Clinical application of platelet-rich fibrin as the sole grafting material in periodontal intrabony defects

Efficacy of platelet rich fibrin with and without metformin in the treatment of periodontal osseous defects: a systematic review and meta-analysis

OBJECTIVE

The systematic review and meta-analysis aimed to evaluate the efficacy of Metformin (MF) with Platelet Rich Fibrin (PRF) over PRF alone in the treatment of periodontal osseous defects.

MATERIALS AND METHODS

An extensive electronic search for articles published up to September 2021 was conducted on 'Embase', 'PubMed' and other library databases accompanied with manual searching. Randomized controlled trials (RCTs), comparing MF plus PRF Vs PRF alone in periodontal osseous defects were identified in which periodontal pocket depth (PPD), Clinical attachment level (CAL) and Intrabony defect depth (IBD Depth) were the outcome measures.

RESULTS

Four studies compared MF plus PRF vs .PRF alone in periodontal osseous defects. Meta-analysis was carried out for PPD reduction, CAL gain and IBD Depth changes. A standardized mean difference (SMD) of 1.86 for PPD reduction, 1.95 for CAL gain and 1.31 for IBD Depth reduction in all the studies was observed and the findings were statistically significant favouring test group.

CONCLUSION

The systematic review indicates supplemental benefits of combination therapy of MF + PRF over monotherapy in resolving periodontal osseous defects. In our quest to achieve maximum regeneration in periodontal osseous defects, combination therapies such as MF + PRF have reported to be better treatment choices over other modalities.

Platelet-rich fibrin and titanium-prepared platelet-rich fibrin in endoperio lesion management

Endo-perio lesions involve a variety of therapy choices that will lead to the best possible elimination of infection. Various therapy approaches have been investigated for curing of patients affected by endo-perio abnormalities. One of the second-generation platelet derivatives is plasma enriched with platelet (PRP).They may aid in the healing of wounds. Enhanced with platelets cells and several growth factors, platelet-rich fibrin (PRF) promotes repair and healing and regeneration of tissue at the periapical area. Platelet cell and leukocyte cell enriched fibrin, prepared in conjunction with titanium (T-PRF), is analogous to fibrin made using the traditional PRF process.The current study was undertaken to compare PRF against T-PRF in the therapy of endo-perio abnormalities using the basic information that was available.280 patients of all sexes between the ages of 18 years and 58 years make up the study's participants. They were divided into two categories. In category I study participants PRF was employed to fill the defect created due to pathology and in category II patients, a T-PRF was used, accompanied by suturing. The one walled, two walled, and three-wall walled infrabony abnormalities were quantified on the digital images acquired using the grid. After three months and six months, the probing periodontal pocket depth in mm and level of attachment (RAL) in mm were measured. In category one, mean change at 3 months was 3.21mm accounting for 33.79% change in PPD. On the other hand mean change at 6 months was 3.61mm accounting for 43.79% change in PPD. When there was evaluation in study participants in category two then it was observed that mean change at 3 months was 2.02mm accounting for 34.79% change in PPD. On the other hand mean change at 6 months was 3.62 mm accounting for 44.79% change in PPD. There was reduction of depth of periodontal pocket at both 3 months follow up and 6 months follow in both categories; however there was no statistical significant variation observed between the two categories regarding decrease in the depth of periodontal pocket on analysis of intergroup variations. It was concluded that there was increase in periodontal attachment and decrease in depth of periodontal pocket in both PRF and T-PRF however there was no statistical substantial variation observed between the two categories regarding increase in the attachment level or decrease in depth of periodontal when intergroup variations between PRF and T-PRF were considered.

Platelet Rich Fibrin Membrane Grafting After Laser Excision for Oral Mucosal Lesions

Platelet rich fibrin (PRF) is a novel surgical biomaterial which has shown immense healing and regenerative potential with diverse clinical applications. Surgical excision is a routinely employed treatment modality for mucosal oral lesions with or without grafting or repair of the base of the wound. We proposed a hypothesis that covering of the base of excised lesion with this platelet rich fibrin membrane can accelerate the rate of physiological healing process and regeneration. To evaluate the role, efficacy, advantages and adverse effects if any, of placement of PRF membrane grafts over surgical excision sites of oral mucosal lesions. Platelet rich fibrin membrane graft was prepared as per recommendation and established protocols. Patients were selected for surgical excision of localized, superficial oral mucosal lesions after meticulous clinical and radiological considerations and informed consent was taken. After laser excision with safe margins, the base of wound was covered with PRF membrane graft, stitched in place by 3-0 vicryl sutures. The operated site was clinically evaluated at regular intervals and a healing score was calculated and statistically tabulated on the basis of various parameters of healing. A total of 34 patients were included in the study with a male preponderance (21 males and 13 females). Satisfactory and clinically acceptable wound healing was observed in most of the patient with minimal morbidities. Surgical site demonstrated good healing score and clinically complete healing with good epithelialisation was achieved in all patients. Platelet rich fibrin membrane is an effective grafting biomaterial after excision of oral mucosal lesions as it enhances the rate of healing with minimal complications. We recommend further multicentre studies with higher sample size to explore its utility and clinical applications in different avenues of oral and head neck surgery.

Clinico-radiographic comparative evaluation of 1% metformin gel plus platelet-rich fibrin over platelet-rich fibrin alone in treatment of Grade II furcation defects: A randomized controlled double-blind clinical trial

BACKGROUND

The present study was aimed to evaluate and compare the effects of 1% MF plus PRF over PRF alone in treatment of Grade II furcation defects, clinically and radiographically by using cone-beam computed tomography.

METHODS

This split-mouth clinical trial randomly allotted 21 patients with 42 bilateral Grade II furcation defects into two groups. Group I was treated with PRF alone while Group II with 1% MF gel and PRF. The primary outcome parameters were clinical attachment level (CAL) and horizontal probing depth (HPD) while the secondary outcome parameters were probing depth (PD) and defect volume (DV). The clinical parameters were evaluated at 3, 6, and 12 months and the radiographic parameters at 12 months.

RESULTS

Both the study groups yielded improvements in assessed parameters; however, significantly greater mean reduction of PD, HPD, and CAL gain was observed in Group II (3.90 ± 0.78 mm, 2.94 ± 0.80 mm, and 3.42 ± 0.93 mm) in comparison with Group I (3.23 ± 0.90 mm, 1.96 ± 0.80 mm, and 2.67 ± 0.88 mm) at 12 months, respectively. A significant reduction of DV was exhibited radiographically in Group II (12.61 ± 4.01 mm³ ) as compared with Group I (9.14 ± 4.31 mm³ ) at the end of 12 months.

CONCLUSIONS

Better clinical and radiographic findings in terms of reduction in PD, HPD, CAL gain, and significant reduction in DV in Group II patients indicated that the combination therapy of 1% MF + PRF promotes regenerative ability within the periodontal tissues in Grade II furcation defects to a greater extent.

Evaluation of PRF Efficiency in the Treatment of Infrabony Defects

AIM

The present study aimed to investigate the effectiveness of PRF in the treatment of infrabony defects in patients with chronic periodontitis by evaluating the clinical outcome through periodontal depth, clinical attachment level at the baseline, 6 and 9 months post operatively.

MATERIAL AND METHODS

Sixty infrabony defects with probing depth ≥ 5 mm were treated. The inclusion criterion was the necessity for surgical bilateral maxillary treatment. By using split-mouth study design, each patient had one side treated with conventional flap surgery and the other side with conventional flap surgery and PRF. Clinical parameters, such as probing depth (PD) and clinical attachment lost (CAL), were recorded in both groups at baseline, 6 and 9 months post operatively.

RESULTS

Positive effects for all clinical and radiographic parameters were evident in the group with PRF. Mean PD reduction demonstrated statistically significant greater results in the test group (4.00±1.07 mm) compared to the control one (4.83±0.99 mm), p = 0.003 after 9 months postoperatively. After 9 months, there were better results in the test group compared to the control group for CAL (5.60±1.61 mm, 6.20±1.58 mm), but statistically not significant.

CONCLUSION

Additional use of PRF in the conventional surgical treatment of infrabony defects demonstrated better parameters than the open flap debridement alone.

Effects of leukocyte- and platelet-rich fibrin associated or not with bovine bone graft on the healing of bone defects in rats with osteoporosis induced by ovariectomy

OBJECTIVE

To evaluate the healing of critical size defects (CSDs) in calvaria of rats with osteoporosis induced by ovariectomy and treated with leukocyte- and platelet-rich fibrin (L-PRF) associated or not with bovine bone graft (XENO).

MATERIAL AND METHODS

A total of 32 rats underwent a bilateral ovariectomy procedure. After 3 months, one 5 mm in diameter CSD was created in the middle of the calvaria of each animal. In group C, defect was filled with blood clot only. In PRF, XENO, and PRF-XENO groups, defects were filled with 0.1 ml of L-PRF, 0.1 ml of XENO, and a mixture of 0.1 ml of L-PRF plus 0.1 ml of XENO, respectively. L-PRF compressed clots were used to cover the defects in PRF and PRF-XENO groups. Animals were submitted to euthanasia at 30 postoperative days. Histomorphometric, microtomographic, and immunohistochemical analyses were performed.

RESULTS

PRF-XENO group presented greater amount of neoformed bone (NB) when compared with XENO group, as well as higher expression of vascular endothelial growth factor (VEGF), osteocalcin (OCN), and bone morphogenetic protein (BMP-2/4) (p < .05). PRF group presented increased amount of NB and higher expression of VEGF, OCN, BMP-2/4, and Runt-related transcription factor 2 (RUNX-2) when compared with group C (p < .05).

CONCLUSIONS

(a) The isolated use of L-PRF clot can improve bone neoformation in CSDs in rats with osteoporosis induced by ovariectomy, but seems to lead to decreased amount of bone neoformation when compared to the isolated use of XENO; (b) L-PRF potentiates the healing of XENO in rats with osteoporosis induced by ovariectomy.

Platelet-Rich Fibrin in Regeneration of Intrabony Defects: A Randomized Controlled Trial

BACKGROUND

Platelet-rich fibrin (PRF) is an autologous non-transfusional hemo-component with a high concentration of platelets. It incorporates leukocytes, platelets, and growth factors within the dense fibrin matrix and can be used as healing biomaterial. This study assesses the adjunctive use of PRF in regenerative management of intrabony defects in comparison with open flap debridement (OFD).

METHODS

Twenty-six bilateral defects (13 per group) in 13 patients were randomized as either PRF (test group) or OFD alone (control group) sites. Probing depth (PD), clinical attachment level (CAL), and bone PD were recorded. Reduction in defect depth and percentage of bone fill was assessed radiographically. Primary outcomes assessed were changes in PD, CAL, and percentage of bone fill, and they were assessed at 6, 9, and 12 months. Secondary outcome was assessment of wound healing using a wound healing index (WHI).

RESULTS

The PRF group showed significant improvement in clinical parameters compared with the control group at 6, 9, and 12 months. The PRF group showed a bone fill of 45.18% ± 7.57%, which was statistically significant compared with 21.6% ± 9.3% seen in the control group at the end of the study period. The PRF group also showed significant soft tissue healing and reduction in PD. WHI also showed significant advantages for the PRF group.

CONCLUSION

The adjunctive use of PRF to conventional OFD may be potentially used in the treatment of intrabony defects.

Three-dimensional structure and cytokine distribution of platelet-rich fibrin

OBJECTIVES:

Previous reports have revealed that several cytokines (including platelet-derived growth factor-BB, transforming growth factors-β1 and insulin-like growth factor-1) can enhance the rate of bone formation and synthesis of extracellular matrix in orthopaedics or periodontology. This study aimed to determine the concentration of cytokines within platelet-rich fibrin microstructures and investigate whether there are differences in the different portions of platelet-rich fibrin, which has implications for proper clinical use of platelet-rich fibrin gel.

METHODS:

Whole blood was obtained from six New Zealand rabbits (male, 7 to 39 weeks old, weight 2.7-4 kg); it was then centrifuged for preparation of platelet-rich fibrin gels and harvest of plasma. The resultant platelet-rich fibrin gels were used for cytokine determination, histological analyses and scanning electron microscopy. All plasmas obtained were subject to the same cytokine determination assays for the purpose of comparison.

RESULTS:

Cytokines platelet-derived growth factor-BB and transforming growth factor-β1 formed concentration gradients from high at the red blood cell end of the platelet-rich fibrin gel (p=1.88×10-5) to low at the plasma end (p=0.19). Insulin-like growth factor-1 concentrations were similar at the red blood cell and plasma ends. The porosities of the platelet-rich fibrin samples taken in sequence from the red blood cell end to the plasma end were 6.5% ± 4.9%, 24.8% ± 7.5%, 30.3% ± 8.5%, 41.4% ± 12.3%, and 40.3% ± 11.7%, respectively, showing a gradual decrease in the compactness of the platelet-rich fibrin network.

CONCLUSION:

Cytokine concentrations are positively associated with platelet-rich fibrin microstructure and portion in a rabbit model. As platelet-rich fibrin is the main entity currently used in regenerative medicine, assessing cytokine concentration and the most valuable portion of PRF gels is essential and recommended to all physicians.

Platelet rich fibrin: a new paradigm in periodontal regeneration

Among the great challenges facing clinical research is the development of bioactive surgical additives regulating inflammation and increasing healing. Although the use of fibrin adhesives and platelet-rich plasma (PRP) is well documented, they have their own limitations. Hence, reconstructive dental surgeons are looking for an "edge" that jump starts the healing process to maximize predictability as well as the volume of regenerated bone. Overcoming the restrictions related to the reimplantation of blood-derived products, a new family of platelet concentrate, which is neither a fibrin glue nor a classical platelet concentrate, was developed in France. This second generation platelet concentrate called platelet-rich fibrin (PRF), has been widely used to accelerate soft and hard tissue healing. Its advantages over the better known PRP include ease of preparation/application, minimal expense, and lack of biochemical modification (no bovine thrombin or anticoagulant is required). This article serves as an introduction to the PRF "concept" and its potential clinical applications with emphasis on periodontal regeneration.