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Wei Y, Cheng Y, Wei H, Wang Y, Zhang X, Miron RJ, Zhang Y, Qing S. Development of a super-hydrophilic anaerobic tube for the optimization of platelet-rich fibrin. Platelets 2024; 35:2316745. [PMID: 38385327 DOI: 10.1080/09537104.2024.2316745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 02/05/2024] [Indexed: 02/23/2024]
Abstract
Horizontal platelet-rich fibrin (H-PRF) contains a variety of bioactive growth factors and cytokines that play a key role in the process of tissue healing and regeneration. The blood collection tubes used to produce Solid-PRF (plasmatrix (PM) tubes) have previously been shown to have a great impact on the morphology, strength and composition of the final H-PRF clot. Therefore, modification to PM tubes is an important step toward the future optimization of PRF. To this end, we innovatively modified the inner wall surface of the PM tubes with plasma and adjusted the gas environment inside the PM tubes to prepare super-hydrophilic anaerobic plasmatrix tubes (SHAP tubes). It was made anaerobic for the preparation of H-PRF with the aim of improving mechanical strength and bioactivity. The findings demonstrated that an anaerobic environment stimulated platelet activation within the PRF tubes. After compression, the prepared H-PRF membrane formed a fibrous cross-linked network with high fracture strength, ideal degradation characteristics, in addition to a significant increase in size. Thereafter, the H-PRF membranes prepared by the SHAP tubes significantly promoted collagen synthesis of gingival fibroblast and the mineralization of osteoblasts while maintaining excellent biocompatibility, and advantageous antibacterial properties. In conclusion, the newly modified PRF tubes had better platelet activation properties leading to better mechanical strength, a longer degradation period, and better regenerative properties in oral cell types including gingival fibroblast and alveolar osteoblasts. It also improves the success rate of H-PRF preparation in patients with coagulation dysfunction and expands the clinical application scenario.
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Affiliation(s)
- Yan Wei
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Yihong Cheng
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Hongjiang Wei
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Yulan Wang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China
- Department of Periodontology, University of Bern, Bern Switzerland
| | - Xiaoxin Zhang
- Department of Periodontology, University of Bern, Bern Switzerland
| | - Richard J Miron
- Department of Dental Implantology, School and Hospital of Stomatology University of Wuhan, Wuhan, China
| | - Yufeng Zhang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China
- Department of Dental Implantology, School and Hospital of Stomatology University of Wuhan, Wuhan, China
| | - Shanglan Qing
- Department of Stomatology Chongqing General Hospital, Chongqing, China
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Bennardo F, Barone S, Antonelli A, Giudice A. Autologous platelet concentrates as adjuvant in the surgical management of medication-related osteonecrosis of the jaw. Periodontol 2000 2024. [PMID: 39345044 DOI: 10.1111/prd.12608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 08/13/2024] [Accepted: 08/15/2024] [Indexed: 10/01/2024]
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) is an infectious side effect associated with bisphosphonates and monoclonal antibodies (denosumab, immune modulators, and antiangiogenic medications). Adjunctive therapies for the surgical management of MRONJ include autologous platelet concentrates (APCs). These APCs serve as a source of various cells and growth factors that aid tissue healing and regeneration. This review evaluated the use of platelet-rich plasma (PRP), plasma-rich in growth factors (PRGF), and leukocyte- and platelet-rich fibrin (L-PRF) as adjuvant therapies for the surgical management of MRONJ by conducting analyses on the results of 58 articles. Compared to surgical treatment alone, the application of PRP and L-PRF after surgery appears to increase healing in the management of patients with MRONJ. No studies have reported unhealed lesions as a result of surgical treatment of MRONJ with PRGF application or compared it with surgical treatment alone. The overall results of this review have shown favorable healing rates of MRONJ lesions managed with the application of APCs after surgical treatment; however, significant methodological limitations may limit the scientific evidence supporting their use. Further randomized controlled trials with strict criteria are needed to establish the extent to which APCs can improve wound healing and quality of life in patients with MRONJ requiring surgical treatment.
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Affiliation(s)
- Francesco Bennardo
- School of Dentistry, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Selene Barone
- School of Dentistry, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | | | - Amerigo Giudice
- School of Dentistry, Magna Graecia University of Catanzaro, Catanzaro, Italy
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Nik Eezammuddeen N, Johari NN, Demius O, Al-Bayaty FH. The effectiveness of autologous platelet-rich concentrates as an adjunct during nonsurgical periodontal therapy: a systematic review and meta-analysis of randomized controlled trials. Evid Based Dent 2024:10.1038/s41432-024-01060-0. [PMID: 39210056 DOI: 10.1038/s41432-024-01060-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Accepted: 08/15/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVES To evaluate the efficacy of autologous platelet concentrates (APC) on periodontal outcomes in nonsurgical therapy of periodontitis patients. METHOD Electronic search via Web of Science, MEDLINE via PubMed, Scopus, and Cochrane CENTRAL registry as well as manual search were done from June 2024 to July 2024 for relevant publication from inception until June 2024. The articles were assessed by 2 independent reviewers and deemed relevant when the interventional studies reported on periodontal outcomes after adjunctive APC were used in NSPT. The studies were excluded if it was not in English or unpublished. The risk of bias for each study was assessed using the Cochrane risk-of-bias tool (RoB 2). Fixed effect meta-analysis was conducted to measure the summary effect for change of periodontal pocket depth (PPD) and Clinical Attachment Level (CAL). The statistical heterogeneity between studies was also calculated using I2 test. RESULT A total of 607 records were found in the four electronic databases. Following the removal of duplicates and initial title screening, 16 full text articles from electronic search and 7 articles from manual search were assessed resulting in 13 studies included in the systematic review. The overall risk of bias showed most studies have moderate to high risk of bias. The fixed-effect meta-analysis showed summary effects favored the adjunctive use of APC in nonsurgical periodontal therapy but with high heterogeneity between the studies, particularly for CAL. CONCLUSION The evidence on APC as adjunct in NSPT is limited by the small number of studies, moderate to high risk of bias in most studies and significant heterogeneity in the results.
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Affiliation(s)
- Nazurah Nik Eezammuddeen
- Periodontology Centre of Studies, Faculty of Dentistry, Universiti Teknologi MARA, Jalan Hospital, 47000, Sungai Buloh, Malaysia.
| | - Nurina Nasuha Johari
- Periodontology Centre of Studies, Faculty of Dentistry, Universiti Teknologi MARA, Jalan Hospital, 47000, Sungai Buloh, Malaysia
| | - Olevia Demius
- Periodontology Centre of Studies, Faculty of Dentistry, Universiti Teknologi MARA, Jalan Hospital, 47000, Sungai Buloh, Malaysia
| | - Fouad Hussain Al-Bayaty
- Faculty of Dentistry, MAHSA University, Jalan SP 2, Bandar Saujana Putra, 42610, Jenjarom, Malaysia
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Chiara M, Mariaelena DC, Alessandro C, Davide DB, Lavinia C, Paola MM, Barbara L, Chiara DP, Flagiello F, Pia PM. Influence of haematological parameters on size of the advanced platelet-rich fibrin+ (A-PRF+) in the horse. Res Vet Sci 2024; 177:105367. [PMID: 39098093 DOI: 10.1016/j.rvsc.2024.105367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 07/26/2024] [Indexed: 08/06/2024]
Abstract
The advanced-PRF+ (A-PRF+) is a platelet concentrate, showing a higher concentration of growth factors, an increased number of cells and looser structure of the fibrin clot than leukocyte-PRF. A high variability in the size of PRF associated with patients, haematological features and centrifugation protocols was reported. The aims of this study were to evaluate the feasibility of A-PRF+ production in the field and the correlation between haematological parameters, macroscopic and microscopic features in equine A-PRF+. Samples from twenty Standardbred horses (3-7 years) were harvested with glass tubes without anticoagulants, previously heated at 37 °C. Blood samples were centrifugated at 1300 rpm for 8 min with a fixed-angle centrifuge and a horizontal centrifuge in the field, at a temperature of 15-17 °C. Clots were measured and placed on the Wound Box® for a 2-min compression. Membranes were measured and fixed in 10% formalin for histological examination. Clot and membrane surface did not differ between sex and centrifuge. Haematological parameters did not show a significant correlation to clot and membrane size. Membranes obtained from both centrifugation protocols showed a loose fibrin structure and cells evenly distributed throughout the clot. Tubes' warming was effective to obtain A-PRF+ clots from all samples, regardless the environmental temperature. Further studies are needed to evaluate the influence of other blood molecules on the A-PRF+ structure and size.
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Affiliation(s)
- Montano Chiara
- Department of Veterinary Medicine and Animal Production, Unit of Surgery, University of Naples "Federico II", Via Federico Delpino 1, 80137 Naples, Italy
| | - de Chiara Mariaelena
- Department of Veterinary Medicine and Animal Production, Unit of Surgery, University of Naples "Federico II", Via Federico Delpino 1, 80137 Naples, Italy.
| | - Crisci Alessandro
- Unit of Dermosurgery, Cutaneous Transplantation and Hard-To-Heal Wound, "Villa Fiorita" Private Hospital, Via Filippo Saporito, 24, 81031 Aversa (CE), Italy
| | - De Biase Davide
- Department of Pharmacy University of Salerno, Via Giovanni Paolo II 132, 84084 Fisciano (SA), Italy
| | - Ciuca Lavinia
- Department of Veterinary Medicine and Animal Production, University of Napoles Federico II, CREMOPAR, WHO Collaborating Centre ITA-116, Naples, Italy
| | - Maurelli Maria Paola
- Department of Veterinary Medicine and Animal Production, University of Napoles Federico II, CREMOPAR, WHO Collaborating Centre ITA-116, Naples, Italy
| | - Lamagna Barbara
- Department of Veterinary Medicine and Animal Production, Unit of Surgery, University of Naples "Federico II", Via Federico Delpino 1, 80137 Naples, Italy
| | - Del Prete Chiara
- Department of Veterinary Medicine and Animal Production, Unit of Animal Reproduction, University of Naples "Federico II", Via Federico Delpino 1, 80137 Naples, Italy
| | - Fabiana Flagiello
- Analysis Laboratory "Villa Fiorita" Private Hospital, Aversa (CE), Italy
| | - Pasolini Maria Pia
- Department of Veterinary Medicine and Animal Production, Unit of Surgery, University of Naples "Federico II", Via Federico Delpino 1, 80137 Naples, Italy
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Quirynen M, Blanco J, Wang HL, Donos N, Temmerman A, Castro A, Pinto N. Instructions for the use of L-PRF in different clinical indications. Periodontol 2000 2024. [PMID: 38803016 DOI: 10.1111/prd.12564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 03/01/2024] [Accepted: 03/02/2024] [Indexed: 05/29/2024]
Abstract
Autologous platelet concentrates (APCs) have demonstrated clear benefits across various clinical applications, including alveolar ridge preservation, guided tissue regeneration, guided bone regeneration, sinus floor elevation (both lateral window approach and transcrestal technique), endodontic surgery, the treatment of medication-related osteonecrosis of the jaw bones, and periodontal plastic surgery. To ensure an optimal clinical outcome, clinicians must adhere strictly to the protocol to prepare the APCs and, especially follow evidence-based surgical guidelines, often simple but crucial, to minimize the likelihood of errors. The majority of clinical trials reported on second-generation APCs [the leukocyte- and platelet-rich fibrin (L-PRF) family, including its modifications (A-PRF, A-PRF+, CGF, T-PRF, H-PRF, etc.)]. These second-generation APCs offer additional benefits compared to the first-generation APCs, making them the preferred choice for the development of clinical recommendations. These recommendations have been formulated through a meticulous examination of the available clinical data and the clinical experience of the authors of this paper.
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Affiliation(s)
- M Quirynen
- Department of Oral Health Sciences, Katholieke Universiteit Leuven, Dentistry (Periodontology), University Hospitals Leuven, Leuven, Belgium
| | - J Blanco
- Department of Department of Stomatology, Unit of Periodontology, Santiago de Compostela University, Santiago de Compostela, Spain
| | - H-L Wang
- Department of Periodontics and Oral Medicine, School of Dentistry, The University of Michigan, Michigan, USA
| | - N Donos
- Centre for Oral Clinical Research, Institute of Dentistry, Faculty of Medicine and Dentistry, Queen Mary University of London (QMUL), London, UK
| | - A Temmerman
- Department of Oral Health Sciences, Katholieke Universiteit Leuven, Dentistry (Periodontology), University Hospitals Leuven, Leuven, Belgium
| | - A Castro
- Department of Oral Health Sciences, Katholieke Universiteit Leuven, Dentistry (Periodontology), University Hospitals Leuven, Leuven, Belgium
| | - N Pinto
- Center of Translational Medicine, Faculty of Medicine, Universidad de la Frontera, Temuco, Chile
- Chairman of Center for Research in Regenerative Medicine and Tissue Engineering, Concepción, Chile
- Faculty of Dentistry, Universidad de Los Andes, Santiago, Chile
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Quirynen M, Siawasch SAM, Yu J, Miron RJ. Essential principles for blood centrifugation. Periodontol 2000 2024. [PMID: 38778518 DOI: 10.1111/prd.12555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 01/09/2024] [Accepted: 02/05/2024] [Indexed: 05/25/2024]
Abstract
Currently, autologous platelet concentrates (APCs) are frequently used for soft- and hard-tissue regeneration, not only within the oral cavity, but also extra-orally including chronic wounds, burns, joints, dermatological conditions, among others. The benefits of APCs are largely influenced by the treatment strategy but also their preparation. This paper therefore discusses in detail: the physical properties of blood cells, the basic principles of blood centrifugation, the impact of the centrifugation protocol (rotations/revolutions per minute, g-force, variation between centrifuges), the importance of timing during the preparation of APCs, the impact of the inner surface of the blood tubes, the use/nonuse of anticoagulants within APC tubes, the impact of the patient's hematocrit, age, and gender, as well as the important requirements for an optimal centrifugation protocol. All these variables indeed have a significant impact on the clinical outcome of APCs.
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Affiliation(s)
- Marc Quirynen
- Department of Oral Health Sciences, KU Leuven & Dentistry (Periodontology), University Hospitals Leuven, Leuven, Belgium
| | - Sayed Ahmad Manoetjer Siawasch
- Department of Oral Health Sciences, KU Leuven & Dentistry (Periodontology), University Hospitals Leuven, Leuven, Belgium
| | - Jize Yu
- Department of Oral Health Sciences, KU Leuven & Dentistry (Periodontology), University Hospitals Leuven, Leuven, Belgium
| | - Richard J Miron
- Department of Periodontology, University of Bern, Bern, Switzerland
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Wong KW, Chen YS, Lin CL. Evaluation optimum ratio of synthetic bone graft material and platelet rich fibrin mixture in a metal 3D printed implant to enhance bone regeneration. J Orthop Surg Res 2024; 19:299. [PMID: 38755635 PMCID: PMC11097440 DOI: 10.1186/s13018-024-04784-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 05/07/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND This study aims to evaluate the optimal ratio of synthetic bone graft (SBG) material and platelet rich fibrin (PRF) mixed in a metal 3D-printed implant to enhance bone regeneration. METHODS Specialized titanium hollow implants (5 mm in diameter and 6 mm in height for rabbit; 6 mm in diameter and 5 mm in height for pig) were designed and manufactured using 3D printing technology. The implants were divided into three groups and filled with different bone graft combinations, namely (1) SBG alone; (2) PRF to SBG in 1:1 ratio; (3) PRF to SBG in 2:1 ratio. These three groups were replicated tightly into each bone defect in distal femurs of rabbits (nine implants, n = 3) and femoral shafts of pigs (fifteen implants, n = 5). Animal tissue sections were obtained after euthanasia at the 8th postoperative week. The rabbit specimens were stained with analine blue, while the pig specimens were stained with Masson-Goldner's trichrome stain to perform histologically examination. All titanium hollow implants were well anchored, except in fracture specimens (three in the rabbit and one fracture in the pig). RESULT Rabbit specimens under analine blue staining showed that collagen tissue increased by about 20% and 40% in the 1:1 ratio group and the 2:1 ratio group, respectively. Masson-Goldner's trichrome stain results showed that new bone growth increased by 32% in the 1:1 ratio PRF to SBG, while - 8% in the 2:1 ratio group. CONCLUSION This study demonstrated that placing a 1:1 ratio combination of PRF and SBG in a stabilized titanium 3D printed implant resulted in an optimal increase in bone growth.
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Affiliation(s)
- Kin Weng Wong
- Department of Orthopaedic Surgery, Chi-Mei Medical Center, Tainan, 710, Taiwan
| | - Yu-San Chen
- Department of Biomedical Engineering, National Yang Ming Chiao Tung University, 2 No.155, Sec.2, Linong Street, Taipei, 112, Taiwan
| | - Chun-Li Lin
- Department of Biomedical Engineering, National Yang Ming Chiao Tung University, 2 No.155, Sec.2, Linong Street, Taipei, 112, Taiwan.
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Jiang Z, Huang C, Guo E, Zhu X, Li N, Huang Y, Wang P, Shan H, Yin Y, Wang H, Huang L, Han Z, Ouyang K, Sun L. Platelet-Rich Plasma in Young and Elderly Humans Exhibits a Different Proteomic Profile. J Proteome Res 2024; 23:1788-1800. [PMID: 38619924 DOI: 10.1021/acs.jproteome.4c00030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
As people age, their ability to resist injury and repair damage decreases significantly. Platelet-rich plasma (PRP) has demonstrated diverse therapeutic effects on tissue repair. However, the inconsistency of patient outcomes poses a challenge to the practical application of PRP in clinical practice. Furthermore, a comprehensive understanding of the specific impact of aging on PRP requires a systematic investigation. We derived PRP from 6 young volunteers and 6 elderly volunteers, respectively. Subsequently, 95% of high-abundance proteins were removed, followed by mass spectrometry analysis. Data are available via ProteomeXchange with the identifier PXD050061. We detected a total of 739 proteins and selected 311 proteins that showed significant differences, including 76 upregulated proteins in the young group and 235 upregulated proteins in the elderly group. Functional annotation and enrichment analysis unveiled upregulation of proteins associated with cell apoptosis, angiogenesis, and complement and coagulation cascades in the elderly. Conversely, IGF1 was found to be upregulated in the young group, potentially serving as the central source of enhanced cell proliferation ability. Our investigation not only provides insights into standardizing PRP preparation but also offers novel strategies for augmenting the functionality of aging cells or tissues.
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Affiliation(s)
- Zhitong Jiang
- Department of Cardiovascular Surgery, Shenzhen Peking University-The Hong Kong University of Science and Technology Medical Center, Peking University Shenzhen Hospital, Shenzhen 518036, China
| | - Can Huang
- Department of Cardiovascular Surgery, Peking University Shenzhen Hospital, Shenzhen 518036, China
| | - Erliang Guo
- Department of Thoracic Surgery, Harbin Medical University Cancer Hospital, Harbin 150081, China
| | - Xiangbin Zhu
- Department of Cardiovascular Surgery, Peking University Shenzhen Hospital, Shenzhen 518036, China
| | - Na Li
- Department of Cardiovascular Surgery, Peking University Shenzhen Hospital, Shenzhen 518036, China
| | - Yu Huang
- Department of Cardiovascular Surgery, Peking University Shenzhen Hospital, Shenzhen 518036, China
| | - Peihe Wang
- Department of Cardiovascular Surgery, Peking University Shenzhen Hospital, Shenzhen 518036, China
| | - Hui Shan
- Institute of Precision Medicine, Peking University Shenzhen Hospital, Shenzhen 518036, China
| | - Yuxin Yin
- Institute of Precision Medicine, Peking University Shenzhen Hospital, Shenzhen 518036, China
| | - Hong Wang
- Central Laboratory, Peking University Shenzhen Hospital, Shenzhen 518036, China
| | - Lei Huang
- Department of Cardiovascular Surgery, Peking University Shenzhen Hospital, Shenzhen 518036, China
| | - Zhen Han
- Department of Cardiovascular Surgery, Peking University Shenzhen Hospital, Shenzhen 518036, China
| | - Kunfu Ouyang
- Department of Cardiovascular Surgery, Peking University Shenzhen Hospital, Shenzhen 518036, China
| | - Lu Sun
- Department of Cardiovascular Surgery, Peking University Shenzhen Hospital, Shenzhen 518036, China
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Karcı B, Savas HB. Comparison of growth factor levels in injectable platelet-rich fibrin obtained from healthy individuals and patients with chronic periodontitis: a pilot study. BMC Oral Health 2024; 24:527. [PMID: 38702671 PMCID: PMC11069209 DOI: 10.1186/s12903-024-04301-x] [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: 01/10/2024] [Accepted: 04/26/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND This study aimed to assess and compare the concentrations of growth factors, white blood cells (WBCs), and platelets in injectable platelet-rich fibrin (i-PRF) derived from people with healthy periodontal conditions and those with chronic periodontitis. METHODS Venous blood samples were obtained from 30 patients diagnosed with chronic periodontitis (test group) and 30 participants with healthy periodontal conditions (control group). The i-PRF was then acquired from centrifuged blood. The growth factors (VEGF, IGF-1, TGF-β1, PDGF-BB and EGF) released from the i-PRF samples were compared between groups with ELISA testing. The amounts of WBCs and platelets were also compared. RESULTS No significant differences in the concentrations of growth factors were found between the groups (the mean values for the control and test groups were, respectively: IGF: 38.82, 42.46; PDGF: 414.25, 466.28; VEGF: 375.69, 412.18; TGF-β1: 21.50, 26.21; EGF: 138.62, 154.82). The test group exhibited a significantly higher WBC count than the control group (8.80 vs. 6.60, respectively). However, the platelet count did not show a statistically significant difference between the groups (control group 242.0 vs. test group 262.50). No significant correlation was observed between WBC count and growth factor level in either group. CONCLUSIONS The growth factor levels in i-PRFs did not exhibit significant difference between the two groups. This suggests that the levels of these growth factors may be unaffected by the periodontal disease.
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Affiliation(s)
- Bilge Karcı
- Faculty of Dentistry, Department of Periodontology, Alanya Alaaddin Keykubat University, Alanya, Antalya, Turkey.
| | - Hasan Basri Savas
- Faculty of Medicine, Department of Biochemistry, Mardin Artuklu University, Mardin, Turkey
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10
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Robin W, Shuichiro K, Leeni K, Rana T, Reginaldo G, Lari H, Larjava H. Delayed centrifugation weakens the in vitro biological properties of platelet-rich fibrin membranes. Clin Oral Investig 2024; 28:225. [PMID: 38514526 DOI: 10.1007/s00784-024-05617-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 03/10/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVE To investigate how delayed blood centrifugation affects the composition of the resultant platelet rich fibrin membrane (PRF, a concentrated growth factor preparation) and its biological effects towards gingival fibroblasts. MATERIALS AND METHODS Blood samples were collected from 18 healthy individuals and centrifuged immediately (T-0), or after a 1-6-minute delay (T-1-6, respectively), to generate PRF. Each PRF membrane was weighed. T-0 and T-6 membranes were incubated for 48 h in cell culture medium at 37 °C to create PRF "releasates" (soluble factors released from the PRF). Human gingival fibroblasts were incubated for 48 h with or without the releasates, followed by RNA isolation and real-time polymerase chain reaction to measure expression of select genes associated with granulation tissue formation, angiogenesis and wound contraction. Additional T-0 and T-6 membranes were used for visualization of leucocyte nuclei and platelets by immunostaining. RESULTS Immediate centrifugation (T-0) resulted in the largest membranes, T-6 membranes being on average 29% smaller. Leucocytes and platelets were significantly more abundant in T-0 than in T-6 samples. Majority of the fibroblast genes studied were consistently either upregulated or downregulated by the T-0 PRF releasates. However, centrifugation after a 6-minute delay significantly weakened the fibroblast responses. CONCLUSIONS Delayed centrifugation resulted in smaller PRF membranes with fewer leucocytes and platelets and also significantly reduced on the expression of a set of healing-related gingival fibroblast genes. CLINICAL RELEVANCE The higher expression of wound healing-related genes in gingival fibroblasts by the immediately-centrifuged PRF membranes may increase their biological properties in clinical use.
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Affiliation(s)
- Wintermute Robin
- Division of Periodontics, Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada
| | - Kobayashi Shuichiro
- Division of Periodontics, Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada
| | - Koivisto Leeni
- Division of Periodontics, Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada
| | - Tarzemany Rana
- Division of Periodontics, Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada
| | - Goncalves Reginaldo
- Division of Periodontics, Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada
| | - Häkkinen Lari
- Division of Periodontics, Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada
| | - Hannu Larjava
- Division of Periodontics, Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada.
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Shah R, M G T, Thomas R, A B TK. Advanced platelet rich fibrin demonstrates improved osteogenic induction potential in human periodontal ligament cells, growth factor production and mechanical properties as compared to leukocyte and platelet fibrin and injectable platelet rich fibrin. Oral Maxillofac Surg 2024; 28:413-424. [PMID: 37269407 DOI: 10.1007/s10006-023-01160-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/21/2023] [Indexed: 06/05/2023]
Abstract
OBJECTIVES This cross-sectional invitro research aimed to compare and contrast the macroscopic and microscopic, mechanical and biochemical features of leukocyte-rich platelet-rich fibrin, advanced platelet-rich fibrin, and injectable platelet-rich fibrin. MATERIALS AND METHODS In all, 150 samples were taken from males aged 18 to 25 with good systemic health (n = 50 each for i-PRF, A-PRF, and L-PRF). The samples were assessed for clot length, clot width, membrane length and width. Microscopic parameters assessed were the distribution of cells and fibrin structure. Mechanical tests were performed for tensile strength using a universal testing machine and growth factor analysis was performed for platelet derived growth factor (PDGF), vascular endothelial growth factor (VEGF), and transforming growth factor (TGF)- β on Days 1, 3 and 7 using commercially available ELISA kits. The osteogenic potential was analyzed in a culture of human periodontal ligament cells for 21 days using cell viability assay, alkaline phosphatase formation and alizarin red staining for mineralization. RESULTS L-PRF demonstrates statistically superior clot length, width, weight, membrane length, width and weight in comparison to A-PRF (p < 0.05). L-PRF demonstrates a denser fibrin structure in comparison to A-PRF and i-PRF (p < 0.05). The cells in L-PRF are most commonly situated in the proximal of the clot where as they are distributed in the proximal and middle aspect for A-PRF(p < 0.05). A-PRF demonstrates the highest tensile strength followed by L-PRF (p < 0.05). When growth factor release was evaluated, A-PRF showed noticeably increased release of all growth factors, namely PDGF-BB, TGF-ß, and VEGF, in comparison to i-PRF and L-PRF (p < 0.05). On days 7 and 14, the cell viability of human periodontal ligament cells in co-culture with A-PRF was statistically substantially greater than that of L-PRF and i-PRF (p < 0.05). Alkaline phosphatase levels were statistically substantially higher in A-PRF, followed by i-PRF and L-PRF on days 14 and 21 (p < 0.05). After 21 days of culture, A-PRF treated cultures had much more Alizarin Red staining than L-PRF and i-PRF cultures did (p < 0.05). CONCLUSION It was determined that although L-PRF exhibits greater size and weight in comparison to A-PRF and i-PRF, A-PRF has superior mechanical properties, increased growth factor releases of TGF-b, PDGF-BB, and VEGF as well as superior cell viability, alkaline phosphatase production, and mineralization on human periodontal ligament cells. CLINICAL RELEVANCE Based on these findings, A-PRF can be recommended for improved delivery of growth factors and osteogenesis whereas L-PRF is better-suited for applications relying on the size of membrane.
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Affiliation(s)
- Rucha Shah
- Department of Periodontics, Bapuji Dental College & Hospital, MCC B Block, Davangere, Karnataka, India, 577004.
| | - Triveni M G
- Department of Periodontics, Bapuji Dental College & Hospital, MCC B Block, Davangere, Karnataka, India, 577004
| | - Raison Thomas
- Department of Periodontics, Bapuji Dental College & Hospital, MCC B Block, Davangere, Karnataka, India, 577004
| | - Tarun Kumar A B
- Department of Periodontics, Bapuji Dental College & Hospital, MCC B Block, Davangere, Karnataka, India, 577004
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Shanbhag S, Al-Sharabi N, Kampleitner C, Mohamed-Ahmed S, Kristoffersen EK, Tangl S, Mustafa K, Gruber R, Sanz M. The use of mesenchymal stromal cell secretome to enhance guided bone regeneration in comparison with leukocyte and platelet-rich fibrin. Clin Oral Implants Res 2024; 35:141-154. [PMID: 37964421 DOI: 10.1111/clr.14205] [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: 06/02/2023] [Revised: 09/25/2023] [Accepted: 11/01/2023] [Indexed: 11/16/2023]
Abstract
OBJECTIVES Secretomes of mesenchymal stromal cells (MSC) represent a novel strategy for growth-factor delivery for tissue regeneration. The objective of this study was to compare the efficacy of adjunctive use of conditioned media of bone-marrow MSC (MSC-CM) with collagen barrier membranes vs. adjunctive use of conditioned media of leukocyte- and platelet-rich fibrin (PRF-CM), a current growth-factor therapy, for guided bone regeneration (GBR). METHODS MSC-CM and PRF-CM prepared from healthy human donors were subjected to proteomic analysis using mass spectrometry and multiplex immunoassay. Collagen membranes functionalized with MSC-CM or PRF-CM were applied on critical-size rat calvaria defects and new bone formation was assessed via three-dimensional (3D) micro-CT analysis of total defect volume (2 and 4 weeks) and 2D histomorphometric analysis of central defect regions (4 weeks). RESULTS While both MSC-CM and PRF-CM revealed several bone-related proteins, differentially expressed proteins, especially extracellular matrix components, were increased in MSC-CM. In rat calvaria defects, micro-CT revealed greater total bone coverage in the MSC-CM group after 2 and 4 weeks. Histologically, both groups showed a combination of regular new bone and 'hybrid' new bone, which was formed within the membrane compartment and characterized by incorporation of mineralized collagen fibers. Histomorphometry in central defect sections revealed greater hybrid bone area in the MSC-CM group, while the total new bone area was similar between groups. CONCLUSION Based on the in vitro and in vivo investigations herein, functionalization of membranes with MSC-CM represents a promising strategy to enhance GBR.
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Affiliation(s)
- Siddharth Shanbhag
- Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway
- Center for Translational Oral Research (TOR), Department of Clinical Dentistry, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Niyaz Al-Sharabi
- Center for Translational Oral Research (TOR), Department of Clinical Dentistry, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Carina Kampleitner
- Karl Donath Laboratory for Hard Tissue and Biomaterial Research, Division of Oral Surgery, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, The Research Center in Cooperation with AUVA, Vienna, Austria
- Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Samih Mohamed-Ahmed
- Center for Translational Oral Research (TOR), Department of Clinical Dentistry, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Einar K Kristoffersen
- Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway
| | - Stefan Tangl
- Karl Donath Laboratory for Hard Tissue and Biomaterial Research, Division of Oral Surgery, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
- Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Kamal Mustafa
- Center for Translational Oral Research (TOR), Department of Clinical Dentistry, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Reinhard Gruber
- Austrian Cluster for Tissue Regeneration, Vienna, Austria
- Department of Oral Biology, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Mariano Sanz
- ETEP Research Group, Faculty of Odontology, University Complutense of Madrid, Madrid, Spain
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13
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Miron RJ, Fujioka-Kobayashi M, Sculean A, Zhang Y. Optimization of platelet-rich fibrin. Periodontol 2000 2024; 94:79-91. [PMID: 37681522 DOI: 10.1111/prd.12521] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 07/25/2023] [Accepted: 08/09/2023] [Indexed: 09/09/2023]
Abstract
The use of platelet-rich fibrin (PRF) has gained tremendous popularity in recent years owing to its ability to speed wound healing postsurgery. However, to date, many clinicians are unaware of methods designed to optimize the technology. This overview article will discuss the advancements and improvements made over the years aimed at maximizing cell and growth factor concentrations. First, a general understanding explaining the differences between RPM and RCF (g-force) is introduced. Then, the low-speed centrifugation concept, fixed angle versus horizontal centrifugation, and methods to maximize platelet concentrations using optimized protocols will be discussed in detail. Thereafter, the importance of chemically modified PRF tubes without the addition of chemical additives, as well as regulation of temperature to induce/delay clotting, will be thoroughly described. This article is a first of its kind summarizing all recent literature on PRF designed to optimize PRF production for clinical treatment.
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Affiliation(s)
- Richard J Miron
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - Masako Fujioka-Kobayashi
- Department of Oral and Maxillofacial Surgery, School of Life Dentistry at Tokyo, The Nippon Dental University, Tokyo, Japan
| | - Anton Sculean
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - Yufeng Zhang
- Department of Oral Implantology, University of Wuhan, Wuhan, China
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14
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Miron RJ, Pikos MA, Estrin NE, Kobayashi-Fujioka M, Espinoza AR, Basma H, Zhang Y. Extended platelet-rich fibrin. Periodontol 2000 2024; 94:114-130. [PMID: 37986559 DOI: 10.1111/prd.12537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/30/2023] [Accepted: 10/02/2023] [Indexed: 11/22/2023]
Abstract
Platelet-rich fibrin (PRF) has been characterized as a regenerative biomaterial that is fully resorbed within a typical 2-3 week period. Very recently, however, a novel heating process was shown to extend the working properties of PRP/PRF from a standard 2-3 week period toward a duration of 4-6 months. Numerous clinicians have now utilized this extended-PRF (e-PRF) membrane as a substitute for collagen barrier membranes in various clinical applications, such as guided tissue/bone regeneration. This review article summarizes the scientific work to date on this novel technology, including its current and future applications in periodontology, implant dentistry, orthopedics and facial aesthetics. A systematic review was conducted investigating key terms including "Bio-Heat," "albumin gel," "albumin-PRF," "Alb-PRF," "extended-PRF," "e-PRF," "activated plasma albumin gel," and "APAG" by searching databases such as MEDLINE, EMBASE and PubMed. Findings from preclinical studies demonstrate that following a simple 10-min heating process, the transformation of the liquid plasma albumin layer into a gel-like injectable albumin gel extends the resorption properties to at least 4 months according to ISO standard 10 993 (subcutaneous animal model). Several clinical studies have now demonstrated the use of e-PRF membranes as a replacement for collagen membranes in GTR/GBR procedures, closing lateral windows in sinus grafting procedures, for extraction site management, and as a stable biological membrane during recession coverage procedures. Furthermore, Alb-PRF may also be injected as a regenerative biological filler that lasts extended periods with advantages in joint injections, osteoarthritis and in the field of facial aesthetics. This article highlights the marked improvement in the stability and degradation properties of the novel Alb-PRF/e-PRF technology with its widespread future potential use as a potential replacement for collagen membranes with indications including extraction site management, GBR procedures, lateral sinus window closure, recession coverage among others, and further highlights its use as a biological regenerative filler for joint injections and facial aesthetics. It is hoped that this review will pioneer future opportunities and research development in the field, leading to further progression toward more natural and less costly biomaterials for use in medicine and dentistry.
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Affiliation(s)
- Richard J Miron
- Advanced PRF Education, Jupiter, Florida, USA
- Department of Periodontology, University of Bern, Bern, Switzerland
| | | | | | - Masako Kobayashi-Fujioka
- Department of Oral and Maxillofacial Surgery, School of Life Dentistry at Tokyo, The Nippon Dental University, Tokyo, Japan
| | | | | | - Yufeng Zhang
- Department of Oral Implantology, University of Wuhan, Wuhan, China
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15
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Salgado-Peralvo ÁO, Kewalramani N, Pérez-Jardón A, Pato-Mourelo J, Castro-Calderón A, Arriba-Fuente L, Pérez-Sayáns M. Understanding Solid-Based Platelet-Rich Fibrin Matrices in Oral and Maxillofacial Surgery: An Integrative Review of the Critical Protocol Factors and Their Influence on the Final Product. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1903. [PMID: 38003952 PMCID: PMC10673335 DOI: 10.3390/medicina59111903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/20/2023] [Accepted: 10/25/2023] [Indexed: 11/26/2023]
Abstract
Platelet-rich fibrin (PRF) is a second-generation platelet concentrate whose use in clinical practice has been widely disseminated. This has led to the development of several commercial protocols, creating great confusion as to the terminology and implications of each of them. This integrative review aims to identify the critical factors of each of the phases of the solid-based PRF matrix protocol and their possible influence on their macro- and microscopic characteristics. An electronic search of the MEDLINE database (via PubMed), Web of Science, Scopus, LILACS, and OpenGrey was carried out. The search was temporarily restricted from 2001 to 2022. After searching, 43 studies were included that met the established criteria. There were numerous factors to consider in the PRF protocol, such as the material of the blood collection tubes, the duration of phlebotomy, the parameters related to blood centrifugation, the time from centrifugation to dehydration of the fibrin clots and their dehydration into membranes, as well as the time to clinical use. These factors influenced the macro- and microscopic characteristics of the PRF and its physical properties, so knowledge of these factors allows for the production of optimised PRF by combining the protocols and materials.
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Affiliation(s)
- Ángel-Orión Salgado-Peralvo
- Department of Dental Clinical Specialties, Faculty of Dentistry, Complutense University of Madrid, 28040 Madrid, Spain; (A.C.-C.); (L.A.-F.)
| | - Naresh Kewalramani
- Department of Nursery and Stomatology, Rey Juan Carlos University, 28922 Madrid, Spain;
| | - Alba Pérez-Jardón
- Oral Medicine, Oral Surgery and Implantology Unit (MedOralRes), Faculty of Medicine and Dentistry, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain; (A.P.-J.); (J.P.-M.)
| | - Jesús Pato-Mourelo
- Oral Medicine, Oral Surgery and Implantology Unit (MedOralRes), Faculty of Medicine and Dentistry, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain; (A.P.-J.); (J.P.-M.)
| | - Adriana Castro-Calderón
- Department of Dental Clinical Specialties, Faculty of Dentistry, Complutense University of Madrid, 28040 Madrid, Spain; (A.C.-C.); (L.A.-F.)
| | - Lorenzo Arriba-Fuente
- Department of Dental Clinical Specialties, Faculty of Dentistry, Complutense University of Madrid, 28040 Madrid, Spain; (A.C.-C.); (L.A.-F.)
| | - Mario Pérez-Sayáns
- Oral Medicine, Oral Surgery and Implantology Unit (MedOralRes), Faculty of Medicine and Dentistry, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain; (A.P.-J.); (J.P.-M.)
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16
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Ucer C, Khan RS. Alveolar Ridge Preservation with Autologous Platelet-Rich Fibrin (PRF): Case Reports and the Rationale. Dent J (Basel) 2023; 11:244. [PMID: 37886929 PMCID: PMC10605266 DOI: 10.3390/dj11100244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 10/09/2023] [Accepted: 10/18/2023] [Indexed: 10/28/2023] Open
Abstract
In dental implantology, alveolar ridge preservation (ARP) has emerged as a standard technique to address dimensional changes that affect alveolar ridge morphology following tooth loss. Various alternative graft materials, including xenografts, alloplasts, and allografts, have been effectively employed in fresh extraction sites for ARP. Current evidence suggests that these materials primarily serve as bio-scaffolds, which are slowly incorporated, thus necessitating a waiting period of at least 4-6 months before implant placement. Consequently, the ARP technique extends the overall duration of implant treatment by several months. Recently, the incorporation of a form of autologous platelet concentrate, known as platelet-rich fibrin (PRF), has been advocated in conjunction with ARP as a method of bioenhancement of soft- and hard-tissue healing and regeneration. PRF contains platelet-derived growth factors, hormones, and bioactive components like cytokines that have demonstrated the ability to stimulate angiogenesis and tissue regeneration throughout all phases of wound healing. Additionally, the concentration of leukocytes present in the PRF matrix plays a vital role in tissue healing and regeneration as part of the osteoimmune response. The reported advantages of incorporating autogenous PRF platelet concentrates during ARP encompass reduced healing time, improved angiogenesis and bone regeneration, socket sealing through the fibrin matrix, antibacterial properties, and decreased post-extraction pain and infection risk. Therefore, the objective of this paper is to review the existing evidence regarding the application of PRF in alveolar ridge preservation (ARP) following tooth extraction. Two clinical case studies are presented, wherein ARP was enhanced with PRF, followed by implant placement within a relatively short period of 8 weeks. These cases serve as further proof of concept for supporting the adjuvant use of PRF to enhance healing and accelerate implant placement after ARP.
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Affiliation(s)
| | - Rabia S. Khan
- I.C.E Postgraduate Dental Institute, University of Salford, Manchester M5 4WT, UK;
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17
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Quirynen M, Siawasch S, Temmerman A, Cortellini S, Dhondt R, Teughels W, Castro AB. Do autologous platelet concentrates (APCs) have a role in intra-oral bone regeneration? A critical review of clinical guidelines on decision-making process. Periodontol 2000 2023; 93:254-269. [PMID: 37845802 DOI: 10.1111/prd.12526] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 07/05/2023] [Accepted: 08/15/2023] [Indexed: 10/18/2023]
Abstract
In the past decades, personalized regenerative medicine has gained increased attention. Autologous platelet concentrates (APCs) such as PRP, PRGF, and L-PRF, all serving as a source of a large variety of cells and growth factors that participate in hard and soft tissue healing and regeneration, could play a significant role in regenerative periodontal procedures. This narrative review evaluated the relative impact of APCs in alveolar ridge preservation, sinus floor augmentation, and the regeneration of bony craters around teeth, both as a single substitute or in combination with a xenograft. L-PRF has a significant beneficial effect on alveolar ridge preservation ( bone quality). The data for PRGF are less convincing, and PRP is controversial. L-PRF can successfully be used as a single substitute during transcrestal (≥3.5 mm bone gain) as well as 1-stage lateral window sinus floor elevation (>5 mm bone gain). For PRGF and especially PRP the data are very scarce. In the treatment of bony craters around teeth, during open flap debridement, L-PRF as a single substitute showed significant adjunctive benefits (e.g., >PPD reduction, >CAL gain, >crater depth reduction). The data for PRP and PRGF were non-conclusive. Adding PRP or L-PRF to a xenograft during OFD resulted in additional improvements (>PPD reduction, >CAL gain, >bone fill), for PRGF no data were found. Autologous platelet concentrates demonstrated to enhance bone and soft tissue healing in periodontal regenerative procedures. The data for L-PRF were most convincing. L-PRF also has the advantage of a greater simplicity of production, and its 100% autologous character.
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Affiliation(s)
- Marc Quirynen
- Department of Oral Health Sciences, Periodontology, KU Leuven & Dentistry, University Hospitals Leuven, Leuven, Belgium
| | - Sam Siawasch
- Department of Oral Health Sciences, Periodontology, KU Leuven & Dentistry, University Hospitals Leuven, Leuven, Belgium
| | - Andy Temmerman
- Department of Oral Health Sciences, Periodontology, KU Leuven & Dentistry, University Hospitals Leuven, Leuven, Belgium
| | - Simone Cortellini
- Department of Oral Health Sciences, Periodontology, KU Leuven & Dentistry, University Hospitals Leuven, Leuven, Belgium
| | - Rutger Dhondt
- Department of Oral Health Sciences, Periodontology, KU Leuven & Dentistry, University Hospitals Leuven, Leuven, Belgium
| | - Wim Teughels
- Department of Oral Health Sciences, Periodontology, KU Leuven & Dentistry, University Hospitals Leuven, Leuven, Belgium
| | - Anna B Castro
- Department of Oral Health Sciences, Periodontology, KU Leuven & Dentistry, University Hospitals Leuven, Leuven, Belgium
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Mubarak R, Adel-Khattab D, Abdel-Ghaffar KA, Gamal AY. Adjunctive effect of collagen membrane coverage to L-PRF in the treatment of periodontal intrabony defects: a randomized controlled clinical trial with biochemical assessment. BMC Oral Health 2023; 23:631. [PMID: 37667213 PMCID: PMC10476412 DOI: 10.1186/s12903-023-03332-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 08/18/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND The innovation of leukocyte platelet-rich fibrin (L-PRF) has added enormous impact on wound healing dynamics especially the field of periodontal regeneration. The release of growth factors (GF) is thought to improve the clinical outcomes in infrabony defects. The aim of this study was to evaluate the clinical effect of covering L-PRF contained infrabony defects with collagen membranes (CM), and to compare their GF release profile to uncovered L-PRF defects and open flap debridement (OFD). METHODS Thirty non- smoking patients with infrabony pockets participated to be randomly assigned to OFD group (n = 10), L-PRF group (n = 10), or L-PRF protected CM group (n = 10). Plaque index (PI), gingival index (GI), probing depth (PD), clinical attachment level (CAL) and the radiographic defect base fill (DBF) were measured at baseline and at 6 month following surgical intervention. Gingival crevicular fluid samples were obtained on days 1, 3, 5, 7, 14, 21 and 30 days following surgery for the Platelet Derived Growth Factor-BB (PDGF-BB) and Vascular Endothelial Growth Factors (VEGF) release profile evaluation. RESULTS For all patients, a statistically significant (P ≤ 0.05) reduction in PI, GI, PD and CAL were reported throughout the study period. Differences between the three treatment modalities were not statistically significant. PRF + CM showed a statistically significant DBF compared to OFD and L-PRF groups at follow up. Quantitative analysis of PDGF-BB and VEGF levels demonstrated a statistically significant (P < 0.001) decline between measurement intervals for all groups with no statistically significant differences between the three groups. CONCLUSION Within the limitations of this study, L-PRF coverage with CM may augment defect base fill through its mechanical protective effect without enhancement in the release profile of VEGF and PDGF. The non-significant intergroup differences question the validity of the claimed extra physiologic concentration of GF offered by L-PRF harvests. TRIAL REGISTRATION The present study was registered at ClinicalTrials.gov (NCT05496608), (11/08/2022).
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Affiliation(s)
- Ramy Mubarak
- Department of Oral Medicine, Periodontology and Diagnosis, Faculty of Oral and Dental Medicine, Future University, Cairo, Egypt.
| | - Doaa Adel-Khattab
- Department of Oral Medicine, Periodontology and Diagnosis, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
| | - Khaled A Abdel-Ghaffar
- Oral Medicine, Periodontology and Diagnosis, Faculty of Dentistry Ain Shams University, Cairo, Egypt
| | - Ahmed Youssef Gamal
- Oral Medicine, Periodontology and Diagnosis, Faculty of Dentistry Ain Shams University, Cairo, Egypt
- Faculty of Dentistry, Misr University for Science and Technology, Giza, Egypt
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Hunger S, Krennmair S, Krennmair G, Otto S, Postl L, Nadalini DM. Platelet-rich fibrin vs. buccal advancement flap for closure of oroantral communications: a prospective clinical study. Clin Oral Investig 2023; 27:2713-2724. [PMID: 36607489 PMCID: PMC10264294 DOI: 10.1007/s00784-022-04846-7] [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: 10/06/2022] [Accepted: 12/26/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVES The primary aim was to evaluate the success of the defect closure (tight or open) of oroantral communications (OAC) after treatment with platelet-rich fibrin (PRF) clots or a buccal advancement flap (BAF). Secondary outcome measurements were the evaluation of the wound healing, the displacement of the mucogingival border (MGB), and the pain level. MATERIAL AND METHODS Fifty eligible patients with an OAC defect larger than 3 mm were randomly assigned to either PRF (test group, n = 25) or BAF (control group, n = 25) for defect closure. In a prospective follow-up program of 21 days, the defect closure healing process, the wound healing course using Landry's wound healing index (score: 0-5), the displacement of the MGB, and the postoperative pain score were evaluated. RESULTS Five patients in each group were lost to follow-up resulting in 40 patients (20 in each group) for continuous evaluation. On postoperative day 21 (study endpoint), no difference regarding success rate (defined as closure of OAC) was noticed between the test (90%; 18/20) and control group (90%; 18/20). A univariate analysis showed significant differences for age and defect size/height for the use of PRF between successful-tight and open-failed defect healing. At the final evaluation, a significantly (p = 0.005) better wound healing score, a lower displacement of the MGB as well as lower pain-score were seen for the use of PRF. CONCLUSIONS Based on the findings of the current study, the use of platelet-rich fibrin represents a reliable and successful method for closure of oroantral communications. The use of PRF clots for defect filling is associated with lowered pain levels and less displacement of the mucogingival border. CLINICAL RELEVANCE The defect size should be taken into account when choosing the number and size of PRF plugs.
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Affiliation(s)
- Stefan Hunger
- Medical Faculty, Johannes Kepler University Linz, Altenberger Strasse 69, 4040, Linz, Austria
- Clinic of Oral and Maxillofacial Surgery, Kepler University Hospital, Johannes Kepler University, Krankenhausstraße 7a, Linz, Austria
| | - Stefan Krennmair
- Medical Faculty, Johannes Kepler University Linz, Altenberger Strasse 69, 4040, Linz, Austria
- NumBioLab, Ludwig-Maximilians University of Munich, Munich, Germany
| | - Gerald Krennmair
- Head of Department of Prosthodontics, Sigmund Freud University Vienna, Freudplatz 1, 1020, Vienna, Austria
| | - Sven Otto
- Department of Oral and Maxillofacial Surgery, Ludwig-Maximilians-University Munich, Lindwurmstr. 2a, 80337, Munich, Germany
| | - Lukas Postl
- Medical Faculty, Johannes Kepler University Linz, Altenberger Strasse 69, 4040, Linz, Austria.
- NumBioLab, Ludwig-Maximilians University of Munich, Munich, Germany.
| | - Danilo-Marc Nadalini
- Clinic of Oral and Maxillofacial Surgery, Kepler University Hospital, Johannes Kepler University, Krankenhausstraße 7a, Linz, Austria
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Kosmidis K, Ehsan K, Pitzurra L, Loos B, Jansen I. An in vitro study into three different PRF preparations for osteogenesis potential. J Periodontal Res 2023; 58:483-492. [PMID: 36942454 DOI: 10.1111/jre.13116] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/21/2023] [Accepted: 03/01/2023] [Indexed: 03/23/2023]
Abstract
OBJECTIVE To investigate the effect of Advanced Platelet-Rich Fibrin (A-PRF+), Leukocyte Platelet-Rich Fibrin (L-PRF), and injectable Platelet-Rich Fibrin (i-PRF) on osteogenesis of a human osteoblast-like cell line in vitro. BACKGROUND Different PRF protocols are used in clinical dentistry in the last years. Recent literature documented the positive impact of PRF derivatives in vivo and in vitro, on different types of cells. However, hardly any literature comparing the new protocols for PRF (the A-PRF+ and i-PRF) with the original protocol of PRF (L-PRF) is present for osteoblast-like cells. MATERIALS AND METHODS A-PRF+, L-PRF, and i-PRF were prepared from six male donors and pre-cultured with 10 mL culture medium for 6 days. 5 x 103 cells/ml osteoblasts from the osteoblast cell line (U2OS) were seeded and cultured either with conditioned medium derived from the different PRF conditions or with regular culture medium. At five different time points (0, 7, 14, 21, 28 days), the osteogenic capacity of the cells was assessed with Alizarin Red S to visualize mineralization. Also in these cells, the calcium concentration and alkaline phosphatase activity were investigated. Using qPCR, the expression of alkaline phosphatase, osteocalcin, osteonectin, ICAM-1, RUNX-2, and collagen 1a was assessed. RESULTS In osteoblast-like cells cultured with conditioned medium, the A-PRF+ conditioned medium induced more mineralization and calcium production after 28 days of culturing compared with the control (p < .05). No significant differences were found in the extent of cell proliferation between the different conditions. RUNX-2 and osteonectin mRNA expression in the cells were lower in all PRF-stimulated cultures compared with control at different time points. The i-PRF-conditioned medium induced more ALP activity (p < .05) compared with control and osteoblasts-like cells differentiated more compared with osteoblasts cultured with L-PRF. CONCLUSIONS The three PRF preparations seem to have the capacity to increase the osteogenic potential of osteoblast-like cells. A-PRF+ seems to have the highest potential for mineralization, while i-PRF seems to have the potential to enhance early cell differentiation.
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Affiliation(s)
- Kostantinos Kosmidis
- Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Karishma Ehsan
- Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Luciano Pitzurra
- Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Bruno Loos
- Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ineke Jansen
- Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Bennardo F, Gallelli L, Palleria C, Colosimo M, Fortunato L, De Sarro G, Giudice A. Can platelet-rich fibrin act as a natural carrier for antibiotics delivery? A proof-of-concept study for oral surgical procedures. BMC Oral Health 2023; 23:134. [PMID: 36894902 PMCID: PMC9996939 DOI: 10.1186/s12903-023-02814-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 02/13/2023] [Indexed: 03/11/2023] Open
Abstract
OBJECTIVES Evaluate the role of platelet-rich fibrin (PRF) as a natural carrier for antibiotics delivery through the analysis of drug release and antimicrobial activity. MATERIALS AND METHODS PRF was prepared according to the L-PRF (leukocyte- and platelet-rich fibrin) protocol. One tube was used as control (without drug), while an increasing amount of gentamicin (0.25 mg, G1; 0.5 mg, G2; 0.75 mg, G3; 1 mg, G4), linezolid (0.5 mg, L1; 1 mg, L2; 1.5 mg, L3; 2 mg, L4), vancomycin (1.25 mg, V1; 2.5 mg, V2; 3.75 mg, V3; 5 mg, V4) was added to the other tubes. At different times the supernatant was collected and analyzed. Strains of E. coli, P. aeruginosa, S. mitis, H. influenzae, S. pneumoniae, S. aureus were used to assess the antimicrobial effect of PRF membranes prepared with the same antibiotics and compared to control PRF. RESULTS Vancomycin interfered with PRF formation. Gentamicin and linezolid did not change the physical properties of PRF and were released from membranes in the time intervals examined. The inhibition area analysis showed that control PRF had slight antibacterial activity against all tested microorganisms. Gentamicin-PRF had a massive antibacterial activity against all tested microorganisms. Results were similar for linezolid-PRF, except for its antibacterial activity against E. coli and P. aeruginosa that was comparable to control PRF. CONCLUSIONS PRF loaded with antibiotics allowed the release of antimicrobial drugs in an effective concentration. Using PRF loaded with antibiotics after oral surgery may reduce the risk of post-operative infection, replace or enhance systemic antibiotic therapy while preserving the healing properties of PRF. Further studies are needed to prove that PRF loaded with antibiotics represents a topical antibiotic delivery tool for oral surgical procedures.
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Affiliation(s)
- Francesco Bennardo
- School of Dentistry, Department of Health Sciences, Magna Graecia University of Catanzaro, Viale Europa, 88100, Catanzaro, Italy.
| | - Luca Gallelli
- Pharmacology Unit, Department of Health Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Caterina Palleria
- Pharmacology Unit, Department of Health Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Manuela Colosimo
- Microbiology and Virology Unit, Pugliese-Ciaccio Hospital, Catanzaro, Italy
| | - Leonzio Fortunato
- School of Dentistry, Department of Health Sciences, Magna Graecia University of Catanzaro, Viale Europa, 88100, Catanzaro, Italy
| | - Giovambattista De Sarro
- Pharmacology Unit, Department of Health Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Amerigo Giudice
- School of Dentistry, Department of Health Sciences, Magna Graecia University of Catanzaro, Viale Europa, 88100, Catanzaro, Italy
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22
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Saboia-Dantas CJ, Limirio PHJO, Costa MDMDA, Linhares CRB, Santana Silva MAF, Borges de Oliveira HAA, Dechichi P. Platelet-Rich Fibrin Progressive Protocol: Third Generation of Blood Concentrates. J Oral Maxillofac Surg 2023; 81:80-87. [PMID: 36209891 DOI: 10.1016/j.joms.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 08/24/2022] [Accepted: 09/05/2022] [Indexed: 01/06/2023]
Abstract
PURPOSE Platelet-rich fibrin (PRF) has been used in several fields of dentistry to improve tissue healing. However, PRF from glass tubes results in a limited number of small membranes, increasing clinical difficulty and work time. The aim of this study was to evaluate cell and platelet amounts and biomechanical strength of PRF-giant membranes produced from plastic tubes without additives. MATERIAL AND METHODS The investigators designed an ex vivo study, to compare 3 different centrifugation protocols for obtaining PRF: 700 × g/12 minutes (leukocyte and PRF [L-PRF]), 350 × g/14 minutes (GM350), and 60-700 × g more than 15 minutes total (progressive PRF [PRO-PRF]). We collected blood samples from 5 volunteers aged 25-54 years, over 3 different time periods (triplicate and paired study). From each venipuncture, 4 mL of blood was collected in vacutainers with ethylenediamine tetraacetic acid (EDTA) and approximately 104 mL in 12 plastic tubes without additives, which were separated into 3 groups, as per the centrifugation protocols (n = 5): L-PRF, GM350, and PRO-PRF. The PRF from the tubes of the same protocol was aspirated and 9 mL were placed in polylactic acid (PLA) forms and 3 mL were placed in a glass receptacle. The membranes from PLA forms were tested for tensile strength and the membranes from glass receptacles were evaluated by histomorphometry, while platelets and leukocytes were counted for those in tubes with EDTA. Statistical analyses were performed using Shapiro-Wilk normality test and then a one-way repeated measures analysis followed by Tukey multiple comparisons test (α < 0.05). RESULTS In tensile analyses, PRO-PRF (0.85 ± 0.23 N) showed a significantly higher maximum breaking strength than L-PRF (0.61 ± 0.26 N, P = .01) and GM350 (0.58 ± 0.23 N, P < .01). The histomorphometry revealed no significant statistical difference in cell counts between the groups (P = .52). Furthermore, there was no significant difference between the leukocyte (P = .25) and platelet counts (P = .59) in whole blood between the groups. CONCLUSION The progressive protocol (PRO-PRF) enabled the production of PRF giant membranes with greater tensile strength and adequate cell distribution. Moreover, it allows biomaterial incorporation during production and enables clinical control of membrane thickness and size as per the surgical procedure.
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Affiliation(s)
- Carlos José Saboia-Dantas
- Tissue Repair Research Laboratory, Brain Storm Academy, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil
| | | | | | - Camila Rodrigues Borges Linhares
- Department of Cell Biology, Histology and Embryology, Biomedical Science Institute, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil
| | - Maria Adelia Faleiro Santana Silva
- Department of Cell Biology, Histology and Embryology, Biomedical Science Institute, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil
| | | | - Paula Dechichi
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil; Department of Cell Biology, Histology and Embryology, Biomedical Science Institute, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil.
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23
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In Vitro and Ex Vivo Kinetic Release Profile of Growth Factors and Cytokines from Leucocyte- and Platelet-Rich Fibrin (L-PRF) Preparations. Cells 2022; 11:cells11132089. [PMID: 35805173 PMCID: PMC9266245 DOI: 10.3390/cells11132089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/22/2022] [Accepted: 06/25/2022] [Indexed: 01/05/2023] Open
Abstract
L-PRF is an autologous blood-derived biomaterial (ABDB) capable of releasing biologically active agents to promote healing. Little is known about its release profile of growth factors (GFs), cytokines, and MMPs. This study reported the in vitro and ex vivo release kinetics of GFs, cytokines, and MMPs from L-PRF at 6, 24, 72, and 168 h. The in vitro release rates of PDGF, TGF-β1, EGF, FGF-2, VEGF, and MMPs decreased over time with different rates, while those of IL-1β, IL-6, TNF-α, IL-8, and IL-10 were low at 6 h and then increased rapidly for up to 24 h and subsequently decreased. Of note, the release rates of the GFs followed first-order kinetics both in vitro and ex vivo. Higher rates of release were found ex vivo, suggesting that significant amounts of GFs were produced by the local cells within the wound. In addition, the half-life times of GFs locally produced in the wound, including PDGF-AA, PDGF-AB/BB, and VEGF, were significantly extended (p < 0.05). This work demonstrates that L-PRF can sustain the release of GFs and cytokines for up to 7 days, and it shows that the former can activate cells to produce additional mediators and amplify the communication network for optimizing the wound environment, thereby enhancing healing.
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da Silva LMP, Sávio DDSF, de Ávila FC, Vicente RM, Reis GGD, Denardi RJ, da Costa NMM, Silva PHF, Mourão CFDAB, Miron RJ, Messora MR. Comparison of the effects of platelet concentrates produced by high and low-speed centrifugation protocols on the healing of critical-size defects in rat calvaria: a microtomographic and histomorphometric study. Platelets 2022; 33:1175-1184. [PMID: 35591762 DOI: 10.1080/09537104.2022.2071851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The current study evaluated the healing of critical-size defects (CSD) created in rat calvaria treated with platelet concentrates produced by high-speed (Leukocyte- and Platelet-Rich Fibrin - L-PRF) and low-speed (Advanced Platelet-Rich Fibrin - A-PRF) protocols of centrifugation. Twenty-four rats were distributed into three groups: Control, L-PRF, and A-PRF. Five mm diameter CSD were created on the animals' calvaria. The defects of the L-PRF and A-PRF groups were filled with 0.01 ml of L-PRF and A-PRF, respectively. The control group defects were filled with a blood clot only. All animals were euthanized on the 35th postoperative day. Histomorphometric and microtomographic analyses were then performed. The L-PRF and A-PRF groups had significantly higher bone volume and neoformed bone area than those of the control group and lowered bone porosity values (p < .05). No significant differences were observed between A-PRF and L-PRF groups for the analyzed parameters. Therefore, it can be concluded that i) L-PRF and A-PRF potentiated the healing of CSD in rat calvaria; ii) high and low-speed centrifugation protocols did not produce PRF matrices with different biological impacts on the amount of bone neoformation.
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Affiliation(s)
- Lucia Moitrel Pequeno da Silva
- Department of Oral and Maxillofacial Surgery and Periodontology - DCTBMF, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Débora de Souza Ferreira Sávio
- Department of Morphology, Physiology, and Basic Pathology - DMFPB, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP
| | - Felipe Correa de Ávila
- Department of Morphology, Physiology, and Basic Pathology - DMFPB, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP
| | - Raphael Martini Vicente
- Department of Orthopedics and Anesthesiology, Ribeirão Preto Medical School, University of São Paulo - USP, Ribeirão Preto, São Paulo, Brazil
| | - Gabriel Guerra David Reis
- Department of Oral and Maxillofacial Surgery and Periodontology - DCTBMF, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Ricardo Junior Denardi
- Department of Oral and Maxillofacial Surgery and Periodontology - DCTBMF, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Natacha Malu Miranda da Costa
- Department of Oral and Maxillofacial Surgery and Periodontology - DCTBMF, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Pedro Henrique Felix Silva
- Department of Oral and Maxillofacial Surgery and Periodontology - DCTBMF, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | | | - Richard J Miron
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - Michel Reis Messora
- Department of Oral and Maxillofacial Surgery and Periodontology - DCTBMF, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
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Ockerman A, Hendrickx A, Willekens W, Fehervary H, Vastmans J, Coucke W, Verhamme P, Politis C, Vanassche T, Braem A, Quirynen M, Jacobs R. Mechanical properties and cellular content of leukocyte- and platelet-rich fibrin membranes of patients on antithrombotic drugs. J Periodontal Res 2022; 57:623-631. [PMID: 35385142 DOI: 10.1111/jre.12991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 03/08/2022] [Accepted: 03/28/2022] [Indexed: 01/06/2023]
Abstract
INTRODUCTION The aim of this study was to examine the potential influence of antithrombotics on leukocyte- and platelet-rich fibrin (L-PRF) membranes. METHODS Tensile tests and cell counts were performed with L-PRF membranes originating from patients on anticoagulants and antiplatelets versus patients not taking antithrombotics. RESULTS For the tensile tests, 13 control patients, 12 on anticoagulants, and 10 on antiplatelets donated blood. Compared to controls, membranes from anticoagulated donors were weaker (strength 0.57 ± 0.24 MPa vs. 0.80 ± 0.27 MPa, p = .03) and could not be stretched as far (1.8 ± 0.3 vs. 2.1 ± 0.3 times the initial length, p = .01). For the cell counting, 23 control patients, 16 on anticoagulants, and 16 on antiplatelets donated blood. The percentage of platelets was ±50% in the three groups. The percentage of leukocytes was lower in the anticoagulant group compared with controls (69 ± 10% vs. 78 ± 8%, p = .04). However, because of the unknown error of method, it is questionable whether the statistical significance is meaningful. There was no difference between membranes from the control group and the group on antiplatelets. CONCLUSION Our results indicate that L-PRF membranes originating from patients on anticoagulants are weaker, stretch less far, and contain less leukocytes than L-PRF membranes of patients not taking these drugs.
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Affiliation(s)
- Anna Ockerman
- OMFS-IMPATH Research Group, Department of Oral & Maxillofacial Surgery, KU Leuven, Leuven, Belgium
| | - Amber Hendrickx
- OMFS-IMPATH Research Group, Department of Oral & Maxillofacial Surgery, KU Leuven, Leuven, Belgium
| | - Wouter Willekens
- Department of Mechanical Engineering, FIBEr KU Leuven Core Facility for Biomechanical Experimentation, KU Leuven, Leuven, Belgium
| | - Heleen Fehervary
- Department of Mechanical Engineering, FIBEr KU Leuven Core Facility for Biomechanical Experimentation, KU Leuven, Leuven, Belgium
| | - Julie Vastmans
- Department of Mechanical Engineering, FIBEr KU Leuven Core Facility for Biomechanical Experimentation, KU Leuven, Leuven, Belgium
| | - Wim Coucke
- Certified Freelance Statistician, Heverlee, Belgium
| | - Peter Verhamme
- Department of Cardiovascular Sciences, Centre for Molecular and Vascular Biology, KU Leuven, Leuven, Belgium
| | - Constantinus Politis
- OMFS-IMPATH Research Group, Department of Oral & Maxillofacial Surgery, KU Leuven, Leuven, Belgium
| | - Thomas Vanassche
- Department of Cardiovascular Sciences, Centre for Molecular and Vascular Biology, KU Leuven, Leuven, Belgium
| | - Annabel Braem
- Biomaterials and Tissue Engineering Research Group, Department of Materials Engineering, KU Leuven, Leuven, Belgium
| | - Marc Quirynen
- Section of Periodontology, Department of Oral Health Sciences, KU Leuven, Leuven, Belgium
| | - Reinhilde Jacobs
- OMFS-IMPATH Research Group, Department of Oral & Maxillofacial Surgery, KU Leuven, Leuven, Belgium.,Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
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Simões-Pedro M, Tróia PMBPS, dos Santos NBM, Completo AMG, Castilho RM, de Oliveira Fernandes GV. Tensile Strength Essay Comparing Three Different Platelet-Rich Fibrin Membranes (L-PRF, A-PRF, and A-PRF+): A Mechanical and Structural In Vitro Evaluation. Polymers (Basel) 2022; 14:polym14071392. [PMID: 35406263 PMCID: PMC9002533 DOI: 10.3390/polym14071392] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 03/22/2022] [Accepted: 03/23/2022] [Indexed: 01/28/2023] Open
Abstract
Predictable outcomes intended by the application of PRF (platelet-rich fibrin) derivative membranes have created a lack of consideration for their consistency and functional integrity. This study aimed to compare the mechanical properties through tensile strength and analyze the structural organization among the membranes produced by L-PRF (leukocyte platelet-rich fibrin), A-PRF (advanced platelet-rich fibrin), and A-PRF+ (advanced platelet-rich fibrin plus) (original protocols) that varied in centrifugation speed and time. L-PRF (n = 12), A-PRF (n = 19), and A-PRF+ (n = 13) membranes were submitted to a traction test, evaluating the maximum and average traction. For maximum traction, 0.0020, 0.0022, and 0.0010 N·mm−2 were obtained for A-PRF, A-PRF+, and L-PRF, respectively; regarding the average resistance to traction, 0.0012, 0.0015, and 0.006 N·mm−2 were obtained, respectively (A-PRF+ > A-PRF > L-PRF). For all groups studied, significant results were found. In the surface morphology observations through SEM, the L-PRF matrix showed a highly compact surface with thick fibers present within interfibrous areas with the apparent destruction of red blood cells and leukocytes. The A-PRF protocol showed a dense matrix composed of thin and elongated fibers that seemed to follow a preferential and orientated direction in which the platelets were well-adhered. Porosity was also evident with a large diameter of the interfibrous spaces whereas A-PRF+ was the most porous platelet concentrate with the greatest fiber abundance and cell preservation. Thus, this study concluded that A-PRF+ produced membranes with significant and higher maximum traction results, indicating a better viscoelastic strength when stretched by two opposing forces.
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Affiliation(s)
- Mara Simões-Pedro
- Faculty of Dental Medicine, Universidade Católica Portuguesa, 3515-320 Viseu, Portugal; (M.S.-P.); (P.M.B.P.S.T.); (N.B.M.d.S.)
| | - Pedro Maria B. P. S. Tróia
- Faculty of Dental Medicine, Universidade Católica Portuguesa, 3515-320 Viseu, Portugal; (M.S.-P.); (P.M.B.P.S.T.); (N.B.M.d.S.)
| | - Nuno Bernardo Malta dos Santos
- Faculty of Dental Medicine, Universidade Católica Portuguesa, 3515-320 Viseu, Portugal; (M.S.-P.); (P.M.B.P.S.T.); (N.B.M.d.S.)
| | - António M. G. Completo
- Centre for Mechanical Technology and Automation, TEMA—University of Aveiro, 3810-549 Aveiro, Portugal;
| | - Rogerio Moraes Castilho
- Department of Periodontics and Oral Medicine, University of Michigan, Ann Arbor, MI 48104, USA;
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Fibrinogen Concentrations in Liquid PRF Using Various Centrifugation Protocols. Molecules 2022; 27:molecules27072043. [PMID: 35408442 PMCID: PMC9000261 DOI: 10.3390/molecules27072043] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/18/2022] [Accepted: 03/18/2022] [Indexed: 02/06/2023] Open
Abstract
Liquid platelet-rich fibrin (PRF) is produced by fractionation of blood without additives that initiate coagulation. Even though liquid PRF is frequently utilized as a natural source of fibrinogen to prepare sticky bone, the concentration of fibrinogen and the overall amount of "clottable PRF" components have not been evaluated. To this aim, we prepared liquid PRF at 300, 700, and 2000 relative centrifugal force (RCF), for 8 min and quantified the fibrinogen levels by immunoassay. We report here that, independent of the RCF, the fibrinogen concentration is higher in the platelet-poor plasma (PPP) compared to the buffy coat (BC) fraction of liquid PRF and further decreases in the remaining red fraction. We then determined the weight of the clotted PRF fractions before and after removing the serum. The PPP and BC fractions consist of 10.2% and 25.3% clottable matrix suggesting that more than half of the weight of clottable BC is caused by cellular components. Our data provide insights into the distribution of fibrinogen in the different fractions of liquid PRF. These findings suggest that PPP is the main source of clottable fibrinogen, while the BC is more a cell source when it comes to the preparation of sticky bone.
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Blatt S, Krüger M, Kämmerer PW, Thiem DGE, Matheis P, Eisenbeiß AK, Wiltfang J, Al-Nawas B, Naujokat H. Non-Interventional Prospective Observational Study of Platelet Rich Fibrin as a Therapy Adjunctive in Patients with Medication-Related Osteonecrosis of the Jaw. J Clin Med 2022; 11:jcm11030682. [PMID: 35160132 PMCID: PMC8837070 DOI: 10.3390/jcm11030682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 01/19/2022] [Accepted: 01/26/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Medication-related osteonecrosis (MRONJ) of the jaw is a severe and feared side effect of antiresorptive therapy in the oncological setting. With growing evidence that impaired angiogenesis may represent a key factor in pathogenesis, the aim of this study was to evaluate an autologous platelet concentrate as a possible additive in surgical therapy to optimize vascularization and, subsequently, resolution rates. MATERIAL AND METHODS A non-interventional, prospective, multicenter study was conducted, and all patients with stage I-III MRONJ, undergoing antiresorptive therapy for an oncological indication, were included. The necrosis was treated surgically without (study arm A) or with (arm B) the addition of an autologous platelet concentrate (platelet-rich fibrin, PRF). RESULTS After 5, 14, and 42 days postoperative, wound healing (primary outcome: mucosal integrity) as well as downstaging, pain perception, and oral health-related quality of life (secondary outcome) were assessed via clinical evaluation. Among the 52 patients included, primarily with MRONJ stage I and II, the use of PRF as an additive in surgical therapy did not display a significant advantage for wound healing (p = 0.302), downstaging (p = 0.9), pain reduction (p = 0.169), or quality of life (p = 0.9). SUMMARY In conclusion, PRF as an adjunct did not significantly optimize wound healing. Further, no significant changes in terms of downstaging, pain sensation, and oral health-related quality of life were found.
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Affiliation(s)
- Sebastian Blatt
- Department of Oral and Maxillofacial Surgery, University Medical Center, 55131 Mainz, Germany; (M.K.); (P.W.K.); (D.G.E.T.); (P.M.); (B.A.-N.)
- Correspondence: ; Tel.: +49-6131-173071
| | - Maximilian Krüger
- Department of Oral and Maxillofacial Surgery, University Medical Center, 55131 Mainz, Germany; (M.K.); (P.W.K.); (D.G.E.T.); (P.M.); (B.A.-N.)
| | - Peer W. Kämmerer
- Department of Oral and Maxillofacial Surgery, University Medical Center, 55131 Mainz, Germany; (M.K.); (P.W.K.); (D.G.E.T.); (P.M.); (B.A.-N.)
| | - Daniel G. E. Thiem
- Department of Oral and Maxillofacial Surgery, University Medical Center, 55131 Mainz, Germany; (M.K.); (P.W.K.); (D.G.E.T.); (P.M.); (B.A.-N.)
| | - Philipp Matheis
- Department of Oral and Maxillofacial Surgery, University Medical Center, 55131 Mainz, Germany; (M.K.); (P.W.K.); (D.G.E.T.); (P.M.); (B.A.-N.)
| | - Anne-Katrin Eisenbeiß
- Department of Oral and Maxillofacial Surgery, University Hospital Schleswig-Holstein, Christian-Albrechts-University, 24118 Kiel, Germany; (A.-K.E.); (J.W.); (H.N.)
| | - Jörg Wiltfang
- Department of Oral and Maxillofacial Surgery, University Hospital Schleswig-Holstein, Christian-Albrechts-University, 24118 Kiel, Germany; (A.-K.E.); (J.W.); (H.N.)
| | - Bilal Al-Nawas
- Department of Oral and Maxillofacial Surgery, University Medical Center, 55131 Mainz, Germany; (M.K.); (P.W.K.); (D.G.E.T.); (P.M.); (B.A.-N.)
| | - Hendrik Naujokat
- Department of Oral and Maxillofacial Surgery, University Hospital Schleswig-Holstein, Christian-Albrechts-University, 24118 Kiel, Germany; (A.-K.E.); (J.W.); (H.N.)
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Das N, Amaranath BJJ. Qualitative analysis of modified advanced-platelet-rich fibrin buffy coat among diabetic patients and tobacco smokers with chronic periodontitis: A cell block cytology study. Contemp Clin Dent 2022; 13:173-182. [PMID: 35846589 PMCID: PMC9285844 DOI: 10.4103/ccd.ccd_1018_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/19/2021] [Accepted: 02/24/2021] [Indexed: 11/20/2022] Open
Abstract
Aim: The aim of this study was to evaluate and compare histologically the pattern of distribution of platelet and leukocyte concentration, quality of fibrin network, and the aggregation of platelets in the three zones of modified advanced platelet-rich fibrin (A-PRF) buffy coat among uncontrolled type 2 diabetic patients, tobacco smokers, and healthy individuals with chronic periodontitis. Materials and Methods: In this cross-sectional cytology study, 180 generalized chronic periodontitis patients (46–55 years) were enrolled – Group 1 (control group): 60 systemically healthy participants, Group 2 (test group): 60 heavy tobacco smokers, and Group 3 (test group): 60 uncontrolled type 2 diabetic patients. Fifteen milliliters of blood was drawn from all study participants. Modified A- PRF membrane was prepared and then processed histologically. Results: The distribution pattern of platelet and leukocyte concentration in modified (A-PRF) gradually declines from the serum to the red blood cell (RBC) end of a clot in all groups. We have assessed that the serum and middle end of modified (A-PRF) membrane had an increasingly moderate distribution of platelets and leukocytes in both type 2 diabetics and tobacco smokers. RBC end had more of sparse distribution in all the three groups. Healthy individuals exhibited 95% of reversible pattern, whereas tobacco smokers had 78.33% and uncontrolled type 2 diabetic patients had 93.33% of irreversible aggregation pattern of platelets. Loose fibrin network pattern was seen in all the three groups. These observations conclude that tobacco smokers had a high percentage of loose fibrin network with sparse distribution of cells. Males showed more loose fibrin network pattern of modified (A-PRF) membrane than compared to females. Conclusion: In the present study, it can be concluded that the application of modified (A-PRF) may provide enhanced periodontal healing in uncontrolled type 2 diabetic patients and tobacco smokers; furthermore, females may have better regenerative capacity compared to males.
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Das N, Janardhana Amaranath BJ. Quantitative evaluation of modified advanced platelet-rich fibrin buffy coat among diabetic patients and tobacco smokers with chronic periodontitis. J Indian Soc Periodontol 2022; 26:24-31. [PMID: 35136313 PMCID: PMC8796772 DOI: 10.4103/jisp.jisp_498_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 05/08/2021] [Accepted: 05/16/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The use of biofuel like platelet-rich fibrin (PRF) may enhance the healing potential of the tissues in tobacco smokers and diabetic patients. AIM To evaluate the modified advanced PRF (A-PRF) buffy coat quantitatively in uncontrolled type-2 diabetic patients and tobacco smokers with chronic periodontitis by determining the size outcome of the buffy coat, the platelet and leukocyte concentration, and also to find out the influence of gender on these parameters. MATERIALS AND METHODS In this cross-sectional study, 180 generalized chronic periodontitis patients (46-55 years) were enrolled, Group 1 (Control group): 60 systemically healthy subjects; Group 2 (Test group): 60 Heavy tobacco smokers; and Group 3 (Test group): 60 uncontrolled type 2 diabetic patients. 15 ml of blood was drawn from all subjects to assess the size outcome, platelet, and leukocyte concentration also to find out the influence of gender on the various parameters of the prepared modified (A-PRF) membrane. RESULTS Uncontrolled type-2 diabetic patients had maximum height (23.39 ± 1.69 mm) and width (7.26 ± 0.16 mm) of modified (A-PRF) clot when compared to healthy individuals and tobacco smokers. The total number of platelet (245.38 ± 40.72 1000/ul) and leukocyte count (6.11 ± 0.60 1000/ul) and their percentage of concentration were 95.21 ± 2.16% and 77.25% ±1.98%, respectively, and is significantly higher in uncontrolled type-2 diabetic patients (P ≤ 0.05). Females were associated with the larger sized modified (A-PRF) clot with more number of platelets and leukocytes count than males. CONCLUSIONS Size outcome of modified (A-PRF) clot was found to be comparatively larger in uncontrolled type-2 diabetic patients particularly in females of all the groups when compared to males. Among the hematological parameters, the total count as well as the percentage of platelet and leukocyte in modified (A-PRF) membrane was found to be higher in uncontrolled type-2 diabetic patients. Female subjects exhibited higher platelet and leukocyte concentration than males.
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Affiliation(s)
- Neelam Das
- Department of Periodontology, Rama Dental College, Hospital and Research Centre, Kanpur, Uttar Pradesh, India
| | - B. J. Janardhana Amaranath
- Department of Periodontology, Rama Dental College, Hospital and Research Centre, Kanpur, Uttar Pradesh, India
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Extending the working properties of liquid platelet-rich fibrin using chemically modified PET tubes and the Bio-Cool device. Clin Oral Investig 2021; 26:2873-2878. [PMID: 34816309 DOI: 10.1007/s00784-021-04268-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 11/02/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Platelet-rich fibrin (PRF) has been utilized in regenerative medicine as a concentration of autologous platelets and growth factors that stimulates tissue regeneration. More recently, liquid-PRF (also called injectable-PRF; i-PRF) has been brought to market utilizing PET plastic tubes. Due to new advances made in tube technology, the first aim of the present study was to investigate the liquid consistency of liquid-PRF utilizing both standard and chemically modified PET plastic tubes. Furthermore, it is well known that the conversion of PRF into a fibrin matrix is derived from the temperature-controlled enzymatic process that converts liquid fibrinogen and thrombin to solid fibrin. This study also investigated for the first time the use of a cooling device (Bio-Cool) to extend the liquid working properties of liquid-PRF. MATERIALS AND METHODS In total, 30 participants enrolled in this study. From each patient, four tubes of liquid-PRF were drawn, two standard white Vacuette tubes and two blue chemically modified hydrophobic tubes. Following centrifugation at 700 RCF-max for 8 min in a Bio-PRF horizontal centrifuge, one white and one blue tube were kept upright at room temperature, while the other white and blue tube were placed within the cooling device. Thereafter, the liquid-PRF layers were monitored over time until clotting occurred. Patient gender, age, and altitude above sea level (+ 5000 ft) were recorded and compared for clotting times. RESULTS The findings from the present study demonstrated that the chemically modified PET tubes performed 37% better than the control tubes (extended the working properties of liquid-PRF by over 20 min). Most surprisingly, tubes kept in the cooling device demonstrated an average of 90 min greater working time (270% improvement). While patients living at altitude did significantly improve the clotting ability of liquid-PRF, no differences were observed when comparing male vs female or younger vs older patients in liquid-PRF clotting times. CONCLUSIONS Cooling of blood following centrifugation represented a 270% improvement in working properties of liquid-PRF. Optimization of liquid-PRF tubes utilizing chemically modified hydrophobic PET tubes also delayed the clotting process by 37%. Patient gender and age had little relevance on liquid-PRF. CLINICAL RELEVANCE The present findings demonstrate for the first time that cooling of liquid-PRF is able to extend the working properties of liquid-PRF by over 90 min. Thus for clinicians performing longer clinical procedures, the cooling of blood may represent a viable strategy to improve the working time of liquid-PRF in clinical practice.
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Meschi N, EzEldeen M, Garcia AET, Lahoud P, Van Gorp G, Coucke W, Jacobs R, Vandamme K, Teughels W, Lambrechts P. Regenerative Endodontic Procedure of Immature Permanent Teeth with Leukocyte and Platelet-rich Fibrin: A Multicenter Controlled Clinical Trial. J Endod 2021; 47:1729-1750. [PMID: 34400199 DOI: 10.1016/j.joen.2021.08.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 07/29/2021] [Accepted: 08/03/2021] [Indexed: 01/09/2023]
Abstract
INTRODUCTION The aim of this nonrandomized, multicenter controlled clinical trial was to evaluate the impact of leukocyte-platelet-rich fibrin (LPRF) on regenerative endodontic procedures (REPs) of immature permanent teeth in terms of periapical bone healing (PBH) and further root development (RD). METHODS Healthy patients between 6-25 years with an inflamed or necrotic immature permanent tooth were included and divided between the test (= REP + LPRF) and control (= REP-LPRF) group depending on their compliance and the clinical setting (university hospital or private practice). After receiving REP ± LPRF, the patients were recalled after 3, 6, 12, 24, and 36 months. At each recall session, the teeth were clinically and radiographically (by means of a periapical radiograph [PR]) evaluated. A cone-beam computed tomographic (CBCT) imaging was taken preoperatively and 2 and 3 years postoperatively. PBH and RD were quantitatively and qualitatively assessed. RESULTS Twenty-nine teeth with a necrotic pulp were included, from which 23 (9 test and 14 control) were analyzed. Three teeth in the test group had a flare-up reaction in the first year after REP. Except for 2 no shows, all the analyzed teeth survived up to 3 years after REP, and, in case of failure, apexification preserved them. Complete PBH was obtained in 91.3% and 87% of the cases based on PR qualitative and quantitative evaluation, respectively, with no significant difference between the groups with respect to the baseline. The PR quantitative change in RD at the last recall session with respect to the baseline was not significant (all P values > .05) in both groups. The qualitative assessment of the type of REP root healing was nonuniform. In the test group, 55.6% of the teeth presented no RD and no apical closure. Only 50% of the 14 teeth assessed with CBCT imaging presented complete PBH. Regarding volumetric measurements on RD 3 years after REP for the change with respect to the baseline in root hard tissue volume, mean root hard tissue thickness, and apical area, the control group performed significantly in favor of RD than the test group (P = .03, .003, and 0.05 respectively). For the volumetric change 3 years after REP with respect to the baseline in root length and maximum root hard tissue thickness, no significant difference (P = .72 and .4, respectively) was found between the groups. The correlation between the PR and CBCT variables assessing RD was weak (root lengthening) to very weak (root thickening). CONCLUSIONS REP-LPRF seems to be a viable treatment option to obtain PBH and aid further RD of necrotic immature permanent teeth. Caution is needed when evaluating REP with PR.
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Affiliation(s)
- Nastaran Meschi
- Department of Oral Health Sciences, Endodontology, KU Leuven and Dentistry, University Hospitals Leuven, Leuven, Belgium; Department of Oral Health Sciences, BIOMAT-Biomaterials Research Group, KU Leuven and Dentistry, Leuven, Belgium.
| | - Mostafa EzEldeen
- OMFS IMPATH-Research Group, Faculty of Medicine, Department of Imaging and Pathology, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Andres Eduardo Torres Garcia
- Department of Oral Health Sciences, Endodontology, KU Leuven and Dentistry, University Hospitals Leuven, Leuven, Belgium; OMFS IMPATH-Research Group, Faculty of Medicine, Department of Imaging and Pathology, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Pierre Lahoud
- OMFS IMPATH-Research Group, Faculty of Medicine, Department of Imaging and Pathology, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Gertrude Van Gorp
- Department of Oral Health Sciences, Endodontology, KU Leuven and Dentistry, University Hospitals Leuven, Leuven, Belgium
| | - Wim Coucke
- Freelance Statistical Consultant, Heverlee, Belgium
| | - Reinhilde Jacobs
- OMFS IMPATH-Research Group, Faculty of Medicine, Department of Imaging and Pathology, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Katleen Vandamme
- Department of Oral Health Sciences, Restorative Dentistry, KU Leuven and Dentistry, University Hospitals Leuven, Leuven, Belgium
| | - Wim Teughels
- Department of Oral Health Sciences, Periodontology, KU Leuven and Dentistry, University Hospitals Leuven, Leuven, Belgium
| | - Paul Lambrechts
- Department of Oral Health Sciences, Endodontology, KU Leuven and Dentistry, University Hospitals Leuven, Leuven, Belgium; Department of Oral Health Sciences, BIOMAT-Biomaterials Research Group, KU Leuven and Dentistry, Leuven, Belgium
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Guided bone regeneration simultaneous with implant placement using bovine-derived xenograft with and without liquid platelet-rich fibrin: a randomized controlled clinical trial. Clin Oral Investig 2021; 25:5563-5575. [PMID: 34047835 DOI: 10.1007/s00784-021-03987-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/11/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To assess augmentation success after guided bone regeneration (GBR) carried out simultaneously with implant placement using bovine-derived xenograft alone and in combination with liquid platelet-rich fibrin (liquid-PRF). METHODS This randomized controlled clinical trial was conducted on patients with horizontal bone deficiency in the posterior regions of the mandible. After implant placement, GBR procedures were randomly performed using liquid-PRF-enriched bovine-derived xenograft (for the test group) and with bovine-derived xenograft alone (for the control group). To assess the change in augmentation thickness, the primary outcome of the study, cone beam computed tomography was carried out at the implant sites on completion and 6 months after surgery. The secondary outcomes were marginal bone level and implant survival rate at prosthetic delivery and at 6 months, 1 year, and 2 years follow-up after loading. The significance level was set at p<0.05 for all analysis. RESULTS Twenty patients with 50 implants were analyzed for the test group and 20 patients with 48 implants for the control group. At 6 months postoperatively, the mean values of augmentation thickness were 1.63 ± 0.21 mm, 2.59 ± 0.34 mm, and 3.11 ± 0.36 mm for the test group and 1.34 ± 0.14 mm, 2.49 ± 0.24 mm, and 2.97 ± 0.24 mm for the control group at 2 mm, 4 mm, and 6 mm below to the implant shoulder (p < 0.001, p = 0.007, and p = 0.036, respectively). The mean marginal bone loss was found to be less than 1 mm for both study groups during the 2 years of follow-up after prosthetic loading. Implant survival rate was 100% for both study groups. CONCLUSION Bovine-derived xenograft alone and in combination with liquid-PRF are both successful in achieving bone augmentation around the implants and produce a small change in marginal bone level and a high implant survival rate after loading. CLINICAL RELEVANCE There is a lack of evidence in the literature regarding the augmentation success of liquid-PRF used in combination with bone graft substitutes. This study indicates that liquid-PRF could be used as a supportive material with bovine-derived xenograft in GBR procedures carried out simultaneously with implant placement.
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Castro AB, Andrade C, Li X, Pinto N, Teughels W, Quirynen M. Impact of g force and timing on the characteristics of platelet-rich fibrin matrices. Sci Rep 2021; 11:6038. [PMID: 33727689 PMCID: PMC7971031 DOI: 10.1038/s41598-021-85736-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 03/04/2021] [Indexed: 02/08/2023] Open
Abstract
Recently, new centrifugation protocols for the preparation of platelet-rich fibrin (PRF) have been introduced in an attempt to further improve the beneficial impact of these 2nd generation platelet concentrate membranes. This in-vitro study aimed to compare the biological and physical characteristics of three types of PRF membranes using two different centrifuges with adapted relative centrifugal forces (RCF): leucocyte- and platelet-rich fibrin, advanced platelet-rich fibrin, and advanced platelet-rich fibrin+. Release of growth factors, macroscopic dimensions, cellular content and mechanical properties of the respective membranes, prepared from blood of the same individual were explored. Furthermore, the impact of timing (blood draw-centrifugation and centrifugation-membrane preparation) was assessed morphologically as well as by electron microscopy scanning. No statistically significant differences amongst the three PRF modifications could be observed, neither in their release of growth factors or the cellular content, nor in clot/membrane dimensions. The difference between both centrifuges were negligible when the same g-force was used. A lower g-force, however, reduced membrane tensile strength. Timing in the preparation process had a significant impact. Adaptation of RCF only had a minimal impact on the final characteristics of PRF membranes.
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Affiliation(s)
- Ana B Castro
- Department of Oral Health Sciences, Periodontology, KU Leuven and Dentistry, University Hospitals Leuven, Kapucijnenvoer 7, blok a - bus 07001, 3000, Leuven, Belgium.
| | - C Andrade
- Department of Periodontology and Oral Implantology, Faculty of Dentistry, School of Dentistry, University of Los Andes, Santiago, Chile
| | - X Li
- Department of Oral Health Sciences, KU Leuven, BIOMAT and University Hospitals Leuven Dentistry, Leuven, Belgium
| | - N Pinto
- Department of Periodontology and Oral Implantology, Faculty of Dentistry, School of Dentistry, University of Los Andes, Santiago, Chile
| | - W Teughels
- Department of Oral Health Sciences, Periodontology, KU Leuven and Dentistry, University Hospitals Leuven, Kapucijnenvoer 7, blok a - bus 07001, 3000, Leuven, Belgium
| | - M Quirynen
- Department of Oral Health Sciences, Periodontology, KU Leuven and Dentistry, University Hospitals Leuven, Kapucijnenvoer 7, blok a - bus 07001, 3000, Leuven, Belgium
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Işık G, Günbay T, Uyanıkgil Y, Kısaog˘lu H, Yüce MÖ. Comparison of Autogenous Block Bone Graft and Screw Tent-Pole Techniques for Vertical Bone Augmentation in the Posterior Mandible: A Split-Mouth Randomized Controlled Study. JOURNAL OF ADVANCED ORAL RESEARCH 2020. [DOI: 10.1177/2320206820976010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aim: To evaluate the effect on vertical bone augmentation of the screw tent-pole technique using particulate allograft in combination with injectable platelet-rich fibrin, and to compare this with autogenous block bone graft. Materials and Methods: This split-mouth randomized controlled study involved patients with bilateral partial edentulism and vertical bone loss in the posterior mandible. In each patient, the control side was treated with autogenous block bone graft harvested from the mandibular ramus and, on the test side, the screw tent-pole technique was employed, using particulate allograft in combination with injectable platelet-rich fibrin. All augmented sites were covered by leukocyte and platelet-rich fibrin membrane. The primary outcome variable of this study was the radiographic changes to bone height 6 months after augmentation. The secondary outcome variables were the percentage of newly formed bone and the implant survival rate. The data were analyzed with a significance level of α = 0.05. Results: Of the 13 patients included, a total of 11 patients (7 females, 4 males; mean age 50.92) completed the study. The mean values of vertical bone gain were 1.72 ± 0.78 mm for the test group and 2.83 ± 0.89 mm for the control group, which constitutes a significant difference ( P = .008). The percentage of newly formed bone was 18.08% ± 2.17% for the test group and 14.26% ± 1.76% for the control group. The difference between the groups was statistically significant ( P < .001). The implant survival rates were 100% for both study groups. Conclusions: Based on the study results, screw tent-pole can be considered a feasible technique for bone augmentation. Further randomized studies will be necessary to fully evaluate vertical bone augmentation using the screw tent-pole technique, with different graft materials and with larger samples.
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Affiliation(s)
- Gözde Işık
- Department of Oral Surgery, School of Dentistry, Ege University, İzmir, Turkey
| | - Tayfun Günbay
- Department of Oral Surgery, School of Dentistry, Ege University, İzmir, Turkey
| | - Yig˘it Uyanıkgil
- Department of Histology and Embryology, School of Medicine, Ege University, İzmir, Turkey
| | - Hüseyin Kısaog˘lu
- Department of Histology and Embryology, School of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Meltem Özden Yüce
- Department of Oral Surgery, School of Dentistry, Ege University, İzmir, Turkey
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Abstract
Platelets play a crucial role in hemostasis, tissue regeneration and host defense. Based on these settings, platelet-rich plasma (PRP) and its derivatives are therapeutically used to promote wound healing in several scenarios. This review summarizes the biological mechanisms underlying the most traditional as well as innovative applications of PRP in wound healing. These mechanisms involve the combined action of platelet-derived growth factors and cytokines, together with the role of plasma-derived fibrillar, antioxidant and homeostatic factors. In addition, regenerative treatments with PRP consist of personalized and non-standardized methods. Thus, the quality of PRP varies depending on endogenous factors (e.g., age; gender; concomitant medication; disease-associated systemic factors; nutrition) and exogenous factors (anticoagulants and cellular composition). This review also analyses whether these factors affect the biological mechanisms of PRP in wound healing applications.
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Affiliation(s)
- Paula Oneto
- Laboratory of Experimental Thrombosis, Institute of Experimental Medicine-CONICET, National Academy of Medicine, Buenos Aires, Argentina
| | - Julia Etulain
- Laboratory of Experimental Thrombosis, Institute of Experimental Medicine-CONICET, National Academy of Medicine, Buenos Aires, Argentina
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Antibacterial effects of platelet-rich fibrin produced by horizontal centrifugation. Int J Oral Sci 2020; 12:32. [PMID: 33243983 PMCID: PMC7693325 DOI: 10.1038/s41368-020-00099-w] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/06/2020] [Accepted: 10/18/2020] [Indexed: 12/13/2022] Open
Abstract
Platelet-rich fibrin (PRF) has been widely used owing to its ability to stimulate tissue regeneration. To date, few studies have described the antibacterial properties of PRF. Previously, PRF prepared by horizontal centrifugation (H-PRF) was shown to contain more immune cells than leukocyte- and platelet-rich fibrin (L-PRF). This study aimed to compare the antimicrobial effects of PRFs against Staphylococcus aureus and Escherichia coli in vitro and to determine whether the antibacterial effects correlated with the number of immune cells. Blood samples were obtained from eight healthy donors to prepare L-PRF and H-PRF. The sizes and weights of L-PRF and H-PRF were first evaluated, and their antibacterial effects against S. aureus and E. coli were then tested in vitro using the inhibition ring and plate-counting test methods. Flow-cytometric analysis of the cell components of L-PRF and H-PRF was also performed. No significant differences in size or weight were observed between the L-PRF and H-PRF groups. The H-PRF group contained more leukocytes than the L-PRF group. While both PRFs had notable antimicrobial activity against S. aureus and E. coli, H-PRF demonstrated a significantly better antibacterial effect than L-PRF. Furthermore, the antimicrobial ability of the PRF solid was less efficient than that of wet PRF. In conclusion, H-PRF exhibited better antibacterial activity than L-PRF, which might have been attributed to having more immune cells.
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Miron RJ, Chai J, Fujioka-Kobayashi M, Sculean A, Zhang Y. Evaluation of 24 protocols for the production of platelet-rich fibrin. BMC Oral Health 2020; 20:310. [PMID: 33160335 PMCID: PMC7648315 DOI: 10.1186/s12903-020-01299-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 10/26/2020] [Indexed: 12/20/2022] Open
Abstract
Background The aim of this study was to evaluate 24 protocols for the production of platelet rich fibrin (PRF) produced via horizontal centrifugation to better understand cell separation following protocols at various times and speeds. Methods All protocols were compared utilizing a recent method to quantify cells in PRF in 1 mL sequential layers pipetted from the upper layer downwards until all 10 mL were harvested. In total, 960 complete blood counts (CBCs) were investigated. Both solid and liquid-based PRF protocols were investigated following 24 protocols involving 6 relative centrifugal force (RCF) values (100, 200, 400, 700, 1000 and 1200g) at 4 centrifugation times (3, 5, 8 and 12 min). Results In general, platelets could more easily accumulate in the upper 4 layers when compared to leukocytes owing to their lower cellular density. Protocol time seemed to have a greater impact on the final cell layer separation when compared to the effect of speed. Protocols of greater than 8 min at 400g led to no leukocyte accumulation in the upper PRF layers (found specifically within the buffy coat). Protocols at or below 200g were unable to effectively accumulate platelets/leukocytes. The optimal centrifugation speed and time for solid-PRF ranged between 400 and 700g for 8 min. It was noted that variability in patient baseline platelet/leukocyte/erythrocyte counts (hematocrit) significantly affected cell layer separation. This finding was more pronounced at lower centrifugation speeds. Conclusions Within the investigated ranges, a protocol of 700g for 8 min presented the highest yield of platelets/leukocytes evenly distributed throughout the upper PRF layers.
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Affiliation(s)
- Richard J Miron
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China. .,Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.
| | - Jihua Chai
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Masako Fujioka-Kobayashi
- Department of Cranio-Maxillofacial Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Yufeng Zhang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China. .,Department of Dental Implantology, School and Hospital of Stomatology, Wuhan University, Wuhan, China.
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Kargarpour Z, Nasirzade J, Panahipour L, Miron RJ, Gruber R. Relative Centrifugal Force (RCF; G-Force) Affects the Distribution of TGF-β in PRF Membranes Produced Using Horizontal Centrifugation. Int J Mol Sci 2020; 21:E7629. [PMID: 33076376 PMCID: PMC7589083 DOI: 10.3390/ijms21207629] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/06/2020] [Accepted: 10/12/2020] [Indexed: 01/03/2023] Open
Abstract
Solid platelet-rich fibrin (PRF) is produced with centrifugation tubes designed to accelerate clotting. Thus, activated platelets may accumulate within the fibrin-rich extracellular matrix even before centrifugation is initiated. It can thus be assumed that platelets and their growth factors such as transforming growth factor-β (TGF-β) are trapped within PRF independent of their relative centrifugal force (RCF), the gravitation or g-force. To test this assumption, we prepared PRF membranes with tubes where clotting is activated by a silicone-coated interior. Tubes underwent 210 g, 650 g and 1500 g for 12 min in a horizontal centrifuge. The respective PRF membranes, either in total or separated into a platelet-poor plasma and buffy coat fraction, were subjected to repeated freeze-thawing to prepare lysates. Gingival fibroblasts were exposed to the PRF lysates to provoke the expression of TGF-β target genes. We show here that the expression of interleukin 11 (IL11) and NADPH oxidase 4 (NOX4), and Smad2/3 signaling were similarly activated by all lysates when normalized to the size of the PRF membranes. Notably, platelet-poor plasma had significantly less TGF-β activity than the buffy coat fraction at both high-speed protocols. In contrast to our original assumption, the TGF-β activity in PRF lysates produced using horizontal centrifugation follows a gradient with increasing concentration from the platelet-poor plasma towards the buffy coat layer.
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Affiliation(s)
- Zahra Kargarpour
- Department of Oral Biology, Medical University of Vienna, 1090 Vienna, Austria; (Z.K.); (J.N.); (L.P.)
| | - Jila Nasirzade
- Department of Oral Biology, Medical University of Vienna, 1090 Vienna, Austria; (Z.K.); (J.N.); (L.P.)
| | - Layla Panahipour
- Department of Oral Biology, Medical University of Vienna, 1090 Vienna, Austria; (Z.K.); (J.N.); (L.P.)
| | - Richard J. Miron
- Department of Periodontology, School of Dental Medicine, University of Bern, 3010 Bern, Switzerland;
| | - Reinhard Gruber
- Department of Oral Biology, Medical University of Vienna, 1090 Vienna, Austria; (Z.K.); (J.N.); (L.P.)
- Department of Periodontology, School of Dental Medicine, University of Bern, 3010 Bern, Switzerland;
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Lourenço ES, Alves GG, de Lima Barbosa R, Spiegel CN, de Mello-Machado RC, Al-Maawi S, Ghanaati S, de Almeida Barros Mourão CF. Effects of rotor angle and time after centrifugation on the biological in vitro properties of platelet rich fibrin membranes. J Biomed Mater Res B Appl Biomater 2020; 109:60-68. [PMID: 32691512 DOI: 10.1002/jbm.b.34680] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 05/29/2020] [Accepted: 06/16/2020] [Indexed: 01/15/2023]
Abstract
This study evaluated the impact of rotor angle and time of storage after centrifugation on the in vitro biological properties of platelet-rich fibrin (PRF) membranes. Blood samples (n = 9) were processed with a vertical fixed-angle (V) or a swing-out horizontal (H) centrifuge, with 20-60 min of sample storage after centrifugation. Leukocytes, platelets, and red blood cells were counted, and fibrin architecture was observed by scanning electron microscopy (SEM). The release of FGF2, PDGFbb, VEGF, IL-6, and IL-1β was measured after incubation on culture media for 7-21 days. Cell content was equivalent in all experimental groups (p > .05). The fibrin matrix was similar for fixed-angle and horizontal centrifugation. Horizontal centrifugation induced a twofold increase in PDGF and 1.7× increase on FGF release as compared to V samples, while IL-1β was significantly reduced (p < .05). No significant difference was observed on the release of growth factors and cytokines at different times after centrifugation (p < .05). These data suggest that both angles of centrifugation produce PRF membranes with similar structure and cellularity, but horizontal centrifugation induces a higher release of growth factors. Higher times of storage after centrifugation did not impact on cell content and the release of growth factors.
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Affiliation(s)
| | - Gutemberg Gomes Alves
- Department of Molecular and Cell Biology, Institute of Biology, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | - Renata de Lima Barbosa
- Post-Graduation Program in Science and Biotechnology, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | - Carolina Nascimento Spiegel
- Department of Molecular and Cell Biology, Institute of Biology, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | | | - Sarah Al-Maawi
- Department of Maxillofacial, Clinic for Maxillofacial and Plastic Surgery, Johann Wolfgang Goethe University, Frankfurt Am Main, Germany
| | - Shahram Ghanaati
- Department of Maxillofacial, Clinic for Maxillofacial and Plastic Surgery, Johann Wolfgang Goethe University, Frankfurt Am Main, Germany
| | - Carlos Fernando de Almeida Barros Mourão
- Post-Graduation Program in Dentistry, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil.,Post-Graduation Program in Science and Biotechnology, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
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Rezuc A, Saavedra C, Maass R, Poblete C, Nappe C. Histological comparison of DBBM and platelet rich fibrin for guided bone regeneration in a rabbit model. J Oral Biol Craniofac Res 2020; 10:287-293. [PMID: 32637304 DOI: 10.1016/j.jobcr.2020.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 05/07/2020] [Indexed: 01/07/2023] Open
Abstract
Purpose To histologically evaluate the use of bovine derived deproteinized xenograft (DBBM), leukocyte and platelet rich fibrin (L-PRF) and the combination of both in Guided Bone Regeneration (GBR) performed in non-critical size defects in rabbit. Methods A prospective experimental study was performed. Four bone defects in the tibiae of 12 rabbits were made and each of them was filled with DBBM, L-PRF, a combination of DBBM + L-PRF or was left to heal as control site. All defects were covered with a collagen membrane. Rabbits were randomly distributed in three groups and euthanatized at 3, 6 or 9 weeks. Samples were obtained and histologically analyzed to determine vital bone, connective tissue and remaining graft particles percentage. Analysis of variance, Kruskal Wallis and non-paired t-test where used to evaluate the significance of the results. Results At 3 weeks of healing, DBBM showed significantly more vital bone percentage than L-PRF (p = 0,05) and DBBM + L-PRF showed significantly less connective tissue than control (p < 0,05). All other groups showed no statistical difference between them. At 6 weeks of healing, DBBM showed significantly more vital bone percentage than L-PRF (p < 0,05), DBBM + L-PRF (p < 0,05) and control (p < 0,05) and there wasn't any other significant difference regarding to connective tissue or remaining particle percentage between groups. At t 9 weeks healing period, there weren't any significant differences between groups. Conclusions DBBM seems to enhance vital bone formation at early healing stages. The use of L-PRF alone or combined with DBBM, didn't show any histological improvement regarding to vital bone formation. The use of DBBM, alone or in conjunction with L-PRF showed a trend to reduce connective tissue percentage. The use of L-PRF combined with DBBM didn't affect the remaining particle percentage.
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Affiliation(s)
- Andres Rezuc
- Mayor University, School of Dentistry, Santiago, Chile, Av. Libertador Bernardo O'Higgins 2013, Santiago, 8320000, Santiago, Chile
| | - Christian Saavedra
- San Sebastian University, Faculty of Dentistry, Puerto Montt, Chile, Lago Panguipulli, 1390, Puerto Montt, Los Lagos, Chile
| | - Rodrigo Maass
- Diego Portales University, Faculty of Medicine, Santiago, Chile, Av. Ejército Libertador 141, Santiago, 8370007, Santiago, Chile
| | - Cristian Poblete
- Mayor University, School of Medical Technology, Santiago, Chile, Camino La Pirámide 5750, Huechuraba. 8580745. Santiago, Chile
| | - Christian Nappe
- Pontifical Catholic University of Chile, Faculty of Medicine, School of Dentistry, Av. Vicuña Mackenna 4860, Macul, 7820436, Santiago, Chile
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Brouwers JE, van der Vorm LN, Buis S, Haumann R, Karanzai A, Konings J, de Groot PG, de Laat B, Remijn JA. Implant stability in patients treated with platelet-rich fibrin and bovine bone substitute for alveolar ridge preservation is associated with peripheral blood cells and coagulation factors. Clin Exp Dent Res 2020; 6:236-243. [PMID: 32250570 PMCID: PMC7133732 DOI: 10.1002/cre2.263] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 10/18/2019] [Accepted: 10/22/2019] [Indexed: 12/26/2022] Open
Abstract
AIMS The aim of the present study was to assess the association between dental implant stability and peripheral blood cell composition and levels of coagulation factors in patients treated with alveolar ridge preservation with platelet-rich fibrin (PRF) and bovine bone substitute. MATERIALS AND METHODS Fifty patients were included between 2015 and 2017. PRF was prepared from autologous blood, in which blood cells and coagulation factor levels were measured. PRF and bovine bone were placed in the socket, followed by closure with PRF membrane. Implants were placed 14 (±2.5) weeks postextraction. The implant stability quotient was measured at t = 0, t = 10 days, t = 7 weeks, and t = 17 weeks by resonance frequency analysis. RESULTS Erythrocyte count was inversely associated with PRF membrane length, but not with implant stability. Conversely, platelet count did not correlate with membrane size but inversely correlated with implant stability at 7 and 17 weeks. In addition, implant stability was directly correlated with levels FXIII (t = 0, p < .01), active von Willebrand factor (VWF; t = 0 and 7 weeks, p < .05), and total VWF (t = 7 weeks, p = .012). CONCLUSION Implant stability following alveolar ridge preservation with PRF and bovine bone substitute is associated with circulating blood cells and coagulation factors. In particular, fibrin structure, VWF, and FXIII may be important modulators of implant stability.
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Affiliation(s)
| | - Lisa N. van der Vorm
- Department of Clinical Chemistry and HematologyGelre HospitalsApeldoornThe Netherlands
- Synapse Research InstituteMaastrichtThe Netherlands
- Cardiovascular Research Institute MaastrichtMaastricht University Medical CentreMaastrichtThe Netherlands
| | - Sharon Buis
- Institute for Dental ImplantologyAmersfoortThe Netherlands
- Department of Clinical Chemistry and HematologyGelre HospitalsApeldoornThe Netherlands
| | - Rianne Haumann
- Department of Clinical Chemistry and HematologyGelre HospitalsApeldoornThe Netherlands
| | | | - Joke Konings
- Synapse Research InstituteMaastrichtThe Netherlands
- Cardiovascular Research Institute MaastrichtMaastricht University Medical CentreMaastrichtThe Netherlands
| | - Philip G. de Groot
- Synapse Research InstituteMaastrichtThe Netherlands
- Cardiovascular Research Institute MaastrichtMaastricht University Medical CentreMaastrichtThe Netherlands
| | - Bas de Laat
- Department of Clinical Chemistry and HematologyGelre HospitalsApeldoornThe Netherlands
- Synapse Research InstituteMaastrichtThe Netherlands
- Cardiovascular Research Institute MaastrichtMaastricht University Medical CentreMaastrichtThe Netherlands
| | - Jasper A. Remijn
- Department of Clinical Chemistry and HematologyGelre HospitalsApeldoornThe Netherlands
- Cardiovascular Research Institute MaastrichtMaastricht University Medical CentreMaastrichtThe Netherlands
- Department of Clinical ChemistryMeander Medical CenterAmersfoortThe Netherlands
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Miron RJ, Xu H, Chai J, Wang J, Zheng S, Feng M, Zhang X, Wei Y, Chen Y, Mourão CFDAB, Sculean A, Zhang Y. Comparison of platelet-rich fibrin (PRF) produced using 3 commercially available centrifuges at both high (~ 700 g) and low (~ 200 g) relative centrifugation forces. Clin Oral Investig 2020; 24:1171-1182. [PMID: 31321574 DOI: 10.1007/s00784-019-02981-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 06/20/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Platelet-rich fibrin (PRF) has gained tremendous momentum in recent years as a natural autologous growth factor derived from blood capable of stimulating tissue regeneration. Owing to its widespread use, many companies have commercialized various centrifugation devices with various proposed protocols. The aim of the present study was to compare 3 different commercially available centrifuges at both high and low g-force protocols. MATERIALS AND METHODS PRF was produced on three commercially available centrifuges including the IntraSpin Device (IntraLock), the Duo Quattro (Process for PRF), and Salvin (Salvin Dental). Two separate protocols were tested on each machine including the original leukocyte and platelet-rich fibrin (L-PRF) protocol (~ 700 RCF max (~ 400 RCF clot) for 12 min) as well as the advanced platelet-rich fibrin (A-PRF+) protocol (~ 200 g RCF max (~ 130 g RCF clot) for 8 min). Each of the tested groups was compared for cell numbers, growth factor release, scanning electron microscopy (SEM) for morphological differences, and clot size (both weight and length/width). RESULTS The present study found that PRF clots produced utilizing the low-speed centrifugation speeds (~ 200 g for 8 min) produce clots that (1) contained a higher concentration of evenly distributed platelets, (2) secreted higher concentrations of growth factors over a 10 day period, and (3) were smaller in size. This was irrespective of the centrifugation device utilized and consistently observed on all 3 devices. The greatest impact was found between the protocols utilized (up to a 200%). Interestingly, it was further revealed that the centrifugation tubes used had a much greater impact on the final size outcome of PRF clots when compared to centrifugation devices. It was found that, in general, the Process for PRF tubes produced significantly greater-sized clots when compared to other commercially available tubes. The Salvin Dental tubes also produced significantly greater PRF clots when compared to the IntraLock tubes on each of the tested centrifugation devices. CONCLUSIONS The present study demonstrated the reproducibility of a scientific concept (reduction in RCF produces PRF clots with more evenly distributed cells and growth factors) utilizing different devices. Furthermore, (and until now overlooked), it was revealed for the first time that the centrifugation tubes are central to the quality production of PRF. Future research investigating tube characteristics thus becomes critically important for the future optimization of PRF. CLINICAL RELEVANCE This is the first study to reveal the marked impact of centrifugation tubes on the final production of PRF. Future study thus becomes markedly important to further optimize the quality of PRF-based matrices. It was further found that little variability existed between the centrifugation devices if optimized centrifugation protocols (lower centrifugation speeds) were utilized.
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Affiliation(s)
- Richard J Miron
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China.
- Department of Periodontology, University of Bern, Bern, Switzerland.
| | - Hudi Xu
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Jihua Chai
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Jiaolong Wang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Shihang Zheng
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Mengge Feng
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Xiaoxin Zhang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Yan Wei
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Yan Chen
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | | | - Anton Sculean
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - Yufeng Zhang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China.
- Department of Dental Implantology, School and Hospital of Stomatology, University of Wuhan, Wuhan, China.
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Canellas JVDS, da Costa RC, Breves RC, de Oliveira GP, Figueredo CMDS, Fischer RG, Thole AA, Medeiros PJD, Ritto FG. Tomographic and histomorphometric evaluation of socket healing after tooth extraction using leukocyte- and platelet-rich fibrin: A randomized, single-blind, controlled clinical trial. J Craniomaxillofac Surg 2019; 48:24-32. [PMID: 31810848 DOI: 10.1016/j.jcms.2019.11.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 10/15/2019] [Accepted: 11/18/2019] [Indexed: 10/25/2022] Open
Abstract
The use of platelet concentrate in alveolar ridge preservation has been broadly studied. However, no randomized clinical trials with histomorphometric analysis and low risk of bias are available in the literature. We conducted a prospective, single-blind, parallel, randomized, controlled clinical trial to evaluate the efficacy of leukocyte- and platelet-rich fibrin (L-PRF) in socket preservation after tooth extraction. Additionally, the effect of L-PRF on bone formation was analyzed histologically using bone biopsy specimens obtained during implant placement. A total of 48 subjects who underwent a non-molar tooth extraction were randomly assigned to the L-PRF group (n = 24) or the control group (n = 24). Cone-beam computed tomographies were performed immediately after tooth extraction and at 3 months after tooth extraction, prior to implant surgery. A significant difference in bone resorption was registered 1 mm below the crest: 0.93 ± 0.9 mm for the L-PRF group and 2.27 ± 1.2 mm for the control group (p = 0.0001). Histomorphometric analysis showed a higher percentage of new bone formation in the L-PRF group compared with the control group. The values were 55.96 ± 11.97% and 39.69 ± 11.13%, respectively (p = 0.00001). These findings indicate that the administration of L-PRF should always be considered when socket preservation is planned (Clinicaltrials.gov NCT03408418).
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Affiliation(s)
- João Vitor Dos Santos Canellas
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Rio de Janeiro State University, Rua Boulevard 28 de Setembro, 157 Vila Isabel, Rio de Janeiro, RJ 20551-030, Brazil.
| | - Rafael Cabral da Costa
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Rio de Janeiro State University, Rua Boulevard 28 de Setembro, 157 Vila Isabel, Rio de Janeiro, RJ 20551-030, Brazil
| | - Ricardo Caldeira Breves
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Rio de Janeiro State University, Rua Boulevard 28 de Setembro, 157 Vila Isabel, Rio de Janeiro, RJ 20551-030, Brazil
| | - Genilza Pereira de Oliveira
- Department of Histology and Embryology, Biology Institute, Rio de Janeiro State University, Rua Boulevard 28 de Setembro, 157 Vila Isabel, Rio de Janeiro, RJ 20551-030, Brazil
| | - Carlos Marcelo da Silva Figueredo
- Department of Periodontology, Faculty of Dentistry, Rio de Janeiro State University, Av. Prof. Manoel de Abreu 444, 3° andar, Rio de Janeiro, RJ 20550-170, Brazil
| | - Ricardo Guimaraes Fischer
- Department of Periodontology, Faculty of Dentistry, Rio de Janeiro State University, Av. Prof. Manoel de Abreu 444, 3° andar, Rio de Janeiro, RJ 20550-170, Brazil
| | - Alessandra Alves Thole
- Department of Histology and Embryology, Biology Institute, Rio de Janeiro State University, Rua Boulevard 28 de Setembro, 157 Vila Isabel, Rio de Janeiro, RJ 20551-030, Brazil
| | - Paulo Jose D'Albuquerque Medeiros
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Rio de Janeiro State University, Rua Boulevard 28 de Setembro, 157 Vila Isabel, Rio de Janeiro, RJ 20551-030, Brazil
| | - Fabio Gamboa Ritto
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Rio de Janeiro State University, Rua Boulevard 28 de Setembro, 157 Vila Isabel, Rio de Janeiro, RJ 20551-030, Brazil
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Impact of different platelet-rich fibrin (PRF) procurement methods on the platelet count, antimicrobial efficacy, and fibrin network pattern in different age groups: an in vitro study. Clin Oral Investig 2019; 24:1663-1675. [DOI: 10.1007/s00784-019-03022-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 07/11/2019] [Indexed: 01/09/2023]
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Levels of growth factors from platelet-rich fibrin from chronic periodontitis versus periodontally healthy subjects: a pilot study. Clin Oral Investig 2019; 24:823-832. [PMID: 31197657 DOI: 10.1007/s00784-019-02944-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 05/02/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES This study aimed to (1) compare the amounts of growth factors from platelet-rich fibrin (PRF) between chronic periodontitis and periodontally healthy subjects and (2) evaluate the relationships between the amounts of growth factors from PRF with complete blood counts (white blood cell (WBC) and platelet counts) and the serum concentrations of IL-1β, IL-6, and tumor necrosis factor-α (TNF-α). MATERIALS AND METHODS Venous blood was collected from chronic periodontitis (test) and periodontally healthy subjects (control). PRF and serum were collected from the centrifuged blood. Liquid exudates from the compression of PRF were collected. The compressed PRF membranes were incubated in saline, and eluted aliquots were collected at 1, 24, and 72 h, and the membranes were then digested with trypsin. Epidermal growth factor, insulin-like growth factor-1, platelet-derived growth factor-BB, transforming growth factor-β1, and vascular endothelial growth factor in the exudates and eluents were quantified by ELISA. Serum was used for IL-1β, IL-6, and TNF-α quantifications. Complete blood counts were measured. RESULTS There were no significant differences in the amounts of growth factors from PRF exudates and membranes measured between groups (all p > 0.05). The test group had significantly higher WBC (p < 0.05). However, there was no significant correlation between the WBC and the amounts of the growth factors from PRF (all p > 0.05). CONCLUSIONS PRF can be utilized as an autologous source of growth factors not affected by periodontal condition and WBC level. CLINICAL RELEVANCE The amounts of growth factors from PRF were not affected by the periodontal condition of the patient.
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