Implant site preparation application of injectable platelet-rich fibrin for vertical and horizontal bone regeneration: A clinical report

A Simplified GBR Treatment and Evaluation of Posterior Seibert Class I Ridge Defects via Bio-collagen and Platelet-Rich Fibrin: A Retrospective Study

BACKGROUND

Classical guided bone regeneration (GBR) treatments can achieve favorable clinical results for ridge defects. However, extensive bone augmentation in the non-esthetic area in the posterior region for minor ridge defects is unnecessary. Therefore, this study used a collagen and Platelet-rich fibrin (PRF) mixture for bone augmentation on minor posterior ridge defects and evaluated the effects.

METHODS

22 Seibert Class I ridge defects were treated with BC and covered with a PRF membrane (simplified guided bone regeneration, simplified GBR) and other 22 were treated with Bio-Oss and covered with Bio-Gide (classical GBR). Cone-beam computed tomography imaging was conducted 6 months post-surgery to compare the ridge's horizontal width (HW) and buccal ridge's horizontal width to assess the osteogenic effect. In addition, the buccal ridge contour morphology was studied and classified.

RESULTS

The buccal ridge contour of simplified GBR was Type A in 14 cases, Type B in 7 cases, and Type C in 1 case and it of classical GBR was Type A in 11 cases, Type B in 8 cases, and Type C in 3 cases. The mean HW significantly increased by 1.50 mm of simplified GBR treatment, while it increased by 1.83 mm in classical GBR treatment.

CONCLUSION

The combined use of BC and PRF had a significant effect on bone augmentation and this treatment exhibited promising clinical results for correcting posterior Seibert Class I ridge defects. The morphological classification of the reconstructive effect in this study can be utilized in future clinical work.

Ten years of injectable platelet-rich fibrin

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

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

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

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

Background

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

Methods

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

Results

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

Conclusions

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

Evaluation of the effect of autologous conditioned serum on the radiographic characteristics of hard tissue after horizontal bone augmentation in implant dentistry

Background. Bone deficiency in different areas is problematic in implant placement. Changes in histological, histomorphometric, and radiographic properties of hard tissues in the implant placement area affect many parameters of implant success. Autologous conditioned serum (ACS) is a blood product with high levels of IL1- receptor antagonists. Augmentation surgeries are required in many cases because implant placement in the edentulous areas requires a sufficient amount of bone. Therefore, this study radiographically evaluated the effect of autologous conditioned serum after horizontal bone augmentation. Methods. In this prospective RCT, 21 patients eligible patients were evaluated. The patient underwent horizontal ridge augmentation surgery in the area. The ACS-impregnated graft was in direct con-tact with the bone. The control side underwent the same surgical protocol without using ACS. Four months after surgery, a CBCT radiograph was taken, and radiographic changes in the two areas were calculated using the differences in the amount of bone formed in the horizontal dimension as well as the Hounsfield unit (HU). The data were reported using descriptive statistical methods, including means (standard deviations) and frequencies (percentages). According to the results of the Kolmog-orov-Smirnov test, the data had a normal distribution (P>0.05); therefore, paired t-test was used to compare the means of the parameters between the two groups. Results. IRadiographic examinations showed that the horizontal dimension of bone before surgery was similar between the two groups. However, after surgery in the ACS group (33.13±6.1), it was significantly higher than in the control group (62.1±86.4) (P>0.05). Also, the rate of horizontal dimension increase (the difference before and after surgery) in the ACS group was significantly higher than in the control group. Bone density before surgery was similar between the two groups. However, after surgery, there was a significant increase in the ACS group (75.56±330.42 HUs) compared to the control group (38.35±292.38 HUs) (P>0.05). Also, the rate of density increase (the difference before and after surgery) in the ACS group was significantly higher than in the control group. Conclusion. Radiographic evaluations of hard tissues showed a significant increase in the horizontal dimension of bone and density of newly formed bone using ACS compared to the control group.

Horizontal augmentation techniques in the mandible: a systematic review

Purpose

Placement of dental implants has evolved to be an advantageous treatment option for rehabilitation of the fully or partially edentulous mandible. In case of extensive horizontal bone resorption, the bone volume needs to be augmented prior to or during implant placement in order to obtain dental rehabilitation and maximize implant survival and success.

Methods

Our aim was to systematically review the available data on lateral augmentation techniques in the horizontally compromised mandible considering all grafting protocols using xenogeneic, synthetic, or allogeneic material. A computerized and manual literature search was performed for clinical studies (published January 1995 to March 2021).

Results

Eight studies ultimately met the inclusion criteria comprising a total of 276 procedures of xenogeneic, allogeneic, or autogenous bone graft applications in horizontal ridge defects. Particulate materials as well as bone blocks were used as grafts with a mean follow-up of 26.0 months across all included studies. Outcome measures, approaches and materials varied from study to study. A gain of horizontal bone width of the mandible with a mean of 4.8 mm was observed in seven of eight studies. All but one study, reported low bone graft failure rates of 4.4% in average.

Conclusions

Only limited data are available on the impact of different horizontal augmentation strategies in the mandible. The results show outcomes for xenogeneic as well as autologous bone materials for horizontal ridge augmentation of the lower jaw. The use of allogeneic bone-block grafts in combination with resorbable barrier membranes must be re-evaluated. Randomized controlled clinical trials are largely missing.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40729-022-00421-7.

Platelet-Rich Fibrin Increases BMP2 Expression in Oral Fibroblasts via Activation of TGF-β Signaling

Solid platelet-rich fibrin (PRF), consisting of coagulated plasma from fractionated blood, has been proposed to be a suitable carrier for recombinant bone morphogenetic protein 2 (BMP2) to target mesenchymal cells during bone regeneration. However, whether solid PRF can increase the expression of BMPs in mesenchymal cells remains unknown. Proteomics analysis confirmed the presence of TGF-β1 but not BMP2 in PRF lysates. According to the existing knowledge of recombinant TGF-β1, we hypothesized that PRF can increase BMP2 expression in mesenchymal cells. To test this hypothesis, we blocked TGF-β receptor 1 kinase with SB431542 in gingival fibroblasts exposed to PRF lysates. RT-PCR and immunoassays confirmed that solid PRF lysates caused a robust SB431542-dependent increase in BMP2 expression in gingival fibroblasts. Additionally, fractions of liquid PRF, namely platelet-poor plasma (PPP) and the buffy coat (BC) layer, but not heat-denatured PPP (Alb-gel), greatly induced the expression of BMP2 in gingival fibroblasts. Even though PRF has no detectable BMPs, PRF lysates similar to recombinant TGF-β1 had the capacity to provoke canonical BMP signaling, as indicated by the nuclear translocation of Smad1/5 and the increase in its phosphorylation. Taken together, our data suggest that PRF can activate TGF-β receptor 1 kinase and consequently induce the production of BMP2 in cells of the mesenchymal lineage.

Does Platelet-Rich Fibrin Enhance the Early Angiogenetic Potential of Different Bone Substitute Materials? An In Vitro and In Vivo Analysis

The impaired angiogenic potential of bone substitute materials (BSMs) may limit regenerative processes. Therefore, changes in the angiogenetic properties of different BSMs in combination with platelet-rich fibrin (PRF) in comparison to PRF alone, as well as to native BSMs, were analyzed in vitro and in vivo to evaluate possible clinical application. In vitro, four BSMs of different origins (allogeneic, alloplastic, and xenogeneic) were biofunctionalized with PRF and compared to PRF in terms of platelet interaction and growth factor release (vascular endothelial growth factor (VEGF), tissue growth factor ß (TGFß) and platelet-derived growth factor (PDGF)) after 15 min. To visualize initial cell–cell interactions, SEM was performed. In vivo, all BSMs (±PRF) were analyzed after 24 h for new-formed vessels using a chorioallantoic membrane (CAM) assay. Especially for alloplastic BSMs, the addition of PRF led to a significant consumption of platelets (p = 0.05). PDGF expression significantly decreased in comparison to PRF alone (all BSMs: p < 0.013). SEM showed the close spatial relation of each BSM and PRF. In vivo, PRF had a significant positive pro-angiogenic influence in combination with alloplastic (p = 0.007) and xenogeneic materials (p = 0.015) in comparison to the native BSMs. For bio-activated xenogeneic BSMs, the branching points were also significantly increased (p = 0.005). Finally, vessel formation was increased for BSMs and PRF in comparison to the native control (allogeneic: p = 0.046; alloplastic: p = 0.046; and xenogeneic: p = 0.050). An early enhancement of angiogenetic properties was demonstrated when combining BSMs with PRF in vitro and led to upregulated vessel formation in vivo. Thus, the use of BSMs in combination with PRF may trigger bony regeneration in clinical approaches.