Platelet-rich fibrin membranes as scaffolds for periosteal tissue engineering

Clinical Applications of Adipose-Derived Stem Cell (ADSC) Exosomes in Tissue Regeneration

Adipose-derived stem cells (ADSCs) are mesenchymal stem cells with a great potential for self-renewal and differentiation. Exosomes derived from ADSCs (ADSC-exos) can imitate their functions, carrying cargoes of bioactive molecules that may affect specific cellular targets and signaling processes. Recent evidence has shown that ADSC-exos can mediate tissue regeneration through the regulation of the inflammatory response, enhancement of cell proliferation, and induction of angiogenesis. At the same time, they may promote wound healing as well as the remodeling of the extracellular matrix. In combination with scaffolds, they present the future of cell-free therapies and promising adjuncts to reconstructive surgery with diverse tissue-specific functions and minimal adverse effects. In this review, we address the main characteristics and functional properties of ADSC-exos in tissue regeneration and explore their most recent clinical application in wound healing, musculoskeletal regeneration, dermatology, and plastic surgery as well as in tissue engineering.

Surgical Management of Radicular Cyst With the Use of Advanced Platelet-Rich Fibrin and Bone Graft: A Case Report

In addition to helping with wound healing, periapical surgery is performed to remove periapical disease. Concentrates of platelets have been applied extensively in endodontics and other fields of regenerative medicine. A periapical inflammatory lesion was found in a 35-year-old male patient who complained of pain in the maxillary anterior region and displayed slight edema in the same area. The lesion was treated with periapical surgery utilizing advanced platelet-rich fibrin (A-PRF). Mesenchymal stem cell processes of proliferation and differentiation can be induced by several types of platelet concentrates. Growth factors are released at the application site by platelet-rich fibrin (PRF) for a minimum of seven days. The activity of osteoblasts is stimulated by growth factors and secreted cytokines. Furthermore, the release of growth factors promotes fibroblast migration, which quickens tissue regeneration.  In addition to helping with wound healing, periapical surgery is performed to remove periapical disease. The synthesis of fibrin networks laden with platelets and growth factors is made possible by PRF, which is subsequently used to accelerate bone regeneration and, consequently, to improve bone formation. In this instance, the best possible bone regeneration and repair were accomplished. After 12 weeks, 24 weeks, and 36 weeks, the patient was brought back for follow-ups. He was found to be asymptomatic, and the radiograph showed considerable periapical healing with nearly enough bone production.

Platelet-Rich Fibrin (PRF) and its Application in Dentistry: A Literature Review

Platelet-rich fibrin (PRF) is a biocompatible fibrin matrix that acts as a resorbable membrane, collecting platelet cytokines, growth factors, and cells and releasing them. It is easily extracted from blood. Many dentists use PRF, a concentrated growth factor solution, to treat various lesions and regenerate tooth and oral tissues. This research examines the pros, cons, and suggestions of using PRF in dentistry.

The Effects of Platelet-Rich Fibrin in the Behavior of Mineralizing Cells Related to Bone Tissue Regeneration-A Scoping Review of In Vitro Evidence

Platelet-rich fibrin (PRF) is a second-generation blood concentrate that serves as an autologous approach for both soft and hard tissue regeneration. It provides a scaffold for cell interaction and promotes the local release of growth factors. PRF has been investigated as an alternative to bone tissue therapy, with the potential to expedite wound healing and bone regeneration, though the mechanisms involved are not yet fully understood. This review aims to explore the in vitro evidence of PRF's effects on the behavior of mineralizing cells related to bone tissue regeneration. A systematic electronic search was conducted up to August 2023, utilizing three databases: PubMed, Web of Science, and Scopus. A total of 76 studies were selected, which presented in vitro evidence of PRF's usefulness, either alone or in conjunction with other biomaterials, for bone tissue treatment. PRF membranes' influence on the proliferation, differentiation, and mineralization of bone cells is linked to the constant release of growth factors, resulting in changes in crucial markers of bone cell metabolism and behavior. This further reinforces their therapeutic potential in wound healing and bone regeneration. While there are some notable differences among the studies, the overall results suggest a positive effect of PRF on cell proliferation, differentiation, mineralization, and a reduction in inflammation. This points to its therapeutic potential in the field of regenerative medicine. Collectively, these findings may help enhance our understanding of how PRF impacts basic physiological processes in bone and mineralized tissue.

To Evaluate the Antimicrobial Activity of PRP and PRF with and without Nanosilver

Aim

To evaluate the antimicrobial activity of PRP and PRF with and without nanosilver.

Materials and Methods

The materials were tested in powdered form is nanosilver. The nanosilver particles was mixed to form with PRP and PRF so as to placed in a wells followed the groups are experimental groups; Group I: PRP + nanosilver particles, Group II: PRF + nanosilver and control group: PRP and PRF and normal saline. Silver nanoparticles was tested at concentrations of 50 μ gram per mL. The powder was prepared for each group with identical amount of the powder (milligram/mg) and then mixed with 1 milliliter liquid. The plates are then incubated at 37°C under appropriate atmospheric conditions (80% N2, 10% CO2, 10% H2) for 24 hours, 48 hours, and 72 hours under anaerobic conditions in a CO2 incubator. The diameters of the zones of bacterial and fungal growth inhibition around the wells containing the test substances are then recorded after the period of incubation. The inhibitory zone determined in millimeter by measuring scale the shortest distance between the outer margin of the well and initial microbial as well as fungal growth. The experiments were performed 20 times and the mean and standard deviations of the inhibitory zones were calculated.

Result

Platelet rich fibrin is mixed with nanosilver particles showed higher antimicrobial efficacy than platelet rich plasma with nanosilver and simple platelet rich plasma and platelet rich fibrin are equivalent when it is placed against the anaerobic bacteria E.faecalis and yeast like fungi Candida albicans, respectively.

Conclusion

Groups presented with antimicrobial efficacy in this order- Group IV > Group II > Group III > Group I.

The effect of dental pulp stem cells and L-PRF when placed into the extraction sockets of impacted mandibular third molars on the periodontal status of adjacent second molars: a split-mouth, randomized, controlled clinical trial

PURPOSE

To compare the clinical and radiographic effectiveness of dental pulp stem cells (DPSCs) seeded onto L-PRF and L-PRF alone in the extraction socket of mandibular third molars.

METHODS

This study analyzed 13 patients who required surgical removal of impacted bilateral mandibular third molars. The main outcome measures were the probing pocket depth (PPD) and clinical attachment levels (CAL) that were recorded for the adjacent second molars (LM2) at the baseline and 6 months after surgery. The secondary outcomes were radiographic vertical bone loss (VD) and relative bone density (rBD) distal to the LM2.

RESULTS

Twenty-six LM2s were evaluated. After 6 months, the L-PRF and L-PRF + DPSC groups showed a significant reduction in PPD (1.65 ± 1.01 mm and 1.54 ± 0.78 mm) and CAL (2.23 ± 1.45 mm and 2.12 ± 0.74 mm), respectively. There was no difference between the groups for any periodontal parameters. No significant differences were found between the groups regarding the VD or rBD at the sixth month.

CONCLUSIONS

This study found that there was a significant improvement regarding the PPD, CAL, and VD measurements with the application of L-PRF, both alone and with the addition of DPSC, at the extraction socket. DPSC did not significantly contribute to the results compared to L-PRF therapy alone.

TRIAL REGISTRATION

This study was registered on 23 December 2020 on ClinicalTrials.gov under the number NCT04641533.

Genipin modified lyophilized platelet-rich fibrin scaffold for sustained release of growth factors to promote bone regeneration

Lyophilized platelet-rich fibrin (L-PRF) was shown to further activate resident platelets in platelet-rich fibrin causing a higher amount of growth factors release. However, it still required further experimental studies to resolve the uncontrolled degradation and burst release problem. In this study, the nature crosslinker genipin is introduced to improve the performance of L-PRF scaffold. We used a series of gradient concentration genipin solutions to react with L-PRF. The crosslinking degree, micro morphology, mean pore size, water absorption and mechanical properties of the crosslinked scaffold were evaluated. In order to study the effect of genipin modification on the release kinetics of growth factors from L-PRF, we detected the release of platelet-derived growth factor, vascular endothelial growth factor and transforming growth factor in vitro by ELISA. To investigate the biodegradability of the crosslinked L-PRF in vivo, the scaffolds were transplanted subcutaneously into backs of rats, and the materials were recovered at 1, 2 and 4 weeks after implantation. The biodegradation, inflammatory reaction and biocompatibility of the scaffolds were examined by histological staining. Finally, the genipin crosslinked/uncrosslinked L- Platelet-rich fibrin scaffolds were implanted with freshly prepared SHED cell sheets into rat critical size calvarial defects and the skull samples were recovered to examine the treatment efficacy of genipin crosslinked L-PRF by histologic and radiographic approaches. Results of this study indicated that genipin can be used to modify L-PRF at room temperature at a very low concentration. Genipin-modified L-PRF shows better biomechanical performance, slower biodegradation, good bioavailable and sustained release of growth factors. The 0.01% w/v and 0.1% w/v genipin crosslinked L-PRF have good porous structure and significantly promote cell proliferation and enhance the expression of key genes in osteogenesis in vitro, and work best in promoting bone regeneration in vivo.

Biomimicking design of artificial periosteum for promoting bone healing

Background

Periosteum is a vascularized tissue membrane covering the bone surface and plays a decisive role in bone reconstruction process after fracture. Various artificial periosteum has been developed to assist the allografts or bionic bone scaffolds in accelerating bone healing. Recently, the biomimicking design of artificial periosteum has attracted increasing attention due to the recapitulation of the natural extracellular microenvironment of the periosteum and has presented unique capacity to modulate the cell fates and ultimately enhance the bone formation and improve neovascularization.

Methods

A systematic literature search is performed and relevant findings in biomimicking design of artificial periosteum have been reviewed and cited.

Results

We give a systematical overview of current development of biomimicking design of artificial periosteum. We first summarize the universal strategies for designing biomimicking artificial periosteum including biochemical biomimicry and biophysical biomimicry aspects. We then discuss three types of novel versatile biomimicking artificial periosteum including physical-chemical combined artificial periosteum, heterogeneous structured biomimicking periosteum, and healing phase-targeting biomimicking periosteum. Finally, we comment on the potential implications and prospects in the future design of biomimicking artificial periosteum.

Conclusion

This review summarizes the preparation strategies of biomimicking artificial periosteum in recent years with a discussion of material selection, animal model adoption, biophysical and biochemical cues to regulate the cell fates as well as three types of latest developed versatile biomimicking artificial periosteum. In future, integration of innervation, osteochondral regeneration, and osteoimmunomodulation, should be taken into consideration when fabricating multifunctional artificial periosteum.

The Translational Potential of this Article: This study provides a holistic view on the design strategy and the therapeutic potential of biomimicking artificial periosteum to promote bone healing. It is hoped to open a new avenue of artificial periosteum design with biomimicking considerations and reposition of the current strategy for accelerated bone healing.

Progress of Platelet Derivatives for Cartilage Tissue Engineering

Articular cartilage has limited self-regeneration ability for lacking of blood vessels, nerves, and lymph that makes it a great challenge to repair defects of the tissue and restore motor functions of the injured or aging population. Platelet derivatives, such as platelet-rich plasma, have been proved effective, safe, and economical in musculoskeletal diseases for their autologous origin and rich in growth factors. The combination of platelet derivatives with biomaterials provides both mechanical support and localized sustained release of bioactive molecules in cartilage tissue engineering and low-cost efficient approaches of potential treatment. In this review, we first provide an overview of platelet derivatives and their application in clinical and experimental therapies, and then we further discuss the techniques of the addition of platelet derivatives and their influences on scaffold properties. Advances in cartilage tissue engineering with platelet derivatives as signal factors and structural components are also introduced before prospects and concerns in this research field. In short, platelet derivatives have broad application prospects as an economical and effective enhancement for tissue engineering–based articular cartilage repair.

Does zinc oxide nanoparticles potentiate the regenerative effect of platelet-rich fibrin in healing of critical bone defect in rabbits?

Background

Many encouraging studies confirmed the ability of Zinc Oxide Nanoparticles (ZnONPs) in accelerating bone growth and mineralization. The use of Platelet Rich-Fibrin (PRF) as a sole filling material for large segmental bone defects remains questionable. The objectives are to investigate the regenerative efficacy of autologous Platelet Rich-Fibrin (PRF) and Zinc Oxide Nanoparticles (ZnONPs) in repairing large segmental bone ulnar defects in a randomized controlled study in rabbits using computed tomographic interpretations. A 12 mm critical size defect was surgically induced in the ulna of 30 rabbits (n = 10/ group). In the control group, the defect was left empty. In the PRF group, the defect is filled with PRF. In the PRF/ZnONPs group, the defect is filled with PRF that was inoculated with 0.1 ml of 0.2% ZnONPs. Radiologic healing capacity was evaluated at the first, second, and third postoperative months.

Results

Statistical analysis showed significant differences in the radiologic healing scores between the groups (P = 0.000–0.0001) at all-time points (P = 0.000–0.047) during the study.

Conclusion

Rabbits in the PRF/ZnONPs group showed the highest appreciable bone quality and quantity followed by the PRF group with high quantity but low bone quality meanwhile, rabbits in the control group showed minimal quantity but medium bone quality. Interestingly, the addition of ZnONPs to PRF can accelerate the healing of ulnar critical-size defects in rabbits.

Autologous Platelet-Rich Fibrin Membrane to Augment Healing of Microfracture Has Better Macroscopic and Histologic Grades Compared With Microfracture Alone on Chondral Defects in a Rabbit Model

PURPOSE

To determine the in vivo effectiveness of a single-stage surgical procedure that combines microfracture and an autologous platelet-rich fibrin (PRF) membrane for cartilage repair in a rabbit model.

METHODS

Cartilage defects were created in the trochlear groove of the knees of adult white rabbits. Defects were divided into 2 treatment groups: microfracture only (control group) and microfracture covered by a PRF membrane (PRF group). To evaluate the repair cartilage, assessments were performed at 4, 12, and 24 weeks postoperatively using the International Cartilage Repair Society (ICRS) macroscopic scoring system and modified Wakitani histologic grading system.

RESULTS

The mean ICRS macroscopic scores in the control and PRF groups were 4.1 and 5.8, respectively, at 4 weeks (P = .0623); 6.3 and 9.8, respectively, at 12 weeks (P = .006); and 6.5 and 10.3, respectively, at 24 weeks (P = .010). The mean modified Wakitani scores in the control and PRF groups were 4.0 and 3.9, respectively, at 4 weeks (P > .999); 5.3 and 10.4, respectively, at 12 weeks (P = .006); and 2.6 and 7.4, respectively, at 24 weeks (P = .012).

CONCLUSIONS

The ICRS macroscopic scores and modified Wakitani scores showed that a single-stage surgical procedure combining microfracture and a PRF membrane was more effective than surgery with only microfracture for promoting cartilage repair.

CLINICAL RELEVANCE

A single-stage surgical procedure combining microfracture and an autologous PRF membrane is a potentially beneficial treatment method for cartilage defects that does not require using any xenocollagen membrane.

Platelets' Role in Dentistry: From Oral Pathology to Regenerative Potential

Platelets are a cellular subgroup of elements circulating in the bloodstream, responsible for the innate immunity and repairing processes. The diseases affecting this cellular population, depending on the degree, can vary from mild to severe conditions, which have to be taken into consideration in cases of minor dental procedures. Their secretion of growth factors made them useful in the regenerative intervention. The aim of this review is to examine the platelets from biological, examining the biogenesis of the platelets and the biological role in the inflammatory and reparative processes and clinical point of view, through the platelets' pathology and their use as platelets concentrates in dental regenerative surgery.

Synthesis of Bio-based monomers and polymers using microbes for a sustainable bioeconomy

As a result of environmental concerns and the depletion of biomass assets, eco-friendly, renewable biomass-based chemical extraction has recently received significant attention. Bio-based chemicals can be prepared using different renewable feedstockbio-resources through microbial fermentation. Chemicals produced from renewable feedstockscan reduce ecological consequences from improper disposal and repurpose them into valuable products. Biodegradability, biocompatibility and non-toxicity, particularly in biomedical applications, have inspired researchers towards developing novel technologies that have social benefit. Among semi-synthetic and synthetic polymeric materials, utilization of natural bio-based monomeric materials can provide opportunities for sustainable development of novel non-toxic, biodegradable and biocompatible products. The purpose of this work is to give a summary of research into the generation of natural bio-based succinic acid (SA) monomer, the development of poly(butylene succinate) (PBS) as biodegradable polymer, PBS-based nanocomposites and their innovative uses.

Comparison of platelet-rich fibrin with zinc oxide eugenol in the relief of pain in alveolar osteitis

BACKGROUND AND AIMS

Alveolar osteitis (AO) is the most common painful post-operative complication after tooth extraction. The common modalities used in the management of AO are lavage, placement of medicated dressings, analgesics, and antibiotics. The present study was undertaken to compare platelet-rich fibrin (PRF) and zinc oxide eugenol (ZOE) for pain relief in AO.

METHODS

All cases meeting the eligibility criteria received two different treatment modalities over a span of 18 months. At the analysis stage, the final sample size comprised 70 patients, with 35 patients appropriated in each group. Group A patients received ZOE and Group B received PRF. Pain scores were measured on "1st, 3rd, 5th, and 7th" days based on a visual analogue scale (VAS) and compared in both groups of patients. The collected data were analyzed using the chi-square test, t test, and Mann-Whitney U test.

RESULTS

In patients treated with ZOE dressing, the average VAS scores observed were 7.4 ± 1.5, 5.1 ± 1.1, 3.4 ± 0.9, and 2.1 ± 0.7, respectively, on the "1st, 3rd, 5th, and 7th" follow-up days. In patients treated with PRF, the average VAS score observed were 4.1 ± 1.2, 2.6 ± 0.9, 1.7 ± 0.9, and 0.8 ± 0.8 respectively.

CONCLUSION

Both ZOE and PRF were effective in pain control during the follow-up period. However, the pain intensity measured as a pain score using VAS was, lower in the PRF group than in the ZOE group on all follow-up days.

Platelet-Rich Fibrin as an Aid to Soft- and Hard-Tissue Healing

Introduction

Contemporary published data present confounding results on use of PRF in soft- and hard-tissue healing in the oral cavity, and many authors have suggested for further studies to reach the definitive conclusion.

Aim

Our main objective therefore was to evaluate soft-tissue healing and osseous regeneration (by using VIXWIN PRO software) in extraction sites of mandibular third molars with substantial sample size to understand the effect of PRF in bony defects.

Methodology

Sixty patients had their bilaterally impacted third molars (120 sites) extracted in the split mouth study, following which platelet-rich fibrin was placed in one of the sockets. Patients were followed up clinically and radiographically, and pain score, presence of infection, exudation of graft and VIXWIN PRO software were used to evaluate healing of soft tissue and bone.

Result and Conclusion

Our study advocates the use of PRF for enhanced soft- and hard-tissue healing. Though the osseous regeneration could be differentiated in both the groups at second month interval only, pain scores were better with PRF at most instances. Subsequent phase to the research should include histopathological investigations for ancillary support.

Poly-ε-caprolactone/Whitlockite Electrospun Bionic Membrane with an Osteogenic-Angiogenic Coupling Effect for Periosteal Regeneration

The periosteum is rich in vascular networks, osteoprogenitor cells, and stem cells and plays an important role in bone defect repair. However, existing artificial periosteum materials still have difficulty in meeting clinical requirements, such as good mechanical properties and bionic structure construction, osteogenic differentiation, and vascularization capabilities. Here, a poly-ε-caprolactone (PCL)/whitlockite (WH, 5, 10, 15 wt %) artificial periosteum with different doping amounts was prepared by electrospinning technology. According to the results of in vitro mineralization experiments, the rapid ion release from WH promotes the deposition of mineralized hydroxyapatite. Inductively coupled plasma-optical emission spectroscopy, in vitro angiogenesis, and cell migration experiments showed that the bionic periosteum of the 15% WH group had the best release rate of Mg²⁺ and the best ability to promote the human umbilical vein endothelial cell angiogenesis and migration. In addition, this group promoted collagen formation and calcium deposition. Finally, the subcutaneous implantation model was used to verify the biocompatibility and angiogenesis ability of the proposed membrane in vivo. Overall, this biomimetic PCL/WH nanofiber membrane combines the positive osteogenic differentiation ability and angiogenic ability of calcium phosphate materials and thus has good application prospects in the field of periosteal repair in the future.

Third molar surgery: Past, present, and the future

Third molar surgery is the most common ambulatory procedure done by oral and maxillofacial surgeons. Surgical approaches for the removal of third molars have been published since the 20th century. This article reviews the history and development of extraction techniques through a literature review. The literature was selected through a search of an electronic database. Key words for the Medline search were "mandibular/maxillary third molar," "impacted mandibular/maxillary third molar," "mandibular/maxillary third molar flap design," and "mandibular/maxillary third molar incision." The search was restricted to English-language articles. Additionally, a manual search in the major oral surgery journals and books was performed. The aim of this article is to examine the evolution of third molar surgery, recognize pioneering techniques, and compare these techniques to current approaches. Common approaches employed today are discussed and treatment philosophies with thoughts for future therapies are provided.

Non-Incised Papilla Surgical Approach and Leukocyte Platelet-Rich Fibrin in Periodontal Reconstruction of Deep Intrabony Defects: A Case Series

We present the preliminary results of the treatment of teeth with a deep, non-contained periodontal residual defect, vestibular bone dehiscence, and soft tissue recession, by combining an apical non-incised papilla surgical approach (NIPSA) to the defect and leukocyte platelet-rich fibrin (L-PRF) in the vestibular aspect. Four patients (upper left first premolar, upper left central incisor, upper right central incisor and upper right lateral incisor) have been treated. At one year of follow up, all cases showed a considerable reduction in the periodontal pocket depth, a gain in clinical attachment and no bleeding on probing, as well as an improvement in the marginal soft tissue minimizing soft tissue contraction (recession and/or loss of papilla) and improving soft tissue architecture. NIPSA plus L-PRF seem to improve clinical outcomes in deep non-contained intrabony defects associated with soft tissue recession.

Will stem cells from fat and growth factors from blood bring new hope to female patients with reproductive disorders?

Female reproductive system disorders (FRSD) with or without infertility are prevalent women's health problems with a variety of treatment approaches including surgery and hormone therapy. It currently considering to sub-branch of regenerative medicine including stem cells or growth factors injection-based delivery treatment might be improved female reproductive health life. The most common products used for these patients treatment are autologous cell or platelet-based products from patients, including platelet-rich plasma, plasma rich in growth factor, platelet-rich fibrin, and stromal vascular fraction. In this review, we discuss each of the above products used in treatment of FRSD and critically evaluate the clinical outcome.

A clinical and radiographic study of implants placed in autogenous bone grafts covered by either a platelet-rich fibrin membrane or deproteinised bovine bone mineral and a collagen membrane: a pilot randomised controlled clinical trial with a 2-year follow-up

Purpose

To compare the survival and clinical performance of implants placed in sites previously augmented with autogenous bone grafts covered by either a platelet-rich fibrin (PRF) membrane (PRF group) or a standard procedure (gold standard) involving coverage of the autogenous bone graft with deproteinised bovine bone mineral and a resorbable collagen membrane (control group).

Methods

A total of 27 partially edentulous patients (test n = 14, control n = 13) with indication for staged lateral bone block augmentation and dental implant placement were included. Twenty-four months after crown placement (range: 14–32 months), patients were recalled for a final clinical and radiographic follow-up. Outcome measures were implant survival, implant crown survival, clinical parameters of the implant, peri-implant marginal bone level, marginal bone level of adjacent tooth surfaces, biological and technical complications and patient-related outcome measures.

Results

Two implants were lost in the control group (85% survival rate); none were lost in the PRF group (100% survival rate). None of the 26 initially placed implant crowns were lost, but one implant and therefore one implant crown were lost after 20 months. Consequently, the definitive implant crown survival was 92% (95% confidence interval (CI): 73–110%) in the control group and 100% in the PRF group. No statistical difference in implant survival rate (p = 0.13) or implant crown survival was seen between the groups (p = 0.28). The mean marginal bone level at the follow-up was 0.26 mm (95% CI: 0.01–0.50 mm) in the PRF group and 0.68 mm (95% CI: 0.41–0.96 mm) in the control group. The difference between the groups was − 0.43 mm (95% CI: − 0.80 to − 0.05 mm, p = 0.03), which was statistically significant (p = 0.03). Both groups demonstrated similar healthy peri-implant soft tissue values at the final follow-up.

Conclusion

Although the current study is based on a small sample of participants, the findings suggest that the methodology of the PRF and the control group approach can both be used for bone augmentation with a similar outcome. A significant, but clinically irrelevant, higher peri-implant marginal bone level was registered in the PRF group than in the control group. Patients in both groups were highly satisfied with the treatment.

Trial registration

ClinicalTrials.gov Identifier: NCT04350749. Registered 17 April 2020. Retrospectively registered.

Mechanical, chemical, structural analysis and comparative release of PDGF-AA from L-PRF, A-PRF and T-PRF - an in vitro study

BACKGROUND

Platelet concentrates have been popularly used in regenerative periodontal therapy as they are autologous in origin and they provide a supernatural concentration of platelets, growth factors and leukocytes. The release profile of various growth factors is considered important during the various phases of wound healing with the most important being the inflammatory phase where the release of the growth factors help in recruitment of cells and in collagen production. With the more recent modifications of PRF namely A-PRF and T-PRF, the mechanical and chemical degradation properties have also improved. The aim of the present study was to correlate the release profile of PDGF-AA from various forms of platelet concentrates (L-PRF, A-PRF, T-PRF) based on their mechanical and chemical properties.

METHODS

Blood samples were drawn from 2 male and 3 female systemically healthy patients between 20 and 25 years of age who were about to undergo periodontal regeneration for PRF preparation. The blood sample was immediately centrifuged using a table top centrifuge (Remi R4C) at 1060 rpm (208 x g) for 14 min for A-PRF preparation, 1960 rpm (708 x g) for 12 min for L-PRF preparation and 1960 rpm (708 x g) for 12 min in titanium tubes for T-PRF preparation. Tensile test was performed using universal testing machine. The in vitro degradation test of the prepared PRF membranes were conducted by placing the PRF membrane in 10 ml of pH 7.4 PBS on an orbital shaker set at 50 rpm. SEM evaluation of the PRF membrane was done under both low and high magnification. In order to determine the amount of released growth factor PDGF-AA at 15 min, 60 min, 8 h, 1 day, 3 days, and 10 days, samples were placed into a shaking incubator at 37 °C to allow for growth factor release into the culture media.

RESULTS

On comparing the three PRF membranes, it was found that T-PRF contained the maximum tensile strength (404.61 ± 5.92 MPa) and modulus of elasticity (151.9 ± 6.92 MPa). Statistically significant differences between the three groups were found on comparing the groups for their mechanical properties. In the degradation test, it was found that the maximum amount of degradation was found in L-PRF (85.75%), followed by A-PRF (84.18%) and the least was found in T-PRF (82.27%). T-PRF released the highest amount of PDGF-AA (6060.4 pg/ml) at early time points when compared to A-PRF (5935.3 pg/ml). While T-PRF had rapid release of PDGF-AA, A-PRF had a sustained release of growth factors released at later time points.

CONCLUSION

Results from the present study indicate that A-PRF is the most favourable form of platelet concentrate in regenerative periodontal therapy as it has a sustained release of growth factors over time.

Fibrin Scaffold Incorporating Platelet Lysate Enhance Follicle Survival and Angiogenesis in Cryopreserved Preantral Follicle Transplantation

Background:

Transplantation of cryopreserved follicles can be regarded as a promising strategy for preserving fertility in cancer patients under chemotherapy and radiotherapy by reducing the risk of cancer recurrence. The present study aimed to evaluate whether fibrin hydrogel supplemented with platelet lysate (PL) could be applied to enhance follicular survival, growth, and angiogenesis in cryopreserved preantral follicle grafts.

Materials and Methods:

Preantral follicles were extracted from 15 four-week-old NMRI mice, cryopreserved by cryotop method, and encapsulated in fibrin-platelet lysate for subsequent heterotopic (subcutaneous) auto-transplantation into the neck. Transplants were assessed in three groups including fresh follicles in fibrin-15%PL, cryopreserved follicles in fibrin-15%PL, and cryopreserved follicles in fibrin-0% PL. Two weeks after transplantation, histological, and immunohistochemistry (CD31) analysis were applied to evaluate follicle morphology, survival rate, and vascular formation, respectively.

Results:

Based on the results, fibrin-15% PL significantly increased neovascularization and survival rate (SR) both in cryopreserved (SR=66.96%) and fresh follicle (SR=90.8%) grafts, compared to PL-less fibrin cryopreserved transplants (SR=28.46%). The grafts supplemented with PL included a significantly higher percentage of preantral and antral follicles. Also, no significant difference was observed in the percentage of preantral follicles between cryopreserved and fresh grafts of fibrin-15% PL. However, a significantly lower (P=0.03) percentage of follicles (23.37%) increased to the antral stage in cryopreserved grafts of fibrin-15%PL, compared to fresh grafts (35.01%).

Conclusion:

The findings demonstrated that fibrin-PL matrix could be a promising strategy to improve cryopreserved follicle transplantation and preserve fertility in cancer patients at the risk of ovarian failure.

Evaluation of efficacy of platelet-rich fibrin membrane and bone graft in coverage of immediate dental implant in esthetic zone: An in vivo study

Objective:

This study compared and evaluated the clinical and radiographic results of guided bone regeneration using platelet-rich fibrin (PRF) and collagen membrane as barrier membrane in immediately placed implants with severe buccal bone defect (with respect to marginal bone level, implant stability quotient [ISQ]), and histological analysis of new bone formation.

Materials and Methods:

Sixteen implants were placed in patients requiring immediate implant placement and having a buccal wall defect and randomly divided into two groups one receiving PRF membranes and other collagen membrane. The sites were grafted with bone-substitute material in both the groups. After 4 months, at the time of second-stage surgery, implant stability is measured by Osstell Mentor, crestal bone level on mesial and distal sides of implant by digital intraoral periapical, buccal defect clinically by probe and histological analysis of biopsied bone.

Results:

The results were insignificant and comparable in both the groups when comparison was made between the groups. The mean buccal defect, mean values of average ISQ, crestal bone level in both the groups at baseline and after 4 months were compared. No significant difference between both the groups was found after 4 months. Bone quality seemed to be equal in both groups after histological analysis. Within the limits of the study, both the groups had shown similar results in all criteria.

Conclusion:

Within the limitation of the study, it can be concluded that both the treatment modalities are successful in terms of buccal defect reduction, stability, and increase in crestal bone level.

Histology of augmented autogenous bone covered by a platelet-rich fibrin membrane or deproteinized bovine bone mineral and a collagen membrane: A pilot randomized controlled trial

OBJECTIVES

This study aimed to evaluate histologic and histomorphometric bone characteristics with a focus on vitality after lateral alveolar ridge augmentation using an autogenous bone graft as a block covered by either a platelet-rich fibrin (PRF) membrane (test group) or a standard procedure involving coverage of the bone block with a deproteinized bovine bone mineral and a resorbable collagen membrane (control group).

MATERIAL AND METHODS

A total of 27 (test = 14, control = 13) partially edentulous patients with indication for bone block augmentation before implant installation were included. For analyses, a biopsy of augmented bone was retrieved six months after bone grafting.

RESULTS

Histologic evaluation of augmented bone revealed a predominance of non-vital bone toward the periosteum and few localized areas of vital bone in the center of the graft in both groups. In contrast, augmented bone toward the native bone demonstrated extensive bone remodeling in both groups. Histomorphometric analyses demonstrated a mean of 14% vital bone, 80% non-vital bone, 5% soft tissue, and 1% blood vessels in the test group. In the control group, the corresponding shares were 14% vital bone, 63% non-vital bone, 22% soft tissue, and 1% blood vessels. We observed no significant differences between the groups (p > .05).

CONCLUSION

In conclusion, a comparable low bone vitality of augmented bone was observed in the PRF and in the control group. Consequently, the present study could not verify the potential beneficial effect of a PRF membrane on bone vitality of an autogenous bone graft used as a block.

Role of Platelet-Rich Fibrin (PRF) and Platelet-Rich Plasma (PRP) in Oro-Facial Tissue Regeneration: A Narrative Review

Background and Aim:

Regeneration potential of platelet-rich fibrin (PRF) and platelet-rich plasma (PRP) in oral tissues regeneration has revolutionized the clinical dentistry in recent years. The in vivo and in vitro research on PRP and PRF has opened a new avenue in the dentistry and medicinal care. It is a minimally invasive and cost-effective technique that will raise the bar of clinical dentistry. The results presently documented are overwhelming; the potential to use PRF and PRP in the clinical dentistry have improved dental quality, satisfaction, and clinical outcome. The aim of the review was to recapitulate the regenerative and healing potential of platelet extracts in different disciplines of clinical dentistry.

Materials and Methods:

The attempt was to answer the following question: what are the various clinical oral health applications for PRF and PRP available in the published literature? The dual functions (tissue sealants and drug delivery systems to carry biomolecules and chemotactic growth factors) have helped the practitioners to treat the complicated oral conditions and tissues regeneration. The PRF and plasma has emerged as a powerful therapeutic tool for management of soft and hard tissue healing and regenerative procedures, including implant osseointegration. More research is mandatory to use these platelets concentrate to their full potential in various clinical applications.

Conclusion:

PRF is an emerging therapeutic tool in the management of oral soft and hard tissue healing and regenerative procedures.

Early therapeutic effect of platelet-rich fibrin combined with allogeneic bone marrow-derived stem cells on rats' critical-sized mandibular defects

BACKGROUND

Critically sized bone defects represent a significant challenge to orthopaedic surgeons worldwide. These defects generally result from severe trauma or resection of a whole large tumour. Autologous bone grafts are the current gold standard for the reconstruction of such defects. However, due to increased patient morbidity and the need for a second operative site, other lines of treatment should be introduced. To find alternative unconventional therapies to manage such defects, bone tissue engineering using a combination of suitable bioactive factors, cells, and biocompatible scaffolds offers a promising new approach for bone regeneration.

AIM

To evaluate the healing capacity of platelet-rich fibrin (PRF) membranes seeded with allogeneic mesenchymal bone marrow-derived stem cells (BMSCs) on critically sized mandibular defects in a rat model.

METHODS

Sixty-three Sprague Dawley rats were subjected to bilateral bone defects of critical size in the mandibles created by a 5-mm diameter trephine bur. Rats were allocated to three equal groups of 21 rats each. Group I bone defects were irrigated with normal saline and designed as negative controls. Defects of group II were grafted with PRF membranes and served as positive controls, while defects of group III were grafted with PRF membranes seeded with allogeneic BMSCs. Seven rats from each group were killed at 1, 2 and 4 wk. The mandibles were dissected and prepared for routine haematoxylin and eosin (HE) staining, Masson's trichrome staining and CD68 immunohistochemical staining.

RESULTS

Four weeks postoperatively, the percentage area of newly formed bone was significantly higher in group III (0.88 ± 0.02) than in groups I (0.02 ± 0.00) and II (0.60 ± 0.02). The amount of granulation tissue formation was lower in group III (0.12 ± 0.02) than in groups I (0.20 ± 0.02) and II (0.40 ± 0.02). The number of inflammatory cells was lower in group III (0.29 ± 0.03) than in groups I (4.82 ± 0.08) and II (3.09 ± 0.07).

CONCLUSION

Bone regenerative quality of critically sized mandibular bone defects in rats was better promoted by PRF membranes seeded with BMSCs than with PRF membranes alone.

Effect of platelet-rich fibrin on cell proliferation, migration, differentiation, inflammation, and osteoclastogenesis: a systematic review of in vitro studies

Objective

To systematically assess the effects of platelet-rich fibrin (PRF) on in vitro cellular behavior.

Methods

A systematic electronic search using MEDLINE database was performed. In vitro studies using PRF were considered and articles published up to June 31, 2018 were screened. Eligible studies were selected based on the use of human PRF.

Results

In total, 1746 titles were identified with the search terms, from these 37 met the inclusion criteria and were chosen for data extraction. In addition, 16 new studies, mainly published in 2019, were also included in the analysis resulting in 53 studies. No meta-analysis could be performed due to the heterogeneity of study designs. Included studies show that PRF enhances proliferation, migration, adhesion, and osteogenic differentiation on a variety of cell types along with cell signaling activation. Furthermore, PRF reduces inflammation, suppresses osteoclastogenesis, and increases the expression of various growth factors in mesenchymal cells.

Summary and conclusions

Despite some notable differences of the studies, the overall findings suggest a positive effect of PRF on cell proliferation, migration, adhesion, differentiation, and inflammation pointing towards a therapeutic potential in regenerative dentistry.

Clinical relevance

PRF serves as a reservoir of bioactive molecules to support wound healing and bone regeneration. Although the cellular mechanisms by which PRF supports the clinical outcomes remain unclear, in vitro research provides possible explanations. This systematic review aims to provide an update of the existing research on how PRF affects basic physiological processes in vitro. The overall findings suggest that PRF induces cell proliferation, migration, adhesion, and differentiation along with possessing anti-inflammatory properties further supporting its therapeutic potential in wound healing and bone regeneration.

Inflammatory Cytokines and Biodegradable Scaffolds in Dental Mesenchymal Stem Cells Priming

Mesenchymal stem cells (MSCs) are multipotent stem cells with wide-ranging clinical applications due to their ability to regenerate tissue from mesenchymal origin and their capability of suppressing immune responses, thus reducing the likelihood of graft versus host disease after transplantation. MSCs can be isolated from a variety of sources including bone marrow, adipose tissue, umbilical cord blood, and immature teeth. Dental stem cells (DSCs) possess progenitor and immunomodulatory abilities as the other MSC types and because they can be easily isolated, are considered as attractive therapeutic agents in regenerative dentistry. Recently, it has been shown that DSCs seeded onto newly developed synthetic biomaterial scaffolds have retained their potential for proliferation and at the same time have enhanced capabilities for differentiation and immunosuppression. The scaffolds are becoming more efficient at MSC priming as researchers learn how short peptide sequences alter the adhesive and proliferative capabilities of the scaffolds by stimulating or inhibiting classical osteogenic pathways. New findings on how to modulate the inflammatory microenvironment, which can prime DSCs for differentiation, combined with the use of next generation scaffolds may significantly improve their therapeutic potential. In this review, we summarize current findings regarding DSCs as a potential regenerative therapy, including stem cell priming with inflammatory cytokines, types of scaffolds currently being explored and the modulation of scaffolds to regulate immune response and promote growth.

Use of Platelet-Rich Plasma and Platelet-Rich Fibrin in Dentistry and Oral Surgery: Introduction and Review of the Literature

Platelet concentrates, mostly represented by platelet-rich plasma and platelet-rich fibrin, have gained significant interest in various medical and oral disciplines because of their potential to stimulate and boost regeneration of hard and soft tissues. Prepared from the patient’s own blood, they have been tested and used in various different surgical fields including oral and maxillofacial surgery. The effects of these biomaterials are described to be a result of the large concentration of platelets which contain a wide range of growth factors. The aim of this article is to introduce the principle and function of these platelet concentrates, to review their preparation, and to provide a comprehensive examination of the published oral and maxillofacial literature on this subject.

Platelet-rich fibrin along with a modified minimally invasive surgical technique for the treatment of intrabony defects: a randomized clinical trial

Purpose

The modified minimally invasive surgical technique (M-MIST) has been successfully employed to achieve periodontal regeneration. Platelet-rich fibrin (PRF) is known to enhance wound healing through the release of growth factors. This study aimed to observe the outcomes of periodontal surgery when M-MIST was used with or without PRF for the treatment of isolated intrabony defects.

Methods

This randomized clinical trial was conducted on 36 systemically healthy patients, who had chronic periodontitis associated with a single-site buccal probing pocket depth (PPD) and clinical attachment level of ≥5 mm. Patients were randomly divided into 2 groups: the test group treated with M-MIST and PRF, and the control group treated with M-MIST alone. The primary periodontal parameters analyzed were PPD, relative attachment level (RAL), and relative gingival margin level. The radiographic parameters analyzed were change in alveolar crest position (C-ACP), linear bone growth (LBG), and percentage bone fill (%BF). Patients were followed up to 6 months post-surgery.

Results

Intragroup comparisons at 3 and 6 months showed consistently significant improvements in PPD and RAL in both the groups. In intergroup comparisons, the improvement in PPD reduction, gain in RAL, and the level of the gingival margin was similar in both groups at 3 and 6 months of follow-up. Furthermore, an intergroup comparison of radiographic parameters also demonstrated similar improvements in C-ACP, LBG, and %BF at 6 months of follow-up.

Conclusions

M-MIST with or without PRF yielded comparable periodontal tissue healing in terms of improvements in periodontal and radiographic parameters. Further investigation is required to confirm the beneficial effects of PRF with M-MIST.

Trial Registration

ClinicalTrials.gov Identifier: NCT03169920.

Regenerative Effect of Platelet Concentrates in Oral and Craniofacial Regeneration

Platelet concentrates (PCs) are biological autologous products derived from the patient's whole blood and consist mainly of supraphysiologic concentration of platelets and growth factors (GFs). These GFs have anti-inflammatory and healing enhancing properties. Overall, PCs seem to enhance bone and soft tissue healing in alveolar ridge augmentation, periodontal surgery, socket preservation, implant surgery, endodontic regeneration, sinus augmentation, bisphosphonate related osteonecrosis of the jaw (BRONJ), osteoradionecrosis, closure of oroantral communication (OAC), and oral ulcers. On the other hand, no effect was reported for gingival recession and guided tissue regeneration (GTR) procedures. Also, PCs could reduce pain and inflammatory complications in temporomandibular disorders (TMDs), oral ulcers, and extraction sockets. However, these effects have been clinically inconsistent across the literature. Differences in study designs and types of PCs used with variable concentration of platelets, GFs, and leucocytes, as well as different application forms and techniques could explain these contradictory results. This study aims to review the clinical applications of PCs in oral and craniofacial tissue regeneration and the role of their molecular components in tissue healing.

Management of Large Oroantral Fistulas Caused by Medication-Related Osteonecrosis with the Combined Sequestrectomy, Buccal Fat Pad Flap and Platelet-Rich Fibrin

Purpose

The aim of this retrospective study was to describe the efficacy of management of bisphosphonate-related maxillary osteonecrosis, which had resulted in an oroantral fistula formation, by performing sequestrectomy, platelet-rich fibrin (PRF) and buccal fat pad (BFP) flap.

Patient and Methods

A total of 7 patients diagnosed with stage III maxillary medication-related osteonecrosis according to guidelines of the American Association of Oral and Maxillofacial Surgeons. All patients complained of persistent pain, swelling and purulent drainage with sinusitis. In order to keep the infection under control, the patients first received an antibiotic combination for 2 weeks. Then, sequestrectomy and bone debridement were performed under general anesthesia. After that, an antrectomy was performed via endoscopic sinus surgery in some cases. And the fistula was closed with BFP after or before the PRF application to the region depending on the size of the fistula.

Results

The fistula was successfully closed. After a mean follow-up of 16 months, no symptoms were seen in the patients.

Conclusions

The patients were successfully managed with a combined treatment consisted of sequestrectomy, PRF and BFP. We suggest that large defects arose from medication-related osteonecrosis of the jaw can be managed with such a combined approach in order to lessen the recurrence risk.

Platelet-rich fibrin and collagen membrane in the preservation of the alveolar bone: Feasibility of the elemental inorganic composition and scanning electron microscopy analysis

The success of dental implants is related to the amount, quality, and composition of the alveolar bone. The placement of platelet-rich fibrin (PRF) clot associated with a resorbable collagen membrane (RCM) in a postextraction alveolus is a technique used for ridge preservation. This case report study analyzed the ultrastructural characteristics of cross-sectioned alveolar bone that received PRF and RCM using scanning electron microscopy and the inorganic composition using "energy dispersive X-ray spectrometry," in order to explore the feasibility of this method to clinical studies. Three alveolar bone samples from two male patients (37 and 58 years old), obtained in the procedure of placing the dental implant, were analyzed. Two bone samples previously received PRF and RCM (M37 and M58), the third sample represented a physiological bone formation without treatment (M37-control). The bone sample M37 showed irregularly shaped islets of calcified material intermingled with connective tissue. The other samples, from the 58-year-old patient with PRF and RCM (M58); and the other untreated bone sample from the same 37-year-old patient (M37-control) showed similar ultrastructural morphology with trabecular conformation without islets agglomerations. The inorganic composition analysis showed higher concentrations of calcium and phosphorus in both samples treated with PRF and RCM in comparison to the untreated bone sample. The Ca/P ratio was higher in the M37 sample compared to the others samples. The results showed morphology and inorganic composition differences among the treatments used, suggesting that this method is feasible to analyze parameters of the alveolar bone tissue.

Changes on the Structural Architecture and Growth Factor Release, and Degradation in Equine Platelet-Rich Fibrin Clots Cultured Over Time

The aims of the present study were (1) to describe the microscopic and ultrastructural appearance of equine platelet-rich fibrin (PRF) clots and (2) to determine the release and degradation of transforming growth factor beta 1 (TGF-β₁) and insulin-like growth factor type I (IGF-I) from PRF clots incubated over 14 days. Whole blood from six horses was collected into plain tubes and centrifuged at 240 g for 8 minutes. Clots were evaluated by histology and by both transmission and scanning electronic microscopy (TEM and SEM). Growth factor concentrations were measured by ELISA at 48-hour intervals over 14 days and analyzed by one-way repeated-measures ANOVA. Histology showed a clot composed by a fibrin layer and a cellular layer with platelets and leukocytes. Scanning electron microscopy showed the cells trapped by an incipient fibrin network at 1 hour. At day 8, these cells were embedded by an incipient fibrin network. At day 14, the leukocytes and platelet aggregates from the clot were imbibed in an organized web of fibrin fibrils. TEM exhibited platelets with preserved cytoplasm and alpha granules randomly scattered at day 8, and damaged platelets with interrupted cytoplasm and organelle emigration to the periphery at day 14. TGF-β₁ and IGF-I concentrations showed a progressive increase until day 14. TGF-β₁ was released from PRF clots in a gradual and controlled manner, and increasing its concentration for two weeks, which supports TEM findings indicating that platelets began disintegrating by day 14. Furthermore, IGF-I production and release from PRF clots is sustained over time.

Successful soft and hard tissue augmentation with platelet-rich fibrin in combination with bovine bone space maintainer in a delayed implant placement protocol in the esthetic zone: A case report

Replacement in the esthetic zone can be very unpredictable and difficult to manage in cases with extreme bone and soft tissue loss. In this case report (2.5-year follow-up), we demonstrate that the use of platelet-rich fibrin in combination with bovine bone can result in a stable, esthetic outcome.

Platelet-Rich Plasma and Platelet-Rich Fibrin in Periodontal Regeneration: A Review

Platelet concentrates (PCs; platelet-rich plasma and platelet-rich fibrin) are autologous bioactive substances that have found varied application in medical and dental fields, particularly in oral and maxillofacial surgery, plastic surgery, and sports medicine. The rationale of these technologies is to extract all the elements from patient’s own blood sample, which could be used to improve healing by promoting tissue regeneration. PCs have evolved a long way since its introduction in 1954. PCs have been used successfully in periodontics and implant dentistry. However, the preparation protocol, processing time, transfer of concentrates, centrifugation temperature, vibration, etc., being not standardized are various factors for the mixed results reported in the literature. This review intends to discuss evolution of PCs, their preparation techniques, and their clinical and technical aspects and applications.

Platelet-rich fibrin in oral surgical procedures: a systematic review and meta-analysis

The effect of platelet-rich fibrin (PRF) in enhancing the healing after oral surgical interventions is still a matter of debate. The purpose of this study was to identify instances where PRF has been shown to be effective in oral surgical procedures. A comprehensive literature search was performed up to 2017 on PubMed/MEDLINE, Cochrane Library, Web of Science, Scopus and LILACS databases and grey literature. The full-text of potentially relevant studies were reviewed and only randomized clinical trials (RCTs) were included. A total of 559 studies were found, of which 30 were included for qualitative analysis and 13 for quantitative analysis. Three review authors assessed the risk of bias independently. The available literature suggests that PRF has a positive effect in improving alveolar preservation on extraction sockets and around dental implants. The qualitative analysis showed a significantly better effect of PRF in promoting bone regeneration for alveolar cleft reconstruction. The meta-analysis for third molar surgery showed a decrease in prevalence of alveolar osteitis. PRF increased implant stability 1 week and 1 month after surgery (P=0.0005 and 0.0003). Due to the lack of studies with low risk of bias and a limited number of patients available, further RCTs are needed to confirm these results.

Effects of leukocyte-platelet-rich fibrin (L-PRF) in different intraoral bone grafting procedures: a systematic review

This systematic review aimed to assess the effects of leukocyte-platelet-rich fibrin (L-PRF) on bone regeneration, soft tissue healing, and postoperative complications in patients undergoing ridge preservation, ridge augmentation, and maxillary sinus augmentation procedures. A comprehensive literature search was conducted by two independent reviewers. Only randomized and non-randomized controlled clinical trials were selected. Outcome data were extracted and critically analyzed. A total of 17 articles were included in the qualitative synthesis. The use of L-PRF in extraction sockets was associated with a modest beneficial effect by decreasing alveolar ridge remodeling and postoperative pain when compared to natural healing. In contrast, the use of L-PRF in maxillary sinus augmentation procedures was not associated with more favorable outcomes, and its use in ridge augmentation procedures could not be assessed adequately as it was reported in only one study. No meta-analysis could be conducted due to the heterogeneity of the selected studies. The limited evidence on the effects of L-PRF in intraoral bone grafting procedures highlights the need for further research to fully assess its clinical indications, with an emphasis on the application of standardized protocols for the preparation of this autologous product.

Evaluation of the relative efficacy of autologous platelet-rich fibrin membrane in combination with β-tricalcium phosphate (Septodont- resorbable tissue replacement)™ alloplast versus β-TCP alloplast alone in the treatment of grade II furcation defects

Introduction:

Platelet-rich fibrin (PRF) is considered as the second-generation platelet concentrate, contains combined properties of fibrin, platelets, leukocytes, growth factors, and cytokines that make it as healing biomaterial with incredible potential for hard tissue and soft tissue regeneration. The present study was aimed to evaluate the effectiveness of PRF with β-tricalcium phosphate (β-TCP) graft (R. T. R) and compare it with β-TCP allograft alone in the treatment of mandibular Grade II furcation defects.

Material and Methods:

A total of 20 mandibular Grade II furcation defects sites were assigned in the study and treated with either β-TCP alone (Group I) or β-TCP with PRF membrane (Group II). The clinical parameters analyzed were probing pocket depth (PPD), clinical attachment level (CAL), gingival recession (GR), horizontal defect depth (HDD), and vertical defect depth (VDD), recorded baseline and at 6 months reentry.

Results:

At 6 months, both groups showed statistically significant results for all parameters from their baseline value, although intergroup changes were statistically insignificant. In Group I, gain in CAL was 2.80 ± 1.40 and in Group II it was 3.00 ± 1.44. Bone fill in Group I was VDD (3.50 ± 2.12) and HDD (3.70 ± 0.67), whereas Group II showed VDD (3.70 ± 1.57) and HDD (4.0 ± 0.88), respectively. PPD reduction was higher in Group I (3.50 ± 2.27) than Group II (2.80 ± 1.93). At reentry GR was established, Group I showed higher GR (0.70 ± 0.67) and Group II (0.40 ± 0.52).

Conclusions:

Significant improvement was found in both groups, but the combination of PRF with β-TCP allograft led to more favorable improvement in the management of Grade II furcation defect except PPD.

Comparative Evaluation of Healing Pattern After Surgical Excision of Oral Mucosal Lesions by Using Platelet-Rich Fibrin (PRF) Membrane and Collagen Membrane as Grafting Materials-A Randomized Clinical Trial

PURPOSE

To compare the healing potential of platelet-rich fibrin (PRF) and collagen membranes in oral mucosal healing.

MATERIALS AND METHODS

Thirty patients with oral premalignant lesions were randomly included in the study and divided in groups A and B. After excising the lesions under local anesthesia, patients in groups A and B underwent grafting with the PRF membrane and the collagen membrane, respectively. Patients were evaluated at postoperative days 7, 15, 30, and 60 for pain, healing, and complications, such as recurrence, fibrosis, scar hypertrophy, and loss of vestibular depth.

RESULTS

In group A, 66.66% of patients reported substantially less pain postoperatively at 15-day follow-up than those in group B. At 30-day follow-up, 86.66% of patients in group A reported no pain versus 60% in group B. Pain scores were similar at 7- and 60-day follow-ups. Healing was accelerated in group A at 15- and 30-day follow-ups, but was the same on day 60. Complications, such as fibrosis, loss of vestibular depth, and scar hypertrophy, were seen in group B. Recurrence was seen in 1 patient in group A at 60-day follow-up.

CONCLUSION

PRF proved superior to collagen membrane for grafting of oral mucosal surgical defects. However, further study with larger samples is required to prove its efficacy.

Regenerative potential of autologous platelet-rich fibrin with and without amnion membrane in the treatment of Grade-II furcation defects: A clinicoradiographic study

Context

Platelet-rich fibrin (PRF), platelet concentrate composed of cytokines and structural glycoproteins trapped within polymerized fibrin meshwork, has the potential to accelerate healing of periodontal tissues. Amnion membrane has also attracted a lot of attention in periodontal regeneration due to the presence of variety of growth factors.

Aims

The aim of the study is to evaluate and compare the regenerative potential of autologous PRF with and without amnion membrane in the treatment of Grade II furcation defects.

Settings and Design

This was a double-masked randomized, split-mouth design study.

Materials and Methods

Fifteen patients with thirty mandibular degree II furcation defects were randomly allotted into Group I (PRF and amnion membrane) and Group II (PRF). Clinical parameters such as plaque index and gingival index-at defect site along with probing pocket depth, and relative attachment level and furcation defect depth were recorded at baseline, 3 months, and 6 months postoperatively. Assessment of radiographic parameters was done at baseline and 6 months postoperatively aided by computer-assisted tomography (Dentascan).

Statistical Analysis Used

For intragroup variations, Wilcoxon signed-rank test, and for comparison between the two groups/intergroup variations, Independent t-test and Mann-Whitney test was performed.

Results

All clinical and radiographic parameters showed statistically significant improvement at the sites treated with PRF and amnion membrane compared to those with PRF alone.

Conclusions

Within the limitation of this study, there was greater pocket reduction, attachment level gain, and bone fill at sites treated with PRF and amnion membrane as compared to PRF alone.

Proliferation and differentiation of stem cells in contact with eluate from fibrin-rich plasma membrane

OBJECTIVE

To evaluate the ability of the eluate from fibrin-rich plasma (FRP) membrane to induce proliferation and differentiation of isolated human adipose-derived stem cells (ASCs) into chondrocytes.

METHOD

FRP membranes were obtained by centrifugation of peripheral blood from two healthy donors, cut, and maintained in culture plate wells for 48 h to prepare the fibrin eluate. The SCATh were isolated from adipose tissue by collagenase digestion solution, and expanded in vitro. Cells were expanded and treated with DMEM-F12 culture, a commercial media for chondrogenic differentiation, and eluate from FRP membrane for three days, and labeled with BrdU for quantitative assessment of cell proliferation using the High-Content Operetta® imaging system. For the chondrogenic differentiation assay, the SCATh were grown in micromass for 21 days and stained with toluidine blue and aggrecan for qualitative evaluation by light microscopy. The statistical analysis was performed using ANOVA and Tukey's test.

RESULTS

There was a greater proliferation of cells treated with the eluate from FRP membrane compared to the other two treatments, where the ANOVA test showed significance (p < 0.001). The differentiation into chondrocytes was visualized by the presence of mucopolysaccharide in the matrix of the cells marked in blue toluidine and aggrecan.

CONCLUSIONS

Treatment with eluate from FRP membrane stimulated cell proliferation and induced differentiation of the stem cells into chondrocytes, suggesting a potential application of FRP membranes in hyaline cartilage regeneration therapies.

Comparative Evaluation of Coronally Advanced Flap Using Amniotic Membrane and Platelet-rich Fibrin Membrane in Gingival Recession: An 18-Month Clinical Study

Background:

An amnion membrane is a placenta-derived tissue that consists of numerous growth factors, proteins, and stem cell reserves which help in accelerated wound healing and regeneration. Platelet-rich fibrin (PRF) also releases growth factors after activation from the platelets and gets trapped within fibrin matrix which has been shown to stimulate the mitogenic response in the periosteum for bone repair and regeneration during normal wound healing. This preliminary, controlled, randomized clinical trial with an 18-month follow-up was aimed to evaluate the effectiveness of coronally advanced flap (CAF) with either PRF membrane or bioresorbable amniotic membrane (AM) in treatment of localized gingival recession defects.

Materials and Methods:

Sixteen healthy adult patients presenting with Miller Class I recession defects were treated surgically with CAF along with AM (Group I) or PRF (Group II) for coverage of the recession defects. For all patients, plaque index, gingival index, bleeding on probing, clinical attachment level, depth of recession, width of recession, width of attached gingiva, and gingival thickness were evaluated at 6 months and 18 months postoperatively. Statistical analysis was done using paired t-test, repeated measure analysis of variance test, Bonferroni test for intragroup comparison and unpaired t-test for intergroup comparison.

Results:

The results showed statistically nonsignificant (P < 0.01) difference in all clinical parameters at the 6- and 18-month follow-ups in both groups. Gingival recession in both PRF and amnion group when evaluated individually, significantly reduced from baseline to 6 months (P = 0.000) and from baseline to 18 months (P = 0.000). However, the mean value from 6 months to 18 months was statistically nonsignificant.

Conclusion:

The present study demonstrated that both CAF + PRF and CAF + AM are equally effective in providing clinically significant outcomes with respect to root coverage with AM showing the better percentage of root coverage as compared to PRF.