Comparative analysis of upper labial frenulum surgical techniques: from scalpel to laser

The aim of this study is to determine the use of platelet-rich fibrin (PRF) in the management of soft tissue donor site healing after harvesting connective tissue graft (CTG) from the palate and evaluate the postoperative discomfort (pain, bleeding, analgesic consumption, tissue color match) of patients. Forty patients were randomly assigned to PRF or control group. In the PRF group, PRF membrane was placed into CTG donor site. After surgery, delayed bleeding, early healing index (EHI), tissue color match, and analgesic consumption were recorded. The visual analog scale (VAS) was used to observe the postoperative pain and tissue color match. Data were analyzed using the independent sample t test and the repeated measure ANOVA test. The patients in the PRF group reported significantly lower pain scores at all-time points. Postoperative 3rd and 7th day, EHI scores were lower in the favor of the PRF group. VAS score values of tissue color match were lower in the control group at 7th and 14th day, compared with the PRF group. Analgesic intake was significantly lower in the PRF group postoperatively at 1st and 3rd day that of control group. PRF application at the palatal donor site demonstrates promising results in terms of better wound healing and reduced postoperative discomfort in the patients after harvesting CTG. Patients may avoid surgical operations because of the discomfort or pain feeling. Reducing postoperative pain and discomfort and accelerating recovery meet the wishes of every patient and physician. PRF can provide these requirements as an easy method to obtain and implement.

The purpose of this study was to compare the efficacy of platelet-rich fibrin (PRF) and platelet-rich fibrin (PRF) with hydroxyapatite (HA) on postoperative pain, swelling, soft tissue healing and osseous regeneration in mandibular third molar extraction socket in human patient. This prospective study included total 40 patients who reported to the Department of Oral and Maxillofacial Surgery (OMFS), Teerthanker Mahaveer Dental College and Research Centre (TMDC&RC), Moradabad (U.P.). Twenty patients each in both the groups of PRF and PRF with HA were included for the management of impacted mandibular 3rd molar extraction sockets and were evaluated for effectiveness. Evaluation was done on the basis of following parameters pain and swelling at time interval of 1st, 3rd, 7th day, soft tissue healing at time interval of 3rd, 7th, 14th day and osseous regeneration at time intervals of 1st, 3rd, 6th month postoperatively. Pain and swelling were less in the PRF with HA group when compared to PRF group. Soft tissue healing was better in the PRF with HA group compared to the PRF group. The result of the study shows rapid bone regeneration in the extraction socket treated with the PRF with HA group when compared with the PRF group. Also there was less postoperative discomfort in the PRF with HA-treated group. PRF a mitogenic promoter together with a bone graft forms a scaffolding, promotes early healing thus being creating beneficial for the patient and is also economic.

Chronic periodontitis characterized by a periodontal pocket over 5 mm, alveolar bone resorption accompanied by tooth mobility, requires periodontal surgical treatment. Conventional surgical treatment can not achieve the regeneration of periodontal tissue and thus requires regenerative procedures, such as with the addition of PRF. PDGF-BB is a growth factor that plays an important role in wound healing. Developments in additional bioactive ingredients in surgical procedures are used to regulate inflammation and increase the speed of the healing process. The purpose of this study was to determine the effect of PRF and bone graft (carbonate apatite) on PDGF-BB levels post-surgical flap in patients with chronic periodontitis. The experimental study with open label and consecutive sampling was conducted on 10 subjects of chronic periodontitis who received surgical flap treatment with bone graft and PRF; and 10 subjects without PRF. GCF samples were collected immediately before surgery and 7 days post flap surgery for examination of PDGF-BB levels by ELISA method. The data were calculated statistically by Mann-Whitney test (p <0.05). The results showed that the mean difference of PDGF-BB level in PRF group was 9.44 pg/ml (-1.20 – 37.79 pg/ml) with p value (0.013) and Non-PRF group was 7.97 pg/ml (-6.62 - 44.42 pg/ml) with p value (0.059). The p value in the PRF group > 0.05 means a significant increase in PDGF-BB levels on the 7th day post flap surgery. Examination of PDGF levels, especially PDGF-BB, should be done in each healing phase of the wound from the inflammatory phase to the maturation and remodeling phase, for example on the 3rd, 7th, 14th and 28th days when PDGF levels approach zero and the healing process it's almost over, referring to the results of Alzahrani's research (2018) and also Matsuoka and Grotendorst (1989) which showed higher levels of PDGF-BB and VEGF in GCF on days 1, 3, 7 and 14 after surgery with minimally invasive surgery (MIS) technique. The conclusions of this study showed that the application of Platelet Rich Fibrin (PRF) and bone graft had an effect on the level of Platelet Derived Growth Factor (PDGF-BB) post-surgical flap in patients with chronic periodontitis, and elevated levels of PDGF-BB post-surgical flap with PRF application higher than surgical flap without the PRF application. Increased levels of PGDF-BB in the group applied to the PRF were higher than those that were not applied PRF, although statistically significant differences were not found, there was a tendency for the healing process of the PRF group to be better than the Non PRF group.

Background: the current study investigated platelet rich fibrin and subepithelial connective tissue graft in preserving crestal bone and soft tissue around delayed implants. Methods: Twelve participants with thin gingival biotype, were randomly assigned in two equal parallel groups. Both received delayed implant, augmented by subepithelial connective tissue graft versus platelet rich fibrin. Crestal bone level was measured at 3, 6 and 9 months. Gingival thickness and keratinized tissue width were measured at baseline, 3 and 6 months, pink esthetic score at 6 months, pain, swelling and patient satisfaction were reported after 7 days and at the end of the follow up period respectively. Results: Both groups showed statistically significant improvement in all clinical outcomes at 3 and 6 months with no statistically significant difference at different observational periods. Subepithelial connective tissue graft showed statistically significant increase in gingival thickness and pink esthetic score compared to platelet rich fibrin after 6 months with no statistically significant difference regarding the crestal bone loss, keratinized tissue width, postoperative pain, swelling and overall patient satisfaction between both groups. Conclusion: Inspite that PRF showed less values of crestal bone loss yet both treatment modalities could not prevent the postsurgical crestal bone loss to occur, with no statistically significant difference between them. Subepithelial connective tissue graft is effective at increasing the gingival thickness around delayed implants. Clinical relevance: Both treatment modalities could be used safely around dental implant. Subepithelial connective tissue graft is more effective in thin phenotype for augmenting gingival thickness.

Gingival recession is becoming a more common condition in many people's oral health and should be addressed as soon as it is discovered. This condition may be associated with periodontal disease or related to mechanical factors such as tooth brushing. Gingival recession usually creates an aesthetic problem and may also lead to root sensitivity, cervical caries, or abrasion. Pedicle gingival grafts, free autogenous gingival grafts, and connective tissue grafts are some of the methods that can be used to surgically cover the root.This case report was conducted with a recession defect on the labial surface of the maxillary anterior. Case 1 was treated with a coronally repositioned flap with platelet-rich fibrin with root biomodification using tetracycline HCl, and Case 2 was treated with a Coronally repositioned flap with platelet-rich fibrin for coverage of areas of isolated gingival recession. Recession length was measured at baseline, 1 month, and 3 months. Both the treatment modalities demonstrated a significant improvement in the recession length, recession width, and clinical attachment level with no post-operative discomfort, but Case 1 was found to be better than Case 2.

Background/Objectives: This study aims to compare the effects of conventional surgical techniques and laser-assisted methods on salivary oxidative stress biomarkers following third molar extraction, in order to evaluate the potential benefits of laser surgery in reducing oxidative stress and promoting faster recovery. Methods: A total of 154 patients, aged 16-30, undergoing third molar extractions were included in the study. Patients were divided into two groups: conventional surgery (n = 75) and laser-assisted surgery (n = 79). Saliva samples were collected at baseline, and 24, 48, 72, and 168 h postoperatively. The levels of total antioxidant capacity (TAC), malondialdehyde (MDA), and 8-hydroxy-2'-deoxyguanosine (8-OHdG) were measured as indicators of oxidative stress. Results: Initial biomarker levels were similar across all participants. Postoperative oxidative stress increased in both groups, with significantly higher levels in the conventional surgery group at 48 and 72 h. Salivary biomarkers of oxidative stress were significantly lower in the laser group at 48 and 72 h post-surgery (p < 0.05), indicating a faster recovery. By 168 h, biomarker levels in the laser group had nearly returned to baseline, whereas levels in the conventional group remained slightly elevated. Conclusions: Laser-assisted surgery significantly reduces oxidative stress and promotes faster recovery when compared with conventional methods, as evidenced by the more rapid normalization of salivary biomarkers. These findings suggest that laser techniques may offer superior clinical outcomes in third molar extractions.

Research has been ongoing on achieving optimum bone healing in the reconstruction of bone loss. Clinically, soft tissue migration into the already existing bone defects is the leading cause of unfavourable bone healing. Platelet-rich fibrin, a recent material that is used to promote bone healing, was compared with single- and double-layered resorbable collagen membranes to determine whether a healing protocol which increases patient comfort is possible. Sixty adult female Sprague-Dawley rats were used. The rats were divided into five main groups as a sacrification group, a control group, and three experimental groups. The bone defects experimental group 1 were covered with a single-layer collagen membrane, and experimental group 2 were covered with the double-layered collagen membrane. Defects on the experimental group 3 were covered with platelet-rich fibrin membranes which were derived from the sacrification group. The animals in the main groups were also divided into eight subgroups arranged by sacrification periods on day 7 and day 28. Statistical analysis of our study revealed that new bone formation in experimental group 3 was significantly higher than in other groups. Fibrosis was found to be lower in experimental group 3 than in any other group. No significant differences were found between experimental group 1 and the control group. Platelet-rich fibrin, which can be used as an autologous membrane which promotes bone healing, yields better clinical result compared to collagen membranes. Histopathologic evaluation has been carried out regarding the effect of platelet-rich fibrin and collagen membranes applied on bone recovery. Our objective is to contribute to barrier membrane studies that continue to guide and accelerate bone recovery.

Introduction: Connective Tissue Graft (CTG) is one of the techniques in gingival recession treatment, but considering the morbidity of using CTG, biomaterials such as Platelet Rich Fibrin (PRF) can be an alternative in gingival recession closure treatment. This systematic review aims to compare and evaluate the use of PRF, CTG and their combination in gingival recession closure. Review: An electronic literature search in Medline (PubMed), Google Scholar, and Elsevier (Sciencedirect) was conducted to identify Randomized Clinical Trial (RCT) reporting on the treatment of gingival recession using PRF, CTG or a combination of both from 2018 to 2023 in English. This systematic review was conducted following the Preferred Reporting Items for Systematic review (PRISMA) guidelines. The parameters assessed in the RCTs were: recession depth (RD), clinical attachment level (CAL), keratinized gingival width and height (KTW, KTH), probing depth (PD), gingival thickness (GT) and patient discomfort after surgery assessed by VAS (Visual Analog Scale). Based on the 1,152 articles retrieved, there were only five RCTs eligible for systematic review. Four articles compared the use of PRF with CTG, and one article compared the use of CTG with the combination of CTG + PRF in gingival recession closure. Conclusion: The use of PRF, CTG, and a combination of both were effective in closing gingival recession. The use of CTG gave better results in increasing gingival thickness and keratinized gingival width compared to the use of PRF, but the combination of CTG and PRF gave significant results in keratinized gingival height and decreasing recession depth compared to the use of CTG alone. Thus, the combination of CTG and PRF may be a more promising gingival recession closure treatment option.

Background and aims: Third molar surgery is one of the most frequent procedures in oral and maxillofacial surgery. Pain, trismus, and swelling are the majority symptoms that have an impact on patients' quality of life. Haemorrhage, alveolitis and infections are general complications. Several endeavors have been through to decrease the possibility of complications and make better patients' quality of life, such as the administration of platelet-rich plasma (PRP) or the administration of platelet-rich fibrin (PRF). The aim of this study is to determine the clinical consequences of PRF subsequent to surgical extraction of impacted lower third molars among a sample of Yemeni adults by evaluate the PRF effect on postoperative complications of pain, swelling, and mouth opening and to compare the difference in the healing process between the PRF surgery site and the control site. Methods: The prospective study consisted of 36 patients who obtainable for subtraction of an impacted bilateral mandibular molar. Subsequent to extraction, plugs were filled up with PRF or without PRF in the study (18 patients) and comparative control (18 patients) groups, respectively. Postoperative edema was calculated using a flexible tape measure by estimating the distance between several facial features on the 2nd to the 7th postoperative days. Postoperative pain was assessed using a line-type visual analog scale (VAS) and a verbal scale (VRS); and trismus by caliper scales. Epi-Info version 7.0 was used for data analysis. Results: There were statistical significant variations concerning the PRF group and the control group in regard to pain intensity, number of analgesics tablets used and the interincisal distance, as the p value were 0.001, 0.0001 and 0.001 respectively. Conclusion: The PRF helps in reducing the post-surgical pain, edema and trismus. As well as accelerate healing process after the application to the socket of surgically extracted lower third molar. Peer Review History: Received: 11 November 2022; Revised: 14 December; Accepted: 6 January 2023, Available online: 15 January 2023 Academic Editor: Prof. Dr. Gorkem Dulger, Duzce University, Turkey, gorkemdulger@yandex.com Received file: Reviewer's Comments: Average Peer review marks at initial stage: 5.0/10 Average Peer review marks at publication stage: 7.0/10 Reviewers: Dr. George Zhu, Tehran University of Medical Sciences, Tehran, Iran, sansan4240732@163.com Dr. Tamer Elhabibi, Suez Canal University, Egypt, tamer_hassan@pharm.suez.edu.eg Similar Articles: HISTOLOGIC AND RADIOGRAPHIC STUDY OF PATHOLOGIC CHANGE IN COMPLETE IMPACTED THIRD MOLARS DENTAL FOLLICLES KNOWLEDGE AND PERCEPTION OF MOLAR INCISOR HYPOMINERALIZATION AMONG DENTAL PRACTITIONERS IN SANA’A CITY- YEMEN

The interdental papilla plays a crucial role in the esthetic of the smile. Papilla reconstruction surgery is one of the most unpredictable periodontal procedures. This study compared the effect of the non-surgical application of a commercial hyaluronic acid (HA) gel with an autogenous gel named "albumin with platelet-rich fibrin" (Alb-PRF) on interdental papilla reconstruction. This trial was conducted on 46 incomplete interdental papillae with class I or II defects. The papillae were randomly divided into two experimental groups, and commercial HA or Alb-PRF (prepared from the patient's peripheral blood) was injected into the papillae twice at a 21-day interval. Three and six months after the intervention, photographs were taken from the black triangles and the black surfaces compared to each other. Patient satisfaction and dental plaque index were also evaluated at the end of the study. The black triangles' surfaces significantly decreased over time in both experimental groups (P<0.001). However, there were no significant differences between the two groups (P=0.994). The intervention resulted in the patients' relative satisfaction with the treatment results in both groups. However, the difference between the two groups was not statistically significant (P=0.965). In addition, no statistically significant differences were observed in plaque index between the two groups (P=0.566). HA or Alb-PRF injection into the incomplete interdental papilla may restore the soft tissue to a great extent and lead to patient satisfaction by reducing the area of black triangles that threaten esthetics; however, more studies are needed.

Objectives: This randomized clinical trial evaluated the effect of platelet-rich fibrin, simvastatin gel with platelet-rich fibrin, and alloplast with platelet-rich fibrin on implant stability and esthetic outcomes following immediate implant placement. Methods: Thirty-six patients requiring maxillary anterior immediate implants were randomized into three groups. Clinical and radiographic parameters including implant stability quotient, labial bone thickness, marginal bone level, pink esthetic score, and patient satisfaction were assessed up to one year. Results: Implant stability and pink esthetic scores showed no statistically significant intergroup differences. All groups demonstrated improved esthetic outcomes over time. Alloplast combined with platelet-rich fibrin exhibited the most stable peri-implant soft tissue parameters. Conclusions: All evaluated grafting protocols produced favorable clinical and esthetic outcomes. Alloplast demonstrated superior peri-implant tissue stability over time.

Clinical studies have shown favorable outcomes following use of platelet rich fibrin (PRF), either alone or in conjunction with biomaterials for alveolar ridge reconstruction (ARR) or guided bone regeneration (GBR) . While PRF application accelerates wound healing and reduces postoperative discomfort, its effects on the alveolar bone gain, as part of ARR or GBR is less clear. Therefore, this study aims to investigate the clinical effectiveness of PRF when used in ARR or GBR, as well as postoperative discomfort following these procedures. A systematic search using the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) method was performed to include database searches from MEDLINE (OVID interface, 1946 onwards), EMBASE (OVID interface, 1974 onwards) and Global Health (OVID interface, 1973 onwards). Of the 74 studies initially identified, 7 studies were included for the systematic review, including 6 randomized controlled trials (RCTs) and 1 cohort study. The meta-analysis showed that the incorporation of PRF as part of ARR or GBR resulted in an increase in horizontal ridge width, a reduction in the rate of resorption increase, while postoperative discomfort was the same or slightly improved. The risk of bias quality was low for only 1 out of the 6 RCTs and the Newcastle Ottawa scale assessment showed that cohort study was of high quality. PRF application in ARR or GBR is associated with increased horizonal alveolar ridge width and reduce rate of graft resorption. However, the findings related to both outcome measures were based on a limited number of studies. PRF application can be effectively used as part of ARR or GBR to increase the horizontal ridge width and reduce the rate of graft resorption.

This clinical narrative review aimed to comprehensively evaluate the effects of platelet-rich fibrin (PRF) on clinically related and patient-reported outcomes during palatal wound healing following autologous palatal graft harvesting. To gather all available evidence, a comprehensive literature search was conducted in PubMed, Scopus, Web of Science, and Google Scholar, along with a manual search of reference lists from eligible studies, up to November 22, 2024. A total of 28 clinical comparative studies were identified, including 21 randomized clinical trials (RCTs), two non-RCTs, and five case series. Most studies investigated the application of PRF following free gingival grafts (FGG) rather than subepithelial connective tissue grafts (SCTG), with the majority also using solid PRF as opposed to liquid PRF. For FGG harvesting sites, PRF demonstrated positive outcomes in enhancing wound healing-related outcomes, reducing postoperative pain and other complications, lowering analgesic consumption, and improving quality of life (QoL). For SCTG harvesting sites, PRF also showed beneficial effects in promoting wound healing, reducing postoperative pain, and eliminating the need for analgesics. Based on the current findings, PRF application following either FGG and SCTG harvesting appears to be a promising approach for enhancing wound healing, minimizing postoperative complications, reducing analgesic consumption, and improving patient satisfaction. Clinical recommendations, along with step-by-step protocols, are also provided in this review article to guide clinicians in optimized efficiency for use of PRF for palatal wound healing following FGG and SCTG harvesting. A recommended simplified use of solid PRF prepared using horizontal centrifugation, in combination with a palatal stent, is suggested. The addition of sutures alongside the stent may provide enhanced stabilization of PRF in place for larger graft sites. Nevertheless, further well-designed RCTs with standardized methods and larger sample sizes are needed to strengthen the evidence base and confirm the therapeutic advantages of PRF in palatal wound healing.

To overview the literature to answer the following question: "What is the performance of different therapies on wound healing and postoperative discomfort after palatal ASTG removal?" SRs that evaluated the wound healing (WH), postoperative pain, bleeding, and analgesic consumption of patients submitted to de-epithelialized/free gingival grafts (FGG) or subepithelial connective tissue grafts (SCTG) removed from the palate were included. The searches were conducted on six white and two gray databases up to December 2023. Methodological quality was evaluated through AMSTAR 2. The synthesis of results was described as a narrative analysis. Ten SRs (involving 25 randomized clinical trials) related to low-level laser therapy (LLLT) (3), platelet-rich fibrin (PRF) (4), cyanoacrylate tissue adhesives (CTA) (2), and ozone therapy (OT) (1) were included in this overview. All techniques demonstrated improvements in WH. LLT, PRF, and CTA reduced pain and analgesic consumption. PRF and CTA reduced bleeding. Regarding methodological quality, the SRs were classified as critically low (2), low (5), moderate (2), or high quality (1). In SRs related to LLLT, PRF, CTA, and OT, the use of different therapies after palatal ASTG removal improved WH and postoperative discomfort. Due to the studies' low methodological quality and high heterogeneity, data should be interpreted with caution. The present overview compiles the evidence of SRs related to different therapies for WH and patients' postoperative experience and reveals that different treatments can significantly improve the clinical outcomes of patients who require ASTG removal for periodontal or peri-implant surgeries. PROSPERO registration number: CRD42022301257.

(1) Purpose: The employment of platelet-rich fibrin (PRF) in the extracted teeth socket has been shown to aid tissue healing. It also minimizes detrimental consequences. The rationale of this systematic review is to observe the possible association between PRF employment and postoperative consequences following mandibular third molar surgery. (2) Materials and Methods: The following databases were explored electronically (till 28 February 2021): PubMed, Cochrane library, Embase, International Clinical Trials Registry Platform (ICTRP), and ClinicalTrials.gov. A manual explore was accomplished on various journals regarding the subject of oral and maxillofacial surgery. The online explore applied the keywords “platelet-rich fibrin or PRF,” and “mandibular third molar.” To review the efficiency of PRF, the accompanying post-operative consequences were collected: pain, swelling, trismus, inter-incisal distance, analgesic consumption, soft tissue healing, bone healing, socket complications, and periodontal parameters. (3) Results: Just 9 full-text studies out of 26 were comprised of review for qualitative analysis. All of the studies were randomized clinical trials (RCTs), with eight split-mouth designs and one parallel design study. Significant outcomes were usually observed for pain, postoperative swelling, mouth opening, periodontal pocket depth, soft tissue healing, and the incidence of alveolar osteitis or dry sockets, but not constantly. The qualitative scrutiny disclosed that the PRF had no considerable outcome in bone healing. (4) Conclusions: Local administration of PRF is a practical way of alleviating pain, trismus, oedema, and enhancing soft tissue healing following mandibular third molar extraction. PRF tends to have no function in bone healing following extraction. More controlled clinical trials and RCTs are necessitating exploring the end results of PRF following mandibular third molar extraction.