Advanced Platelet-rich Fibrin Membrane Research Articles

Root Coverage in Miller's Class 3 Gingival Recession using a Laterally Positioned Flap with Advanced PRF: A Two-year Follow-up Case Report

Introduction: Gingival recession, marked by the apical migration of gingival tissue, presents aesthetic and functional challenges. The laterally positioned flap (LPF) technique, often used for localized root coverage, remains effective, particularly when combined with advanced platelet-rich fibrin (A-PRF). Case Report: A 23-year-old male presented with Miller Class III gingival recession on tooth 41, with clinical attachment loss of 4.5 mm and high frenum attachment. A treatment plan involved the revised LPF technique, A-PRF membrane application, and frenectomy. Surgical Procedure: Following patient consent and scaling, a sulcular incision was made, and flaps were elevated. A-PRF was prepared and placed over the exposed root, with the flap secured by sutures. Post-operative Care: The patient received antibiotics and analgesics, with follow-up at 2 years showing a 4 mm gain in clinical attachment level and complete root coverage. Results: The combination of the LPF technique and A-PRF effectively managed Miller Class III gingival recession, restoring both function and aesthetics. Conclusion: This case underscores the efficacy of using A-PRF with the LPF technique for treating gingival recession, offering a reliable approach for restoring the keratinized gingival zone.

Tooth Autotransplantation, Autogenous Dentin Graft, and Growth Factors Application: A Method for Preserving the Alveolar Ridge in Cases of Severe Infraocclusion-A Case Report and Literature Review.

Background: Tooth infraocclusion is a process in which a completely or partially erupted tooth gradually moves away from the occlusal plane. Submerged teeth can lead to serious complications. Treating teeth with infraocclusion is very challenging. One of the procedures allowing for the replacement of a missing tooth is autotransplantation. The aim of this paper is to review the literature on teeth autotransplantation, supported by a case report involving the autotransplantation of a third mandibular molar into the site of an extracted infraoccluded first mandibular molar, as well as the utilization of advanced platelet-rich fibrin (A-PRF) alongside autogenous dentin grafts for bone tissue regeneration. Methods: A severely infraoccluded first permanent right mandibular molar was extracted and then ground to obtain the dentin graft. A-PRF clots (collected from the patient's peripheral blood) were added to the autogenous dentin graft, to create the A-PRF membrane. An atraumatic extraction of the lower left third molar was performed and then it was transplanted into the socket of tooth no. 46. Immediately after transplantation, tooth no. 38 was stabilized with orthodontic bracket splints for 3 months. The patient attended regular follow-up visits within 12 months. Results: After one year, the patient did not report any pain. In the clinical examination, the tooth and surrounding tissues did not show any signs of infection. However, radiographically, cervical inflammatory resorption, unchanged pulp canal dimensions, absent root growth, periapical radiolucency, and lack of apical and marginal healing were observed. Reconstruction of the bone defect was obtained and the alveolar ridge of the mandible was preserved. Due to poor stability of the tooth and severe resorption, the tooth needed to be extracted. Conclusions: This study is designed to critically evaluate the efficacy of autotransplantation, the application of growth factors, and the integration of autogenous dentin grafts in remedying dental deficiencies resulting from reinclusion. We aim to point out the possible causes of treatment failure.

Comparative evaluation of the effectiveness of bioresorbable collagen membrane in combination with deproteinized bovine bone matrix xenograft (DBBM), and advanced platelet rich fibrin membrane in combination with deproteinized bovine bone matrix xenograft for periodontal regeneration

Introduction: Periodontitis is a chronic, multifactorial, inflammatory disease that leads to gradual loss of bone and periodontal attachment. Thus, periodontal surgery is required according to severity of diseases. The goal of periodontal reconstructive surgery is to regenerate soft and hard tissues destroyed during periodontal disease. Aim: To compare the effectiveness of bioresorbable collagen membrane in combination with Deproteinized Bovine Bone Matrix xenograft (group A); and Advanced Plasma rich fibrin(A-PRF) membrane in combination with Deproteinized Bovine Bone Matrix xenograft (group B) in the treatment of human infrabony defects. Methods: This randomised controlled trial will be carried out at the periodontics outpatient department. We will choose 24 patients with moderate to advanced chronic periodontitis who are otherwise systemically healthy. Infrabony defects will be treated by open flap debridement using bovine-derived xenograft and bioresorbable collagen membrane (group A) and open flap debridement using bovine-derived xenograft and A-PRF after the completion of first therapy (group B). At baseline and six months after undergoing periodontal surgery, probing pocket depth, clinical attachment level, radiographic bone fill, gingival recession, oral hygiene status, and gingival health will be measured. Expected results: It is suggested that Bioresorbable Collagen Membrane in combination with Deproteinized Bovine Bone Matrix xenograft will show better results as compared to Advanced Platelet Rich Fibrin Membrane with Deproteinized Bovine Bone Matrix Xenograft. Clinical trial registry of India (CTRI): REF/2023/05/066732. Protocol version: v1 (12/05/23)

Effects of advanced platelet-rich fibrin on deep partial-thickness burn wounds in nude mice

Effects of advanced platelet-rich fibrin on deep partial-thickness burn wounds in nude mice

Impact of glutaraldehyde cross-linking on the advanced platelet-rich fibrin membrane: Macroscopic, conventional light microscopic and scanning electron microscopic analysis.

Advanced platelet-rich fibrin (A-PRF) is a biopolymer that releases growth factors to facilitate healing. Along with other barrier membranes, the A-PRF membrane has proven to be beneficial in guided tissue regeneration (GTR) treatment. The cross-linking of the A-PRF membrane with glutaraldehyde (GLUT) has been attempted previously, and has been shown to prolong its degradation time and improve its mechanical properties. In the present study, the effects of GLUT cross-linking on macroscopic changes in the A-PRF membrane were assessed, and microscopic features were analyzed using a light microscope and a scanning electron microscope (SEM). The aim of the present study was to evaluate and compare the effects of GLUT cross-linking on the A-PRF membrane through the macroscopic, microscopic and SEM examinations. A total of 18 human A-PRF membrane samples were prepared, half of which were treated with 0.1% GLUT, and the remaining were left untreated. The macroscopic measurements of the samples included weight, length and thickness, while specimen slides were prepared for light microscopic evaluation and SEM analysis. The GLUT cross-linked membranes weighed more and were thicker than the non-cross-linked membranes, but there was no change in length. Light microscopic images showed fewer cells at the head and tail, though cells were abundant in the body of the A-PRF membrane. The images acquired using SEM showed fibrin strands of greater thickness, but fewer interspersed cell bodies in the cross-linked membranes. This in vitro study revealed an increase in thickness and cross-linking fiber density along with the presence of viable cells in the GLUT-treated A-PRF membrane, which may prove its effectiveness in healing or serving as a barrier membrane in clinical trials.

Effect on Cellular Vitality In Vitro of Novel APRF-Chlorhexidine Treated Membranes.

Chlorhexidine (CHX) has been used for some time in clinical practice as a local antiseptic agent with excellent efficacy. The combination of CHX with APRF (Advanced-platelet rich fibrin) membrane has the potential to stimulate tissue regeneration and to provide a bactericidal effect. We hypothesize that this may reduce the rate of infections development and protect cell viability. The aim of this study was two-fold-to create a stable APRF membrane treated with different concentrations of CHX (0.01% and 0.02%) and to monitor its effect on the viability of PDL cells in vitro. This benefits the introduction of a new protocol for APRF membrane production -CHX-PRF and enriches the available evidence on the effect of this antiseptic agent on PDL (Periodontal ligament) cells. APRF membranes were prepared by the addition of two concentrations (0.01% and 0.02%) of CHX. Membranes without the antiseptic were also prepared and used as control samples. PDL cells were cultivated on the membranes for 72 h. Cell number and vitality were examined by fluorescent cell viability assays. Our results demonstrated that a concentration of 0.01% CHX allowed the production of a stable APRF membrane. This concentration slightly reduced the viability of PDL cells to 96.7%, but significantly decreased the average number of cells attached to the membrane-149 ± 16.5 cells/field compared to controls -336 ± 26.9 cells/field. APRF-CHX 0.02% membranes were unstable, indicating a dose-dependent cytotoxic effect of CHX. The introduced novel protocol leads to the production of a new type of APRF membrane-CHX-PRF. The incorporation of an antiseptic into the APRF membrane can improve its bactericidal activity and might serve as an important step for the prevention of postoperative infections.

Immediate implant placement with simultaneous bone augmentation versus delayed implant placement following alveolar ridge preservation: A clinical and radiographic study

ObjectiveThe present study aimed to evaluate the clinical and radiographic outcomes of immediate implant placement (IIP) with guided bone regeneration (GBR) as compared to delayed implant placement (DIP) following alveolar ridge preservation (ARP) and to identify the potential risk factors influencing these outcomes. MethodologyA total of 56 patients (IIP = 28 vs. DIP = 28) with class I or II bony defects received 56 implants were included. GBR procedure using Bio-Oss® bone substitute mixed with advanced platelet-rich fibrin (A-PRF) and covered by Bio-Gide® membrane and additional A-PRF membrane was performed either simultaneously with the IIP or earlier at the time of ARP in DIP. Clinical and 3-D radiographic analyses of bone level, thickness, and density were performed at three-time intervals (T1, immediately; T2, 6-7 months; and T3, 1.5 to 2 years post-implantation), corresponding to the neck, coronal, middle, and apex of implants. ResultsThe survival rate was 100% in both groups. IIP showed significant favorable outcomes regarding distal marginal bone level (anterior maxilla, T1-T3) and neck and coronal horizontal facial bone thickness (HFBT) (posterior maxilla, T1; and anterior maxilla, T1-T3, respectively) compared to DIP. However, DIP showed significant facial bone density at the neck and coronal parts in the anterior maxilla (T1) and the coronal part in the posterior maxilla (T3). The facial marginal bone level change was positively correlated with HFBT change (P = 0.007), which is negatively correlated with the secondary implant stability (P = 0.019). The implant region (anterior or posterior maxilla) was the only factor affecting on Implant stability quotient value (ISQ) and change in HFBT (P ˂ 0.05). ConclusionOverall, the IIP combined with GBR in the post-extraction sites with pre-implant class I or II bony defects had some favorable outcomes compared to DIP after ARP. However, the clinical outcomes, ISQ value, and changes in bone level, thickness, and density from T1-T3 were comparable.

Combination of A-PRF and A Strip Free Keratinized Mucosal Graft for Increasing the Width of Keratinized Tissue Around Dental Implants: A Case Series

<p>Abstract: Background: Insufficient width of keratinized tissue (KT) around dental implants is a potential contributing factor of peri-implant diseases, and soft tissue grafting procedures are recommended for long-term maintenance of dental implants. A bulk free keratinized mucosal graft (FKMG) from the hard palate in conjunction with an apically positioned flap (APF) is the gold standard for KT augmentation. However, the major shortcomings are limited sources of the grafts and risks of donor wound morbidity. This case series proposed an alternative approach for KT augmentation by the combination of advanced platelet-rich fibrin (A-PRF) with a strip FKMG. Material and methods: Two patients with insufficient peri-implant KT width (< 2mm) bilaterally were enrolled for the split-mouth observation. Two different surgical methods were utilized to augment KT in the same patient. The recipient bed was fully covered by a bulk FKMG on one side, and topical hemostatic agents were applied to the donor wound. A strip FKMG was placed at the apical border on the other side with the remaining recipient bed being covered by an A-PRF membrane, and the donor wound was protected by another A-PRF membrane. Results: All four treated sites exhibited 4-5 mm significant gain in KT width, and the width was maintained for 12 months. Compared with the surgeries using a bulk FKMG, patients reported lower postoperative pain scores with a strip FKMG and A-PRF combination. Conclusion: The combination of an A-PRF membrane and a FKMG strip demonstrated satisfactory short-term outcomes for peri-implant KT augmentation, and donor wound morbidity was reduced.</p> <p> </p>

Vestibular incision subperiosteal tunnel access and multilayered advanced platelet rich fibrin membrane for management of multiple gingival recessions

Treatment of multiple recession defects on the lingual is challenging owing to the site-specific anatomical features of this region. Surgical approaches based on the use of subepithelial connective tissue grafts are considered the “gold standard” for the treatment but represent various complications and morbidity. Various techniques have been suggested for the treatment of multiple adjacent recessions with less patient discomfort and enhanced esthetics. Advanced platelet-rich fibrin (A-PRF) has been shown to promote soft-tissue healing. A-PRF is a fibrin matrix network, in which platelets are trapped and release a high amount of growth factors which take part in soft tissue and hard tissue repair and regeneration. The current case report introduces a novel, minimally invasive predictable approach applicable for both isolated as well as multiple defects with the use of the (vestibular incision subperiosteal tunnel access) technique in combination with a multilayered A-PRF membrane.

Does Cigarette Smoking Induce Changes in Biologic and Mechanical Properties of Platelet-Rich Fibrin Membranes?

Smoking has a profound effect on platelet morphology and activation and has also been shown to affect hemostasis, coagulation, and healing cascade. To date, no previous reports are available to assess the impact of cigarette smoke on leukocyte- and platelet-rich fibrin (L-PRF) and advanced platelet-rich fibrin (A-PRF) membranes. Therefore, this study aims to analyze the impact of cigarette smoking on the mechanical and biologic properties of L-PRF and A-PRF membranes. Sixty blood samples from both smokers (n = 34) and nonsmokers (n = 26) who were matched for age and other factors were collected and subjected to complete blood count and platelet indices (mean platelet volume, platelet distribution width, platelet large cell ratio, and plateletcrit). The L-PRF membrane (2,700 rpm; 12 minutes) and A-PRF membrane (1,500 rpm; 14 minutes) were prepared using a standard protocol. A total of 64 experimental L-PRF and A-PRF membranes from 16 individuals selected randomly from the two groups were subjected to tensile strength evaluation using a micro universal testing machine and growth factor release analysis (platelet-derived growth factor [PDGF-AB], vascular endothelial growth factor [VEGF], and bone morphogenic protein-2 [BMP-2]) using ELISA (enzyme-linked immune sorbent assay). Results were tabulated, and statistical analysis was done using Mann-Whitney, Kruskal-Wallis, and Spearman correlation tests. Tensile strengths of L-PRF and A-PRF did not show a statistical difference between groups (P = .47). BMP-2 was not detected in any of the groups. A high initial release of PDGF-AB and VEGF was noticed in A-PRF samples from smokers. Although statistically insignificant, cigarette smoking does affect platelet activation and influences the tensile strength of L-PRF membranes as well as growth factor release in A-PRF membranes in smokers.

Advanced Platelet-Rich Fibrin as a Therapeutic Option in the Treatment of Dry Socket: Literature Review and Case Series

Alveolar osteitis (AO) is one of the complications that occur after tooth extraction. The aim of this study has been to evaluate the efficacy of Advanced Platelet-rich Fibrin (A-PRF) in the management of pain and the acceleration of wound healing in the treatment of AO. Consecutive patients who were diagnosed with AO, recruited from patients referred to the Oral Surgery Department of the University of Naples Federico II, were enrolled. After local anesthesia, the dry socket was curetted and irrigated with saline. The Platelet-rich Fibrin (PRF) clot was placed in the socket and then covered with an A-PRF membrane. Clinical parameters, such as the degree of pain and rate of granulation tissue (GT) formation, were measured before treatment and after 1, 3, 7, 14, and 21 days. The Friedman test for dependent samples was used to detect the treatment and time effect. Four patients with established AO were included. On all the examination days, the post-operative recovery was uneventful. The pain scores progressively reduced, from an average of 8.5 before treatment to 0.25 on the third day, and the GT formation improved over time. The use of A-PRF in the treatment of AO significantly reduced the pain level and enhanced the wound-healing process.

Comparison of surface microtopography and mechanodegradation characteristics of platelet-rich fibrin membranes using two different centrifugation protocols

Aim: To compare the surface microtopography and in vitro mechanodegradation characteristics of two different platelet-rich fibrin (PRF) preparation protocols, that is, leukocyte platelet-rich fibrin (L-PRF) and advanced platelet-rich fibrin (A-PRF). Materials and Methods: For the present ex vivo study, blood samples were obtained from 20 healthy volunteers, who were divided into two groups: group I (L-PRF) and group II (A-PRF). For each experiment, five samples each were used for obtaining L-PRF and A-PRF membranes. Surface microtopography was demonstrated by using light microscopic studies and scanning electron microscope (SEM) analysis. Mechanical characteristics were evaluated by using Universal Testing Machine and nano Triboindentor. Membrane degradation properties were studied by using the Bradford method. The data were expressed in mean and standard deviation (SPSS 20.0 version, USA). Intergroup statistical significance was assessed by using an unpaired t-test and defined significant as P < 0.05. Results: Light microscopic examinations and SEM analysis have demonstrated that the L-PRF membrane contained thick densely arranged fibers than the A-PRF membrane. Mechanical characteristics have revealed that the tensile strength was higher, and the breaking strain was lower in the L-PRF membranes as compared with A-PRF membranes. The degradation profile demonstrated that the A-PRF membrane takes a prolonged time for degradation as compared with L-PRF. Conclusion: The present study justifies that differences in the centrifugation protocol have an influence on the surface microtopography and mechanodegradation characteristics of the PRF membrane.

Micro- and nanoscale characterization of different natural biomaterials for ocular surface regeneration

Objectives: This study aims to characterize the widely used biological derived membranes in clinics in terms of micro-nano scale mechanical and morphological properties. Within this scope, advanced platelet-rich fibrin (A-PRF), leucocyte-and platelet-rich fibrin (L-PRF) and human amniotic membrane were studied in this research study. Methods: Nano-indentation, optical coherence tomography (OCT), scanning electron microscopy (SEM), and in vitro degradation test were performed for material characterization. Results: The nano-indentation test revealed significantly higher modulus of elasticity and hardness values in A-PRF group, while OCT presented significantly higher thickness measurements when compared L-PRF. A loose 3D architecture formation due to the large pores formed by means of large fiber diameter were observed in A-PRF group. Besides, platelets were observed among the large fibers in A-PRF membranes on the contrary of L-PRF membranes. Low fiber diameter and high cellular separation were recorded in L-PRF group due to the high centrifugal force application. Therefore, it was observed that the platelets were located mostly on the surface of the membranes in L-PRF. The loose 3D architecture of A-PRF membranes is thought to release growth factors for a longer period of time, ensuring cellular integrity. On the other hand, degradation test results indicated that amniotic membranes degrade to about 85% in one week, while L-PRF and A-PRF were lost their initial weights approximately 31% and 40%, respectively. Conclusions: This comparative characterization study of three different natural biomaterials used in a wide range of clinical applications, from dentistry to ophthalmology, was thought to guide surgeons on the selection of site-specific material.

Effect of Cigarette Smoking on Morphologic Characteristics of Two Different Platelet-Rich Fibrin Membranes: A Scanning Electron Microscopic Study.

Platelet concentrates are used for regenerative periodontal and implant therapy. Up to now, no study has reported the influence of smoking on platelet-rich fibrin membranes. Hence, this cross-sectional in vitro study aimed to analyze the influence of cigarette smoking on platelet morphology and fiber characteristics of both leukocyte- and platelet-rich fibrin and advanced platelet-rich fibrin membranes. Sixty blood samples from both smokers (n = 34) and nonsmokers (n = 26) based on power analysis were collected and subjected for complete blood count and platelet morphology indices (mean platelet volume, platelet distribution width, platelet-large cell ratio, and plateletcrit). Leukocyte- and platelet-rich fibrin membrane (2,700 revolutions per minute for 12 minutes) and advanced platelet-rich fibrin membrane (1,500 revolutions per minute for 14 minutes) were prepared using a standard protocol. Thirty-two platelet-rich fibrin membranes from 16 individuals were selected randomly from the two groups and were subjected to morphologic examination using a scanning electron microscope. Both of the groups were matched for age. Red cell counts and white cell counts showed no statistical difference between the groups. Platelet indices of smokers did show slightly higher values than the nonsmoking group. Scanning electron microscopic analysis showed variations in the fiber width and pattern among smokers in both the leukocyte- and platelet-rich fibrin and advanced platelet-rich fibrin membranes. Platelet cell morphology of the smoking group demonstrated spiky architecture, suggesting an active state, while in the nonsmoking group, the platelet cells were seen in clusters, suggesting a resting state. Scanning electron microscopic results show that long-term cigarette smoking does affect the thickness and arrangement of fiber architecture in both leukocyte- and platelet-rich fibrin and advanced platelet-rich fibrin membranes and also could have an impact on activation of platelets.

Effect of A-PRF Application on Palatal Wound Healing after Free Gingival Graft Harvesting: A Prospective Randomized Study.

Objective The aim of this study was to investigate the healing effect of advanced platelet-rich fibrin (A-PRF) clot membranes in palatal wounds, resulting from free gingival graft (FGG) harvesting, on the reepithelization rate and on the pain experience after surgery. Materials and Methods Twenty-five patients requiring FGG have participated in this prospective cohort study. After FGG harvesting, the test group ( n = 14) received A-PRF clot membranes at the palatal wound and the control group ( n = 11) received a gelatin sponge. Epithelialization rate of the palatal wound, wound healing area, correspondent percentage of reduction, and postsurgical pain experience were assessed at 2, 7, 14, 30, and 90 days. Results A-PRF group had higher palatal wound reduction than the control group, at 7, 14, and 30 days of follow-up. The highest difference between the groups was attained at 30 days (91.5% for A-PRF vs. 59.0% control group). At 14 days, a significant difference in the proportion of patients showing total epithelization was found: 64.3% for A-PRF versus 9.1% for the control group. At 90 days, both groups showed total recovery. The control group experienced higher pain level and discomfort until the 14th day, being notably higher on the second day. Conclusion The results suggest that A-PRF membranes haste the healing process, and promote greater reduction along the recovery period and less painful postoperative period.

Fabrication, modeling and optimization of lyophilized advanced platelet rich fibrin in combination with collagen-chitosan as a guided bone regeneration membrane

In this study, lyophilized advanced platelet rich fibrin (A-PRF) was used in combination with collagen-chitosan membrane for the first time to combine advantages of both collagen and A-PRF membranes. Response surface methodology (RSM) was used to design the experimental condition and to correlate the effects of parameters, including chitosan/collagen (chit/col) weight ratio and A-PRF concentration on Young's modulus, mesenchymal stem cell (MSCs) viability and degradation rate of the membranes. Results showed that Young's modulus of the membranes was intensified by increasing chit/col weight ratio and decreasing A-PRF concentration from 3 to 8 MPa. Cell viability of MSCs was improved by both increasing chit/col weight ratio and A-PRF concentration. Moreover, as chit/col weight ratio increased from 0 to 4 and A-PRF concentration decreased from 5 to 0, degradation rate of the membranes decreased from 90 to 20% after four weeks incubation. Finally, based on Design Expert Software calculation for minimizing the degradation rate and maximizing both Young's modulus and cell viability, the values of chit/col weight ratio and A-PRF concentration were suggested to be 4 and 0.58 mg/ml, respectively. Alkaline phosphatase (ALP) activity analysis showed that the addition of A-PRF caused higher osteogenic differentiation.

The Application of Three-Dimensional Printing Model and Platelet-Rich Fibrin Technology in Guided Tissue Regeneration Surgery for Severe Bone Defects

A 36-year-old male patient diagnosed with severe chronic periodontitis was treated with novel surgery for his maxillary right lateral incisor. Preoperatively, a 3D printer was used, based on CBCT datasets, to produce a photosensitive resin bony anatomy replica. The patient's blood was centrifuged to obtain advanced platelet-rich fibrin (A-PRF) and injected platelet-rich fibrin (I-PRF), then mixed with Bio-Oss and packed onto the 3D replica to form the ideal shape. The replica was positioned at the planned sites without changes. The A-PRF membrane was applied over the replica as well as a Bio-Gide collagen membrane. Fifteen months after the surgery, clinical and radiographic followup revealed greatly reduced pocket depths and significant 3D alveolar bone fill at the treatment site. Based on these short-term results, the initial 3D printing surgical temple assisted guided tissue regeneration method resulted in significant clinical and radiographic improvements; A-PRF/I-PRF should be considered an ideal biomaterial for regenerative periodontal therapy.