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Blanco J, García Alonso A, Hermida-Nogueira L, Castro AB. How to explain the beneficial effects of leukocyte- and platelet-rich fibrin. Periodontol 2000 2024. [PMID: 38923566 DOI: 10.1111/prd.12570] [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: 01/24/2024] [Revised: 03/06/2024] [Accepted: 04/15/2024] [Indexed: 06/28/2024]
Abstract
The survival of an organism relies on its ability to repair the damage caused by trauma, toxic agents, and inflammation. This process involving cell proliferation and differentiation is driven by several growth factors and is critically dependent on the organization of the extracellular matrix. Since autologous platelet concentrates (APCs) are fibrin matrices in which cells, growth factors, and cytokines are trapped and delivered over time, they are able to influence that response at different levels. The present review thoroughly describes the molecular components present in one of these APCs, leukocyte- and platelet-rich fibrin (L-PRF), and summarizes the level of evidence regarding the influence of L-PRF on anti-inflammatory reactions, analgesia, hemostasis, antimicrobial capacity, and its biological mechanisms on bone/soft tissue regeneration.
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Affiliation(s)
- Juan Blanco
- Department of Surgery (Stomatology, Unit of Periodontology), Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Angel García Alonso
- Platelet Proteomics Group, Center for Research in Molecular Medicine and Chronic Diseases (CIMUS), Santiago de Compostela University, Santiago de Compostela, Spain
| | - Lidia Hermida-Nogueira
- Platelet Proteomics Group, Center for Research in Molecular Medicine and Chronic Diseases (CIMUS), Santiago de Compostela University, Santiago de Compostela, Spain
| | - Ana B Castro
- Department of Oral Health Sciences, Section of Periodontology, KU Leuven & Dentistry, University Hospitals Leuven, Leuven, Belgium
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2
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Bains VK, Mahendra J, Mittal M, Bedi M, Mahendra L. Technical considerations in obtaining platelet rich fibrin for clinical and periodontal research. J Oral Biol Craniofac Res 2023; 13:714-719. [PMID: 37731846 PMCID: PMC10507643 DOI: 10.1016/j.jobcr.2023.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/12/2023] [Accepted: 09/11/2023] [Indexed: 09/22/2023] Open
Abstract
Autologous platelet rich fibrin (PRF), is currently being widely used and investigated across the globe by clinicians and periodontal research. The technical aspect required for the procurement of PRF includes revolution per minute (RPM), relative centrifugal force (RCF) or G-force, rotor radius, rotor angle, stability or vibration in the centrifugal machine and material of test-tube, besides the systemic health of the individual may influence the final outcome. Present technical note intends to compile these aspects for better understanding and appropriate outcome while preparing PRF in varying clinical scenarios.
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Affiliation(s)
- Vivek Kumar Bains
- Department of Periodontology, Saraswati Dental College & Hospital, Lucknow, India
| | - Jaideep Mahendra
- Department of Periodontology, Meenakshi Ammal Dental College & Hospital, Meenakshi Academy of Higher Education and Research, Chennai, India
| | - Madhukar Mittal
- Department of Endocrinology & Metabolism, AIIMS, Jodhpur, India
| | - Muskan Bedi
- Department of Basic Medical Sciences, Sri Ramachandra Medical College and Hospital, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Little Mahendra
- Maktoum Bin Hamdan Dental University College, Dubai, United Arab Emirates
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3
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Ucer C, Khan RS. Alveolar Ridge Preservation with Autologous Platelet-Rich Fibrin (PRF): Case Reports and the Rationale. Dent J (Basel) 2023; 11:244. [PMID: 37886929 PMCID: PMC10605266 DOI: 10.3390/dj11100244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 10/09/2023] [Accepted: 10/18/2023] [Indexed: 10/28/2023] Open
Abstract
In dental implantology, alveolar ridge preservation (ARP) has emerged as a standard technique to address dimensional changes that affect alveolar ridge morphology following tooth loss. Various alternative graft materials, including xenografts, alloplasts, and allografts, have been effectively employed in fresh extraction sites for ARP. Current evidence suggests that these materials primarily serve as bio-scaffolds, which are slowly incorporated, thus necessitating a waiting period of at least 4-6 months before implant placement. Consequently, the ARP technique extends the overall duration of implant treatment by several months. Recently, the incorporation of a form of autologous platelet concentrate, known as platelet-rich fibrin (PRF), has been advocated in conjunction with ARP as a method of bioenhancement of soft- and hard-tissue healing and regeneration. PRF contains platelet-derived growth factors, hormones, and bioactive components like cytokines that have demonstrated the ability to stimulate angiogenesis and tissue regeneration throughout all phases of wound healing. Additionally, the concentration of leukocytes present in the PRF matrix plays a vital role in tissue healing and regeneration as part of the osteoimmune response. The reported advantages of incorporating autogenous PRF platelet concentrates during ARP encompass reduced healing time, improved angiogenesis and bone regeneration, socket sealing through the fibrin matrix, antibacterial properties, and decreased post-extraction pain and infection risk. Therefore, the objective of this paper is to review the existing evidence regarding the application of PRF in alveolar ridge preservation (ARP) following tooth extraction. Two clinical case studies are presented, wherein ARP was enhanced with PRF, followed by implant placement within a relatively short period of 8 weeks. These cases serve as further proof of concept for supporting the adjuvant use of PRF to enhance healing and accelerate implant placement after ARP.
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Affiliation(s)
| | - Rabia S. Khan
- I.C.E Postgraduate Dental Institute, University of Salford, Manchester M5 4WT, UK;
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Campana MD, Aliberti A, Acerra A, Sammartino P, Dolce P, Sammartino G, Gasparro R. The Effectiveness and Safety of Autologous Platelet Concentrates as Hemostatic Agents after Tooth Extraction in Patients on Anticoagulant Therapy: A Systematic Review of Randomized, Controlled Trials. J Clin Med 2023; 12:5342. [PMID: 37629387 PMCID: PMC10455824 DOI: 10.3390/jcm12165342] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/25/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023] Open
Abstract
One of the common challenges in oral surgery is dealing with patients who are taking oral anticoagulant/antiaggregant drugs. Several local hemostatic agents have been proposed as an alternative to conventional suturing. Among these, autologous platelet concentrates (APCs) have been widely used to decrease the risk of hemorrhage after dental extraction. Nevertheless, there is a lack of consensus regarding the superiority of any one specific hemostatic agent over the others. This systematic review is aimed at evaluating the effectiveness of APCs as hemostatic agents after tooth extraction in patients on anticoagulant therapy. A literature search was conducted of articles published before March 2023 on PubMed, Scopus, and the Cochrane Central Register of Controlled Trials (CENTRAL). Studies on the use of APCs in patients undergoing dental extractions and being treated with anticoagulant drugs were included. Only randomized, controlled trials (RCTs) published up to March 2023 were included; the outcomes assessed were the time to hemostasis, the presence of post-operative bleeding and pain, and the effectiveness of wound healing. The risk of bias for each RCT was assessed by using the 'risk of bias' tool (RoB 1.0). The research revealed 6 RCTs. The findings indicated that patients on anticoagulant therapy who received APCs without discontinuing their medication experienced a decreased post-operative bleeding, a shorter hemostasis time, reduced pain, and accelerated wound healing. However, due to the high/unclear risk of bias of the studies included, no definitive conclusions can be drawn on the superiority of APCs as hemostatic agents over other similar products. Additional studies are required to validate these findings.
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Affiliation(s)
- Maria Domenica Campana
- Department of Neurosciences, Reproductive Sciences and Odontostomatological Sciences, University of Naples Federico II, 80131 Naples, Italy; (M.D.C.); (A.A.); (A.A.); (R.G.)
| | - Angelo Aliberti
- Department of Neurosciences, Reproductive Sciences and Odontostomatological Sciences, University of Naples Federico II, 80131 Naples, Italy; (M.D.C.); (A.A.); (A.A.); (R.G.)
| | - Alfonso Acerra
- Department of Neurosciences, Reproductive Sciences and Odontostomatological Sciences, University of Naples Federico II, 80131 Naples, Italy; (M.D.C.); (A.A.); (A.A.); (R.G.)
| | - Pasquale Sammartino
- Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialties, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy;
| | - Pasquale Dolce
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy;
| | - Gilberto Sammartino
- Department of Neurosciences, Reproductive Sciences and Odontostomatological Sciences, University of Naples Federico II, 80131 Naples, Italy; (M.D.C.); (A.A.); (A.A.); (R.G.)
| | - Roberta Gasparro
- Department of Neurosciences, Reproductive Sciences and Odontostomatological Sciences, University of Naples Federico II, 80131 Naples, Italy; (M.D.C.); (A.A.); (A.A.); (R.G.)
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Berton F, Costantinides F, Stacchi C, Corradini A, Di Lenarda A, Di Lenarda R. Is L-PRF an effective hemostatic agent in single tooth extractions? A cohort study on VKA and DOAC patients. Clin Oral Investig 2023; 27:2865-2874. [PMID: 36707441 PMCID: PMC10264503 DOI: 10.1007/s00784-023-04880-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 01/23/2023] [Indexed: 01/29/2023]
Abstract
OBJECTIVES The aim of this clinical observational study was to assess the efficacy of L-PRF as a hemostatic agent in patients under treatment with vitamin K antagonists (VKAs) or direct oral anticoagulants (DOACs). MATERIALS AND METHODS Patients under oral anticoagulant therapy (VKA or DOACs) who needed a single simple tooth extraction were enrolled. L-PRF plug was positioned inside the alveolus and secured with non-absorbable sutures. Surgical time, pain-VAS, paracetamol intake, intra-operative, post-operative biological complications, and bleeding events have been registered. RESULTS A total of 112 patients (59 patients for DOAC and 53 for VKA group) were enrolled. Post-operative bleeding was recorded in nine patients (17%) for VKA group and nine patients (15.3%) for DOACs group. None of the patients needed a medical support for managing of bleeding. Seven days after surgery, no cases of post-extractive complications occurred. CONCLUSIONS The use of L-PRF resulted in limited mild late post-operative bleedings without the need of medical intervention. CLINICAL RELEVANCE The use of L-PRF can be adopted for an uneventful post-operative curse in anticoagulated patients without chasing their therapy for single tooth extraction.
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Affiliation(s)
- Federico Berton
- Maxillofacial and Dental Surgical Clinic, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.
| | - Fulvia Costantinides
- Maxillofacial and Dental Surgical Clinic, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Claudio Stacchi
- Maxillofacial and Dental Surgical Clinic, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Ambra Corradini
- Maxillofacial and Dental Surgical Clinic, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Andrea Di Lenarda
- Cardiovascular Center, University Hospital and Health Services, Trieste, Italy
| | - Roberto Di Lenarda
- Maxillofacial and Dental Surgical Clinic, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
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Marinho E, de Almeida Viana G, de Barros Silva P, Alves A, Mota M, de Sousa Alves R, Sousa F. Mechanical properties of platelet-rich fibrin from patients on warfarin. Int J Oral Maxillofac Surg 2022:S0901-5027(22)00448-9. [DOI: 10.1016/j.ijom.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/12/2022] [Accepted: 11/03/2022] [Indexed: 11/29/2022]
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Does Platelet-Rich Fibrin Prevent Hemorrhagic Complications After Dental Extractions in Patients Using Oral Anticoagulant Therapy? J Oral Maxillofac Surg 2021; 79:2215-2226. [PMID: 34343502 DOI: 10.1016/j.joms.2021.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/30/2021] [Accepted: 07/01/2021] [Indexed: 01/05/2023]
Abstract
PURPOSE The number of anticoagulated patients requiring dental extractions and other minor dentoalveolar surgical procedures has increased significantly. The purpose of this study was to determine whether the use of platelet-rich fibrin (PRF) prevents hemorrhagic complications after dental extractions in patients being treated with oral anticoagulants. METHODS A 2-phase PROSPERO-registered systematic review of published within-subject controlled trials (CRD42020186678) was conducted in accordance with the PRISMA statement. Searches were conducted through Medline via PubMed, Web of Science, LILACS, Central Cochrane, Scopus, DOSS, and Google Scholar, until May 2020. The predictor variable was the study group (PRF vs use/non-use of other hemostatic agents). The main outcome of interest was the risk of bleeding after tooth extraction and the covariates were postoperative complications. Data analysis included synthesis of results, risk of bias (RoB) evaluation, meta-analysis (random effects; I²-based heterogeneity; 95% confidence), and certainty of evidence assessment. RESULTS From a total of 216 articles, 3 articles (low-moderate RoB) were included for evaluation in this systematic review and meta-analysis. A total of 130 patients were involved. The outcomes of the meta-analysis showed that the use of PRF in extraction wounds did not reduce the risk of bleeding after extraction in anticoagulated patients (P= .330; I² = 99%). Furthermore, the use of PRF did not improve pain scores (P = .470; I² = 96%) or the risk of postoperative alveolitis (P = .4300; I² = 38%) in anticoagulated patients. The certainty of the evidence ranged from moderate to low. CONCLUSIONS The findings of this systematic review and meta-analysis suggest that PRF does not prevent hemorrhagic complications after tooth extraction in patients using oral anticoagulant therapy.
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de Almeida Malzoni CM, Nícoli LG, da Col Dos Santos Pinto G, Pigossi SC, Zotesso VA, Verzola MHA, Marcantonio C, Gonçalves V, Zandim-Barcelos DL, Marcantonio E. The Effectiveness of L-PRF in the Treatment of Schneiderian Membrane Large Perforations: Long-Term Follow-Up of a Case Series. J ORAL IMPLANTOL 2021; 47:31-35. [PMID: 32662834 DOI: 10.1563/aaid-joi-d-20-00044] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The perforation of the Schneiderian membrane (SM) is a common surgical complication during the sinus floor augmentation (SFA) procedure. Different approaches have been proposed to completely closer the SM perforation and to avoid graft contamination or migration and postoperative sinus infection. In this context, the leukocyte and platelet-rich fibrin (L-PRF) membranes have been proposed for SM perforation treatment because of their natural adhesive property and resistance. Thus, this case series aims to evaluate the effectiveness of L-PRF in the treatment of SM large perforations during SFA. A total of 9 SM perforations were treated in this case series. The L-PRF membranes were interposed on the perforated SM until the rupture could not be visualized. The maxillary sinus cavities were filled with deproteinized bovine mineral bone (Bio-oss, Geistlich, Switzerland), and a collagen membrane was positioned to cover the lateral access window. After 8 months, 13 implants were placed, achieving satisfactory primary stability. The osseointegration of all implants and absence of infection signs/mucus in the maxillary sinus were observed in cone beam computed tomography or panoramic radiography qualitative analysis after 3-5 years of follow-up. It can be concluded that the use of L-PRF can be considered a viable alternative for the repair of large SM perforations.
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Affiliation(s)
| | - Lélis Gustavo Nícoli
- Department of Clinic and Surgery, School of Dentistry, Alfenas Federal University (Unifal-MG), Alfenas, Minas Gerais, Brazil
| | - Gustavo da Col Dos Santos Pinto
- Department of Clinic and Surgery, School of Dentistry, Alfenas Federal University (Unifal-MG), Alfenas, Minas Gerais, Brazil
| | - Suzane Cristina Pigossi
- Department of Clinic and Surgery, School of Dentistry, Alfenas Federal University (Unifal-MG), Alfenas, Minas Gerais, Brazil
| | | | | | - Cláudio Marcantonio
- Dental Graduate Program, Universidade de Araraquara-UNIARA, Araraquara, SP, Brazil
| | - Victor Gonçalves
- Department of Diagnosis and Surgery, School of Dentristry at Araraquara, São Paulo Sate University-UNESP, Araraquara, SP, Brazil
| | - Daniela Leal Zandim-Barcelos
- Department of Diagnosis and Surgery, School of Dentristry at Araraquara, São Paulo Sate University-UNESP, Araraquara, SP, Brazil
| | - Elcio Marcantonio
- Department of Diagnosis and Surgery, School of Dentristry at Araraquara, São Paulo Sate University-UNESP, Araraquara, SP, Brazil
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An Injectable Fibrin Scaffold Rich in Growth Factors for Skin Repair. BIOMED RESEARCH INTERNATIONAL 2021; 2021:8094932. [PMID: 33628814 PMCID: PMC7884109 DOI: 10.1155/2021/8094932] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 11/18/2020] [Accepted: 01/11/2021] [Indexed: 12/21/2022]
Abstract
Platelet aggregates, such as PRP, PRF, and CGF, have been used alone or in combination with other grafting materials to enhance restoration outcomes. The process for preparing these autografting materials requires two-step centrifugation or specific centrifuges. In this study, we obtained an injectable fibrin scaffold (IFS) rich in growth factors by one-step centrifugation of whole blood from rabbits. The purpose of this study is to introduce some characteristics of IFS. This scaffold was characterized using various techniques, including Masson's trichrome staining, scanning electron microscopy, porosity measurements, and cell counting. The sustained release of growth factors, including PDGF, VEGF, TGF-β1, IGF, FGF, and EGF, was quantified using ELISA assay. The obtained IFS was tested for its effects on cell proliferation, extracellular matrix deposition, and full-thickness skin defect repair. The prepared IFS is characterized by a loose fibrin network structure with white blood cells and platelets that slowly release growth factors and can promote the healing of skin defects via the promotion of cell proliferation, collagen deposition, and tissue revascularization. In addition, its liquid properties and porous structure are conducive to its application as a therapeutic component in tissue engineering.
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Damsaz M, Castagnoli CZ, Eshghpour M, Alamdari DH, Alamdari AH, Noujeim ZEF, Haidar ZS. Evidence-Based Clinical Efficacy of Leukocyte and Platelet-Rich Fibrin in Maxillary Sinus Floor Lift, Graft and Surgical Augmentation Procedures. Front Surg 2020; 7:537138. [PMID: 33330603 PMCID: PMC7732646 DOI: 10.3389/fsurg.2020.537138] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 09/18/2020] [Indexed: 12/20/2022] Open
Abstract
Bone augmentation techniques have increasingly been indicated for re-creating adequate bone height and volume suitable for dental implant sites. This is particularly applicable in the severely atrophic posterior maxilla where sinus perforation (ruptured Schneiderian membrane) is a very common complication and sinus floor elevation or lift is frequently considered a standard procedure. The augmentation of the maxillary sinus can be performed with or without grafting biomaterials. Herein, numerous biomaterials and bone substitutes have been proposed, primarily to sustain the lifted space. In addition, cytokines and growth factors have been used to stimulate angiogenesis, enhance bone formation as well as improve healing and recovery period, either as the sole filling material or in combination with bone substitute materials. Within such, is the family of autologous blood extracts, so-called platelet concentrates, which are simply the "product" resulting from the simple centrifugation of collected whole blood samples of the patient, immediately pre-surgery. Platelet-Rich Fibrin (PRF), a sub-family of platelet concentrates, is a three-dimensional (3-D) autogenous biomaterial obtained, without including anti-coagulants, bovine thrombin, additives, or any gelifying agents during the centrifugation process. Today, it is safe to say that, in implant dentistry and oral and maxillofacial surgery, PRFs (particularly, the pure platelet-rich fibrin or P-PRF and leukocyte and platelet-rich fibrin or L-PRF sub-classes) are receiving the most attention, essentially due to their simplicity, rapidness, user-friendliness/malleability, and cost-effectiveness. Whether used as the sole "bioactive" filling/additive material or combined with bone substitutes, the revolutionary second-generation PRFs have been very often associated with promising clinical results. Hence, this review aims to provide a 10-years update on the clinical effectiveness of L-PRF when applied/used as the "sole" biomaterial in maxillary sinus augmentation procedures. An electronic search using specific keywords for L-PRF and maxillary sinus augmentation was conducted in three main databases (PubMed-MEDLINE database, Google Scholar and Cochrane library) for the period between January 2009-February 2020. The quest yielded a total of 468 articles. Based on the pre-established strict inclusion/exclusion criteria, only seven articles were deemed eligible and included in the analysis. Surprisingly, of the 5 studies which used de-proteinized bovine bone mineral (DBBM) in combination with L-PRF, 60% acclaimed no significant effects and only 40% declared positive effects. Of the two articles which had used allogenous bone graft, 50% declared no significant effects and 50% acclaimed positive effects. Only one study had used L-PRF as the sole grafting material and reported a positive effect. Likewise, positive effects were reported in one other study using L-PRF in combination with a collagen membrane. Due to the heterogeneity of the included studies, this review is limited by the inability to perform a proper systematic meta-analysis. Overall, most of the published studies reported impressive results of L-PRF application as a grafting material (sole or adjuvant) in maxillary sinus augmentation and dental implant restorative procedures. Yet, distinct technical processing for L-PRF preparation was noted. Hence, studies should be approached with caution. Here in, in sinus lift and treatment of Schneider membrane, the formation of mature bone remains inconclusive. More studies are eagerly awaited in order to prove the beneficial or detrimental effects of PRFs, in general and L-PRFs, in specific; especially in their tissue regenerative potential pertaining to the promotion of angiogenesis, enhancing of cell proliferation, stimulation of cell migration and autocrine/paracrine secretion of growth factors, as well as to reach a consensus or a conclusive and distinct determination of the effect of leukocytes (and their inclusion) on inflammation or edema and pain; a call for standardization in PRFs and L-PRFs composition reporting and regimenting the preparation protocols.
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Affiliation(s)
- Mohamadamin Damsaz
- Dentistry Student Research Committee, Mashhad Dental School, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Majid Eshghpour
- Oral and Maxillofacial Surgery Department, Mashhad Dental School, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Daryouosh Hamidi Alamdari
- Surgical Oncology Research Center, Emam Reza Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Aida Hamidi Alamdari
- Dentistry Student Research Committee, Mashhad Dental School, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ziad Eva Fouad Noujeim
- BioMAT'X R&D&I Laboratory, Universidad de los Andes, Santiago, Chile
- Department of Oral and MaxilloFacial Surgery, Faculty of Dental Medicine, Lebanese University, Beirut, Lebanon
| | - Ziyad Samir Haidar
- BioMAT'X R&D&I Laboratory, Universidad de los Andes, Santiago, Chile
- Programa de Doctorado en BioMedicina, Facultad de Medicina, Universidad de los Andes, Santiago, Chile
- Centro de Investigación e Innovación Biomédica (CIIB), Universidad de los Andes, Santiago, Chile
- Facultad de Odontología, Universidad de los Andes, Santiago, Chile
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11
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Effects of ınjectable platelet-rich fibrin in experimental periodontitis in rats. Odontology 2020; 109:422-432. [PMID: 33068206 DOI: 10.1007/s10266-020-00557-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 09/17/2020] [Indexed: 12/30/2022]
Abstract
Injectable platelet-rich fibrin (i-PRF) is an effective biological material that positively contributes to angiogenesis, wound healing, inflammation, regeneration processes, etc. This research aimed to evaluate the effect of i-PRF in rats with experimental periodontitis. Following the development of ligature-induced periodontitis, 24 Wistar albino rats were divided into three groups. Group-1: scaling and root planing (only-SRP); Group-2: SRP + i-PRF; Group-3: only- i-PRF. Heart blood from six donors was used for the i-PRF application. i-PRF was administered as a subgingival injection in the relevant groups on the 1st, 3rd, and 7th days. The tissues were evaluated histopathologically and immunohistochemically. Also, bone structures were examined using micro-CT. According to the data obtained, no statistically significant difference was observed among the groups in terms of bone resorption, inflammation, bone volume, bone levels (mesial/distal), and IL-1β, IFN-ɤ, TNF-α, VEGF values (p > 0.05). However, bone mineral density was statistically significantly different among the groups (Group3 > Group2 > Group1) (p < 0.0001). Subgingival injection of only-i-PRF showed promising results in periodontitis treatment but contribution to SRP has not been proved according to this study results. The study results suggested that the i-PRF application was as effective as SRP in reducing bone loss, modulating inflammatory process, and effecting cytokines in experimental periodontitis. The significant effect of i-PRF on bone mineral density was the most remarkable result.
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12
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Brancaccio Y, Antonelli A, Barone S, Bennardo F, Fortunato L, Giudice A. Evaluation of local hemostatic efficacy after dental extractions in patients taking antiplatelet drugs: a randomized clinical trial. Clin Oral Investig 2020; 25:1159-1167. [PMID: 32613433 DOI: 10.1007/s00784-020-03420-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 06/17/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate clinical efficacy of four different local hemostatics in patients taking oral antiplatelet therapy, after multiple dental extractions without discontinuing drugs. MATERIALS AND METHODS Study sample included 102 patients (mean age 64.1 ± 17.4 years) in treatment with oral antiplatelet agents needing multiple dental extractions. After surgery, the sockets were randomly sealing with suture alone (control group), hemostatic plug (HEM), advanced platelet-rich fibrin (A-PRF+), and leukocyte-platelet-rich fibrin (L-PRF). Primary outcomes were post-operative bleeding, wound healing index, and possible complications. Secondary outcomes were correlation between primary outcomes and patient's comorbidities and voluptuous habits. Descriptive statistics, bivariate comparisons, and logistic regression analysis were performed (p < 0.05). RESULTS Both A-PRF+ and L-PRF showed a reduced bleeding risk when compared with suture alone (OR = 0.09, p = 0.001 for A-PRF+; OR = 0.09, p = 0.005 for L-PRF). Only L-PRF showed a reduced risk for incomplete wound healing when compared with the control site (OR = 0.43, p = 0.019). Patients affected by hypertension (OR 3.91, p = 0.015) and diabetes (OR 3.24, p = 0.026) had the highest bleeding risk. Smoking (OR 4.30, p = 0.016) and diabetes (OR 3.79, p = 0.007) interfered with healing process. CONCLUSION L-PRF and A-PRF represent a valid alternative to the traditional hemostatics, reducing post-surgical bleeding and promoting wound healing. CLINICAL RELEVANCE In patients taking antiplatelet drugs, different local hemostatics are useful to control potential post-operative bleeding and to favor wound healing. However, comorbidities and voluptuous habits may increase bleeding risk, interfering with healing process.
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Affiliation(s)
- Ylenia Brancaccio
- Department of Health Sciences, School of Dentistry, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Alessandro Antonelli
- Department of Health Sciences, School of Dentistry, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Selene Barone
- Department of Health Sciences, School of Dentistry, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Francesco Bennardo
- Department of Health Sciences, School of Dentistry, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Leonzio Fortunato
- Department of Health Sciences, School of Dentistry, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Amerigo Giudice
- Department of Health Sciences, Magna Graecia University of Catanzaro, Viale Europa, 88100, Catanzaro, Italy.
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Tooth extractions in patients under antiresorptive therapy for osteoporosis: Primary closure of the extraction socket with a mucoperiosteal flap versus application of platelet-rich fibrin for the prevention of antiresorptive agent-related osteonecrosis of the jaw. J Craniomaxillofac Surg 2020; 48:444-451. [DOI: 10.1016/j.jcms.2020.02.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 01/20/2020] [Accepted: 02/10/2020] [Indexed: 12/17/2022] Open
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The Effect of Warfarin on the Fibrin Architecture of Platelet-Rich Fibrin. J Craniofac Surg 2020; 31:e13-e18. [DOI: 10.1097/scs.0000000000005808] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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A novel method for harvesting concentrated platelet-rich fibrin (C-PRF) with a 10-fold increase in platelet and leukocyte yields. Clin Oral Investig 2019; 24:2819-2828. [PMID: 31788748 DOI: 10.1007/s00784-019-03147-w] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 11/06/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND OBJECTIVES Liquid platelet rich fibrin (PRF; often referred to as injectable PRF) has been utilized as an injectable formulation of PRF that is capable of stimulating tissue regeneration. Our research group recently found that following standard L-PRF protocols (2700 RPM for 12 min), a massive increase in platelets and leukocytes was observed directly within the buffy-coat layer directly above the red blood cell layer. The purpose of this study was to develop a novel harvesting technique to isolate liquid PRF directly from this buffy coat layer and to compare this technique to standard i-PRF. MATERIALS AND METHODS Standard high g-force L-PRF and low g-force i-PRF protocols were utilized to separate blood layers. Above the red blood corpuscle layer, sequential 100-μL layers of plasma were harvested (12 layers total; i.e., 1.2 mL, which represents the total i-PRF volume), and 3 layers (3 × 100 μL) were harvested from the red blood cell layer to quantify blood cells. Each layer was then sent for complete blood count (CBC) analysis, and the cell numbers were quantified including red blood cells, leukocytes, neutrophils, lymphocytes, monocytes, and platelets. The liquid PRF that was directly collected from the buffy-coat layer following L-PRF protocols was referred to as concentrated PRF (C-PRF). RESULTS The i-PRF protocol typically yielded a 2- to 3-fold increase in platelets and a l.5-fold increase in leukocyte concentration from the 1- to 1.2-mL plasma layer compared to baseline concentrations in whole blood. While almost no cells were found in the first 4-mL layer of L-PRF, a massive accumulation of platelets and leukocytes was found directly within the buffy coat layer demonstrating extremely high concentrations of cells in this 0.3-0.5-mL layer (~ 20-fold increases). We therefore proposed harvesting this 0.3- to 0.5-mL layer directly above the red blood cell corpuscle layer as liquid C-PRF. In general, i-PRF was able to increase platelet numbers by ~ 250%, whereas a 1200-1700% increase in platelet numbers could easily be achieved by harvesting this 0.3-0.5 mL of C-PRF (total platelet concentrations of > 2000-3000 × 109 cells/L). CONCLUSION While conventional i-PRF protocols increase platelet yield by 2-3-fold and leukocyte yield by 50%, we convincingly demonstrated the ability to concentrate platelets and leukocytes over 10-fold by harvesting the 0.3-0.5 mL of C-PRF within the buffy coat following L-PRF protocols. CLINICAL RELEVANCE Previous studies have demonstrated only a slight increase in platelet and leukocyte concentrations in i-PRF. The present study described a novel harvesting technique with over a 10-fold increase in platelets and leukocytes that can be further utilized for tissue regeneration.
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Feigin K, Shope B. Use of Platelet-Rich Plasma and Platelet-Rich Fibrin in Dentistry and Oral Surgery: Introduction and Review of the Literature. J Vet Dent 2019; 36:109-123. [DOI: 10.1177/0898756419876057] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
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.
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Tehranchi A, Behnia H, Pourdanesh F, Behnia P, Pinto N, Younessian F. The effect of autologous leukocyte platelet rich fibrin on the rate of orthodontic tooth movement: A prospective randomized clinical trial. Eur J Dent 2019; 12:350-357. [PMID: 30147398 PMCID: PMC6089057 DOI: 10.4103/ejd.ejd_424_17] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Objective: The aim of this study was to evaluate the effect of LPRF, placed in extraction sockets, on orthodontic tooth movement (OTM). Materials and Methods: Thirty extraction sockets from eight patients (five males, three females, with a mean age of 17.37 years; range 12–25 years) requiring extraction of first premolars based on their orthodontic treatment plan participated in this split-mouth clinical trial. In one randomly selected quadrant of each jaw, the extraction socket was preserved as the experimental group by immediate placement of LPRF in the extraction socket. The other quadrant served as the control group for secondary healing. Immediately, the teeth adjacent to the defects were pulled together by a NiTi closed-coil spring with constant force. A piece of 0.016 × 0.022-inch stainless steel wire was used as the main arch wire. The amount of OTM was measured on the study casts at eight time points with 2-week intervals for 3 months. Analysis of random effect model was performed for the purpose of comparison between the experimental and control groups. Results: According to the random effect model, a statistically significant difference was found between the experimental and control group in rate of OTM (P = 0.006). Conclusion: According to the results, application of LPRF, as an interdisciplinary approach combining orthodontics and surgery, may accelerate OTM, particularly in extraction cases.
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Affiliation(s)
- Azita Tehranchi
- Dental Research Center, Dental Research Institute, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Behnia
- Dentofacial Deformities Research Center, Dental Research Institute, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereydoun Pourdanesh
- Department of Oral and Maxillofacial Surgery, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parsa Behnia
- Postgraduate Student, Department of Oral and Maxillofacial Surgery, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nelson Pinto
- Department of Periodontic and Implant Dentistry, Faculty of Dentistry, University of The Andes, Las Condes, Santiago, Chile
| | - Farnaz Younessian
- Department of Orthodontics, College of Dental Medicine, Nova Southeastern University, Fort Lauderdale, FL 33328, USA
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de Almeida Barros Mourão CF, Miron RJ, de Mello Machado RC, Ghanaati S, Alves GG, Calasans-Maia MD. Usefulness of platelet-rich fibrin as a hemostatic agent after dental extractions in patients receiving anticoagulant therapy with factor Xa inhibitors: a case series. Oral Maxillofac Surg 2019; 23:381-386. [PMID: 31102080 DOI: 10.1007/s10006-019-00769-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 04/30/2019] [Indexed: 06/09/2023]
Abstract
PURPOSE To evaluate the clinical outcomes of platelet-rich fibrin (PRF) application for hemostasis after dental extraction in patients receiving anticoagulant therapy with factor Xa inhibitors. METHODS In total, 25 patients receiving anticoagulant therapy with rivaroxaban or apixaban who required routine dental extraction were evaluated. In all patients, PRF was used for hemostasis in addition to adapting sutures. Bleeding was subjectively assessed using a sterilize gauze pad at 24, 48, and 72 h after the procedure. RESULTS All invited participants (n = 25) consented to participate. The PRF clots successfully arrested bleeding after extraction in all patients, with no complications at any time point after the procedure. Favorable soft tissue healing was observed during suture removal at 10 days after the procedure in all patients, with no signs of infection or late healing. CONCLUSIONS The results of this case series indicate that PRF is a promising natural hemostatic agent for the management of bleeding after dental extraction in patients receiving factor Xa inhibitor therapy. Further controlled clinical studies with larger patient samples are necessary to clarify the findings of this case series.
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Affiliation(s)
- Carlos Fernando de Almeida Barros Mourão
- Department of Molecular and Cell Biology, Institute of Biology, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil.
- Department of Oral Surgery, Dentistry School, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil.
| | - Richard J Miron
- Department of Periodontology, University of Bern, Bern, Switzerland
| | | | - Shahram Ghanaati
- Department of Maxillofacial, Clinic for Maxillofacial and Plastic Surgery, Johann Wolfgang Goethe University, Frankfurt Am Main, Germany
| | - Gutemberg Gomes Alves
- Department of Molecular and Cell Biology, Institute of Biology, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | - Mônica Diuana Calasans-Maia
- Department of Oral Surgery, Dentistry School, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
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Sarkar S, Prashanth NT, Shobha ES, Rangan V, Nikhila G. Efficacy of Platelet Rich Fibrin versus chitosan as a hemostatic agent following dental extraction in patients on antiplatelet therapy. J Oral Biol Craniofac Res 2019; 9:336-339. [PMID: 31467833 DOI: 10.1016/j.jobcr.2019.07.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/16/2019] [Accepted: 07/30/2019] [Indexed: 01/14/2023] Open
Abstract
Objectives The aim of this study is to compare the effectiveness of Platelet Rich Fibrin gel and Chitosan gel dressing in providing hemostasis in patients receiving Oral Antiplatelet Therapy and also to evaluate their surgical healing outcome following dental extractions. Methodology A total of 60 patients under Oral Antiplatelet Therapy indicated for tooth extraction were included for treatment in the study without altering the oral antiplatelet regimens. Patients were allocated equally in two groups; Group A: where PRF gel was packed into the extraction socket, while Group B: Chitosan hydrogel was packed. Timing of hemostasis was noted for each patient of both the groups. Patients were examined for any pain/secondary bleeding/healing/soft tissue dehiscence/alveolar osteitis in the extraction site on first, third and seventh post-operative days. Results All extraction sockets with Platelet-rich fibrin achieved hemostasis in 2.64 min and sockets with Chitosan hydrogel achieved hemostasis in 1.182 min (p < 0.001). Post-operative pain in Group A sites (3.2, 1.4, 0.37 on 1st, 3rd & 7th day respectively) was significantly lower than the control sites (3.4, 1.67, 0.53 on 1st, 3rd & 7th day respectively) p-value 0.001, 0.001 respectively. Conclusion In this study, Chitosan hydrogel dressing thus proved to be a superior hemostatic agent compared to PRF gel, that significantly shortens the clotting time following dental extraction in patients under antiplatelet therapy. But, PRF gel has superior wound healing properties than Chitosan with less postoperative pain following minor oral surgical procedures under local anesthesia.
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Affiliation(s)
- Sourav Sarkar
- Department of Oral and Maxillofacial Surgery, Dayananda Sagar College of Dental Sciences and Hospitals, India
| | - N T Prashanth
- Department of Oral and Maxillofacial Surgery, Dayananda Sagar College of Dental Sciences and Hospitals, India
| | - E S Shobha
- Department of Oral and Maxillofacial Surgery, Dayananda Sagar College of Dental Sciences and Hospitals, India
| | - Vinod Rangan
- Department of Oral and Maxillofacial Surgery, Dayananda Sagar College of Dental Sciences and Hospitals, India
| | - G Nikhila
- Department of Oral and Maxillofacial Surgery, Dayananda Sagar College of Dental Sciences and Hospitals, India
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Andrade C, Camino J, Nally M, Quirynen M, Martínez B, Pinto N. Combining autologous particulate dentin, L-PRF, and fibrinogen to create a matrix for predictable ridge preservation: a pilot clinical study. Clin Oral Investig 2019; 24:1151-1160. [PMID: 31292776 DOI: 10.1007/s00784-019-02922-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 04/29/2019] [Indexed: 01/11/2023]
Abstract
OBJECTIVES The aim of this study was to describe the histological and clinical outcome of "dentin block" (a mixture of autologous particulate dentin, leukocyte- and platelet-rich fibrin (L-PRF), and liquid fibrinogen) in alveolar ridge preservation. MATERIAL AND METHODS Ten extraction sockets were grafted with "dentin block," a mixture of particulate autologous dentin with chopped leukocyte-platelet-rich fibrin (L-PRF) membranes at a 1:1 ratio, and liquid fibrinogen as a binder. Two grafted sites were followed at 4 and 5 months, and 6 sites at 6 months. Biopsies were taken from the core of the grafted site for histologic and histo-morphometric analysis. RESULTS All patients completed the study without any adverse event. The vertical and horizontal dimensions of the alveolar ridge were preserved or even increased after 4, 5, or 6 months and remained stable after 6 months of the implant placement. The histological examination revealed a median relative percentage of bone, dentin, and connective tissue of 57.0, 0.9, and 39.3%, respectively. A comparison of samples at different time points (4, 5, and 6 months) showed a progressive increase in the proportion of bone with a decrease in the proportion of dentin. The bone was compact with normal osteocytes and moderate osteoblastic activity. In 4 out of 10 samples, no dentin was observed; in the other samples, it represented 1-5% (with geometric fragments). CONCLUSIONS Dentin block showed to be a suitable bone substitute in an alveolar ridges preservation model. CLINICAL RELEVANCE The promising results of dentin block as a bone substitute in alveolar ridge preservation could have an important clinical impact considering this biomaterial brings together the regenerative potential of three autologous products with excellent biological and clinical behavior, low risk of adverse effects, and feasible acquisition.
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Affiliation(s)
- Catherine Andrade
- Department of Periodontology and Oral Implantology, Faculty of Dentistry, School of Dentistry, Universidad de Los Andes, Monseñor Álvaro del Portillo12455, Las Condes, Santiago, Chile.
| | - Joaquin Camino
- Department of Periodontology and Oral Implantology, Faculty of Dentistry, School of Dentistry, Universidad de Los Andes, Monseñor Álvaro del Portillo12455, Las Condes, Santiago, Chile
| | - Mauricio Nally
- Department of Periodontology and Oral Implantology, Faculty of Dentistry, School of Dentistry, Universidad de Los Andes, Monseñor Álvaro del Portillo12455, Las Condes, Santiago, Chile
| | - Marc Quirynen
- Section of Periodontology, Department of Oral Health Sciences, KU Leuven & Dentistry, University Hospitals, KU Leuven, Kapucijnenvoer 7, 3000, Leuven, Belgium
| | - Benjamín Martínez
- Department of Oral Diagnosis and Oral Pathology, School of Dentistry, Universidad Mayor, Santiago, Chile
| | - Nelson Pinto
- Department of Periodontology and Oral Implantology, Faculty of Dentistry, School of Dentistry, Universidad de Los Andes, Monseñor Álvaro del Portillo12455, Las Condes, Santiago, Chile.,Section of Periodontology, Department of Oral Health Sciences, KU Leuven & Dentistry, University Hospitals, KU Leuven, Kapucijnenvoer 7, 3000, Leuven, Belgium
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Aghaloo TL, Tencati E, Hadaya D. Biomimetic Enhancement of Bone Graft Reconstruction. Oral Maxillofac Surg Clin North Am 2019; 31:193-205. [DOI: 10.1016/j.coms.2018.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Yamakawa S, Hayashida K. Advances in surgical applications of growth factors for wound healing. BURNS & TRAUMA 2019; 7:10. [PMID: 30993143 PMCID: PMC6450003 DOI: 10.1186/s41038-019-0148-1] [Citation(s) in RCA: 142] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 03/13/2019] [Indexed: 12/15/2022]
Abstract
Growth factors have recently gained clinical importance for wound management. Application of recombinant growth factors has been shown to mimic cell migration, proliferation, and differentiation in vivo, allowing for external modulation of the healing process. Perioperative drug delivery systems can enhance the biological activity of these growth factors, which have a very short in vivo half-life after topical administration. Although the basic mechanisms of these growth factors are well understood, most have yet to demonstrate a significant impact in animal studies or small-sized clinical trials. In this review, we emphasized currently approved growth factor therapies, including a sustained release system for growth factors, emerging therapies, and future research possibilities combined with surgical procedures. Approaches seeking to understand wound healing at a systemic level are currently ongoing. However, further research and consideration in surgery will be needed to provide definitive confirmation of the efficacy of growth factor therapies for intractable wounds.
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Affiliation(s)
- Sho Yamakawa
- Division of Plastic and Reconstructive Surgery, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane 693-8501 Japan
| | - Kenji Hayashida
- Division of Plastic and Reconstructive Surgery, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane 693-8501 Japan
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Afat IM, Akdoğan ET, Gönül O. Effects of leukocyte- and platelet-rich fibrin alone and combined with hyaluronic acid on early soft tissue healing after surgical extraction of impacted mandibular third molars: A prospective clinical study. J Craniomaxillofac Surg 2019; 47:280-286. [DOI: 10.1016/j.jcms.2018.11.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 11/20/2018] [Accepted: 11/26/2018] [Indexed: 11/30/2022] Open
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Ghanaati S, Herrera-Vizcaino C, Al-Maawi S, Lorenz J, Miron RJ, Nelson K, Schwarz F, Choukroun J, Sader R. Fifteen Years of Platelet Rich Fibrin in Dentistry and Oromaxillofacial Surgery: How High is the Level of Scientific Evidence? J ORAL IMPLANTOL 2018; 44:471-492. [DOI: 10.1563/aaid-joi-d-17-00179] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Platelet-rich fibrin is a blood concentrate system used for soft tissue and bone tissue regeneration. In the last decade, platelet rich fibrin (PRF) has been widely used in different indication fields, particularly in oral and maxillofacial surgery. This review investigates the level of scientific evidence of published articles related to the use of PRF for bone and soft tissue regeneration in dentistry and maxillofacial surgery. An electronic literature research using the biomedical search engine “National Library of Medicine” (PubMed-MEDLINE) was performed in May 2017. A total of 392 articles were found, 72 of which were classified for each indication field. When comparing PRF with biomaterials vs biomaterial alone in sinus lift (5 studies; IIa), no statistically significant differences were detected. Socket preservation and ridge augmentation using PRF significantly enhanced new bone formation compared to healing without PRF (7 studies Ib, IIa, IIb). Reepithelialization and bone regeneration was achieved in 96 of 101 patients diagnosed with medication-related osteonecrosis of the jaw (5 studies, III). In periodontology, PRF alone (6 studies; Ib, IIa, IIb) or its combination with biomaterials (6 studies; Ib, IIa, IIb) significantly improved the pocket depth and attachment loss compared to a treatment without PRF. Over 70% of the patients were part of studies with a high level of scientific evidence (randomized and controlled prospective studies). This published evidence (38 articles), with a high scientific level, showed that PRF is a beneficial tool that significantly improves bone and soft tissue regeneration. However, the clinical community requires a standardization of PRF protocols to further examine the benefit of PRF in bone and soft tissue regeneration in reproducible studies, with a higher scientific level of evidence.
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Affiliation(s)
- Shahram Ghanaati
- Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Frankfurt Orofacial Regenerative Medicine (FORM) Lab, University Hospital Frankfurt Goethe University, Frankfurt, Germany
| | - Carlos Herrera-Vizcaino
- Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Frankfurt Orofacial Regenerative Medicine (FORM) Lab, University Hospital Frankfurt Goethe University, Frankfurt, Germany
| | - Sarah Al-Maawi
- Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Frankfurt Orofacial Regenerative Medicine (FORM) Lab, University Hospital Frankfurt Goethe University, Frankfurt, Germany
| | - Jonas Lorenz
- Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Frankfurt Orofacial Regenerative Medicine (FORM) Lab, University Hospital Frankfurt Goethe University, Frankfurt, Germany
| | - Richard J Miron
- Department of Periodontology, College of Dental Medicine, Nova Southeastern University, Fort Lauderdale, Fla
| | - Katja Nelson
- Department of Oral and Craniomaxillofacial Surgery, Center for Dental Medicine, University Medical Center, Freiburg, Germany
| | - Frank Schwarz
- Department of Oral Surgery and Implantology, Carolinum, Johann Wolfgang Goethe-University, Frankfurt, Germany
| | | | - Robert Sader
- Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Frankfurt Orofacial Regenerative Medicine (FORM) Lab, University Hospital Frankfurt Goethe University, Frankfurt, Germany
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Miron RJ, Dham A, Dham U, Zhang Y, Pikos MA, Sculean A. The effect of age, gender, and time between blood draw and start of centrifugation on the size outcomes of platelet-rich fibrin (PRF) membranes. Clin Oral Investig 2018; 23:2179-2185. [DOI: 10.1007/s00784-018-2673-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 09/27/2018] [Indexed: 01/31/2023]
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26
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Kapse S, Surana S, Satish M, Hussain SE, Vyas S, Thakur D. Autologous platelet-rich fibrin: can it secure a better healing? Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 127:8-18. [PMID: 30287202 DOI: 10.1016/j.oooo.2018.08.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 06/22/2018] [Accepted: 08/22/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the efficacy of platelet-rich fibrin (PRF) in the healing of impacted mandibular third molar (M3) extraction sockets. STUDY DESIGN This study included 30 patients with bilaterally symmetric impacted M3 (N = 60) requiring transalveolar extraction. All patients were assigned numbers randomly; left-sided M3 patients with odd numbers and right-sided patients with even numbers were categorized into group A (test group), and the other side of the mouth was classified as "group B" (control group). Group A M3 extraction sockets received PRF, whereas group B sockets were closed without PRF. Patients were evaluated for pain and swelling on postoperative days 1, 3, 7, and 14. Bone healing was compared on postoperative weeks 8 and 16. Analysis of variance (ANOVA) and Tukey's multiple comparison tests were applied for statistical analysis. RESULTS A total of 30 patients, ages 18 to 40 years, participated in this study. The overall postoperative pain score (visual analogue scale [VAS]) and facial swelling percentages were lower for group A compared with group B (P < .05). Early bone healing was also evident on postoperative radiographs obtained at weeks 8 and 16 in group A (P < .001). CONCLUSIONS The use of autologous PRF aids in earlier and better wound healing in a controlled manner.
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Affiliation(s)
- Sheetal Kapse
- Fellow, Maxillofacial Trauma, Association of Oral and Maxillofacial Surgeons of India, Bangalore, India); Private practitioner, Raipur, Chhattisgarh, India.
| | - Sanidhya Surana
- Private practitioner at Swasthya Sanchay Dental Clinic, Balod, Durg, Chhattisgarh, India
| | - M Satish
- Professor and Head of Department, Department of Oral and Maxillofacial Surgery at Anil Neerukonda Institute of Dental Sciences, Visakhapatnam, Andhra Pradesh, India
| | | | - Sunil Vyas
- Private practitioner, Raipur, Chhattisgarh, India
| | - Deepak Thakur
- Professor, Rungta College of Dental Sciences and Research, Bhilai, Chhattisgarh, India
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de Almeida Barros Mourão CF, Calasans-Maia MD, de Mello Machado RC, de Brito Resende RF, Alves GG. The use of platelet-rich fibrin as a hemostatic material in oral soft tissues. Oral Maxillofac Surg 2018; 22:329-333. [PMID: 29946892 DOI: 10.1007/s10006-018-0708-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 06/11/2018] [Indexed: 12/20/2022]
Abstract
The control of postoperative bleeding represents one of the main intercurrent events associated with soft tissue surgical procedures in the oral cavity. In this context, platelet-rich fibrin (PRF) membranes are materials with great potential for optimizing soft tissue healing and induction of hemostasis. This interventional case series describes the treatment of 10 patients with excisional biopsy of benign oral cavity lesions, following a screening sequence at the surgery clinic of a Brazilian dental school between the years of 2015 and 2017. After treatment with PRF, patients presented mean time for postoperative hemostasis of 10.3 ± 2.5 s, requiring the average use of three membranes to cover the surgical area. The results suggest that the use of platelet-rich fibrin membranes may represent a feasible alternative hemostatic material for the treatment of oral lesions.
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Affiliation(s)
- Carlos Fernando de Almeida Barros Mourão
- Department of Molecular and Cell Biology, Institute of Biology, Fluminense Federal University, Rua Miguel de Frias, 9 - Icaraí, Niterói, RJ, 24220-900, Brazil.
- Department of Oral Surgery, Dentistry School, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil.
- Department of Oral Surgery, São José Dentistry School, Realengo, Rio de Janeiro, Brazil.
- Department of Surgical Sciences, University of Genoa, Genoa, Italy.
| | - Mônica Diuana Calasans-Maia
- Department of Oral Surgery, Dentistry School, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | | | | | - Gutemberg Gomes Alves
- Department of Molecular and Cell Biology, Institute of Biology, Fluminense Federal University, Rua Miguel de Frias, 9 - Icaraí, Niterói, RJ, 24220-900, Brazil
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Temmerman A, Cleeren GJ, Castro AB, Teughels W, Quirynen M. L-PRF for increasing the width of keratinized mucosa around implants: A split-mouth, randomized, controlled pilot clinical trial. J Periodontal Res 2018; 53:793-800. [PMID: 29858875 DOI: 10.1111/jre.12568] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study aims to evaluate the use of the leukocyte- and platelet-rich fibrin (L-PRF) membranes in increasing the width of the keratinized mucosa (KM) around implants. MATERIAL AND METHODS Eight patients in need for bilateral widening of the KM around implants in the lower jaw were recruited for a spit-mouth randomized controlled trial. At the control site, a free gingival graft (FGG) was used, whereas at the other side (test), L-PRF membranes were applied. The primary outcome was the increase in width of KM around the implants. As secondary outcomes, the postoperative pain and surgical time were assessed. The follow-up period was 6 weeks. RESULTS A significant increase in the total bucco-lingual width of KM in both groups was observed, with 1.3 mm ± 0.9 extra gain (P < .05) for the FGG sites. Shrinkage of the widened areas in this period was 32.1% at the test site and 23.6% at the control site. All values of the postoperative pain scores at the control site were higher than at the test site. The mean surgery time in the test and control group was 29.1 ± 4.8 and 48.1 ± 7.7 minutes, respectively. CONCLUSION Within the limitations of this randomized controlled trial with split mouth design, it can be concluded that L-PRF can increase the width of KM around implants. Furthermore, the use of L-PRF results in a lower surgical time with less postoperative discomfort and pain for the patients in comparison to the FGG.
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Affiliation(s)
- A Temmerman
- Section of Periodontology, Department of Oral Health Sciences, KU Leuven & Dentistry, University Hospitals, KU Leuven, Leuven, Belgium
| | - G J Cleeren
- Section of Periodontology, Department of Oral Health Sciences, KU Leuven & Dentistry, University Hospitals, KU Leuven, Leuven, Belgium
| | - A B Castro
- Section of Periodontology, Department of Oral Health Sciences, KU Leuven & Dentistry, University Hospitals, KU Leuven, Leuven, Belgium
| | - W Teughels
- Section of Periodontology, Department of Oral Health Sciences, KU Leuven & Dentistry, University Hospitals, KU Leuven, Leuven, Belgium
| | - M Quirynen
- Section of Periodontology, Department of Oral Health Sciences, KU Leuven & Dentistry, University Hospitals, KU Leuven, Leuven, Belgium
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Gasparro R, Qorri E, Valletta A, Masucci M, Sammartino P, Amato A, Marenzi G. Non-Transfusional Hemocomponents: From Biology to the Clinic-A Literature Review. Bioengineering (Basel) 2018; 5:bioengineering5020027. [PMID: 29614717 PMCID: PMC6027172 DOI: 10.3390/bioengineering5020027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 03/23/2018] [Accepted: 03/29/2018] [Indexed: 12/17/2022] Open
Abstract
Non-transfusional hemocomponents for surgical use are autogenous products prepared through the centrifugation of a blood sample from a patient. Their potential beneficial outcomes include hard and soft tissue regeneration, local hemostasis, and the acceleration of wound healing. Therefore, they are suitable for application in different medical fields as therapeutic options and in surgical practices that require tissue regeneration.
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Affiliation(s)
- Roberta Gasparro
- Department of Neuroscience, Reproductive Science and Dental Science, University of Naples Federico II, 80131 Naples, Italy.
| | - Erda Qorri
- Division of Oral and Maxillofacial Surgery, Department of Dentistry, Albanian University, 1000 Tirana, Albania.
| | - Alessandra Valletta
- Department of Neuroscience, Reproductive Science and Dental Science, University of Naples Federico II, 80131 Naples, Italy.
| | - Michele Masucci
- Department of Neuroscience, Reproductive Science and Dental Science, University of Naples Federico II, 80131 Naples, Italy.
| | - Pasquale Sammartino
- Multidisciplinary Department of medical-Surgical and Dental Specialities, University of Naples "Luigi Vanvitelli", 80136 Italy.
| | - Alessandra Amato
- Department of Neuroscience, Reproductive Science and Dental Science, University of Naples Federico II, 80131 Naples, Italy.
| | - Gaetano Marenzi
- Department of Neuroscience, Reproductive Science and Dental Science, University of Naples Federico II, 80131 Naples, Italy.
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Öncü E, Kaymaz E. Assessment of the effectiveness of platelet rich fibrin in the treatment of Schneiderian membrane perforation. Clin Implant Dent Relat Res 2017; 19:1009-1014. [DOI: 10.1111/cid.12528] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 07/24/2017] [Accepted: 08/05/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Elif Öncü
- Department of Periodontology, School of Dentistry; Necmettin Erbakan University; Konya Turkey
| | - Esin Kaymaz
- Department of Medical Pathology; Bülent Ecevit University School of Medicine; Zonguldak Turkey
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Cabaro S, D'Esposito V, Gasparro R, Borriello F, Granata F, Mosca G, Passaretti F, Sammartino JC, Beguinot F, Sammartino G, Formisano P, Riccitiello F. White cell and platelet content affects the release of bioactive factors in different blood-derived scaffolds. Platelets 2017. [PMID: 28635382 DOI: 10.1080/09537104.2017.1319046] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Platelet-derived factors are biomaterials that might accelerate healing process in oral, maxillofacial, and several other applications. Release of specific factors by platelet concentrates is critical to achieving a successful outcome. Here, we have shown that platelet-rich fibrin (PRF) clots were beneficial sources of leukocytes, which may directly affect the release of chemokines and growth factors. When compared with the standard leukocyte-PRF (L-PRF), the experimental low-force modified procedure [defined as advanced-PRF (A-PRF)] entrapped the same content of viable leukocytes, released a similar amount of inflammatory cytokines, but secreted 3-, 1.6-, 3-, and 1.2-fold higher levels of Eotaxin, CCL5, platelet-derived growth factor (PDGF) and vascular endothelial growth factor (VEGF), respectively. A leukocyte-free scaffold, such as plasma rich in growth factors (PRGF), released only platelet-specific factors and, in particular, the F3 fraction, the richest in growth factors, secreted higher amount of CCL5 and PDGF compared to F1 and F2 fractions. In conclusion, different procedures and leukocyte content affect cytokine, chemokines, and growth factor release from platelet derivatives, which may be helpful in different clinical settings.
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Affiliation(s)
- S Cabaro
- a Department of Translational Medicine , Federico II University of Naples , Naples , Italy.,b URT "Genomic of Diabetes" of Institute of Experimental Endocrinology and Oncology , National Council of Research (CNR) , Naples , Italy
| | - V D'Esposito
- a Department of Translational Medicine , Federico II University of Naples , Naples , Italy.,b URT "Genomic of Diabetes" of Institute of Experimental Endocrinology and Oncology , National Council of Research (CNR) , Naples , Italy
| | - R Gasparro
- c Department of Neurosciences, Reproductive Sciences and Odontostomatology , Federico II University of Naples , Naples , Italy
| | - F Borriello
- a Department of Translational Medicine , Federico II University of Naples , Naples , Italy.,d Center for Basic and Clinical Immunology Research (CISI) , University of Naples Federico II , Naples , Italy
| | - F Granata
- a Department of Translational Medicine , Federico II University of Naples , Naples , Italy.,d Center for Basic and Clinical Immunology Research (CISI) , University of Naples Federico II , Naples , Italy
| | - G Mosca
- a Department of Translational Medicine , Federico II University of Naples , Naples , Italy.,b URT "Genomic of Diabetes" of Institute of Experimental Endocrinology and Oncology , National Council of Research (CNR) , Naples , Italy
| | - F Passaretti
- a Department of Translational Medicine , Federico II University of Naples , Naples , Italy.,b URT "Genomic of Diabetes" of Institute of Experimental Endocrinology and Oncology , National Council of Research (CNR) , Naples , Italy
| | - J C Sammartino
- c Department of Neurosciences, Reproductive Sciences and Odontostomatology , Federico II University of Naples , Naples , Italy
| | - F Beguinot
- a Department of Translational Medicine , Federico II University of Naples , Naples , Italy.,b URT "Genomic of Diabetes" of Institute of Experimental Endocrinology and Oncology , National Council of Research (CNR) , Naples , Italy
| | - G Sammartino
- c Department of Neurosciences, Reproductive Sciences and Odontostomatology , Federico II University of Naples , Naples , Italy
| | - P Formisano
- a Department of Translational Medicine , Federico II University of Naples , Naples , Italy.,b URT "Genomic of Diabetes" of Institute of Experimental Endocrinology and Oncology , National Council of Research (CNR) , Naples , Italy
| | - F Riccitiello
- c Department of Neurosciences, Reproductive Sciences and Odontostomatology , Federico II University of Naples , Naples , Italy
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Dohan Ehrenfest DM, Pinto NR, Pereda A, Jiménez P, Corso MD, Kang BS, Nally M, Lanata N, Wang HL, Quirynen M. The impact of the centrifuge characteristics and centrifugation protocols on the cells, growth factors, and fibrin architecture of a leukocyte- and platelet-rich fibrin (L-PRF) clot and membrane. Platelets 2017; 29:171-184. [DOI: 10.1080/09537104.2017.1293812] [Citation(s) in RCA: 132] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- David M. Dohan Ehrenfest
- LoB5 research unit, School of Dentistry & Research Center for Biomineralization Disorders, Chonnam National University, Gwangju, South Korea
- Department of Oral and Maxillofacial Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Nelson R. Pinto
- Graduate School of Periodontics and Implant Dentistry, University of the Andes (UANDES), Santiago, Chile
- Department of Oral Health Sciences, Katholieke Universiteit Leuven (KUL) & Periodontology, University Hospitals Leuven, Leuven, Belgium
| | - Andrea Pereda
- Graduate School of Periodontics and Implant Dentistry, University of the Andes (UANDES), Santiago, Chile
| | - Paula Jiménez
- Graduate School of Periodontics and Implant Dentistry, University of the Andes (UANDES), Santiago, Chile
| | | | - Byung-Soo Kang
- Department of Physics, Seoul National University, Seoul, South Korea
| | - Mauricio Nally
- Graduate School of Periodontics and Implant Dentistry, University of the Andes (UANDES), Santiago, Chile
| | - Nicole Lanata
- Research Center of Tissue Engineering and Regenerative Medicine, Concepcion, Chile
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Marc Quirynen
- Department of Oral Health Sciences, Katholieke Universiteit Leuven (KUL) & Periodontology, University Hospitals Leuven, Leuven, Belgium
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Injectable platelet rich fibrin (i-PRF): opportunities in regenerative dentistry? Clin Oral Investig 2017; 21:2619-2627. [DOI: 10.1007/s00784-017-2063-9] [Citation(s) in RCA: 116] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 01/25/2017] [Indexed: 12/19/2022]
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Platelet Rich Fibrin “PRF” and Regenerative Medicine: ‘The Low-Speed Concept’. STEM CELL BIOLOGY AND REGENERATIVE MEDICINE 2017. [DOI: 10.1007/978-3-319-55645-1_2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Miron RJ, Fujioka-Kobayashi M, Bishara M, Zhang Y, Hernandez M, Choukroun J. Platelet-Rich Fibrin and Soft Tissue Wound Healing: A Systematic Review. TISSUE ENGINEERING PART B-REVIEWS 2016; 23:83-99. [PMID: 27672729 DOI: 10.1089/ten.teb.2016.0233] [Citation(s) in RCA: 222] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The growing multidisciplinary field of tissue engineering aims at predictably regenerating, enhancing, or replacing damaged or missing tissues for a variety of conditions caused by trauma, disease, and old age. One area of research that has gained tremendous awareness in recent years is that of platelet-rich fibrin (PRF), which has been utilized across a wide variety of medical fields for the regeneration of soft tissues. This systematic review gathered all the currently available in vitro, in vivo, and clinical literature utilizing PRF for soft tissue regeneration, augmentation, and/or wound healing. In total, 164 publications met the original search criteria, with a total of 48 publications meeting inclusion criteria (kappa score = 94%). These studies were divided into 7 in vitro, 11 in vivo, and 31 clinical studies. In summary, 6 out of 7 (85.7%) and 11 out of 11 (100%) of the in vitro and in vivo studies, respectively, demonstrated a statistically significant advantage for combining PRF to their regenerative therapies. Out of the remaining 31 clinical studies, a total of 8 reported the effects of PRF in a randomized clinical trial, with 5 additional studies (13 total) reporting appropriate controls. In those clinical studies, 9 out of the 13 studies (69.2%) demonstrated a statistically relevant positive outcome for the primary endpoints measured. In total, 18 studies (58% of clinical studies) reported positive wound-healing events associated with the use of PRF, despite using controls. Furthermore, 27 of the 31 clinical studies (87%) supported the use of PRF for soft tissue regeneration and wound healing for a variety of procedures in medicine and dentistry. In conclusion, the results from the present systematic review highlight the positive effects of PRF on wound healing after regenerative therapy for the management of various soft tissue defects found in medicine and dentistry.
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Affiliation(s)
- Richard J Miron
- 1 Department of Periodontology, Nova Southeastern University , Fort Lauderdale, Florida
| | - Masako Fujioka-Kobayashi
- 1 Department of Periodontology, Nova Southeastern University , Fort Lauderdale, Florida.,2 Cranio-Maxillofacial Surgery, Bern University Hospital , Inselspital, Bern, Switzerland .,3 Department of Oral Surgery, Clinical Dentistry, Institute of Biomedical Sciences, Tokushima University Graduate School , Tokushima, Japan
| | - Mark Bishara
- 4 West Bowmanville Family Dental , Ontario, Canada
| | - Yufeng Zhang
- 5 Department of Oral Implantology, University of Wuhan , Wuhan, China
| | - Maria Hernandez
- 1 Department of Periodontology, Nova Southeastern University , Fort Lauderdale, Florida
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Temmerman A, Vandessel J, Castro A, Jacobs R, Teughels W, Pinto N, Quirynen M. The use of leucocyte and platelet-rich fibrin in socket management and ridge preservation: a split-mouth, randomized, controlled clinical trial. J Clin Periodontol 2016; 43:990-999. [PMID: 27509214 DOI: 10.1111/jcpe.12612] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2016] [Indexed: 12/30/2022]
Abstract
AIM To investigate the influence of the use L-PRF as a socket filling material and its ridge preservation properties. MATERIALS AND METHODS Twenty-two patients in need of single bilateral and closely symmetrical tooth extractions in the maxilla or mandible were included in a split-mouth RCT. Treatments were randomly assigned (L-PRF socket filling versus natural healing). CBCT scans were obtained after tooth extraction and three months. Scans were evaluated by superimposition using the original DICOM data. Mean ridge width differences between timepoints were measured at three levels below the crest on both the buccal and lingual sides (crest -1 mm (primary outcome variable), -3 mm and -5 mm). RESULTS Mean vertical height changes at the buccal were -1.5 mm (±1.3) for control sites and 0.5 mm (±2.3) for test sites (p < 0.005). At the buccal side, control sites values were, respectively, -2.1 (±2.5), -0.3 mm (±0.3) (p < 0.005) and -0.1 mm (±0.0), and test sites values were, respectively, -0.6 mm (±2.2) (p < 0.005), -0.1 mm (±0.3) and 0.0 mm (±0.1). Significant differences (p < 0.005) were found for total width reduction between test (-22.84%) and control sites (-51.92%) at 1 mm below crest level. Significant differences were found for socket fill (visible mineralized bone) between test (94.7%) and control sites (63.3%). CONCLUSION The use of L-PRF as a socket filling material to achieve preservation of horizontal and vertical ridge dimension at three months after tooth extraction is beneficial.
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Affiliation(s)
- Andy Temmerman
- Section of Periodontology, Department of Oral Health Sciences, KU Leuven and Dentistry, University Hospitals, KU Leuven, Leuven, Belgium.
| | - Jeroen Vandessel
- OMFS-Impath Research Group, Department of Oral and Maxillofacial Surgery, University Hospitals, KU Leuven, Leuven, Belgium
| | - Ana Castro
- Section of Periodontology, Department of Oral Health Sciences, KU Leuven and Dentistry, University Hospitals, KU Leuven, Leuven, Belgium
| | - Reinhilde Jacobs
- OMFS-Impath Research Group, Department of Oral and Maxillofacial Surgery, University Hospitals, KU Leuven, Leuven, Belgium
| | - Wim Teughels
- Section of Periodontology, Department of Oral Health Sciences, KU Leuven and Dentistry, University Hospitals, KU Leuven, Leuven, Belgium
| | - Nelson Pinto
- Department of Oral Implantology, University De Los Andes, Santiago, Chile
| | - Marc Quirynen
- Section of Periodontology, Department of Oral Health Sciences, KU Leuven and Dentistry, University Hospitals, KU Leuven, Leuven, Belgium
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López-López J, Jané-Salas E, Santamaría A, González-Navarro B, Arranz-Obispo C, López R, Miquel I, Arias B, Sánchez P, Rincón E, Rodríguez JR, Rojas S, Murat J. TETIS study: evaluation of new topical hemostatic agent TT-173 in tooth extraction. Clin Oral Investig 2015; 20:1055-63. [PMID: 26374745 DOI: 10.1007/s00784-015-1586-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 08/30/2015] [Indexed: 01/14/2023]
Affiliation(s)
- José López-López
- Department of Odontostomatology, School of Dentistry-Hospital Odontológico Universidad de Barcelona, Barcelona University, C/Feixa Llarga s/n, 08907, Hospitalet de Llobregat, Barcelona, Spain.
| | - Enric Jané-Salas
- Department of Odontostomatology, School of Dentistry-Hospital Odontológico Universidad de Barcelona, Barcelona University, C/Feixa Llarga s/n, 08907, Hospitalet de Llobregat, Barcelona, Spain
| | - Amparo Santamaría
- Hemostasia and Thrombosis Unit, Department of Hematology, Hospital Universitari Vall d'Hebrón, Barcelona, Spain
| | - Beatriz González-Navarro
- Department of Odontostomatology, School of Dentistry-Hospital Odontológico Universidad de Barcelona, Barcelona University, C/Feixa Llarga s/n, 08907, Hospitalet de Llobregat, Barcelona, Spain
| | - Carlos Arranz-Obispo
- Department of Odontostomatology, School of Dentistry-Hospital Odontológico Universidad de Barcelona, Barcelona University, C/Feixa Llarga s/n, 08907, Hospitalet de Llobregat, Barcelona, Spain
| | - Ramón López
- S.L. Parque Mediterráneo de la Tecnología, Thombotargets Europe, Castelldefels, Spain
| | - Ignasi Miquel
- S.L. Parque Mediterráneo de la Tecnología, Thombotargets Europe, Castelldefels, Spain
| | - Belén Arias
- S.L. Parque Mediterráneo de la Tecnología, Thombotargets Europe, Castelldefels, Spain
| | - Pilar Sánchez
- S.L. Parque Mediterráneo de la Tecnología, Thombotargets Europe, Castelldefels, Spain
| | - Esther Rincón
- S.L. Parque Mediterráneo de la Tecnología, Thombotargets Europe, Castelldefels, Spain
| | - Juan R Rodríguez
- S.L. Parque Mediterráneo de la Tecnología, Thombotargets Europe, Castelldefels, Spain
| | - Santiago Rojas
- S.L. Parque Mediterráneo de la Tecnología, Thombotargets Europe, Castelldefels, Spain
| | - Jesus Murat
- S.L. Parque Mediterráneo de la Tecnología, Thombotargets Europe, Castelldefels, Spain
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Influence of Leukocyte- and Platelet-Rich Fibrin (L-PRF) in the Healing of Simple Postextraction Sockets: A Split-Mouth Study. BIOMED RESEARCH INTERNATIONAL 2015; 2015:369273. [PMID: 26273612 PMCID: PMC4529911 DOI: 10.1155/2015/369273] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 11/11/2014] [Accepted: 11/11/2014] [Indexed: 12/02/2022]
Abstract
The aim of this study was to evaluate the effects of leukocyte- and platelet-rich fibrin (L-PRF) on the pain and soft tissue healing after tooth extractions. Twenty-six patients (9 males and 17 females) were treated with multiple extractions (2 to 8), with a total of 108 extractions. This was an exploratory single blinded randomized clinical trial with a split-mouth design. The pain after the surgery was assessed in each patient by the VAS scale (1 to 10) at intervals of 24-48-72-96 hours. The soft tissue healing was clinically evaluated at 3, 7, 14, and 21 days after surgery by the same examiner surgeon, using the modified Healing Index (4 to 12). The mean value of postextraction pain was 3.2 ± 0.3 in the experimental sides and 4.1 ± 0.1 in the control sides. After 7 days from the extractions, the values of modified Healing Index in the experimental and control groups were, respectively, 4.8 ± 0.6 and 5.1 ± 0.9. The use of L-PRF in postextraction sockets filling can be proposed as a useful procedure in order to manage the postoperative pain and to promote the soft tissue healing process, reducing the early adverse effects of the inflammation.
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Rodella LF, Bonazza V. Platelet preparations in dentistry: How? Why? Where? When? World J Stomatol 2015; 4:39-55. [DOI: 10.5321/wjs.v4.i2.39] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 04/08/2015] [Accepted: 04/30/2015] [Indexed: 02/06/2023] Open
Abstract
The aim of this article is to review the outcomes of platelet preparations in dentistry. A structured electronic search discovered 348 articles, which described the use of autologous platelet concentrates with a relevance to clinical dentistry. Among these articles, 220 articles investigated platelet rich plasma, 99 investigated platelet rich fibrin, 22 investigated plasma rich in growth factors and 7 investigated the use of concentrated growth factors. Several studies reported beneficial treament outcomes in terms of enhanced bone and soft tissue regeneration.
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40
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Dental surgery in anticoagulated patients—stop the interruption. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 119:136-57. [DOI: 10.1016/j.oooo.2014.10.011] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 09/06/2014] [Accepted: 10/15/2014] [Indexed: 01/12/2023]
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41
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Platelet rich fibrin versus Hemcon dental dressing following dental extraction in patients under anticoagulant therapy. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.tdj.2014.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Scarano A, Murmura G, Di Cerbo A, Palmieri B, Pinchi V, Mavriqi L, Varvara G. Anti-hemorrhagic agents in oral and dental practice: an update. Int J Immunopathol Pharmacol 2014; 26:847-54. [PMID: 24355219 DOI: 10.1177/039463201302600402] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Many oral surgeons in their daily practice have the problem of controlling postoperative bleeding. In surgical, oral and maxillofacial practice, standard anti-hemorrhagic protocols, especially in high risk patients, are obviously required and need to be continuously updated. The purpose of this review is to give a rational insight into the management of bleeding in oral and dental practice through modern drugs and medical devices such as lysine analogues and serine protease inhibitors, desmopressin, fibrin sealants, cyanoacrylates, gelatins, collagen and foams, protein concentrates, recombinant factors, complementary and alternative medicine and other compounds.
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Affiliation(s)
- A Scarano
- Department of Medical, Oral and Biotechnological Sciences, University of ChietiPescara, Chieti, Italy
| | - G Murmura
- Department of Medical, Oral and Biotechnological Sciences, University of ChietiPescara, Chieti, Italy
| | - A Di Cerbo
- Department of General Surgery and Surgical Specialties, University of Modena and Reggio Emilia Medical School, Modena, Italy
| | - B Palmieri
- Department of General Surgery and Surgical Specialties, University of Modena and Reggio Emilia Medical School, Modena, Italy
| | - V Pinchi
- Departmental Section of Legal Medicine, University of Florence, Florence, Italy
| | - L Mavriqi
- Department of Medical, Oral and Biotechnological Sciences, University of ChietiPescara, Chieti, Italy
| | - G Varvara
- Department of Medical, Oral and Biotechnological Sciences, University of ChietiPescara, Chieti, Italy
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Bölükbaşı N, Yeniyol S, Tekkesin MS, Altunatmaz K. The use of platelet-rich fibrin in combination with biphasic calcium phosphate in the treatment of bone defects: a histologic and histomorphometric study. Curr Ther Res Clin Exp 2014; 75:15-21. [PMID: 24465037 PMCID: PMC3898181 DOI: 10.1016/j.curtheres.2013.05.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2013] [Indexed: 01/27/2023] Open
Abstract
Background Platelet-rich fibrin (PRF) is a leukocyte and platelet concentrate containing many growth factors. Its potential for hard tissue augmentation as a sole grafting material or in combination with other grafting materials has been investigated in many studies. Objective The aim of this histologic study was to evaluate the efficacy of PRF mixed with biphasic calcium phosphate (BCP) on bone regeneration in surgically created bone defects. Methods Defects 5 mm in diameter were created in both tibias of 6 sheep. The defects were left empty or grafted with BCP, PRF, or BCP+PRF. Animals were killed at 10, 20, and 40 days. The specimens underwent histologic and histomorphometric analysis. Results None of the groups displayed any signs of necrosis. Inflammation was observed in all groups at 10 days; 2 specimens of PRF+BCP and all empty defects showed inflammatory cell infiltration at 20 days. During the 40-day evaluation period, the PRF+BCP group showed the highest ratios of new bone. The other 3 groups showed statistically similar results. In the BCP and PRF+BCP groups, the residual graft ratios were decreased at consecutive time intervals. The difference between the 2 groups was not statistically significant during follow-up. Conclusions The current study revealed a histomorphometric increase in bone formation with the addition of PRF to BCP in surgically created defects in sheep tibia.
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Affiliation(s)
- Nilüfer Bölükbaşı
- Department of Oral Implantology, Faculty of Dentistry, Istanbul University, Istanbul, Turkey
| | - Sinem Yeniyol
- Department of Oral Implantology, Faculty of Dentistry, Istanbul University, Istanbul, Turkey
| | - Merva Soluk Tekkesin
- Institute of Oncology, Department of Tumor Pathology, Istanbul University, Istanbul, Turkey
| | - Kemal Altunatmaz
- Department of Surgery, Faculty of Veterinary Medicine, Istanbul University, Istanbul, Turkey
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Naik B, Karunakar P, Jayadev M, Marshal VR. Role of Platelet rich fibrin in wound healing: A critical review. J Conserv Dent 2013; 16:284-93. [PMID: 23956527 PMCID: PMC3740636 DOI: 10.4103/0972-0707.114344] [Citation(s) in RCA: 122] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 03/21/2013] [Accepted: 04/22/2013] [Indexed: 02/02/2023] Open
Abstract
AIM The aim is to review and discuss the strategies available for use of platelet rich fibrin as healing aid in dentistry. BACKGROUND Platelet rich fibrin (PRF) is a fibrin matrix in which platelet cytokines, growth factors, and cells are trapped and may be released after a certain time and that can serve as a resorbable membrane. Choukroun and his associates were amongst the pioneers for using PRF protocol in oral and maxillofacial surgery to improve bone healing in implant dentistry. Autologous PRF is considered to be a healing biomaterial, and presently, studies have shown its application in various disciplines of dentistry. MATERIALS AND METHODS By using specific keywords, electronic search of scientific papers was carried out on the entire PubMed database with custom range of 5 years. The electronic search yielded 302 papers; based on inclusion and exclusion criteria which were specifically predetermined, 72 papers were identified as suitable to the inclusion criteria and the remaining 230 papers were excluded. After adding three more selected papers through hand search, full text of all the articles retrieved and review was done. By pooling the extracted data from selected papers, the reviewed data was synthesized. CONCLUSION Recently by showing good promising results with use of the PRF, it has proved to have a good prospect for its use as healing aid in various aspects of the dentistry.
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Affiliation(s)
- Balaram Naik
- Department of Conservative Dentistry and Endodontics, Sri Dharmasthala Manjunatheshwara College of Dental Sciences, Dharwad, Karnataka, India
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Passaretti F, Tia M, D'Esposito V, De Pascale M, Del Corso M, Sepulveres R, Liguoro D, Valentino R, Beguinot F, Formisano P, Sammartino G. Growth-promoting action and growth factor release by different platelet derivatives. Platelets 2013; 25:252-6. [PMID: 23855408 DOI: 10.3109/09537104.2013.809060] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract Platelet derivatives are commonly used in wound healing and tissue regeneration. Different procedures of platelet preparation may differentially affect growth factor release and cell growth. Preparation of platelet-rich fibrin (PRF) is accompanied by release of growth factors, including platelet-derived growth factor (PDGF), vascular endothelial growth factor (VEGF) and transforming growth factor β1 (TGFβ1), and several cytokines. When compared with the standard procedure for platelet-rich plasma (PRP), PRF released 2-fold less PDGF, but >15-fold and >2-fold VEGF and TGFβ1, respectively. Also, the release of several cytokines (IL-4, IL-6, IL-8, IL-10, IFNγ, MIP-1α, MIP-1β and TNFα) was significantly increased in PRF-conditioned medium (CM), compared to PRP-CM. Incubation of both human skin fibroblasts and human umbilical vein endothelial cells (HUVECs) with PRF-derived membrane (mPRF) or with PRF-CM enhanced cell proliferation by >2-fold (p<0.05). Interestingly, PRP elicited fibroblast growth at a higher extent compared to PRF. At variance, PRF effect on HUVEC growth was significantly greater than that of PRP, consistent with a higher concentration of VEGF in the PRF-CM. Thus, the procedure of PRP preparation leads to a larger release of PDGF, as a possible result of platelet degranulation, while PRF enhances the release of proangiogenic factors.
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Affiliation(s)
- F Passaretti
- Department of Translational Medical Sciences, Federico II University of Naples , Naples , Italy
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Rutkowski JL, Dohan Ehrenfest DM. Research letters: a new editorial format for the rapid disclosure of innovative data and concepts, didactic demonstrations, and scientific discussions. J ORAL IMPLANTOL 2012; 38:101-3. [PMID: 22568467 DOI: 10.1563/aaid-joi-d-12-editorial.3802] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Del Corso M, Mazor Z, Rutkowski JL, Dohan Ehrenfest DM. The use of leukocyte- and platelet-rich fibrin during immediate postextractive implantation and loading for the esthetic replacement of a fractured maxillary central incisor. J ORAL IMPLANTOL 2012; 38:181-7. [PMID: 22568469 DOI: 10.1563/aaid-joi-d-12-cl.3802] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Rutkowski JL, Dohan Ehrenfest DM. A fluent electronic support and clinical case letters: new formats and more interactivity between journal of oral implantology and its readers. J ORAL IMPLANTOL 2012; 38:1-2. [PMID: 22401664 DOI: 10.1563/aaid-joi-d-12-editorial.3801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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