Effect of platelet-rich fibrin on alveolar ridge preservation: A systematic review

Does Injectable Platelet-Rich Fibrin Combined With Autogenous Demineralized Dentine Enhance Alveolar Ridge Preservation? A Randomized Controlled Trial

OBJECTIVE

The present trial evaluated the first-time application of autogenous demineralized dentin graft with injectable platelet-rich fibrin (ADDG + i-PRF) versus autogenous demineralized dentin graft (ADDG), in alveolar ridge preservation (ARP) in the maxillary aesthetic zone.

MATERIAL AND METHODS

Twenty-two maxillary (n = 22) non-molar teeth indicated for extraction were randomized into two groups (n = 11/group). Extracted teeth were prepared into ADDG, implanted into extraction sockets with or without i-PRF amalgamation and covered by collagen sponge. Cone-beam computed tomography scans at baseline and 6 months were compared to assess ridge-dimensional changes. Keratinized tissue width, patient satisfaction, pain score and chair time were recorded. In the course of dental implant placements at 6 months, bone core biopsies of engrafted sites were obtained and analysed histomorphometrically.

RESULTS

Reduction in ridge width was 1.71 ± 1.08 and 1.8 ± 1.35 mm, while reduction in ridge height was 1.11 ± 0.76 and 1.8 ± 0.96 mm for ADDG + i-PRF and ADDG, respectively (p > 0.05). Significant differences in keratinized tissue width reduction were notable between ADDG + i-PRF and ADDG (0.12 ± 0.34 and 0.58 ± 0.34 mm respectively; p = 0.008). Postoperative pain scores were significantly lower in ADDG + i-PRF (p = 0.012). All patients in the two groups were satisfied with no differences in chair time (p > 0.05). No differences in total percentage area of newly formed bone, soft tissue or graft particles were observed between the groups (p > 0.05).

CONCLUSIONS

ADDG alone or in combination with i-PRF yields similar results regarding ARP clinically, quality of the formed osseous tissues, as well as patients' satisfaction. Yet, the addition of i-PRF to ADDG tends to preserve the keratinized tissue and lessen postoperative pain.

Efficacy of autologous platelet concentrate products for alveolar preservation: A meta-analysis

PURPOSE

The purpose of the study was to systematically evaluate the efficacy of autologous platelet concentrate products in the preservation of the alveolar ridge after tooth extraction through meta-analysis and provide a theoretical basis for the clinical application of autologous platelet concentrates to reduce alveolar bone resorption.

METHODS

This study conducted a meta-analysis of clinical trials between 2013 and 2023, focusing on autologous platelet concentrate products (e.g., PRP, PRF, CGF, and PRCF) used for alveolar ridge preservation after tooth extraction. The analysis included 122 articles and 371 extraction sockets. All statistical analyses were performed using Review Manager version 5.4.

RESULTS

Results indicate that these platelet concentrates effectively reduced changes in horizontal width 1 mm below the alveolar crest and vertical socket height. They also promoted a higher percentage of new bone formation in extraction sockets compared with control groups. However, they did not significantly prevent horizontal bone resorption at 3 and 5 mm below the alveolar crest.

CONCLUSION

In conclusion, autologous platelet concentrates are useful for alveolar ridge preservation, but larger clinical studies are needed to confirm these findings due to the relatively small sample size in this study.

Comparative Effectiveness of an Autologous Dentin Matrix for Alveolar Ridge Preservation

An urgent issue is the preservation or reconstruction of the volume of bone tissue in planning and surgical treatment in the fields of medicine, such as traumatology, orthopedics, maxillofacial surgery and dentistry. After tooth extraction, resorption of the bone tissue of the alveolar crest of the jaws occurs, which must either be further eliminated by performing additional operations or using osteoplastic material for socket preservation at the extraction stage. Background and Objectives: The aim of the study was a comparative analysis of various osteoplastic materials used to preserve the volume of bone tissue in the preimplantation period. Materials and Methods: As part of the study, 80 patients were treated, who underwent socket preservation using xenografts, plasma enriched with growth factors, an autologous dentin matrix (ADM) and hydroxyapatite. Results: The results of the treatment 16 weeks after removal were comprehensively analyzed using a morphometric analysis of the bone's volume, cone beam tomography and morphological examination of burr biopsy specimens, as well as by determining the stability of the installed implant at different stages of treatment. Conclusions: The lowest level of bone tissue resorption according to the CBCT data was noted in the ADM and xenograft groups. It should be noted that the use of osteoplastic material in jaw surgery when reconstructing alveolar defects is an essential procedure for preventing the atrophy of bone tissue.

Efficacy of Platelet-Rich Fibrin in Preserving Alveolar Ridge Volume and Reducing Postoperative Pain in Site Preservation of Post-Extracted Sockets

Background and Objectives: In socket preservation, the goal is to minimize bone resorption after tooth extraction to maintain the volume and contour of the alveolar ridge. The use of PRF in post extraction sites may reduce ridge resorption by encouraging the growth of new bone and acting as a scaffold for tissue. In addition, PRF may enhance healing and minimize postoperative pain. The aim of this study was to evaluate the effectiveness of platelet-rich fibrin (PRF) in maintaining the ridges' dimensions at the extraction site, in the maxilla and mandible, as well as its impact on post-extraction discomfort. Methods: The study was conducted on 60 patients presenting for extraction of posterior teeth and was randomly divided into three groups: group I PRF (n = 20), group II PRF + collagen (n = 20), and group III control (n = 20). Sockets were filled with PRF (group I) and PRF + collagen (group II). At baseline and follow-up after 3 months, CBCT was used to assess the bone dimensions. The postoperative pain evaluations were performed at 24 h, 3 days, and 7 days after the tooth extraction. The pain rate was evaluated using a numerical rating scale from the British Pain Society. Results: The study examined the effects of platelet-rich fibrin (PRF) and PRF combined with collagen on the height and width of the ridges, as well as the pain experienced by the patients following alveolar ridge preservation surgery. ANOVA and t-tests were used to evaluate and compare the ridge dimensions. Comparing the results to the control group, there were no significant differences in the height or width of the ridges. However, both the PRF and PRF + Collaplug® treatments effectively reduced the short-term postoperative pain. Conclusions: The study findings suggest that platelet-rich fibrin (PRF) and PRF combined with collagen do not exert significant effects on ridge width and height compared to the standard treatment following alveolar ridge preservation. However, it is noteworthy that both the PRF and PRF + collagen treatments demonstrated efficacy in reducing postoperative pain in the short term, offering a potential advantage over standard treatment protocols.

The effect of platelet-rich fibrin (PRF) versus freeze-dried bone allograft (FDBA) used in alveolar ridge preservation on the peri-implant soft and hard tissues: a randomized clinical trial

BACKGROUND

The effectiveness of alveolar ridge preservation on bone regeneration and tissue healing has been thoroughly documented in the literature. This study aimed to evaluate the peri-implant soft and hard tissue changes after alveolar ridge preservation using either platelet-rich fibrin (PRF) or freeze-dried bone allograft (FDBA) over a 12-month period following the prosthetic loading of implants.

METHODS

In this randomized clinical trial, 40 individuals were recruited for alveolar ridge preservation using (1) FDBA or (2) PRF in incisal/premolar areas. At two follow-up sessions (six- and 12-months post-implant insertion), radiographic imaging and clinical examinations assessed marginal bone loss and soft tissue factors, including gingival recession and bleeding on probing. The differences between study groups were analyzed using Generalized estimating Equations, the Binary logistic regression model, and Cochran's Q test.

RESULTS

There was a statistically significant difference regarding gingival recession at both follow-up evaluations; values in the PRF group were considerably lower compared to the FDBA group (p < 0.05). The mean values for vertical marginal bone loss and bleeding on probing showed no significant differences between the two study groups (p > 0.05).

CONCLUSIONS

Except for gingival recession, applying PRF yielded comparable clinical results to FDBA after one year of implant loading and could be recommended as a potential biomaterial for alveolar ridge preservation following tooth extractions.

CLINICAL TRIAL REGISTRATION

The research protocol was registered in the Protocol Registration and Results System on 13/08/2021, available at https://clinicaltrials.gov/ (NCT05005377).

Healing of Extraction Sites after Alveolar Ridge Preservation Using Advanced Platelet-Rich Fibrin: A Retrospective Study

BACKGROUND

Over time, numerous surgical procedures and biomaterials have been proposed for the reconstruction of post-extraction bone defects, each with their advantages and disadvantages. The main objective of this study was to evaluate dimensional changes in the alveolar bone 3 months after tooth extraction, before implant planning, comparing alveolar ridge preservation (ARP) with spontaneous healing.

METHODS

A total of 84 patients with non-restorable molars were included in the study. Forty-two patients received ARP with advanced platelet-rich fibrin (A-PRF) and spontaneous healing was evaluated in these patients. Cone beam computed tomography (CBCT) analysis performed before and after surgical intervention was used to determine the changes in vertical and horizontal bone dimensions produced after tooth extraction.

RESULTS

CBCT measurements showed reduction in both vertical and horizontal alveolar bone size in both groups. For the study group, the alveolar parameters (height, width) were higher compared to the control group. The percentage variations between dimensional differences from the two groups were 38.58% for height, and for width were 36.88% at 0 mm, 35.56% at 3 mm, 36.61% at 5 mm, and 38.73% at 7 mm. The differences were statistically significant (p ˂ 0.0005).

CONCLUSIONS

The results obtained after ARP with A-PRF showed a reduced loss of bone volume compared to spontaneous healing.

Evaluation of Alveolar Ridge Dimensions by Socket Preservation Therapy Using a Bone Graft and Platelet-Rich Fibrin: A Randomized Controlled Trial

BACKGROUND

Following the loss of a tooth, the new edentulous area of the ridge will undergo several adaptive modifications due to changes in function within and surrounding the socket. This bone resorption explains the need for socket preservation techniques in areas of esthetic concerns and functional demands. Demineralized freeze-dried bone allograft (DFDBA) possesses greater osteoinductive potential due to the exposure of bone morphogenetic protein (BMP-3​​​​​​)​and collagen fibrils and can be used efficiently in socket preservation techniques. DFDBA yields better results when combined with an autologous platelet concentrate, such as platelet-rich fibrin. Therefore, we formulated this randomized controlled clinical trial to assess the clinical and radiovisiographical outcomes of platelet-rich fibrin (PRF) and DFDBAs for extraction socket preservation in humans at different time intervals.

MATERIALS AND METHODS

This was a randomized controlled trial with 100 people as study subjects, and they were randomly divided into two groups: the test group (DFDBA and PRF placed in the extraction socket) and the control group (natural healing of the extraction socket). Clinical and radiographic evaluation using radiovisiography (RVG) was done at baseline, three-month, and six-month intervals. Cone-beam computed tomography (CBCT) was used at six months to determine the bone density in the test and control groups.

RESULTS

When compared from baseline to six months, the percentage change in clinical and RVG measurements for the test group was 15.96% (11.9064 mm) and 16.77% (12.1840 mm), respectively, whereas for the control group, it was 46.09% (14.0396 mm) and 47.61% (14.5716 mm), thus indicating lesser bone resorption in the test group as opposed to the control group. CBCT values also showed greater bone density for the test group (682.3120 HU) than the control group (503.8336 HU).

CONCLUSION

This study demonstrates the advantages of DFDBA bone graft with PRF compared to natural healing in achieving socket preservation by maintaining the marginal and buccolingual bone levels.

Effect of thermal manipulation on the biological and mechanical characteristics of horizontal platelet rich fibrin membranes

BACKGROUD

Regardless of application scenarios, proper mechanical characteristics and degradation properties are prerequisites for horizontal platelet rich fibrin (H-PRF) to manifest its ability. Among the methods used to modify PRF, thermal manipulation is promising as it is easy to handle without adding extra additives. Yet there is no consensus on optimal temperature treatment. This study aimed to investigate the effects of heating on the biological and mechanical characteristics of H-PRF and explore the optimum heating temperature for H-PRF thermal treatment.

METHODS

We employed a series of temperature gradients, room temperature, 50℃, 75℃, 90℃, 105℃. The microstructure and the mechanical properties were recorded by Scanning Electron Microscope (SEM) and tensile strength tests respectively. The degradation rate of H-PRF membranes was examined by digestion assay with plasmin and trypsin. The viability of cells within H-PRF membranes and the proliferation of osteoblasts cultured with extracts from different H-PRF groups was evaluated using CCK-8 assays.

RESULTS

Compared with the nonheated group, overheated manipulation beyond 90℃ can significantly prolong the degradation properties for up to 3 to 4 weeks and enhance the mass stress of H-PRF membranes. A high-temperature treatment of 105℃ accompanied by the cell activity beneath H-PRF reduced more than half, and thus, the biological effect on human osteoblasts (hFOBs) also reduced dramatically.

CONCLUSIONS

High thermal manipulation can prolong the degradation properties and enhance the mechanical properties of PRF membranes accompanied by the loss of biological effect.

The effect of recurrent application of concentrated platelet-rich fibrin inside the extraction socket on the hard and soft tissues. a randomized controlled trial

Background

Platelet-rich fibrin (PRF) is commonly used for ridge preservation following tooth extraction. However, its effectiveness diminishes over a period of two weeks as it is resorbed and loses its biological activities. Therefore, this clinical study aims to evaluate the effect of recurrent application of concentrated PRF (C-PRF) inside the extraction socket on the hard and soft tissue alterations.

Methods

Twenty patients requiring single tooth extraction and replacement with a dental implant were randomized into one of two ridge preservation approaches: Advanced PRF plus alone (Control group) or advanced PRF plus with the recurrent application of a C-PRF inside the socket every two weeks for 2 months (four times). The ridge width, the ridge height, and the soft tissue thickness were assessed clinically at the baseline and reassessed after 3 months from tooth extraction during implant surgery. Then the amount of hard tissue loss and soft tissue alterations were calculated.

Results

There was a statistically significant difference in the amount of hard tissue loss between groups in the third month. The amount of horizontal ridge loss for the control and test groups were 2.9 ± 0.7 mm and 1.9 ± 0.5 mm, respectively (p-value < 0.05). The vertical bone loss for control and test groups were 1.8 ± 0.5 mm and 1.0 ± 0.3 mm, respectively (p-value < 0.05). Additionally, for the soft tissue thickness, there was no statistical difference between the groups (p-value > 0.05).

Conclusion

Within the limitations of this study, the recurrent application of C-PRF in the extraction socket could decrease the amount of ridge alteration following tooth extraction and may play a role in the bone regeneration procedures.

Trial registration

Registered on ClinicalTrials.gov (ID: NCT05492357, on 08/08/2022).

The effect of recurrent application of concentrated platelet-rich fibrin inside the extraction socket on the hard and soft tissues. a randomized controlled trial

BACKGROUND

Platelet-rich fibrin (PRF) is commonly used for ridge preservation following tooth extraction. However, its effectiveness diminishes over a period of two weeks as it is resorbed and loses its biological activities. Therefore, this clinical study aims to evaluate the effect of recurrent application of concentrated PRF (C-PRF) inside the extraction socket on the hard and soft tissue alterations.

METHODS

Twenty patients requiring single tooth extraction and replacement with a dental implant were randomized into one of two ridge preservation approaches: Advanced PRF plus alone (Control group) or advanced PRF plus with the recurrent application of a C-PRF inside the socket every two weeks for 2 months (four times). The ridge width, the ridge height, and the soft tissue thickness were assessed clinically at the baseline and reassessed after 3 months from tooth extraction during implant surgery. Then the amount of hard tissue loss and soft tissue alterations were calculated.

RESULTS

There was a statistically significant difference in the amount of hard tissue loss between groups in the third month. The amount of horizontal ridge loss for the control and test groups were 2.9 ± 0.7 mm and 1.9 ± 0.5 mm, respectively (p-value < 0.05). The vertical bone loss for control and test groups were 1.8 ± 0.5 mm and 1.0 ± 0.3 mm, respectively (p-value < 0.05). Additionally, for the soft tissue thickness, there was no statistical difference between the groups (p-value > 0.05).

CONCLUSION

Within the limitations of this study, the recurrent application of C-PRF in the extraction socket could decrease the amount of ridge alteration following tooth extraction and may play a role in the bone regeneration procedures.

TRIAL REGISTRATION

Registered on ClinicalTrials.gov (ID: NCT05492357, on 08/08/2022).

Radiographic and immuno-histochemical evaluation of root perforation repair using MTA with or without platelet-rich fibrin or concentrated growth factors as an internal matrix in dog's teeth: in vivo animal study

OBJECTIVES

To comparatively evaluate the in vivo outcome of MTA repair for contaminated and non-contaminated furcation perforations (FP) with or without PRF and CGF as a matrix in dogs' teeth.

METHODS

Ninety dog teeth were divided into five groups based on the iatrogenic FP repair approach after doing root canal treatment: negative control (without FP), positive control (FP without repair), MTA, MTA + PRF and MTA + CGF groups, where FP were repaired promptly in subdivision 1 (n = 10; non-contaminated) and after 4 weeks of oral contamination in subdivision 2 (n = 10;contaminated). After 3 months, the perforation site was assessed radiographically (vertical bone density), histologically (inflammatory cell count, epithelial proliferation, cementum and bone deposition) and immunohistochemically (OPN and TRAP antibodies localisation). Data collected were statistically analysed using SPSS software at a 0.05 significance level.

RESULTS

The MTA + PRF and MTA + CGF groups demonstrated significantly more bone formation, OPN immunolocalisation and fewer inflammatory cell counts than MTA group. MTA, MTA + PRF and MTA + CGF groups showed significantly favourable radiographic, histological and immunohistochemical healing features than the positive control, especially in non-contaminated subdivisions, that significantly showed better features than the contaminated subdivisions (P < 0.001).

CONCLUSION

The use CGF and PRF as a matrix beneath MTA in FP repair in dog's teeth is promising as it could increase hard and soft tissue regeneration in non-contaminated and contaminated perforations.

CLINICAL RELEVANCE

The repair of FP is challenging especially when associated with contaminated inter-radicular bone loss. Radiographic, histological and immunohistochemical comprehensive evaluation of the root and surrounding attachment apparatus response to different perforation repair protocols could give a predictable clinical outcome.

Effect of the use of platelet concentrates on new bone formation in alveolar ridge preservation: a systematic review, meta-analysis, and trial sequential analysis

OBJECTIVES

To investigate the histomorphometric changes occurring in alveolar ridge preservation (ARP) based on the use of different plasma concentrates (PCs) in randomized clinical trials (RCT). There is controversy whether the placement of PCs in ARP is effective in the formation of new bone.

MATERIALS AND METHODS

A systematic review search was conducted in PubMed, Scopus, Web of Science, and Cochrane Database to answer the PICO question: In patients undergoing tooth extraction followed by ARP, do PCs alone in the post-extraction socket in comparison with spontaneous healing improve new vital bone formation percentage in histomorphometric analysis after more than 10 weeks? The risk of bias was assessed and a meta-analysis was conducted.

RESULTS

Of 3809 results, 8 studies were considered suitable for inclusion. A total of 255 teeth were extracted in 250 patients. Regarding the PCs used, ARP was performed with platelet- and leukocyte-rich fibrin (L-PRF) in 120 sockets, and with pure platelet-rich plasma (P-PRP) in 31 sockets and 104 sockets were controlled. PCs improved new bone formation in ARP with respect to the spontaneous healing group (SMD = 1.77, 95%C.I. = 1.47-2.06, p-value < 000.1). There were no differences between the different PCs (L-PRF and P-PRP).

CONCLUSION

The results of this meta-analysis support the efficacy of the use of PCs in new bone formation in ARP. With respect to the different types of PCs studied, no differences were observed.

CLINICAL RELEVANCE

When planning implant surgery after tooth extraction, treatment with PCs should be considered for ARP. Any PC increases new bone formation compared to spontaneous healing.

Effects of Photobiomodulation Using Low-Level Laser Therapy on Alveolar Bone Repair

Alveolar bone repair is a complex and extremely important process, so that functions such as the mastication, occlusion and osseointegration of implants can be properly reestablished. Therefore, in order to optimize this process, many procedures have been used, such as grafting with biomaterials and the application of platelet-rich fibrin (PRF). Another method that has been studied is the use of photobiomodulation (PBM) with the use of low-level laser therapy (LLLT), which, through the absorption of photons by the tissue, triggers photochemical mechanisms in the cells so that they start to act in the search for homeostasis of the affected region. Therefore, the objective of this review was to analyze the use of LLLT as a possible auxiliary tool in the alveolar bone repair process. A search was carried out in scientific databases (PubMed/MEDLINE, Web of Science, Scopus and Cochrane) regarding the following descriptors: “low-level laser therapy AND alveolar bone repair” and “photobiomodulation AND alveolar bone repair”. Eighteen studies were selected for detailed analysis, after excluding duplicates and articles that did not meet predetermined inclusion or non-inclusion criteria. According to the studies, it has been seen that LLLT promotes the acceleration of alveolar repair due to the stimulation of ATP production, activation of transcription and growth factors, attenuation of the inflammatory process and induction of angiogenesis. These factors depend on the laser application protocol, and the Gallium Aluminum Arsenide—GaAlAs laser, with a wavelength of 830 nm, was the most used and, when applications of different energy densities were compared, the highest dosages showed themselves to be more efficient. Thus, it was possible to conclude that PBM with LLLT has beneficial effects on the alveolar bone repair process due to its ability to reduce pain, the inflammatory process, induce vascular sprouting and, consequently, accelerate the formation of a new bone matrix, favoring the maintenance or increase in height and/or thickness of the alveolar bone ridge.

Alveolar ridge preservation: A review of concepts and controversies

The loss of thickness and height of the alveolar process after tooth extraction is a significant impediment to implant placement, which limits the aesthetic results of many restorative treatments. Alveolar ridge preservation can reduce bone resorption. Knowing how beneficial this procedure is can help clinicians decide if it is worth doing. The purpose of this article is to present a contemporary review of the different approaches to preserving the dimensions of the alveolar ridge. We analyze the alveolar healing process, atraumatic extraction techniques, graft materials, and controversies.

Enamel Matrix Derivatives as an Adjunct to Alveolar Ridge Preservation-A Systematic Review

PURPOSE

To systematically assess the current evidence regarding the adjunctive application of enamel matrix derivatives (EMDs) during alveolar ridge preservation (ARP) following tooth extraction.

METHODS

A comprehensive literature search was conducted in MEDLINE, Cochrane Library, PsycINFO, Web of Science, Google Scholar, and Scopus to identify relevant randomized controlled clinical trials (RCTs). The primary outcome parameters of this systematic review were histomorphometric and radiographic data; secondary outcomes were the feasibility of implant placement after ARP as well as patient-related outcomes such as postoperative discomfort.

RESULTS

The search identified 436 eligible articles published from 2011 to 2022, but only five were ultimately included for data extraction (146 patients). Given the substantial heterogeneity among the included studies, no meta-analysis could be performed. The authors' qualitative analysis showed marginally improved outcomes regarding an increased percentage of new bone formation after tooth extraction and a reduction in postoperative discomfort.

CONCLUSIONS

Given the potential value of EMDs in other fields of regenerative dentistry, more consideration should be given to EMDs as an adjunctive treatment option in ARP. However, more well-controlled randomized clinical trials are necessary to evaluate the exact potential and impacts of EMDs.

Platelet-rich fibrin combined with a particulate bone substitute versus guided bone regeneration in the damaged extraction socket: An in vivo study

AIM

It has been proposed that platelet-rich fibrin (PRF) can be used to support bone regeneration during alveolar ridge augmentation. The aim of this study was to determine whether an approach utilizing PRF provides similar performance to the established guided bone regeneration (GBR) procedure.

MATERIALS AND METHODS

Two-wall defects were surgically created in beagle dogs and treated in three experimental groups: (i) a sticky bone (SB) substitute prepared using liquid PRF and deproteinized porcine bone mineral (DPBM); (ii) SB covered with solid PRF compressed into a membrane; and (iii) GBR performed using DPBM covered by a collagen membrane. Quantitative reverse-transcription polymerase chain reaction was applied to the specimen after 1 week of healing, and microcomputed tomography (micro-CT) and histological outcomes were analysed after 8 weeks of healing.

RESULTS

Compared with GBR, PRF resulted in a moderate increase in the expression levels of osteoblast and osteoclast markers, osteocalcin, and calcitonin receptor. Moreover, PRF modestly increased angiogenesis and the inflammation markers vascular endothelial growth factor (VEGF) and IL-6. Micro-CT and histological analyses confirmed the expected increased alveolar ridge area, with no significant differences between the three groups. Consistently, graft consolidation, as indicated by new bone formation at the defect site, did not differ significantly between groups.

CONCLUSIONS

The present results demonstrate that PRF-based approaches perform comparably to the established GBR procedure in terms of the consolidation of DPBM in two-wall alveolar defects.

The impact of gender and peripheral blood parameters on the characteristics of L-PRF membranes

Aim

The purpose of this study was to evaluate the impact of gender and peripheral blood parameters on the characteristics of Leucocyte-and Platelet-Rich Fibrin (L-PRF) membranes and to describe histologically three different zones of L-PRF membranes.

Methods

Blood was collected from twenty healthy donors (10 men and 10 women). Peripheral blood parameters including leucocyte and platelet counts, and fibrinogen levels were recorded. L-PRF membranes were prepared to quantify the release of growth factors (PDGF, VEGF, BMP-2, and BMP-9) at 1, 2, 3 and 7 days and for histological examination. Three zones within each L-PRF membrane (face, body, and tail) were analysed separately, quantifying the area of leucocytes, platelets, and fibrin in percentage. The Young's modulus of the membranes was also considered (during tensile and compression tests).

Results

Women had significantly higher fibrinogen levels in their peripheral blood, and a higher release of BMP-9, whereas men showed a significantly higher Young's modulus in compression tests. The histology revealed significant differences in cellular content and fibrin concentration between the 3 areas, with the face being biologically the richest.

Conclusion

Several factors influenced the final characteristics of L-PRF membranes. These need to be taken into consideration when interpreting the results of research, but especially in clinical practice.

Unravelling Alveolar Bone Regeneration Ability of Platelet-Rich Plasma: A Systematic Review with Meta-Analysis

Background: This systematic review aims to evaluate the efficacy of the available platelet-rich plasma (PRP) products and composition to regenerate alveolar bone after tooth extraction. Methods: PubMed, Cochrane Central Register of Controlled Trials, and EBSCO databases were searched up to 2 July 2021. Only randomized clinical trials using leukocyte-rich plasma (L-PRP) or pure-platelet rich plasma (P-PRP) for bone regeneration in alveolar ridge preservation were selected. The following outcomes were considered: (1) new bone formation (primary outcome) and (2) bone density (secondary outcome). A meta-analysis for PRP, P-PRP, and L-PRP using a fixed effect model was performed with Review Manager 5.4 software. Overall evidence was qualified using GRADE. Results: Six randomized clinical trials from 2639 unique articles initially identified met the inclusion criteria. The meta-analysis showed a significant effect of the P-PRP on the outcome of new bone formation (SMD, 1.44; 95% CI, 0.84 to 2.03) for P-PRP treatment. No information was retrieved for L-PRP. A statistically significant difference was also observed in the P-PRP group for bone density outcome (SMD, 1.24; 95% CI, 0.81 to 1.68). The L-PRP treated sockets also showed higher bone density (SMD, 0.88; 95% CI, 0.31 to 1.45) in comparison to control sockets. The quality of evidence was moderate for both outcomes in the P-PRP group and low for the L-PRP group. Conclusions: Despite the limitations of the included studies, our data suggest that P-PRP, in comparison to unassisted healing, can improve alveolar bone regenerative potential. However, more high-quality clinical studies are needed.

Regenerative Potential of Platelet Rich Fibrin (PRF) in Socket Preservation in Comparison with Conventional Treatment Modalities: A Systematic Review and Meta-Analysis

BACKGROUND

Platelet rich fibrin (PRF) has shown great potential in osteogenesis; however, some studies still question utilizing it as a grafting material. Thus, the aim of this review is to evaluate the effect of PRF when used in socket and ridge preservation procedures.

METHODS

Electronic searches through MEDLINE, EMBASE, and Cochrane, Science Citation Index Expanded databases and manual searches of unpublished data, academic theses, and journals were conducted up until July 2021. The outcomes were to assess the ability of PRF as a graft material to preserve bone width, height, and density after tooth extraction.

RESULTS

Twelve studies were included in the review, using PRF showed significant results in all three outcomes when compared to no grafting at all, however when compared to other commonly used grafting materials it showed a lesser effect. On the other hand, most studies included reported mixing PRF with a graft material showed the best result. The meta-analysis also revealed the significant results in using PRF on the three outcomes.

CONCLUSION

The meta-analysis of the studies included proved the beneficial effect of PRF in socket preservation surgeries alone or in combination with other graft materials, but further individual multi-centre randomized controlled studies with appropriate sample size are still needed to further confirm our findings.

Impact of local and systemic antimicrobials on leukocyte- and platelet rich fibrin: an in vitro study

The aim of this study was to evaluate the effect of local and systemic administration of antimicrobials to leukocyte- and platelet-rich fibrin (L-PRF). For part A, 16 tubes of venous blood were collected from each of eight systemically healthy subjects. Prior to blood centrifugation, 12 of the 16 tubes were injected with 0.125 ml, 0.25 ml or 0.50 ml metronidazole solution. One set of L-PRF membranes was used to assess the release of vascular endothelial growth factor AB, platelet-derived growth factor, transforming growth factor beta 1, and bone morphogenetic protein 2 at indicated time points. The metronidazole release over time by L-PRF membranes was also evaluated. The remaining L-PRF membranes were placed on the surface of agar plates inoculated with three different periodontal pathogens to determine their antibacterial activity. For part B, another six subjects were enrolled with three subjects taking 2 g amoxicillin and three subjects 500 mg metronidazole as prophylaxis prior to a periodontal treatment. Before and 2 h after consuming one of the prescribed antimicrobials, three tubes of blood were collected for preparing L-PRF membranes. These membranes were used to measure the antibacterial activity against periodontal pathogens. No statistically significant difference could be found in the release of growth factors between L-PRF membranes with and without incorporation of metronidazole solution. The release of metronidazole could be detected up to day 3, however with the highest concentration during the first 4 h. This concentration was dose dependent. The antibacterial capacity of L-PRF membranes increased significantly for both the systemic intake, and after the addition of metronidazole solution to the blood tubes before centrifugation, the latter again dose dependent. The antibacterial capacity of L-PRF against the periodontal pathogens tested can significantly be enhanced by the addition of antimicrobials, without disadvantage for the release of growth factors.

Short-Term Evaluation of Guided Bone Reconstruction with Titanium Mesh Membranes and CGF Membranes in Immediate Implantation of Anterior Maxillary Tooth

Purpose

The aim of the present prospective study was to evaluate the effect of titanium mesh and concentrated growth factor (CGF) membranes in reconstructing severe labial bone defects during immediate implantation of anterior maxillary tooth.

Methods

Patients with severe defects presenting on the anterior labial bone plate of maxillary were enrolled in this study. During immediate implantation, the titanium mesh was used to maintain the space of bone graft, collagen membrane, and xenograft bone that were used to guide bone regeneration (GBR). Cone beam computed tomography (CBCT) was used to measure the height and the labial bone thickness around the implant at the time of the second stage surgery, 6 months, 1 year, and 2 years after restoration. The pink esthetic score (PES) was used to evaluate the esthetic outcomes after restoration.

Results

18 patients were enrolled in this study. The survival rate of implants was 100%, and no complication was observed, except for 1 case of titanium mesh exposure which did not affect osteogenesis. In the second stage of surgery, the labial bone was completely reconstructed, and the top of the implant was covered with a small amount of new bone. The thickness of the labial bone was 3.01 mm (±0.23), 2.96 mm (±0.21), 2.93 mm (±0.19), and 2.92 mm (±0.16) at the time of the second stage surgery, 6 months, 1 year, and 2 years after restoration, respectively. The height of the marginal bone around implants was above the top of implant at the time of the second stage surgery and then reduced 0.72 mm (±0.07), 0.91 mm (±0.08), and 0.90 mm (±0.07) at the time point of 6 months, 1 year, and 2 years after restoration, respectively. The changes of bone thickness and height were statistically significant within one year, but stable after one year. The PES values showed the same tendency.

Conclusions

With the limitation of the present prospective study, the combination of titanium mesh and CGF membrane could provide space maintenance for bone augmentation of alveolar bone defects and improve the bone regeneration in patients with severe labial bone defect when immediate implant of anterior maxillary.

Structure, Barrier Function, and Bioactivity of Platelet-Rich Fibrin Following Thermal Processing

Platelet-rich fibrin (PRF) has been utilized as a substitute for resorbable membranes during guided bone regeneration therapy as it is a more bioactive biomaterial with living cells and growth factors than resorbable membranes. Nevertheless, PRF poses obvious disadvantages in its mechanical strength since its rapid degradability has been shown to typically resorb within a 2-week time period. In the present study, the barrier function and biological and mechanical properties of PRF were investigated both as standard therapy and after thermal processing. Two heating processes were applied: both single-side heating and double-side heating at 90°C for 10 s using a metal plate heater. The appearance and weight of PRF membranes were documented after heating, along with their morphological and mechanical properties evaluated by scanning electron microscope and tensile strength tests. The viability of cells found within PRF membranes was also evaluated using live/dead cell viability and CCK-8 (cell counting kit-8) assays. To comprehensively evaluate the barrier function of PRF membranes, Hoechst staining of human gingival fibroblasts, which can be distinguished from cells within the PRF membrane by emitting blue light at an excitation wavelength of 488 nm, was seeded onto the surface of PRF membranes. Furthermore, osteoblasts were cultured with extracts from different PRF groups to evaluate the biocompatibility of PRF membranes. The degradation rate of PRF membranes was examined by digestion assay. Compared with the nonheated PRF control, the size and weight of PRF membranes led to a significant decrease with a denser PRF microstructure following heating. In summary, the double-sided heating of PRF membranes not only demonstrated an improvement in mechanical and degradation properties but also led to a decrease in cell viability and proliferation.

Alveolar ridge preservation: an overview of systematic reviews

The aim of this overview was to assess the methodological quality of systematic reviews of randomized clinical trials on alveolar ridge preservation after a tooth extraction. During March 2020, two independent reviewers performed an electronic search of the PubMed (MEDLINE), Scopus, Web of Science, and Cochrane Library databases to identify all relevant systematic reviews including randomized clinical trials on alveolar ridge preservation. A manual search of articles in renowned journals was also conducted. The methodological quality of the included reviews was determined using the AMSTAR-2 tool. From the 53 initially retrieved studies, 11 were finally included: three systematic reviews and eight systematic reviews with meta-analyses. The methodological quality of the included reviews was low or critically low. Higher quality clinical studies should be conducted prior to performing further reviews and these should meet the methodological requirements that are fundamental to this type of research.

Xenograft materials in maxillary sinus floor elevation surgery: a systematic review with network meta-analyses

A systematic review and network meta-analysis was conducted to compare different commercially available xenograft materials used in maxillary sinus floor elevation surgery (MSFES). Embase, PubMed, the Cochrane Library, Web of Science, Scopus, LILACS, and grey literature were searched up to 13 July 2020. Only randomised controlled trials (RCTs) were included. A frequentist network meta-analysis using a random effects model compared different commercially available xenograft materials. The primary outcomes were the percentage of newly-formed bone and residual bone-substitute rate. Both were measured by histomorphometric analysis from bone biopsies obtained during preparation of the implant site. Of the 659 studies initially identified, 11 involving 242 MSFES were included in the quantitative analyses. A total of six bone-substitute materials were analysed (Bio-Oss® (Geistlich Pharma), InduCera® Dual Coat, Lumina-Bone Porous® (Critéria), Osseous® (SIN - Sistema de Implantes Nacional), THE Graft® (Purgo Biologics), and Osteoplant Osteoxenon® (Bioteck)). The P-score estimation showed that Osteoplant Osteoxenon® produced the most newly-formed bone and reabsorbed faster than other xenograft materials after six months. The combination of Bio-Oss® plus bone marrow aspirate concentrate (BMAC) significantly increased the percentage of newly-formed bone compared with Bio-Oss® alone. In contrast, the addition of Emdogain® (Straumann) and leucocyte and platelet-rich fibrin (L-PRF) to Bio-Oss® did not significantly improve the amount of regenerated bone. Study-level data indicated that the percentage of newly-formed bone differs among commercially available xenograft materials. Osteoplant Osteoxenon® seems to result in the highest amount of new bone in MSFES.

Advanced platelet-rich fibrin plus and osseous bone graft for socket preservation and ridge augmentation - A randomized control clinical trial

Objective

To compare the clinical and radiographic effectiveness of A PRF Plus as an adjuctive material to osseous bone graft in socket preservation and ridge augmentation.

Methods

Twenty patients with need to preserve extraction socket in non-molar sites planning for further prosthetic rehabilitation were divided into two groups. Test Group (Group A) was treated with A PRF Plus membrane and Sybograf plus ™ (70% HA and 30 %β TCP) bone graft. The Control Group (Group B) was treated with Sybograf plus ™ (70% HA and 30% βTCP) bone graft. Both groups had same socket preservation surgical technique.

Results

Both Group A and Group B showed significant improvement in clinical and radiographic parameters. Mean socket length, Vertical Resorption reduction in Group A was 1.48 whereas in Group B was 1.67 which is statistically significant. (p ​≤ ​0.05). Changes in Horizontal width reduction at 1,3, and 5 ​mm depth of the socket for both groups were not statistically significant. The Gain in socket fill for Group A and B 6 months postoperatively was 1185.30HU ± 473.21 and 966.60 HU ± 273.27 respectively. But intergroup comparison was not statistically significant. (p ​= ​0.17). There were no significant statistical differences in postoperative pain in Group A and Group B as subjects experienced moderate amount of pain. The assessment of post-operative swelling showed that only 30% subjects in Group A reported with swelling. Whereas 80% subjects in Group B complained of post-operative swelling.

Conclusion

The results of the present study proved utilisation of A PRF Plus as a promising adjunct to conventional regenerative therapy for socket preservation.

Biological effect of the nanocrystalline calcium sulfate bone graft in the periodontal regeneration

BACKGROUND

The ultimate goal of tissue engineering is to reproduce functional alveolar∖Periodontal complex. This study aimed to asses micro- and nano-formulated crystalline calcium sulfate as possible treatment of intrabony defect utilizing an autologous Platelet rich fibrin scaffold.

SUBJECTS

and Methods: An experimental prospective split mouth design using eight healthy mongrel dog's was conducted. After two months of extracting the first premolar, bilateral intrabony defects were created mesial to the mandibular second premolar. One side was grafted by nanocrystalline calcium sulfate, while, the opposite side was grafted with microcrystalline calcium sulfate graft. Dogs were randomly euthanized after one month (group I) and 3 months (group II). The primary outcomes were the histological changes of new bone formation in hematoxylin and eosin and Masson trichrome stains, while histomorphometric and radiographic analysis were the secondary outcome followed by statistical analysis (P value was set at .05).

RESULTS

There was a significant increase in the percentage of bone formation in relation to defect height in nanocrystalline compared to microcrystalline form after one month and three months in both histological (p-values of <0.0001) and radiographic results (p-values of <0.0001).

CONCLUSION

Nanocrystalline calcium sulfate presented a significant enhanced periodontal regeneration compared to the microcrystalline form.

Concentrated Growth Factors vs. Leukocyte-and-Platelet-Rich Fibrin for Enhancing Postextraction Socket Healing. A Longitudinal Comparative Study

Platelet concentrates (PCs) have been used for over 20 years in dentistry, as an adjunct to oral surgery procedures, to improve hard and soft tissue healing and control postoperative symptoms. Among various PCs, Leukocyte and Platelet-Rich Fibrin (L-PRF) has become very popular due to its excellent cost-effectiveness ratio, and to the simple preparation protocol, but comparative clinical studies with other PCs are lacking. The aim of this split-mouth cohort study was to evaluate the effect of Concentrated Growth Factors (CGF), a recently introduced PC, as compared to L-PRF for enhancing post-extraction socket healing. Methods: Patients in need of bilateral tooth extractions were included. Each side was treated with either CGF or L-PRF. Pain, socket closure and healing index were the main outcomes. Results: Forty-five patients (24 women), aged 60.52 ± 11.75 years (range 37–87 years) were treated. No significant difference in outcomes was found, except for Pain at day 1 (p < 0.001) and socket closure in the vestibulo-palatal/lingual dimension at day 7 post-extraction (p = 0.04), both in favor of CGF. Conclusions: based on the present results, CGF proved to be as effective and safe as L-PRF, representing a valid alternative option for improving alveolar socket healing and reducing postoperative discomfort.

Leukocyte and Platelet-Rich Fibrin Have Same Effect as Blood Clot in the 3-Dimensional Alveolar Ridge Preservation. A Split-Mouth Randomized Clinical Trial

PURPOSE

Leukocyte- and platelet-rich fibrin (L-PRF) has been used for alveolar ridge preservation (ARP) in postextraction tooth sockets. However, current reports have measured its effectiveness in linear measurements of 3-dimensional ridge preservation. The purpose of this study was to determine the effectiveness of the use of L-PRF filling versus natural clot blood healing in ARP according to the clinical, radiographic, and volumetric measurements of postextraction tooth sockets.

MATERIALS AND METHODS

A split-mouth randomized clinical trial was designed. Healthy patients who needed bilateral extraction of upper third molars were selected. After the tooth extraction, the socket was filled and distributed randomly with L-PRF and the contralateral socket only with the blood clot. The dimensional change of soft tissue healing around the sockets, and the length, depth, and difference of bone formation were examined using standardized periapical radiographs. Volumetric measurement variation of the sockets was evaluated by 3-dimensional scanning of dental casts. Changes of all measures were analyzed at 7 days (initial) and 3 months (final) after the tooth extraction and compared between both groups (t test; P < .05).

RESULTS

Sixteen patients (aged 24.75 ± 3.53 years; 56.25% women) participated. Measurements of wound healing and the length, depth, and difference of bone formation were similar for both study groups at initial and final times. The calculation of initial-final volumetric socket variation was 15.45 ± 13.12 μL using L-PRF and 14.12 ± 11.23 μL using blood clot (P = .78).

CONCLUSIONS

L-PRF filling showed the same dimensional and volumetric behavior as normal blood clot healing in the ARP of postextraction tooth sockets. Future investigations will have to analyze the use of surgical models and digital instruments in ARP techniques.

Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry

This comprehensive review of the 2019 restorative dental literature is offered to inform busy dentists regarding remarkable publications and noteworthy progress made in the profession. Developed by the Scientific Investigation Committee of the American Academy of Restorative Dentistry, each author brings discipline-specific expertise to 1 of 8 sections of the report: (1) prosthodontics; (2) periodontics, alveolar bone, and peri-implant tissues; (3) implant dentistry; (4) dental materials and therapeutics; (5) occlusion and temporomandibular disorders; (6) sleep-related breathing disorders; (7) oral medicine and oral and maxillofacial surgery; and (8) dental caries and cariology. The report targets important information likely to influence day-to-day dental treatment decisions. Each review is not intended to stand alone but to update interested readers so that they may visit source material when greater detail is desired. As the profession moves toward evidence-based clinical decision-making, an incredible volume of potentially valuable dental literature continues to increase. It is the intention of this review and its authors to provide assistance in negotiating the extensive dental literature published in 2019. It is our hope that readers find this work useful in the clinical management of dental patients.

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

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.

Autologous platelet-rich fibrin stimulates canine periodontal regeneration

Platelet-rich fibrin (PRF) provides a scaffold for cell migration and growth factors for promoting wound healing and tissue regeneration. Here, we report using PRF in periodontal healing after open flap debridement (OFD) in canine periodontitis. A split-mouth design was performed in twenty dogs. Forty periodontitis surgical sites were randomly categorized into 2 groups; OFD alone and OFD with PRF treatment. Clinical parameters of periodontal pocket depth, gingival index, and the cemento-enamel junction-alveolar bone levels/root length ratio were improved in the OFD + PRF group. The OFD + PRF group also demonstrated a dramatically decreased inflammatory score compared with the OFD group. Collagen accumulation was improved in the OFD + PRF group at later time points compared with baseline. PRF application also significantly reduced inflammatory cytokine expression (TNFA and IL1B), and promoted the expression of collagen production-related genes (COL1A1, COL3A1, and TIMP1) and growth factors (PDGFB, TGFB1, and VEGFA). These findings suggest that PRF combined with OFD provides a new strategy to enhance the overall improvement of canine periodontitis treatment outcomes, especially in terms of inflammation and soft tissue healing. Therefore, PRF use in treating periodontitis could play an important role as a regenerative material to improve canine periodontitis treatment.