prospective studies). This published evidence (38 articles), with a high scientific level, showed that PRF is a beneficial tool that significantly improves bone and soft tissue regeneration. However, the clinical community requires a standardization of PRF protocols to further examine the benefit of PRF in bone and soft tissue regeneration in reproducible studies, with a higher scientific level of evidence.
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Affiliation(s)
- Shahram Ghanaati
- Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Frankfurt Orofacial Regenerative Medicine (FORM) Lab, University Hospital Frankfurt Goethe University, Frankfurt, Germany
| | - Carlos Herrera-Vizcaino
- Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Frankfurt Orofacial Regenerative Medicine (FORM) Lab, University Hospital Frankfurt Goethe University, Frankfurt, Germany
| | - Sarah Al-Maawi
- Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Frankfurt Orofacial Regenerative Medicine (FORM) Lab, University Hospital Frankfurt Goethe University, Frankfurt, Germany
| | - Jonas Lorenz
- Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Frankfurt Orofacial Regenerative Medicine (FORM) Lab, University Hospital Frankfurt Goethe University, Frankfurt, Germany
| | - Richard J Miron
- Department of Periodontology, College of Dental Medicine, Nova Southeastern University, Fort Lauderdale, Fla
| | - Katja Nelson
- Department of Oral and Craniomaxillofacial Surgery, Center for Dental Medicine, University Medical Center, Freiburg, Germany
| | - Frank Schwarz
- Department of Oral Surgery and Implantology, Carolinum, Johann Wolfgang Goethe-University, Frankfurt, Germany
| | | | - Robert Sader
- Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Frankfurt Orofacial Regenerative Medicine (FORM) Lab, University Hospital Frankfurt Goethe University, Frankfurt, Germany
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Choukroun J, Ghanaati S. Reduction of relative centrifugation force within injectable platelet-rich-fibrin (PRF) concentrates advances patients' own inflammatory cells, platelets and growth factors: the first introduction to the low speed centrifugation concept. Eur J Trauma Emerg Surg 2017; 44:87-95. [PMID: 28283682 PMCID: PMC5808086 DOI: 10.1007/s00068-017-0767-9] [Citation(s) in RCA: 185] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 01/23/2017] [Indexed: 12/19/2022]
Abstract
Purpose The aim of this study was to analyze systematically the influence of the relative centrifugation force (RCF) on leukocytes, platelets and growth factor release within fluid platelet-rich fibrin matrices (PRF). Materials and methods Systematically using peripheral blood from six healthy volunteers, the RCF was reduced four times for each of the three experimental protocols (I–III) within the spectrum (710–44 g), while maintaining a constant centrifugation time. Flow cytometry was applied to determine the platelets and leukocyte number. The growth factor concentration was quantified 1 and 24 h after clotting using ELISA. Results Reducing RCF in accordance with protocol-II (177 g) led to a significantly higher platelets and leukocytes numbers compared to protocol-I (710 g). Protocol-III (44 g) showed a highly significant increase of leukocytes and platelets number in comparison to -I and -II. The growth factors’ concentration of VEGF and TGF-β1 was significantly higher in protocol-II compared to -I, whereas protocol-III exhibited significantly higher growth factor concentration compared to protocols-I and -II. These findings were observed among 1 and 24 h after clotting, as well as the accumulated growth factor concentration over 24 h. Discussion Based on the results, it has been demonstrated that it is possible to enrich PRF-based fluid matrices with leukocytes, platelets and growth factors by means of a single alteration of the centrifugation settings within the clinical routine. Conclusions We postulate that the so-called low speed centrifugation concept (LSCC) selectively enriches leukocytes, platelets and growth factors within fluid PRF-based matrices. Further studies are needed to evaluate the effect of cell and growth factor enrichment on wound healing and tissue regeneration while comparing blood concentrates gained by high and low RCF.
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Affiliation(s)
- J Choukroun
- Private Practice, Pain Therapy Center, Nice, France.
- Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, FORM (Frankfurt Orofacial Regenerative Medicine) Laboratory, University Hospital Frankfurt Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
| | - S Ghanaati
- Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, FORM (Frankfurt Orofacial Regenerative Medicine) Laboratory, University Hospital Frankfurt Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
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Kanno T, Karino M, Yoshino A, Koike T, Tatsumi H, Tsunematsu K, Nariai Y, Ide T, Bai Y, Dong QN, Sekine J. Computer-assisted Secondary Reconstruction of Mandibular Continuity Defects Using Non-Vascularized Iliac Crest Bone Graft Following Oral Cancer Resection. J HARD TISSUE BIOL 2017. [DOI: 10.2485/jhtb.26.386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Takahiro Kanno
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine
| | - Masaaki Karino
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine
| | - Aya Yoshino
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine
| | - Takashi Koike
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine
- Division of Oral and Maxillofacial Surgery, Hamada Medical Center
| | - Hiroto Tatsumi
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine
- Division of Oral and Maxillofacial Surgery, Oki Regional Hospital
| | - Koji Tsunematsu
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine
- Division of Oral and Maxillofacial Surgery, Masuda Red Cross Hospital
| | - Yoshiki Nariai
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine
- Division of Oral and Maxillofacial Surgery, Matsue City Hospital
| | - Taichi Ide
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine
| | - Yunpeng Bai
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine
| | - Quang Ngoc Dong
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine
| | - Joji Sekine
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine
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