The Effects of Photobiomodulation on Leukocyte and Platelet-Rich Fibrin as Barrier Membrane on Bone Regeneration: An Experimental Animal Study

Platelet rich fibrin is not a barrier membrane! Or is it?

Platelet-rich fibrin (PRF) is widely used in dentistry and other fields of medicine, and its use has become popular in dental implantology. In several published studies, PRF has been used as a barrier membrane. A barrier membrane is a sheet of a certain material that acts as a biological and mechanical barrier against the invasion of cells that are not involved in bone formation, such as epithelial cells. Among the basic requirements of a 'barrier membrane, occlusivity, stiffness, and space maintenance are the criteria that PRF primarily lacks; therefore, it does not fall under the category of barrier membranes. However, there is evidence that PRF membranes are useful in significantly improving wound healing. Does the PRF membrane act as a barrier? Should we think of adding or subtracting some points from the ideal requirements of a barrier membrane, or should we coin a new term or concept for PRF that will incorporate some features of a barrier membrane and be a combination of tissue engineering and biotechnology? This review is aimed at answering the basic question of whether the PRF membrane should be considered a barrier membrane or whether it is something more beyond the boundaries of a barrier membrane.

Can Collagen Membrane on Bone Graft Interfere with Light Transmission and Influence Tissue Neoformation During Photobiomodulation? A Preliminary Study

Objective: This study qualitatively and quantitatively evaluated the transmission of light through a collagen membrane and the consequent local bone formation in a critical bone defect in vitro and in an animal model. Background: Currently, bone substitutes and collagen membranes are used to promote new bone formation; however, when associated with photobiomodulation, biomaterials can act as a barrier, hindering the passage of light radiation to the area to be treated. Methods: Light transmittance was evaluated in vitro with a power meter and a 100 mW, 808 nm laser source with and without membrane. Twenty-four male rats received a critical surgical defect of 5 mm in diameter in the calvarial bone, subsequently a biomaterial (Bio-Oss; Geistlich®, Switzerland) was applied, and the animals were divided into the following three groups: G1-collagen membrane and no irradiation; G2-collagen membrane and photobiomodulation (irradiation with 4 J of 808 nm); and G3-photobiomodulation (4 J) followed by a collagen membrane. Histomophometric analyses were performed at 7 and 14 days after euthanasia. Results: The membrane reduced the light transmittance (808 nm) by an average of 78%. Histomophometric analyses showed significant differences in new blood vessels on day 7 and bone neoformation on day 14. Irradiation without membrane interposition resulted in a 15% more neoformed bone compared with the control (G1), and 6.5% more bone compared with irradiation over the membrane (G2). Conclusions: The collagen membrane interferes with light penetration during photobiomodulation, decreases light dosimetry on the wound area, and interferes with bone neoformation.

Medication-Related Osteonecrosis of the Jaw: Successful Medical Management of Complex Maxillary Alveolus with Sinus Involvement

Medication-related osteonecrosis of the jaw (MRONJ) in cancer patients presents a considerable challenge in management. Current management is primarily based on interventions in a limited number of cases assessing a single approach. Medical management typically is reported to include antimicrobial therapy with or without surgery. Advances in the understanding of pathogenesis have led to the investigation of additional medical interventions for early-stage necrosis. We present 3 patients with advanced-stage MRONJ of the maxilla using combined medical modalities including antimicrobial therapy, photobiomodulation therapy, pentoxifylline, vitamin E, and synthetic parathyroid hormone. All patients had a good outcome and avoided surgical intervention. We also report biological and functional imaging that may assist in more effective diagnosis and management of MRONJ. The 3 patients reported suggest that combined medical management should be considered in all cases of MRONJ (including stage III) prior to determining if surgical intervention is required. Functional imaging with a technetium bone scan or positron emission tomography scan correlated with diagnosis and confirmed resolution in patients. We present 3 challenging MRONJ patients that were effectively managed with a combined medical and nonsurgical therapy that demonstrated good clinical outcomes avoiding surgical interventions.

Impact of Frontier Development of Alveolar Bone Grafting on Orthodontic Tooth Movement

Sufficient alveolar bone is a safeguard for achieving desired outcomes in orthodontic treatment. Moving a tooth into an alveolar bony defect may result in a periodontal defect or worse–tooth loss. Therefore, when facing a pathologic situation such as periodontal bone loss, alveolar clefts, long-term tooth loss, trauma, and thin phenotype, bone grafting is often necessary to augment bone for orthodontic treatment purposes. Currently, diverse bone grafts are used in clinical practice, but no single grafting material shows absolutely superior results over the others. All available materials demonstrate pros and cons, most notably donor morbidity and adverse effects on orthodontic treatment. Here, we review newly developed graft materials that are still in the pre-clinical stage, as well as new combinations of existing materials, by highlighting their effects on alveolar bone regeneration and orthodontic tooth movement. In addition, novel manufacturing techniques, such as bioprinting, will be discussed. This mini-review article will provide state-of-the-art information to assist clinicians in selecting grafting material(s) that enhance alveolar bone augmentation while avoiding unfavorable side effects during orthodontic treatment.

Efficacy and safety of autologous platelet-rich fibrin for the treatment of infertility with intrauterine adhesions

AIM

To evaluate the efficacy and safety of autologous platelet-rich fibrin (PRF) for the treatment of infertility with intrauterine adhesions.

METHODS

Forty patients who suffered from infertility with intrauterine adhesions (IUAs) were enrolled in this prospective trial from October 2018 to December 2019. They were randomly divided into a PRF group and a control group. Both groups underwent transcervical resection of adhesions (TCRA) during the follicular phase. PRF group: PRF prepared from autologous venous blood was placed in the uterine cavity after TCRA and after the first menstrual re-fluid; control group: no PRF insertion. After the second menstrual re-fluid, both groups underwent hysteroscopy to reevaluate adhesion severity. Pregnancy rate, intrauterine adhesion score, menstrual volume and duration, and endometrial thickness were assessed and adverse events were recorded.

RESULTS

(1) PRF group pregnancy rate was significantly higher than the control group (55.0% vs. 20.0%). Mean follow-up time was (17.63 ± 2.33) months. All patients fell pregnant naturally. Four (PRF) and one (control) patients delivered live births without placental complications. (2) Intrauterine adhesion scores decreased compared with treatment-before. (3) In the pictorial blood loss assessment chart, score and menstrual duration during the 3rd menstrual cycle showed significant improvements for both groups. (4) Endometrial thickness also showed an increasing trend, and subendometrial bloodflow improved. (5) No treatment-related serious adverse events were noted.

CONCLUSION

Placing PRF into the uterine cavity of infertility patients with IUAs following TCRA is a safe and effective therapeutic method.