The Use of Leukocyte- and Platelet-Rich Fibrin During Immediate Postextractive Implantation and Loading for the Esthetic Replacement of a Fractured Maxillary Central Incisor

Abstract

I mplant-supported restoration of the maxillary anterior segment that is biologically, functionally, and esthetically acceptable following traumatic injuries in the maxillary anterior segment is always complex. Careful extraction of the fractured root, residual labial bone preservation, proper flap design, ideal positioning of the implant, appropriate softtissue contour, and the crown emergence are all important steps necessary to achieve a predictable, stable, functional, and esthetic success. However, healing of the tissues is always difficult to control and the development of new techniques and materials to improve these treatments is still necessary. The use of platelet concentrates is an interesting approach. Platelet concentrates for surgical use are widely used and continuously investigated in oral and maxillofacial surgery. The objective is to gather platelet growth factors and to inject them on a surgical site to stimulate the healing process. A significant percentage of the literature is focused on the platelet-rich plasma (PRP) families. PRP is a liquid platelet suspension often activated into a platelet-rich gel (like fibrin glues). Another technology called leukocyteand platelet-rich fibrin (L-PRF) allows for the preparation of strong fibrin membranes enriched with cells (activated platelets, leukocytes, circulating cells) and platelet growth factors. This autologous healing biomaterial is free of additives (no anticoagulant during blood harvest, no chemicals for activation), simple, inexpensive, and quick to prepare (15 minutes for all steps). This technique is specifically adapted to the practical needs in daily implant dentistry. Several articles have reported the use of these L-PRF membranes for the stimulation of bone and 1 Private practice, Turin, Italy. 2 Private practice, Ra’anana, Israel. 3 Clarion Research Group, Clarion, Penn. Department of Restorative Dentistry, State University of New York at Buffalo, Buffalo, NY. 4 LoB5 Unit, Research Center for Biomineralization Disorders, School of Dentistry, Chonnam National University, Gwangju, South Korea. Department of Stomatology, Oral Surgery, and Dental and MaxilloFacial Radiology, School of Dental Medicine, University of Geneva, Geneva, Switzerland. * Corresponding author, e-mail: LoB5@mac.com DOI: 10.1563/AAID-JOI-D-12-CL.3802