A comparative evaluation of iliac crest bone graft with and without injectable and advanced platelet rich fibrin in secondary alveolar bone grafting for cleft alveolus in unilateral cleft lip and palate patients: A randomized prospective study

Iliac Crest Bone Graft and Fascia Lata Free Flap for Rescue of Mandibular Osteoradionecrosis

OBJECTIVE

Describe the use, indications, and outcomes of iliac crest bone graft (ICBG) with concomitant anterolateral thigh fascia lata (ALTFL) rescue flap for the management of mandibular osteoradionecrosis (ORN).

STUDY DESIGN

Retrospective chart review.

SETTING

Single institution.

METHODS

Retrospective chart review of patients who underwent ICBG with ALTFL rescue flap for mandibular ORN between 2011 and 2023.

RESULTS

Twenty-three patients (mean age 66.5 years, 73.9% male) with mandibular ORN underwent ICBG at the time of ATLFL. Patients failed prior antibiotic therapy (78.3%), hyperbaric oxygen therapy (39.1%), and/or pentoxifylline/tocopherol (34.8%). The most common mandibular subsites included the body (91.3%) and the angle (60.9%). All patients underwent concurrent ICBG with ALTFL to augment cortical height of retained mandible (<1 cm following debridement of ORN to healthy, bleeding bone). Following the ALTFL rescue flap with ICBG, the median length of stay was 3 days. There was 1 episode of flap failure noted at follow-up, requiring additional ALTFL procedure. No other major complications were reported at the reconstructed site. There were no complications associated with ICBG harvest, with all patients ambulating at the time of discharge. The mean clinical follow-up length was 20 months. Mandibular stability, based on radiographic features and clinical symptoms, was maintained in the majority of patients. Mandibular height was restored to an average of 1.9 cm, with a mean radiographic follow-up length of 16.8 months. A subset of patients (n = 4, 17.4%) experienced a flare in ORN symptoms following this procedure and required additional mandibular debridement with antibiotic therapy. One such patient required segmental mandibulectomy with osteocutaneous free flap reconstruction; however, all other patients exhibited radiographic and clinical arrest of symptoms for the follow-up period of 6.5 to 61.7 months.

CONCLUSION

In patients undergoing ALTFL rescue flap for mandibular ORN, ICBG appears to supplement mandibular height and strength in patients with limited remaining mandibular bone height following debridement, with successful arrest of clinical and radiographic disease progression, low morbidity, and abbreviated hospital stays.

LEVEL OF EVIDENCE

Level 4.

Application of Advanced Platelet-Rich Fibrin in Oral and Maxillo-Facial Surgery: A Systematic Review

Background: Advanced platelet-rich fibrin (A-PRF) is produced by centrifuging the patient's blood in vacuum tubes for 14 min at 1500 rpm. The most important component of A-PRF is the platelets, which release growth factors from their ⍺-granules during the clotting process. This process is believed to be the main source of growth factors. The aim of this paper was to systematically review the literature and to summarize the role of A-PRF in oral and maxillo-facial surgery. Materials and Methods: A systematic review was carried out, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (PROSPERO: CRD42024584161). Results: Thirty-eight articles published before 11 November 2024 were included in the systematic review. The largest study group consisted of 102 patients, and the smallest study group consisted of 10 patients. A-PRF was most often analyzed compared to leukocyte-PRF (L-PRF) or blood cloth. A-PRF was correlated with lower postoperative pain. Also, A-PRF was highlighted to have a positive effect on grafting material integration. A-PRF protected areas after free gingival graft very well, promoted more efficient epithelialization of donor sites and enhanced wound healing. Conclusions: Due to its biological properties, A-PRF could be considered a reliable addition to the surgical protocols, both alone and as an additive to bio-materials, with the advantages of healing improvement, pain relief, soft tissue management and bone preservation, as well as graft integration. However, to determine the long-term clinical implications and recommendations for clinical practice, more well-designed randomized clinical trials are needed in each application, especially those with larger patient cohorts, as well as additional blinding of personnel and long follow-up periods.

Does the adjunctive use of autologous platelet concentrate during secondary alveolar bone grafting reduce the risk of wound dehiscence? A systematic review and meta-analysis

Wound dehiscence is a common complication after secondary alveolar bone grafting (SABG), leading to unfavourable surgical outcomes. Studies have shown that autologous platelet concentrates (APC) may enhance wound healing and improve outcomes. Therefore, this review aimed to evaluate in patients with alveolar clefts, whether using APC and iliac crest bone graft can mitigate the likelihood of wound dehiscence formation compared with those who underwent iliac bone grafting only following SABG. A comprehensive literature search was conducted using various electronic databases, including PubMed, Embase, Scopus, Web of Science, EBSCOhost, Ovid MEDLINE, LILACS, Cochrane Library, and grey literature, to include studies until July 31, 2023, without any restriction to language and time of publication. Only randomized (RCT) and controlled (CCT) clinical trials were included. Two independent reviewers screened the studies based on the predefined criteria, after which a qualitative and quantitative analysis was conducted. The search yielded 821 studies, of which seven were deemed eligible for systematic review. The risk of bias assessment done using "The Cochrane collaboration tool for risk of bias assessment" for six RCTs and the "Risk of Bias in Non-randomized Studies - of Interventions" for one CCT revealed a moderate to high risk of bias. The meta-analysis of five studies showed that the overall risk of developing wound dehiscence was lower in the APC group (RR = 0.33; 95% CI: 0.16, 0.71; p = 0.005; χ2 = 0.82; I2 = 0%). Subgroup analyses based on study design further supported these findings. Although the adjuvant use of APC for alveolar cleft reconstruction reduces the risk of wound dehiscence, more studies with increased scientific rigour and fewer confounding variables are warranted.

Tooth Autotransplantation, Autogenous Dentin Graft, and Growth Factors Application: A Method for Preserving the Alveolar Ridge in Cases of Severe Infraocclusion-A Case Report and Literature Review

Background: Tooth infraocclusion is a process in which a completely or partially erupted tooth gradually moves away from the occlusal plane. Submerged teeth can lead to serious complications. Treating teeth with infraocclusion is very challenging. One of the procedures allowing for the replacement of a missing tooth is autotransplantation. The aim of this paper is to review the literature on teeth autotransplantation, supported by a case report involving the autotransplantation of a third mandibular molar into the site of an extracted infraoccluded first mandibular molar, as well as the utilization of advanced platelet-rich fibrin (A-PRF) alongside autogenous dentin grafts for bone tissue regeneration. Methods: A severely infraoccluded first permanent right mandibular molar was extracted and then ground to obtain the dentin graft. A-PRF clots (collected from the patient's peripheral blood) were added to the autogenous dentin graft, to create the A-PRF membrane. An atraumatic extraction of the lower left third molar was performed and then it was transplanted into the socket of tooth no. 46. Immediately after transplantation, tooth no. 38 was stabilized with orthodontic bracket splints for 3 months. The patient attended regular follow-up visits within 12 months. Results: After one year, the patient did not report any pain. In the clinical examination, the tooth and surrounding tissues did not show any signs of infection. However, radiographically, cervical inflammatory resorption, unchanged pulp canal dimensions, absent root growth, periapical radiolucency, and lack of apical and marginal healing were observed. Reconstruction of the bone defect was obtained and the alveolar ridge of the mandible was preserved. Due to poor stability of the tooth and severe resorption, the tooth needed to be extracted. Conclusions: This study is designed to critically evaluate the efficacy of autotransplantation, the application of growth factors, and the integration of autogenous dentin grafts in remedying dental deficiencies resulting from reinclusion. We aim to point out the possible causes of treatment failure.

Platelet-rich fibrin as an autologous biomaterial for bone regeneration: mechanisms, applications, optimization

Platelet-rich fibrin, a classical autologous-derived bioactive material, consists of a fibrin scaffold and its internal loading of growth factors, platelets, and leukocytes, with the gradual degradation of the fibrin scaffold and the slow release of physiological doses of growth factors. PRF promotes vascular regeneration, promotes the proliferation and migration of osteoblast-related cells such as mesenchymal cells, osteoblasts, and osteoclasts while having certain immunomodulatory and anti-bacterial effects. PRF has excellent osteogenic potential and has been widely used in the field of bone tissue engineering and dentistry. However, there are still some limitations of PRF, and the improvement of its biological properties is one of the most important issues to be solved. Therefore, it is often combined with bone tissue engineering scaffolds to enhance its mechanical properties and delay its degradation. In this paper, we present a systematic review of the development of platelet-rich derivatives, the structure and biological properties of PRF, osteogenic mechanisms, applications, and optimization to broaden their clinical applications and provide guidance for their clinical translation.

Treatment of Odontogenic Maxillary Sinusitis with the Use of Growth Factors in Advanced Platelet-Rich Fibrin for Immediate Closure of Oro-Antral Communication: A Case Report

Chronic odontogenic maxillary sinusitis (COMS), a prolonged inflammation of the maxillary sinus lasting over 12 weeks, is often a result of periapical lesions, marginal periodontitis, and complications like oro-antral communication (OAC) and fistula (OAF). OAC, commonly emerging post-teeth extraction in the lateral maxilla, lacks documented treatments using advanced platelet-rich fibrin (A-PRF). This study evaluates A-PRF's efficacy in treating COMS and immediately sealing extensive OAC. A case of a 28-year-old male with COMS linked to a periapical lesion and supernumerary molars is presented. Treatment involved extracting specific teeth while preserving adjacent ones and using A-PRF for immediate OAC closure. A-PRF, enriched with growth factors, was pivotal in healing, showcasing enhanced tissue regeneration, pain reduction, and faster recovery. The findings suggest A-PRF as an effective adjunct in treating extensive OAC and COMS, proposing its inclusion in standard treatment protocols. This study underscores A-PRF's potential in improving outcomes for patients with COMS and related complications.

Stem Cell-Based Regenerative Approaches for the Treatment of Cleft Lip and Palate: A Comprehensive Review

Cleft lip and/or palate (CLP) is a prevalent congenital craniofacial abnormality that can lead to difficulties in eating, speaking, hearing, and psychological distress. The traditional approach for treating CLP involves bone graft surgery, which has limitations, post-surgical complications, and donor site morbidity. However, regenerative medicine has emerged as a promising alternative, employing a combination of stem cells, growth factors, and scaffolds to promote tissue regeneration. This review aims to provide a comprehensive overview of stem cell-based regenerative approaches in the management of CLP. A thorough search was conducted in the Medline/PubMed and Scopus databases, including cohort studies, randomized controlled trials, case series, case controls, case reports, and animal studies. The identified studies were categorized into two main groups: clinical studies involving human subjects and in vivo studies using animal models. While there are only a limited number of studies investigating the combined use of stem cells and scaffolds for CLP treatment, they have shown promising results. Various types of stem cells have been utilized in conjunction with scaffolds. Importantly, regenerative methods have been successfully applied to patients across a broad range of age groups. The collective findings derived from the reviewed studies consistently support the notion that regenerative medicine holds potential advantages over conventional bone grafting and represents a promising therapeutic option for CLP. However, future well-designed clinical trials, encompassing diverse combinations of stem cells and scaffolds, are warranted to establish the clinical efficacy of these interventions with a larger number of patients.

Ten years of injectable platelet-rich fibrin

The use of platelet-rich fibrin (PRF) has seen widespread advantages over platelet-rich plasma (PRP) in many fields of medicine. However, until 2014, PRF remained clinically available only in its solid clotted form. Modifications to centrifugation protocols and tube technology have led to the development of a liquid injectable version of PRF (i-PRF). This narrative review takes a look back at the technological developments made throughout the past decade and further elaborates on their future clinical applications. Topics covered include improvements in isolation techniques and protocols, ways to further concentrate i-PRF, and the clinical impact and relevance of cooling i-PRF. Next, various uses of i-PRF are discussed, including its use in regenerative periodontology, implantology, endodontics, temporomandibular joint injections, and orthodontic tooth movement. Furthermore, various indications in medicine are also covered, including its use in sports injuries and osteoarthritis of various joints, treatment of diabetic ulcers/wound care, and facial esthetics and hair regrowth. Finally, future applications are discussed, mainly its use as a drug delivery vehicle for small biomolecules, such as growth factors, antibiotics, exosomes, and other medications that may benefit from the controlled and gradual release of biomolecules over time.

Effectiveness of i-PRF in periodontal regeneration - A systematic review and meta-analysis

Background

Periapical diseases are common dental conditions that require non-surgical endodontic intervention (NEI) for successful treatment. However, the impact of diabetes mellitus (DM) on the periapical healing (PH) outcome in diabetic patients remains somewhat unclear. This review aimed to evaluate the PH outcome following endodontic intervention among DM-afflicted individuals.

Methods

A comprehensive search was conducted across multiple electronic databases to identify relevant studies. Specifically devised selection criteria were applied to select studies that assessed PH outcomes in DM sufferers undergoing different treatment protocols. Data extraction and quality assessment were performed following predetermined protocols. ROB - 2 risk assessment tool assessed quality of the included studies.

Results

A total of 11 studies met the inclusion criteria and were included in the investigation. Four studies showed greater occurrence of apical periodontitis and five of them reduced healing and success rate in diabetic as compared to controls. Overall, nine studies showed that diabetes mellitus affected periapical outcome negatively. This suggests that diabetes mellitus is an important factor in the prognosis of endodontic intervention. Assessment tools used were PAI, PR, SC and FD analysis. RoB-2 assessed the included studies to have moderate risk of bias.

Conclusion

This review provided compelling evidence that DM patients experienced a noticeable negative impact on PH outcome as compared to control population. These findings highlight the importance of considering the diabetic status of patients when assessing the prognosis of periapical diseases and planning NEI interventions. Further research is needed to validate these findings and explore potential mechanisms underlying the observed associations.

The Use of Platelet Concentrates in the Reconstruction of the Alveolar Cleft Defect: A Systematic Review and Meta-Analysis

OBJECTIVE

Evaluate quantitative and qualitative outputs when comparing the incidence of platelet concentrates (PCs) combined with autogenous bone grafts to an autograft control group for the reconstruction of alveolar cleft defects.

DESIGN

Systematic review and meta-analysis.

PATIENTS/PARTICIPANTS

Randomized and nonrandomized controlled clinical trials where PCs were used in the reconstruction of alveolar cleft defects.

INTERVENTIONS

Use of PCs in combination with autogenous bone graft in the experimental group and autogenous bone graft alone in the control group.

MAIN OUTCOME MEASURE(S)

Average bone formation and bone density were evaluated, mean differences were calculated and pooled by a meta-analysis technique. Additionally, clinical outcomes such as wound dehiscence, closure of the oronasal fistula, pain, swelling, discharges, infections, and bleeding were considered in the qualitative synthesis.

RESULTS

After an evaluation of forty-nine articles, nineteen were considered for the review. The qualitative assessment of bone density, bone formation, and clinical outcomes showed no differences between groups in most of the included studies. The meta-analysis showed no statistical differences between PCs groups when compared to the control group in bone density at three months (mean difference 45.67 HU, P = .23) and six months (mean difference 48.57 HU, P = .64). Neither were statistical differences in the percentage of regenerated bone volume at six months (mean difference 6.39%, P = .15) and the volume of newly formed bone at 12 months (mean difference 0.37 mm3, P = .99).

CONCLUSIONS

There were no significant differences in terms of bone formation, bone density, and clinical outputs between groups.

Effect of adjuvant autologous platelet concentrates on secondary repair of alveolar clefts: A systematic review and meta-analysis

OBJECTIVE

To review the existing evidence on the adjuvant use of autologous platelet concentrates (APCs) with iliac crest bone graft (ICBG) in the reconstruction of the secondary alveolar cleft.

METHODS

Electronic databases were searched systematically until November 2022. Clinical trials comparing the three-dimensional radiological outcomes of patients who underwent secondary alveolar bone grafting (SABG) with ICBG and APCs to those with ICBG alone and the radiological outcomes assessed 6 months after surgery were included. Two authors performed the study selection and the assessment of the risk of bias. Meta-analysis was performed using the random-effects model to determine the risk ratio (RR) for developing wound dehiscence and the mean difference (MD) with a 95% confidence interval (CI) for the percentage of newly formed bone.

RESULTS

Nine studies (seven RCT and two CCT) were included with a low to high risk of bias. At the 6-month follow-up, the study group revealed insignificant results regarding the percentage of newly formed bone (MD = 6.49; 95% CI: -0.97, 13.94; p = .09; χ2  = 0.01; I2  = 71%). In addition, the overall risk of developing wound dehiscence was lower in the study group (RR = 0.34; 95% CI: 0.15, 0.78; p = .01; χ2  = 0.67; I2  = 0%).

CONCLUSION

Currently, there is insufficient evidence to support the adjuvant use of APCs with ICBG on enhanced bone regeneration following secondary alveolar bone grafting. However, combining ICBG and APCs might be beneficial in reducing the risk of developing wound dehiscence.

Use of autologous platelet derivatives for secondary alveoloplasty in patients with cleft lip and palate: a systematic review and meta-analysis

This study aimed to evaluate the effectiveness of autologous platelet derivatives (APD), specifically platelet-rich plasma (PRP) or platelet-rich fibrin (PRF), combined with autogenous iliac crest bone grafts in secondary alveoloplasty for patients with cleft lip and palate. Electronic databases, relevant journals, and reference lists of included studies were searched until July 2022. Best-evidence synthesis was performed to draw conclusions. After the search strategies, 12 randomized controlled trials were included that provided data on six outcomes: newly formed bone, mean bone loss in height and width, bone density, functionality, and postoperative complications. Two authors independently assessed the risk of bias, and the certainty of evidence was assessed using the GRADE approach. The pooled results suggest that there is uncertainty as to whether the combination of APDs with autogenous iliac crest bone grafts improves the percentage of newly formed bone, as the certainty of the evidence was assessed as very low. It may slightly improve the functionality of patients (with low certainty of the evidence) and probably slightly reduces the incidence of postoperative complications (with moderate certainty of evidence). Further randomized clinical trials with standardized methodologies are required to validate these findings.

Injectable platelet-rich fibrin positively regulates osteogenic differentiation of stem cells from implant hole via the ERK1/2 pathway

Bone regeneration in dentistry is a dynamic approach for treating critical size bone defects that are unlikely to self-heal. Human bone marrow stem cell (hBMSCs) therapies are being tested clinically for various disorders and have remarkable clinical advancements in bone regeneration. Injectable platelet-rich fibrin (i-PRF), which is obtained from autologous blood centrifuged at 700 rpm (60 G) for 3 min can promote osteogenic differentiation of this cell, but the mechanism remains unclear. The objectives of this study were to explore the contents of i-PRF further and investigate its effect on the cell behavior of hBMSCs and the underlying molecular mechanisms. The results showed that i-PRF contained 41 cytokines, including macrophage colony-stimulating factor (M-CSF) and β-nerve growth factor (β-NGF), which had not been reported before. The Cell Counting Kit-8 and wound healing assay showed that 10% and 20% i-PRF improved the proliferation rate and the migration capacity of hBMSCs without toxicity to cells. Besides, the expression of osteogenic markers and the capacity to form mineralized nodules of hBMSCs were promoted by 20% i-PRF. Furthermore, i-PRF activated the ERK pathway, and the ERK inhibitor attenuated its effects. In summary, i-PRF promotes hBMSCs proliferation and migration and facilitates cell osteogenesis through the ERK pathway, which has promising potential in bone regeneration.

Using the Dermal Fat Graft as a Barrier Membrane in Unilateral Alveolar Cleft Grafting: A Randomized Clinical Trial

INTRODUCTION

Alveolar cleft grafting is a surgical procedure that usually suffers from inferior results.

METHODOLOGY

The patients were divided into 2 groups; study and control. In the study group, the grafted site was covered with a dermal fat graft.

RESULTS

Showed that the bone fill percentage (Bergland Scale) recorded in the study was significantly better ( P =0.03); the study group had 14 successful cases out of 18 compared with the control, which had only 9 out of 20. The study group significantly ( P = 0.002) better bone fill (71%±32%) compared with the control (46%±33%). There was a significant reduction in dehiscence in the study compared with the control ( P =0.02); the study group had no dehiscence compared with the control, which had 5 dehiscence.

CONCLUSION

The dermal fat graft use as a barrier membrane was successful in improving alveolar cleft grafting.

A Comparative Evaluation of Iliac Crest Cortical-Cancellous Bone Blocks Graft With and Without Concentrated Growth Factors (CGFs) in Secondary Alveolar Bone Grafting: A Retrospective Study

BACKGROUND

The purpose of this study was to investigate the clinical effect and bone resorption of iliac crest cortical-cancellous bone block grafts combined with concentrated growth factor (CGF) compared with iliac crest cortical-cancellous bone block grafts only in secondary alveolar bone grafting.

MATERIALS AND METHODS

Eighty-six patients (43 in the CGF group and 43 in the non-CGF group) with unilateral alveolar clefts were examined. Patients (17 in the CGF group and 17 in the non-CGF group) were randomly chosen for radiologic evaluation. Quantitative evaluation of the bone resorption rate was made with cone-beam computed tomography and Mimics 19.0 software at 1 week and 12 months after surgery.

RESULTS

The success rate of bone grafting was 95.3% and 79.1% in the CGF and non-CGF groups, respectively ( P =0.025). The mean bone resorption rate at 12 months postoperatively was 35.66±15.80% and 41.39±19.57% in the CGF and non-CGF groups, respectively ( P =0.355). The bone resorption patterns of the 2 groups were similar on the labial, alveolar process, and palatal sides, and there was no obvious bone resorption on the labial side in either group. Nasal side bone resorption in the CGF group was significantly less than that in the non-CGF group ( P =0.047).

CONCLUSIONS

Cortical-cancellous bone block grafts reduce labial bone resorption, while CGF reduces nasal bone resorption and improves the success rate. The combination of bone block and CGF in secondary alveolar bone grafting is worthy of further clinical application.

Comparing the Healing Abilities of Fluorapatite and Hydroxyapatite Ceramics in Regenerating Bone Tissue: An In Vivo Study

Some reports in the literature show the advantages of fluoride-containing apatite ceramics over hydroxyapatite (HAP), at least in some aspects. While HAP has been used extensively in the treatment of bone defects, fluoridated apatite has hardly been tested in vivo. In order to verify the biological properties of fluoride-doped apatite and to assess its therapeutic potential, we synthesized fluorapatite (FAP) and applied it as a filling in bone defects of experimental animals (rabbits). The treatment effects were evaluated on extracted bones after 3 and 6 months from implantation using peripheral quantitative computed tomography (pQCT), dual-energy X-ray absorptiometry (DXA), radiography (X-ray) and histological staining. The study proved the integration between FAP and the bone tissue, thus indicating its stimulating effect on new bone formation and mineralization. The results achieved after 3 months of treatment were difficult to interpret unequivocally and suggested the transient delay in FAP integration of bone in comparison with HAP. The reasons for this phenomenon are unclear. Most likely, these differences between FAP and HAP resulted mainly from the different porosities, densities and ionic reactivity of the ceramics, which in our opinion affected their solubility, integration and degree of bone tissue resorption. However, it was shown that 6 months after implantation, similar level of bone defect regeneration was achieved for both FAP and HAP. In this article, we present our hypothesis concerning the basis of this phenomenon.

Can Our Blood Help Ensure Antimicrobial and Anti-Inflammatory Properties in Oral and Maxillofacial Surgery?

In recent decades, the potential of PRF has been extensively studied. The number of studies about PRF has increased three times since the year 2012, but the full spectrum of its fundamental properties, such as antimicrobial and anti-inflammatory activity, is not clearly described. In oral and maxillofacial surgery, PRF is described in alveolar ridge preservation, orthognathic surgery, cleft lip and palate surgery, maxillary sinus augmentation, and dental implant placement as demonstrating favorable results and its clinical advantages. The structural complexity, inhomogeneous nature, and clotting ability of PRF make its antimicrobial effect evaluation complicated. Nevertheless, most of the used antimicrobial testing methods are based on antibacterial agent diffusion ability in culture media. Because the oral and maxillofacial region is the most frequent area of PRF application, its antimicrobial activity evaluation also prevails in the oral microbiome. PRF's biological potential is highly dependent on the specific preparation protocol and methodology used; it should be carefully prepared and kept under proper conditions to keep cellular content alive. PRF's influence on living cells demonstrates a stimulating effect on bone regeneration, and an angiogenetic effect, and it provides anti-inflammatory activity. According to analyzed studies, PRF demonstrated success in oral and maxillofacial surgery in various methods of application. Antibacterial and anti-inflammatory properties were proven by antibacterial activity against different bacterial species, sustained growth factor, sustained release, and cell activity on the material application. Accurately and correctly prepared PRF can ensure antibacterial and anti-inflammatory properties, and it can be a beneficial clinical tool in oral and maxillofacial surgery.

The application of injectable platelet-rich fibrin in regenerative dentistry: A systematic scoping review of In vitro and In vivo studies

Background

Ongoing research in the dental field has begun to focus on the use of injectable platelet-rich fibrin (I-PRF) as a regenerative tool with the potential to prompt tissue regeneration. In this regard, this systematic scoping review aimed to collect, map, and appraise the in vitro and in vivo studies regarding the role of I-PRF in or soft and hard tissue regeneration in relation to oral and maxillofacial structures.

Methods

A systematic electronic search of Medline, Scopus, Web of Science, and Embase databases was performed from 2000 to December 2021 using a combination of keywords. All in vitro and in vivo studies, written in English and concerning the potential role of I-PRF in regenerative dentistry were considered.

Results

In total, 18 in vitro studies, 5 animal studies, 6 case reports, and 31 clinical studies have evaluated the effect of I-PRF on oral and maxillofacial soft and hard tissue regeneration. The investigated studies verified the anti-inflammatory, anti-microbial efficacy and the positive effects of I-PRF application for wound, periodontal, bone, cartilage, and pulp regeneration, as well as acceleration in tooth movement during orthodontic treatment.

Conclusions

Current literature approves the feasibility of I-PRF application as a promising regenerative adjunct to dental procedures.

Injectable Platelet-Rich Fibrin - A Revolution in Periodontal Regeneration

As of a few years ago, platelet concentrates have been applied in a variety of medical and dental procedures. A notable aspect is that platelet-rich fibrin (PRF) is the most commonly utilized platelet concentrate in the field of dentistry. The most significant modification that was used over the years but had the biggest impact was injectable platelet-rich fibrin (I-PRF), which has more special properties. Additionally, the results of this I-PRF have been useful. The solid platelet-rich fibrin (PRF), which is a noticeable feature and has a low speed and duration in centrifugation, is the main advantage of I-PRF. I-PRF is primarily found in liquid form as PRF. It facilitates the quickening of increased vascularization and aids in accelerating the healing of wounds. An autologous blood concentration known as I-PRF has been known for many years.

The advantage of I-PRF is that it exhibits constant release of growth factors and promotes cell migration by announcing the expression of type I collagen and transforming growth factor mRNA. The majority of the time, plastic and orthopedic operations use injectable platelet aggregates. It also reduces adverse reactions to transplanted material as compared to other grafting techniques. Additionally, it makes numerous other operations, like regenerative ones, much better options. In circumstances where it has been noticed, I-PRF is helpful and crucial in periodontics for bone regeneration and wound healing. It is therefore not difficult to predict that this fully autologous blood concentrate, which is now being utilized in numerous applications and requires little invasiveness, will become even more frequently used in the future. This review paper contains the differences between platelet-rich plasma (PRP) and PRF, the development of diverse platelets, and the use of I-PRF in periodontal therapy.

The feasibility of injectable PRF (I-PRF) for bone tissue engineering and its application in oral and maxillofacial reconstruction: From bench to chairside

Among all the biomaterials introduced in the field of bone tissue engineering, injectable platelet-rich fibrin (I-PRF) has recently gained considerable attention. I-PRF, as a rich source of biologically active molecules, is a potential candidate which can be easily obtained in bedside and constitutes several biological factors which can result in higher anti-bacterial, anti-inflammatory and regenerative capabilities. According to the studies evaluating the osteogenic efficacy of I-PRF, this biomaterial has exhibited favorable outcomes in terms of adhesion, differentiation, migration, proliferation and mineralization potential of stem cells. In addition, the injectability and ease-of-applicability of this biomaterial has led to its various clinical applications in the oral and maxillofacial bone regeneration such as ridge augmentation, sinus floor elevation, cleft palate reconstruction and so on. Furthermore, to enhance the clinical performance of I-PRF, albumin gel-PRF as a long-lasting material for long-term utilization has been recently introduced with a gradual increase in growth factor release pattern. This review provides a comprehensive approach to better evaluate the applicability of I-PRF by separately appraising its performance in in-vitro, in-vivo and clinical situations. The critical approach of this review toward the different production protocols and different physical and biological aspects of I-PRF can pave the way for future studies to better assess the efficacy of I-PRF in bone regeneration.

Efficiency of advanced-PRF usage in the treatment of alveolar cleft with iliac bone graft: A retrospective study

The aim of this study was to evaluate the efficiency of a new alveolar bone grafting protocol using advanced-PRF (a-PRF) by comparing the volumes of newly formed bone after a bone graft combining autogenous iliac crest bone with either PRF or a-PRF. Patients presenting with unilateral or a bilateral alveolar cleft were included retrospectively in two groups: one group was grafted using cancellous iliac crest bone with PRF (PRF group), whereas for the other group the same procedure was followed using a-PRF (a-PRF group). CBCT scans were performed 3 months preoperatively and 6 months postoperatively. The volume of newly formed bone was measured by subtracting the postoperative cleft volume from the preoperative cleft volume. The mean volume of newly formed bone was compared between the two groups using Student's t-test. Twenty-four patients were included, with 12 allocated to each group. Forty-eight CBCT scans were analyzed. The mean volume of newly formed bone was 0.29 (±0.09) cm³ in the a-PRF group, versus 0.20 (±0.08) cm³ in the PRF group (Student's t-test, p = 0.024). The percentage of newly formed bone was 60.4 (±10.4) % in the a-PRF group versus 51.4 (±18.4) % in the PRF group (Student's t-test, p = 0.165). Our study demonstrated improved bone regeneration in the a-PRF group. While bearing in mind the limitations of this study, the a-PRF procedure should be adopted in cleft bone grafting whenever possible.