The use of L‐PRF and A‐PRF for three‐dimensional gain in implantation sites – The open wound technique

Abstract

Background Since the discovery of osseointegration in the 1960s, the greatest challenge for the placement of functional implants is the presence of an implantation site - a muco-osseous envelope that guarantees these proper three-dimensional positioning. Several strategies to overcome this quest have been proposed in the last decades, most notably techniques of Tissue Engineering (Langer and Vacanti, 1993). In recent years dentists have seen a primordial shift in regenerative and reconstructive techniques such as the inductive and conductive function of potential of blood concentrates. Through the fundamental use of Tissue Engineering in clinical procedures, technical and conceptual modifications have contributed to the adoption of more scientifically efficient, less-invasive and less-morbid solutions. These have substantially improved the outcomes of surgical procedures with the use of three-dimensional blood transitory matrix. Nonetheless, achieving clinical results would require a revolution in current surgical techniques. Obtaining of maximum efficiency when using blood concentrate matrices can be conquered through principals of biomodulation with biofunctional sutures and biotensegrity. In this scenario, the aim of this work is to present and describe of procedures that we call Biologically Intelligent Tissue Engineering (BITE), through a series of clinical cases using a new procedure called the Open Wound Technique. Aim/Hypothesis The aim of this work is to evaluate the gain of keratinized mucosa+ phenotype modification+ bone profile in twenty implantation sites. This will be performed with the use of BITE (Biologically Intelligent Tissue Engineering) methodology, using the technique of the Open Wound. Material and Methods Twenty edentulous sites of immediate and late placement of implants were evaluated by calibrate examination in a probe measuring the thickness of peri-implant mucosa. After the implant's placement, the surgical site was filled with L-PRF or A-PRF plugs and covered by six to eight PRF membranes inserted in bone-mucoperiosteal flap interface. These were left exposed to the oral environment. The flaps were stabilized by layered sutures. The evolution of the wound repair was registered periodically (3 days, 7 days, 15 days, 30 days and 1-year follow-up), as well as the thickness of keratinized mucosa and tomographic profile were measured within 30 and 60 days and after 1 year. Results In all cases the PRF plugs and membranes were replaced by healthy keratinized tissue with 1.5–4 mm thickness (average of 3 mm) and modified with peri-implant phenotype. The bone profile average gain was identified by tomographic evaluation and ranged in thickness from 0.5 to 1.5 mm. The value remained the same after 1 year of follow-up. Conclusion and Clinical Implications The Biologically Intelligent Tissue Engineering (BITE), can and will improve the peri-implant tissues with three-dimensional gain through a series of a new procedure called the Open Wound Technique. The outcome will be a less morbid and invasive strategy for development and correction of small defects in implantation sites