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Ribeiro ED, de Santana IHG, Viana MRM, Júnior ESH, Dias JCP, Ferreira-Júnior O, Sant'Ana E. The efficacy of Platelet and Leukocyte Rich Fibrin (L-PRF) in the healing process and bone repair in oral and maxillofacial surgeries: a systematic review. Clin Oral Investig 2024; 28:414. [PMID: 38965076 DOI: 10.1007/s00784-024-05817-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 07/01/2024] [Indexed: 07/06/2024]
Abstract
INTRODUCTION The search to optimize the healing and bone repair processes in oral and maxillofacial surgeries reflects the constant evolution in clinical practice, driven by the demand for increasingly satisfactory results and the need to minimize postoperative complications. OBJECTIVE To evaluate the efficacy of Platelet and Leukocyte Rich Fibrin (L-PRF) in the healing and bone repair process in oral and maxillofacial surgeries. MATERIALS AND METHODS The systematic review protocol for this study included the definition of the research question, the domain of the study, the databases searched, the search strategy, the inclusion and exclusion criteria, the types of studies to be included, the measures of effect, the methods for screening, data extraction and analysis, and the approach to data synthesis. Systematic literature searches were carried out on Cochrane databases, Web of Science, PubMed, ScienceDirect, Embase and Google Scholar. RESULTS The strategic search in the databases identified 1,159 studies. After removing the duplicates with the Rayyan© software, 946 articles remained. Of these, 30 met the inclusion criteria. After careful evaluation based on the inclusion and exclusion criteria, 8 studies were considered highly relevant and included in the systematic review. CONCLUSION Platelet and Leukocyte Rich Fibrin (L-PRF) has a positive effect on the healing process and bone repair in oral and maxillofacial surgeries.
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Affiliation(s)
- Eduardo Dias Ribeiro
- Department of Clinical and Social Dentistry (DCOS), Health Sciences Center, Federal University of Paraíba (UFPB), João Pessoa, Paraíba, Brazil
| | | | | | | | | | - Osny Ferreira-Júnior
- Bauru School of Dentistry, University of São Paulo, (FOB-USP), São Paulo, Brazil
| | - Eduardo Sant'Ana
- Bauru School of Dentistry, University of São Paulo, (FOB-USP), São Paulo, Brazil
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Khaddour AS, Ghiță RE, Ionescu M, Rîcă RG, Mercuț V, Manolea HO, Camen A, Drăghici EC, Radu A, Popescu SM. Healing of Extraction Sites after Alveolar Ridge Preservation Using Advanced Platelet-Rich Fibrin: A Retrospective Study. Bioengineering (Basel) 2024; 11:566. [PMID: 38927802 PMCID: PMC11201034 DOI: 10.3390/bioengineering11060566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 05/28/2024] [Accepted: 05/30/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Over time, numerous surgical procedures and biomaterials have been proposed for the reconstruction of post-extraction bone defects, each with their advantages and disadvantages. The main objective of this study was to evaluate dimensional changes in the alveolar bone 3 months after tooth extraction, before implant planning, comparing alveolar ridge preservation (ARP) with spontaneous healing. METHODS A total of 84 patients with non-restorable molars were included in the study. Forty-two patients received ARP with advanced platelet-rich fibrin (A-PRF) and spontaneous healing was evaluated in these patients. Cone beam computed tomography (CBCT) analysis performed before and after surgical intervention was used to determine the changes in vertical and horizontal bone dimensions produced after tooth extraction. RESULTS CBCT measurements showed reduction in both vertical and horizontal alveolar bone size in both groups. For the study group, the alveolar parameters (height, width) were higher compared to the control group. The percentage variations between dimensional differences from the two groups were 38.58% for height, and for width were 36.88% at 0 mm, 35.56% at 3 mm, 36.61% at 5 mm, and 38.73% at 7 mm. The differences were statistically significant (p ˂ 0.0005). CONCLUSIONS The results obtained after ARP with A-PRF showed a reduced loss of bone volume compared to spontaneous healing.
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Affiliation(s)
- Antonia Samia Khaddour
- Department of Oral Rehabilitation, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.S.K.); (E.C.D.); (A.R.); (S.M.P.)
| | - Răzvan Eugen Ghiță
- Department of Oral Rehabilitation, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.S.K.); (E.C.D.); (A.R.); (S.M.P.)
| | - Mihaela Ionescu
- Department of Medical Informatics and Biostatistics, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Radu Gabriel Rîcă
- Department of Dental Technology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Veronica Mercuț
- Department of Prosthetic Dentistry, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Horia Octavian Manolea
- Department of Dental Materials, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Adrian Camen
- Department of Oral and Maxillofacial Surgery, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Emma Cristina Drăghici
- Department of Oral Rehabilitation, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.S.K.); (E.C.D.); (A.R.); (S.M.P.)
| | - Andrei Radu
- Department of Oral Rehabilitation, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.S.K.); (E.C.D.); (A.R.); (S.M.P.)
| | - Sanda Mihaela Popescu
- Department of Oral Rehabilitation, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.S.K.); (E.C.D.); (A.R.); (S.M.P.)
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Goswami A, Lanjewar S, Mangalekar S, Dodwad V, Oza R, Vhanmane P, Shirbhate U. A Comparative Evaluation of Advanced Platelet-Rich Fibrin Combined With Demineralized Freeze-Dried Bone Allograft and Demineralized Freeze-Dried Bone Allograft Alone in the Treatment of Periodontal Infrabony Defects: A Clinical and Radiographic Study. Cureus 2024; 16:e61808. [PMID: 38975514 PMCID: PMC11227282 DOI: 10.7759/cureus.61808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 06/06/2024] [Indexed: 07/09/2024] Open
Abstract
Aim Allografts, autografts, alloplast and xenografts are frequently used for periodontal regeneration. The aim of this study was to determine the efficacy of advanced platelet-rich fibrin (A-PRF) in combination with demineralized freeze-dried bone allograft (DFDBA) and DFDBA alone in periodontal infrabony defects. Methodology This was a split-mouth design study where 20 infrabony defects in 10 patients were included. Patients were randomly divided into two groups, where DFDBA allograft and A-PRF were used in the test group, while the DFDBA allograft alone was used in the control group. Furthermore, the results were evaluated at baseline, three, and nine months, respectively, in terms of clinical and radiographic parameters. Data were analysed with an unpaired t-test at the significance level of P < 0.05 (statistically significant). Results Both treatments showed reduced clinical and radiographic parameters from baseline to nine months. There was a non-significant difference in the plaque index (PI), bleeding on probing (BOP), clinical attachment level (CAL), and radiographic defect fill (RDF). In comparison to the control group (3.40 ± 0.516), the probing pocket depth (PPD) in the test group at nine months (3.22 ± 0.422) was statistically significant showing reduction in the PPD (P = 0.042). Conclusion Within its limitations, the study showed that A-PRF plus DFDBA and DFDBA alone treatment modalities reduced clinical and radiographic parameters from baseline, at 9 months; however, the inclusion of A-PRF did not substantially improve the treatment outcome when comparing both the groups, except for the probing pocket depth after nine months.
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Affiliation(s)
- Aakash Goswami
- Department of Periodontics, Maitri College of Dentistry and Research Center, Durg, IND
| | - Shivani Lanjewar
- Department of Periodontics, Bharati Vidyapeeth Dental College and Hospital, Sangli, IND
| | - Sachin Mangalekar
- Department of Periodontics, Bharati Vidyapeeth Dental College and Hospital, Sangli, IND
| | - Vidya Dodwad
- Department of Periodontics, Bharati Vidyapeeth Dental College and Hospital, Pune, IND
| | - Ranu Oza
- Department of Periodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Priyanka Vhanmane
- Department of Periodontics, Bharati Vidyapeeth Dental College and Hospital, Sangli, IND
| | - Unnati Shirbhate
- Department of Periodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Yari A, Fasih P, Ghotbi N, Badkoobeh A, Goodarzi A, Hosseini Hooshiar M. Do Platelet-Rich Concentrates Improve the Adverse Sequelae of Impacted Mandibular Third Molar Removal? J Oral Maxillofac Surg 2024; 82:671-683. [PMID: 38513712 DOI: 10.1016/j.joms.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/14/2024] [Accepted: 02/26/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Several measures have been implemented to minimize the side effects of impacted third molar (M3) removal including the use of platelet-rich fibrin (PRF). PURPOSE This study compared the effects of three modifications of PRF (leukocyte-PRF [L-PRF], advanced-PRF [A-PRF], and advanced-PRF plus [A-PRF +]) on the side effects of impacted M3 removal. STUDY DESIGN, SETTING, AND SAMPLE This double-blinded randomized controlled trial was conducted at the Oral Surgery Department of Kashan University between September 2022 and May 2023 on patients undergoing mandibular impacted M3 removal. Exclusion criteria were age over 30, local inflammation and infection, medication usage, and systemic disease. INDEPENDENT VARIABLE The independent variable was the PRF product grouped into four categories (control, L-PRF, A-PRF, and A-PRF+). Study subjects were randomly distributed among the four groups. MAIN OUTCOME VARIABLE(S) The main outcome variables were postoperative sequelae including measures of soft tissue healing, pain, analgesic use, alveolar osteitis, trismus, and swelling. Subjects were assessed at baseline and on days 1, 2, 3, and 7 postsurgery. COVARIATES Age, sex, duration of surgery, and side of surgery were the covariates. ANALYSES Changes at different time points were analyzed using repeated measures analysis of variance. Pairwise comparisons were performed if significant. P values ≤.05 were considered statistically significant. RESULTS The sample consisted of 64 subjects (16 per group). All three modifications of PRF yielded significantly better soft tissue healing index than the control group on days 2, 3, 7, and 14 postoperatively (P > .05). A-PRF and A-PRF + had significantly better healing index than L-PRF on the third day (P = .02, P = .01). All the study groups significantly reduced visual analog scale pain score than the control group on days 1, 2, and 3. A-PRF and A-PRF + had significantly lower visual analog scale scores than L-PRF on the second day (P = .003, P = .02). No significant difference was found in maximum mouth opening during follow-up sessions (P = .2). Study groups had less facial swelling on days 2 and 3 than the control group (P < .05). CONCLUSION AND RELEVANCE L-PRF, A-PRF, and A-PRF + can improve postoperative outcomes after M3 removal but may not impact trismus. A-PRF and A-PRF + may be more effective than L-PRF in promoting soft tissue healing and reducing pain. A-PRF and A-PRF + have comparable results.
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Affiliation(s)
- Amir Yari
- Assistant Professor, Department of Oral and Maxillofacial Surgery, School of Dentistry, Kashan University of Medical Sciences, Kashan, Iran.
| | - Paniz Fasih
- Assistant Professor, Department of Prosthodontics, School of Dentistry, Kashan University of Medical Sciences, Kashan, Iran
| | - Nader Ghotbi
- General Dentist, Isfahan Azad University, School of Dentistry, Isfahan, Iran
| | - Ashkan Badkoobeh
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Qom University of Medical Sciences, Qom, Iran
| | - Ali Goodarzi
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hosseini Hooshiar
- Dental Research Center, Dentistry Research Institute, Tehran University of Medical Sciences & Department of Periodontology, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran.
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El-Wakeel N, Mohamed Abd-Elaziz L. Single-flap approach versus without concentrate growth factor in the treatment of periodontal supra-osseous defects: A randomized controlled clinical trial. Saudi Dent J 2024; 36:328-333. [PMID: 38419996 PMCID: PMC10897590 DOI: 10.1016/j.sdentj.2023.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/12/2023] [Accepted: 11/14/2023] [Indexed: 03/02/2024] Open
Abstract
Objectives We aimed to compare treatment outcomes of periodontal supra-bony defects using single flap (SFA) plus concentrate growth factor versus SFA alone. Methods 32 supra-bony periodontal defects were randomly assigned to test and control groups. Outcome variables were clinical attachment level (primary outcome). Probing pocket depths, gingival recessions, bone gain, post-surgical pain using visual analogue scale and wound healing index were recorded as secondary outcomes. Clinical and radiographic assessments were recorded at baseline and 6 months after treatment, whereas pain score and wound healing index were recorded within 10 days after surgery. Results Test group showed a significant improvement in all tested parameters compared to control group (P-value ≤ 0.05). Better patient centered outcomes (wound healing and pain scores) were highly achieved in the test group compared to controls. Conclusion The tested combined approach offers better periodontal and patient centered treatment outcomes in management of periodontal supra-bony defects.
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Affiliation(s)
- Naglaa El-Wakeel
- Oral Medicine and Periodontology Department, Faculty of Dentistry, Al-Azhar University (Girls Branch), Cairo, Egypt
| | - Lobna Mohamed Abd-Elaziz
- Oral Medicine and Periodontology Department, Faculty of Dentistry, Al-Azhar University (Girls Branch), Cairo, Egypt
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Liu M, Liu Y, Luo F. The role and mechanism of platelet-rich fibrin in alveolar bone regeneration. Biomed Pharmacother 2023; 168:115795. [PMID: 37918253 DOI: 10.1016/j.biopha.2023.115795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 10/21/2023] [Accepted: 10/26/2023] [Indexed: 11/04/2023] Open
Abstract
Platelet-rich fibrin (PRF), as an autologous blood preparation, has been receiving increasing attention in recent years and has been successfully applied in various clinical treatments for alveolar bone regeneration in the oral field. This review focuses on analyzing and summarizing the role and mechanism of PRF in alveolar bone regeneration. We first provide a brief introduction to PRF, then summarize the mechanisms by which PRF promotes alveolar bone regeneration from three aspects: osteogenesis mechanism, bone induction mechanism, and bone conduction mechanism, involving multiple signaling pathways such as Smad, ERK1/2, PI3K/Akt, and Wnt/β-catenin. We also explore the various roles of PRF as a scaffold, filler, and in combination with bone graft materials, detailing how PRF promotes alveolar bone regeneration and provides a wealth of experimental evidence. Finally, we summarize the current applications of PRF in various oral fields. The role of PRF in alveolar bone regeneration is becoming increasingly important, and its role and mechanism are receiving more and more research and understanding. This article will provide a reference of significant value for research in related fields. The exploration of the role and mechanism of PRF in alveolar bone regeneration may lead to the discovery of new therapeutic targets and the development of more effective and efficient treatment strategies.
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Affiliation(s)
- Ming Liu
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China
| | - Yu Liu
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China
| | - Feng Luo
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China.
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Al-Badran A, Bierbaum S, Wolf-Brandstetter C. Does the Choice of Preparation Protocol for Platelet-Rich Fibrin Have Consequences for Healing and Alveolar Ridge Preservation After Tooth Extraction? A Meta-Analysis. J Oral Maxillofac Surg 2023; 81:602-621. [PMID: 36736375 DOI: 10.1016/j.joms.2023.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 01/06/2023] [Accepted: 01/06/2023] [Indexed: 02/03/2023]
Abstract
PURPOSE Multiple preparation protocols for platelet-rich fibrin (PRF) are in use today, and clinical results are often heterogeneous. This study analyzes the impact of the chosen PRF preparation protocol on 1) wound healing and 2) alveolar ridge preservation. METHODS For this systematic review and meta-analysis, eligible studies were identified in PubMed and Cochrane databases. Included were randomized controlled and controlled clinical trials with healthy patients treated with PRF after atraumatic tooth extraction compared to untreated socket(s), reporting at least one of the following outcome variables: pain, swelling, soft tissue healing, alveolar osteitis risk, horizontal and vertical bone loss, socket fill, and new bone formation. Main predictor variable was relative centrifugal force (RCF) comparing high RCF (high PRF), intermediate RCF (standard [S-PRF]), low RCF (advanced PRF), and various RCF settings (concentrated growth factor preparation [CGF]). The type of centrifugation tubes (silica-coated plastic and glass) was a secondary predictor. Weighted or standardized mean differences, risk ratio and corresponding 95% confidence intervals were calculated. RESULTS Forty studies published between 2012 and 2022 were selected. The pooled effects of all outcomes were significant against untreated sockets. Within the subgroups high PRF or advanced PRF had the lowest efficacy for many outcome parameters. Pain reduction (in visual analog scale units) was highest for S-PRF (-1.18 [-1.48, -0.88], P < .00001) and CGF (-1.03 [-1.16, -0.90], P < .001). The risk ratio of alveolar osteitis (0.09 [0.01, 0.69], P < .02) and soft tissue healing (standardized mean difference = 2.55 [2.06, 3.03], P < .001) were best for CGF. No subgroup differences were found for bone-related outcomes. No meaningful analysis of the tube material effect was possible. CONCLUSION This study confirms that PRF is associated with reduced postoperative complications but indicates that preparation protocol influences clinical outcomes. S-PRF and CGF protocols appear to be superior for several outcome parameters.
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Affiliation(s)
- Alsafa Al-Badran
- Master of Science in Implantology and Dental Surgery, Dentist at Zahnarztpraxis am Erbdrostenhof, Münster, Germany
| | - Susanne Bierbaum
- Scientific Editor, Senior Lecturer, International Medical College, University of Duisburg-Essen, Münster, Germany
| | - Cornelia Wolf-Brandstetter
- Senior Scientist, Group leader "Biofunctionalized surfaces", Max Bergmann Center of Biomaterials, Technische Universität Dresden, Dresden, Germany; Senior Scientist, International Medical College, University of Duisburg-Essen, Münster, Germany.
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Shirbhate U, Bajaj P. Third-Generation Platelet Concentrates in Periodontal Regeneration: Gaining Ground in the Field of Regeneration. Cureus 2022; 14:e28072. [PMID: 36127983 PMCID: PMC9477433 DOI: 10.7759/cureus.28072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 08/16/2022] [Indexed: 11/17/2022] Open
Abstract
Platelets are important for hemostasis and the healing of wounds. In clinical settings, healing cytokines including insulin-like growth factors (IGF), platelet-derived growth factors (PDGF), and transforming growth factors (TGF) are commonly implemented. The regenerative approach in dentistry frequently employs platelet concentrates (PCs) that are “autologous in origin” and have a high concentration of platelets, growth factors, and leukocytes. First-generation PCs is made of platelet-rich plasma (PRP), while second-generation PC is made of platelet-rich fibrin (PRF). Both have limitations, so modification protocols and development in PRP and PRF derivatives are required for advancement mechanisms, strength, biodegradability, retention ability in the field of regenerative dentistry, and so on. As third-generation PC, newer genera kinds of PRF, such as advanced-PRF (A-PRF), advanced-PRF+ (A-PRF+), injectable-PRF (i-PRF), and titanium-PRF (T-PRF), were introduced. A-PRF matrices in their solid form were introduced using the low-speed centrifugation concept (LSCC). The applied relative centrifugal force (RCF) for A-PRF is reduced to 208 g as a result of this improved preparation process. A-PRF features a greater number of neutrophil granules in the distal region, especially at the red blood cells-buffer coat (RBC-BC) interface, and the A-PRF clot has a more porosity-like structure with a bigger interfibrous space than PRF. Since the PRF is in a gel form and is difficult to inject, i-PRF was formulated to address this problem. Compared to the other two protocols, the i-PRF protocol requires far less time, and this is the advantage of this PC. This is because i-PRF just needs the blood components to be separated, which happens within the first two to four minutes. Compared to normal L-PRF, T-PRF creates fibrin that is thicker and more densely woven. Titanium has a higher hemocompatibility than glass, which could lead to greater polymerized fibrin formation. In periodontal regenerative operations, oral surgery, and implant dentistry, PRF and its newer advanced modifications have demonstrated promising results and desirable results in both soft and hard tissue regenerative techniques.
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