Fibrin Matrix Research Articles

Effects of Advanced Platelet Rich Fibrin (A-PRF+), Enamel Matrix Derivative (EMD) and Open Flap Debridement on clinical and wound healing parameters in molar furcation sites: A case series from a RCT study

AimTo study effects of advanced platelet rich Fibrin (A-PRF+) and enamel matrix derivative (EMD) compared to open flap debridement (OFD) alone in molar furcation sites grade II on clinical and wound healing parameters.Materials and methodsA randomized controlled trial was designed. Eligible patients were randomly allocated in one of three treatment groups: A-PRF+, EMD or OFD. The patients and clinical examiners were blinded for the treatment received. A minimally invasive microsurgical approach was performed for the three modalities. Clinical measurements were scored at baseline and 6 months postoperatively. The clinical healing of each furcation was scored via Early Wound Healing Index on day 3, 1 week, 2 weeks and 6 weeks.Results17 patients (A-PRF+ n = 6, EMD n = 5, OFD n = 6) completed the 6 months follow-up. The further completion of the trial had to be cancelled due to the COVID-19 pandemic. In three patients in the A-PRF+ group, the grade II of the treated furcation regressed to grade I; the corresponding number in the EMD and OFD groups were zero and one respectively. Further, 3, 1 and 4 patients in the PRF, EMD and OFD groups respectively, showed a gain of bone level ≥1 mm. The defects in the A-PRF+ group showed delayed early healing compared to EMD and OFD groups.ConclusionThe case series (RCT design) suggest a slight advantage for A-PRF+ over EMD and OFD, regarding the regressing of a furcation II to grade I, however this treatment showed delayed early wound healing compared to EMD or OFD.Clinical Trial Registrationhttps://www.isrctn.com/, identifier ISRCTN13520922.

Comparative evaluation of platelet rich fibrin matrix (PRFM) membrane and platelet rich fibrin (PRF) membrane using the vestibular incision subperiosteal tunnel access (VISTA) approach technique for the treatment of multiple gingival recession in humans: A double-blind, parallel-group, randomized controlled clinical trial

Background: In this evolutionary era of dentistry, newer techniques have evolved for complete coverage of multiple recession defects (MRDs). Since 2012, MRDs have been treated using the vestibular incision subperiosteal tunnel access (VISTA) approach and a variety of regenerating membranes with varying degrees of success. Platelet‑rich fibrin matrix (PRFM) membrane has shown a robust release of growth factors and was known to enhance the healing process. Thus, in this study we have evaluated the effectiveness of platelet-rich fibrin matrix (PRFM) with that of platelet-rich fibrin (PRF) membrane using the vestibular incision subperiosteal tunnel access (VISTA) technique in Miller Class I and II multiple gingival recession defects. Methods: This randomized, parallel designed, controlled, clinical study was conducted in 20 subjects (10 male and 10 female) having class I/II MGR defects either buccally or labially. The test group was treated with VISTA and PRFM membrane while the control group was treated with VISTA and PRF membrane. The clinical measurements such as plaque index, papillary bleeding index, probing pocket depth, relative attachment level (RAL) and relative gingival marginal level (R-GML), width of keratinized gingiva (WKG), gingival recession (REC) and gingival thickness (GT) were measured at baseline, three and six months. A Student’s paired t-test was utilized to analyse data from the day of surgery to six months. Results: Ten patients in the test group (89.23±15.04) and 10 patients in the control group (85.06±17.71) showed marked root coverage compared to baseline. Conclusions: Both test and control groups showed statistically significant enhancement in root coverage. However, no statistically significant difference was found when a comparison was made between the two groups in terms of PD, relative RAL, R-GML and REC reduction, gain in WKG, and increase in GT. Trial registration: CTRI/2021/07/035240, registered 29 July 2021.

The Revolutionary Potential of i-PRF: A Breakthrough in Implant Dentistry

Implant dentistry has significantly advanced over the years, offering effective solutions for patients with missing teeth. However, optimizing implant success and promoting efficient osseointegration remains a continuous focus for dental professionals. Injectable Platelet-Rich Fibrin (i-PRF) has emerged as a valuable adjunctive therapy in implant dentistry, aiming to enhance the regenerative potential of tissues and improve clinical outcomes.I-PRF is an autologous blood concentrate derived from the patient's own blood, rich in platelets, leukocytes, growth factors, and fibrin matrix. This biological material offers numerous benefits in implant dentistry, including its ability to accelerate wound healing, enhance soft tissue regeneration, and stimulate bone formation. I-PRF is obtained through a simple and chairside centrifugation process, making it readily accessible and cost-effective.In conclusion, i-PRF represents a valuable adjunctive therapy in implant dentistry, providing clinicians with a natural and effective means to optimize implant success and promote tissue regeneration. As research continues to expand in this field, further investigations are needed to explore the full potential and standardize the protocols for i-PRF application, ensuring its widespread utilization and integration into routine implant procedures.

Acoustic droplet vaporization for on-demand modulation of microporosity in smart hydrogels.

Microporosity in hydrogels is critical for directing tissue formation and function. We have developed a fibrin-based smart hydrogel, termed an acoustically responsive scaffold (ARS), which responds to focused ultrasound in a spatiotemporally controlled, user-defined manner. ARSs are highly flexible platforms due to the inclusion of phase-shift droplets and their tunable response to ultrasound through a mechanism termed acoustic droplet vaporization (ADV). Here, we demonstrated that ADV enabled consistent generation of micropores in ARSs, throughout the entire thickness (∼5.5 mm), utilizing perfluorooctane phase-shift droplets. Size characteristics of the generated micropores were quantified in response to critical parameters including acoustic properties, droplet size, and shear elastic modulus of fibrin using confocal microscopy. The findings showed that the length of the generated micropores correlated directly with excitation frequency, peak rarefactional pressure, pulse duration, droplet size, and indirectly with the shear elastic modulus of the fibrin matrix. The ADV-generated micropores in ARSs were further compared with cavitation-mediated micropores in fibrin gels without droplets. Additionally, the Keller-Miksis equation was used to predict an upper bound for micropore formation in ARSs at varying driving frequencies and droplet sizes. Finally, our in vivo studies showed that host cell migration following ADV-induced micropore formation was frequency-dependent, with up to 2.6 times higher cell migration at lower frequencies. Overall, these findings demonstrate a new potential application of ADV in hydrogels. STATEMENT OF SIGNIFICANCE: Interconnected micropores within a hydrogel can facilitate many cell-mediated processes. Most techniques for generating micropores are typically not biocompatible or do not enable controlled, in situ micropore formation. We used an ultrasound-based technique, termed acoustic droplet vaporization, to generate microporosity in smart hydrogels termed acoustically responsive scaffolds (ARSs). ARSs contain a fibrin matrix doped with a phase-shift droplet. We demonstrate that unique acoustic properties of phase-shift droplets can be tailored to yield spatiotemporally controlled, on-demand micropore formation. Additionally, the size characteristics of the ultrasound-generated micropores can be modulated by tuning ultrasound parameters, droplet properties, and bulk elastic properties of fibrin. Finally, we demonstrate significant, frequency-dependent host cell migration in subcutaneously implanted ARSs in mice following ultrasound-induced micropore formation in situ.

Platelet-rich fibrin: A promising regenerative material

Periodontal regeneration is a process involving biological events such as cell adhesion, migration, proliferation, and differentiation in an orchestrated sequence. It is well known that platelets play a key role in hemostasis and the wound healing process. Platelets were introduced as regenerative potential. Choukroun et al. (2001) first described platelet-rich fibrin (PRF). It is the second generation of platelet concentration. It consists of a natural fibrin matrix. It is autogenous fibrin made up of the patient’s blood free from anticoagulants. It is three-dimensional architecture consisting of the specific composition of leukocyte and platelet-rich fibrin biomaterials. Various technique has been used in the preparation of PRF but Choukroun’s PRF technique is the most common and easy technique developed in France. The patient’s blood was taken at around 5 ml which is collected in each of the two sterile vacutainer tubes with a 6 ml capacity without anticoagulant and centrifugation. PRF is used in various fields such as endodontics, oral and maxillofacial surgery, periodontics, and tissue engineering. It is more economical and easy preparation than other grafts. PRF should be handled properly before it shrinks and gets dehydrated. It is the most successful periodontal regenerative material.

Role of Platelet Rich Fibrin Matrix in Management of Electric Burns

Electric burns injury is a problem which is still found now a days. The wound ranges from mild blistering to full thickness charring of tissues, when the wound goes into the healing phase there is difficulty due to the nature of the burns and the large area it involves. Any problem with the edge of the wound can be detrimental to healing and may cause delay in wound healing. In this article, we share our experience of using Platelet Rich Fibrin (PRF) for wound bed preparation in electric burns wound healing.

Simultaneous induction of vasculature and neuronal network formation on a chip reveals a dynamic interrelationship between cell types

BackgroundNeuronal networks receive and deliver information to regulate bodily functions while the vascular network provides oxygen, nutrients, and signaling molecules to tissues. Neurovascular interactions are vital for both tissue development and maintaining homeostasis in adulthood; these two network systems align and reciprocally communicate with one another. Although communication between network systems has been acknowledged, the lack of relevant in vitro models has hindered research at the mechanistic level. For example, the current used in vitro neurovascular models are typically established to be short-term (≤ 7 days) culture models, and they miss the supporting vascular mural cells.MethodsIn this study, we utilized human induced pluripotent stem cell (hiPSC) -derived neurons, fluorescence tagged human umbilical vein endothelial cells (HUVECs), and either human bone marrow or adipose stem/stromal cells (BMSCs or ASCs) as the mural cell types to create a novel 3D neurovascular network-on-a-chip model. Collagen 1–fibrin matrix was used to establish long-term (≥ 14 days) 3D cell culture in a perfusable microphysiological environment.ResultsAprotinin-supplemented endothelial cell growth medium-2 (EGM-2) supported the simultaneous formation of neuronal networks, vascular structures, mural cell differentiation, and the stability of the 3D matrix. The formed neuronal and vascular networks were morphologically and functionally characterized. Neuronal networks supported vasculature formation based on direct cell contacts and by dramatically increasing the secretion of angiogenesis-related factors in multicultures in contrast to cocultures without neurons. Both utilized mural cell types supported the formation of neurovascular networks; however, the BMSCs seemed to boost neurovascular networks to greater extent.ConclusionsOverall, our study provides a novel human neurovascular network model that is applicable for creating in vivo-like tissue models with intrinsic neurovascular interactions. The 3D neurovascular network model on chip forms an initial platform for the development of vascularized and innervated organ-on-chip and further body-on-chip concepts and offers the possibility for mechanistic studies on neurovascular communication both under healthy and in disease conditions.DtMPMfM_nPvk_pFj8pUo8rVideo

Progress in Application of Concentrated Growth Factor in Oral Tissue Regeneration

Tissue regeneration is an important engineering method for the treatment of oral soft and hard tissue defects.Growth factors,as one of the three elements of tissue regeneration,are a necessary condition for tissue regeneration.Concentrated growth factor(CGF)is a new generation of blood extract prepared by changing the centrifugal speed on the basis of the preparation of platelet-rich plasma(PRP)and platelet-rich fibrin(PRF).It contains abundant growth factors and a fibrin matrix with a three-dimensional network structure,being capable of activating angiogenesis and promoting tissue regeneration and healing.CGF has been widely used in the repair and regeneration of oral soft and hard tissues.This paper introduces the preparation and composition of CGF and reviews the application of CGF in oral implantation and the regeneration of oral bone tissue,periodontal tissue,and dental pulp tissue.

Use of platelet-rich fibrin (PRF) in the periodontology: A Review

Platelets play an essential role in wound healing and periodontal regeneration, so using platelet concentrates can speed up wound healing after periodontal treatment. Platelet-rich fibrin (PRF), an autogenous concentrated blood product, is a fibrin matrix comprising molecular and cellular elements that allow for optimum improvement and PRF also increases the production of osteoprotegerin, which causes osteoblast proliferation and acts as an osteoconductive and osteoinductive material, initiating bone regeneration. Platelet-rich plasma (PRP) and PRF are platelet concentrates prepared from the patient's own blood. Recent studies have focused on the development of therapeutic alternatives that are simple to prepare, non-toxic or biocompatible to living tissues, and inexpensive, with the potential to result in the local release of growth factors that accelerate hard and soft tissue healing. PRP is a plasma fraction that contains a high concentration of growth factors. PRF is a natural fibrin-based biomaterial derived from an anticoagulant-free blood harvest without any artificial biochemical modification, allowing fibrin membranes enriched with platelets and growth factors to be obtained. It facilitates the application of growth factors to the surgical area in a concentrated form, thereby accelerating wound improvement and regeneration. Platelet concentrates are used in many areas of dentistry, including soft tissue improvement, plastic periodontal surgery, gingival enlargement, ridge preservation, regeneration of bone defects, drug-related osteonecrosis of the jawbone, sinus augmentation, immediate implant placement, and implant osseointegration. Their use is preferred due to their ease of application and low cost. This paper reviews the current literature concerning the utilization of platelet-rich fibrin in periodontology. How to cite this article: Sağsöz A, Acun Kaya F. Use of platelet-rich fibrin (PRF) in periodontology: A review. J Med Dent Invest 2023;4:e230317. https://doi.org/10.5577/jomdi.e230317 Linguistic Revision: The English in this manuscript has been checked by at least two professional editors, both native speakers of English.

Abstract 143: Differential Suppression Of Arterial Versus Venous Thrombosis But Preserved Hemostasis In Mice Expressing Fibrinogen That Cannot Support Fibrin Formation

Elevated circulating fibrinogen correlates with increased risk for both cardiovascular and venous thromboembolic diseases. In vitro studies show that formation of a highly dense fibrin matrix is a major determinant of clot structure and stability. However, the precise contribution of fibrin matrix to occlusive arterial and venous thrombus formation in vivo remains largely undefined. To determine the contribution of fibrinogen versus fibrin to arterial thrombosis, venous thrombosis, and hemostatic potential in vivo , arterial and venous thrombotic challenges as well as hemostatic tests were performed in wildtype ( Fga WT ) and Fga EK mice that express normal levels of fibrinogen “locked” in the monomeric form. In a model arterial thrombosis, a 10% FeCl 3 injury to the carotid artery resulted in similar times to occlusion between Fga WT/WT , Fga WT/EK and Fga EK/EK mice, while Fga -/- mice were completely protected. However, when injured with 5% FeCl 3 , Fga EK/EK mice were partially protected from occlusion but had increased embolic events. These results suggest that fibrinogen can contribute to arterial thrombus formation independent of fibrin formation. Consistently, fibrinogen-dependent platelet aggregation and intraplatelet fibrinogen content in Fga WT/WT , Fga WT/EK and Fga EK/EK mice were similar. In an inferior vena cava stasis model of venous thrombosis, Fga EK/EK had near complete protection from thrombus formation. Intriguingly, Fga WT/EK mice also displayed significant reduction in thrombus frequency and mass relative to Fga WT/WT mice. Plasma from Fga WT/EK mice produced prolonged prothrombin and thrombin times with reduced fibrin formation based on turbidity assay. In bleeding models, Fga WT/EK and, Fga EK/EK mice had preserved hemostasis in contrast to Fga -/- mice that presented with significantly impaired hemostasis. These findings show that selective prevention of fibrin polymerization significantly reduces venous thrombosis and suppresses arterial thrombosis based on the severity of injury with minimal disruption to hemostasis. Moreover, the data suggests that administration of non-polymerizable fibrinogen may be a therapeutic strategy against thrombosis.

Return to Sports and Functional Outcomes after Autologous Platelet-Rich Fibrin Matrix (PRFM) and Debridement in Midportion Achilles Tendinopathy: A Case Series with 24-Month Follow-Up

(1) Background: Achilles tendinopathy (AT) is characterized by load-induced tendon pain, stiffness, and functional impairment that may affect the tendon midportion or insertion. Platelet-rich fibrin matrix (PRFM) is a promising adjunctive therapy for AT. We analyzed 24-month pain and functional outcomes in a cohort of patients managed by tendon debridement and autologous PRFM application to determine whether the combined treatment ensured an early return to sports/work and satisfactory clinical outcomes and functional scores. (2) Methods: The 24-month outcomes of 32 sport-practicing patients with chronic midportion AT treated with debridement and autologous PRFM were evaluated in terms of time to return to sports/work. The AOFAS and VISA-A were computed preoperatively and at 6 and 24 months. Blazina scores were evaluated preoperatively and at 6 months; ankle range of motion was assessed at 1, 6, 12, 24 months; and patient satisfaction was assessed at 24 months. (3) Results: Altogether, all patients had resumed their sport(s) activity, at the same or higher level, after 25.41 days (±5.37). Regarding work, all patients were able to return to their jobs after 16.41 days (±2.43). Ankle dorsiflexion and plantarflexion increased significantly: the AOFAS rose from 54.56 (±6.47) to 97.06 (±4.06) and 98.88 (±2.21) at 6 and 12 months, respectively, and the mean VISA-A score rose from 69.16 (±7.35) preoperatively to 95.03 (±4.67) and 97.28 (±2.43) at 6 and 12 months, respectively, after treatment. There were no complications. Most (90.62%) patients were very satisfied. (4) Conclusions: In symptomatic midportion AT, surgical debridement and autologous PRFM ensured a fast return to sports/work (4 weeks), significantly improving AOFAS and VISA-A and Blazina scores already at 6 months and providing excellent clinical outcomes at 24 months.

A Comparative Study on Therapeutic Efficacy of Autologous Platelet-rich Plasma, Autologous Platelet-rich Fibrin Matrix, Recombinant Human Epidermal Growth Factor, and Collagen Particles in Nonhealing Leg Ulcers.

Nonhealing leg ulcers are challenging to manage and cause significant patient morbidity. To promote healing, newer techniques focus on delivering/enhancing dermal matrix components. The aim of this study was to compare the therapeutic efficacy of autologous platelet-rich plasma (PRP), autologous platelet-rich fibrin matrix (PRFM), recombinant human epidermal growth factor (rhEGF), and collagen particles in treating nonhealing leg ulcers. Open, randomized prospective study was conducted in a single tertiary center over 2 years where after fulfilling the criteria, randomization was done into four groups. Group A: Autologous PRP (double spin, manual method, weekly); Group B: Autologous PRFM (weekly); Group C: rhEGF (daily application); and Group D: Collagen particles (weekly) along with cleansing, debris removal, and wound dressing. Treatment endpoints were complete healing/6 months of treatment, whichever was earlier. Follow-up was done two weekly by clinical assessment, photographs, and measurement of the ulcer area. Epi info 7 software was used for statistical analysis. A total of 48 patients completed the study, 12 in each group, with mean age: 42.37 ± 4.56 years and male-to-female ratio 2.6:1. Underlying etiology was varicosities (43.75%), traumatic (25%), diabetes (22.91%), and leprosy (8.34%). At baseline, all groups were comparable in terms of patient and ulcer characteristics. Complete healing was seen in 79.17% at the end of 12 weeks: 91.67% of patients from Groups A and B each, and 66.67% from Groups C and D each. The mean time to complete healing was 6.9 ± 2.5 weeks, the least in Group B (4.73 ± 2.3 weeks). Differences between excellent (≥75%) ulcer healing across all groups were statistically significant at the end of 8 weeks where Group B showed maximum improvement. No major adverse events were seen. PRFM resulted in relatively faster ulcer healing compared with other modalities.

Ischemia Impaired Wound Healing Model in the Rat—Demonstrating Its Ability to Test Proangiogenic Factors

Chronic wounds remain a serious clinical problem with insufficient therapeutic approaches. In this study we investigated the dose dependency of rhVEGF165 in fibrin sealant in both ischemic and non-ischemic excision wounds using our recently developed impaired-wound healing model. An abdominal flap was harvested from the rat with unilateral ligation of the epigastric bundle and consequent unilateral flap ischemia. Two excisional wounds were set in the ischemic and non-ischemic area. Wounds were treated with three different rhVEGF165 doses (10, 50 and 100 ng) mixed with fibrin or fibrin alone. Control animals received no therapy. Laser Doppler imaging (LDI) and immunohistochemistry were performed to verify ischemia and angiogenesis. Wound size was monitored with computed planimetric analysis. LDI revealed insufficient tissue perfusion in all groups. Planimetric analysis showed slower wound healing in the ischemic area in all groups. Wound healing was fastest with fibrin treatment-irrespective of tissue vitality. Lower dose VEGF (10 and 50 ng) led to faster wound healing compared to high-dose VEGF. Immunohistochemistry showed the highest vessel numbers in low-dose VEGF groups. In our previously established model, different rhVEGF165 treatments led to dose-dependent differences in angiogenesis and wound healing, but the fastest wound closure was achieved with fibrin matrix alone.

A novel 3D culture model for human primary mammary adipocytes to study their metabolic crosstalk with breast cancer in lean and obese conditions

Obesity is a negative prognosis factor for breast cancer. Yet, the biological mechanisms underlying this effect are still largely unknown. An emerging hypothesis is that the transfer of free fatty acids (FFA) between adipocytes and tumor cells might be altered under obese conditions, contributing to tumor progression. Currently there is a paucity of models to study human mammary adipocytes (M-Ads)-cancer crosstalk. As for other types of isolated white adipocytes, herein, we showed that human M-Ads die within 2–3 days by necrosis when grown in 2D. As an alternative, M-Ads were grown in a fibrin matrix, a 3D model that preserve their distribution, integrity and metabolic function for up to 5 days at physiological glucose concentrations (5 mM). Higher glucose concentrations frequently used in in vitro models promote lipogenesis during M-Ads culture, impairing their lipolytic function. Using transwell inserts, the matrix embedded adipocytes were cocultured with breast cancer cells. FFA transfer between M-Ads and cancer cells was observed, and this event was amplified by obesity. Together these data show that our 3D model is a new tool for studying the effect of M-Ads on tumor cells and beyond with all the components of the tumor microenvironment including the immune cells.

Platelet rich fibrin (PRF) and its application in oral surgery: A literature review

Platelet rich fibrin (PRF) is a autogenous platelet concentrate containing growth factors and cytokines, trapped in fibrin matrix. Growth factors which are present provides ideal environment for wound healing and regeneration of the tissues. Platelet Concentrate have evolved a long way since 1954. In recent time it has been used in the field of medical science including dentistry, oral surgery, plastic surgery, orthopaedic surgery etc. This review discuss the evolution of platelet concentrate, its preparation technique and its application in the field of dentistry and oral surgery.

Combining topical dermal infused exosomes with injected calcium hydroxylapatite for enhanced tissue biostimulation.

Exosome research continues to flourish. Subsequent knowledge surrounding indications, dose-response, safety, efficacy, and the ability to combine exosome treatment as a "skin primer"-for biostimulation modalities such as calcium hydroxylapatite (CaHA), platelet-rich plasma (PRP), and platelet-rich fibrin matrix (PRFM) is growing rapidly. The objective of this study was to develop safe, reproducible methods of improving topical exosome absorption to enhance the quality of skin either by themselves, or in combination with injectable CaHA. Under IRB Approval (International Cell Surgical Society: ICSS-2022-007), 40 patients were enrolled in this study. Twenty patients underwent facial biostimulatory dermal infusion alone, to determine if this method allowed adequate exosome absorption. Five patients underwent facial biostimulatory infusion followed immediately by Dilute CaHA injection (1:1 dilution) to the face. Five patients underwent exosome biostimulatory dermal infusion followed immediately by hyperdilute CaHA (dilution 1:4) injection to the neck. Five patients underwent Facial Dilute CaHA injection (1:1 dilution) alone, without dermal infusion. Five patients underwent neck hyperdilute CaHA injection (1:4 dilution) alone, without dermal infusion. All patients had pretreatment Quantificare 3-D photo-documentation and skin analysis (Quantificare, France). In all patients, the skin was first cleansed with a gentle glycolic acid facial wash (Gregory MD). To induce a "homing inflammatory environment" for the exosomes, sea salt exfoliation was performed (SaltFacial®, SaltMed, Cardiff, CA). A nitric oxide-generating serum (N101 Pneuma Nitric Oxide, Austin, TX) was then applied to act as an enhanced vehicle for absorption. A 3MHz ultrasound (SaltFacial®, SaltMed, Cardiff, CA) was then utilized to further deepen the absorption of the nitric oxide serum. A topical emulsion containing equal volumes (1.0cc containing 1 million) of exosomes (Kimera Labs, Miramar, FL), 25 units of botulinum toxin (Xeomin, Merz Aesthetics, Raleigh, NC) and hyaluronic acid (Belatero, Merz Aesthetics, Raleigh, NC) was mixed via back-and-forth propulsion in a 3-cc syringe. When adequately mixed, the emulsion was then applied to the treatment areas. The cavitating ultrasound was then used to aid in the absorption of the emulsion. The patients were then treated with high-intensity LED therapy (SaltFacial®, SaltMed, Cardiff, CA), utilizing the collagen restoration preset program of combination red (660 nm) near-infrared (930 nm) wavelength for 20 min. Post-treatment Quantificare analysis was performed at 15 and 30 days after treatment. Without exception, all dermal infusion alone and CaHA injection alone patients showed an improvement in the tone, quality, and texture of their skin. Quantificare results showed consistent improvement in wrinkles, pores, skin evenness, improved vascularity, and a reduction in oiliness and unwanted pigment. When employed as a skin primer prior to injections (CaHA), enhanced and more rapid results were seen. Biostimulatory dermal infusion can be achieved utilizing topical placental mesenchymal stem cell-derived exosomes. These exosomes can be used alone, or mixed with ancillary ingredients such as botulinum toxin, hyaluronic acid dermal filler, and CaHA to customize and personalize treatments based upon individual patient needs. Topical absorption is enhanced with sea salt exfoliation, a topical nitric oxide-generating serum, and 3MHz cavitating ultrasound. Post-absorption activity is enhanced with high-intensity LED treatment. The addition of CaHA injections after the topical exosome "priming of the skin" yielded enhanced skin quality faster than exosomes or CaHA alone.

Bioprinted Schwann and Mesenchymal Stem Cell Co-Cultures for Enhanced Spatial Control of Neurite Outgrowth.

Bioprinting nerve conduits supplemented with glial or stem cells is a promising approach to promote axonal regeneration in the injured nervous system. In this study, we examined the effects of different compositions of bioprinted fibrin hydrogels supplemented with Schwann cells and mesenchymal stem cells (MSCs) on cell viability, production of neurotrophic factors, and neurite outgrowth from adult sensory neurons. To reduce cell damage during bioprinting, we analyzed and optimized the shear stress magnitude and exposure time. The results demonstrated that fibrin hydrogel made from 9 mg/mL of fibrinogen and 50IE/mL of thrombin maintained the gel's highest stability and cell viability. Gene transcription levels for neurotrophic factors were significantly higher in cultures containing Schwann cells. However, the amount of the secreted neurotrophic factors was similar in all co-cultures with the different ratios of Schwann cells and MSCs. By testing various co-culture combinations, we found that the number of Schwann cells can feasibly be reduced by half and still stimulate guided neurite outgrowth in a 3D-printed fibrin matrix. This study demonstrates that bioprinting can be used to develop nerve conduits with optimized cell compositions to guide axonal regeneration.

Hemostasis in liver surgery: Indonesian Society of Digestive Surgeons (IKABDI) consensus statements

Liver resection is a complex operation with bleeding control as one of the most crucial factors. It is essential to determine the amount of bleeding to predict the mortality and morbidity after liver surgery. With technology and scientific development, liver resection can use open or laparoscopic surgical techniques supported by various energy devices and medical management. However, the main goal is to remove the tumor with adequate negative margins and good flow. Indonesian Society of Digestive Surgeons agreed to have an agreement using the Modified Delphi method consisting of twenty digestive surgeons. The consensus was established for hemostasis management choices as surgical and medical strategies in liver surgery. The surgical strategies recommendation include performing anatomical resection in primary hepatic tumor and non-anatomical resection for liver metastases; using of Glissonean Pedicle approach as an inflow control option; doing routine intermittent pringle maneuvers; prohibiting total vascular exclusion; and making a statement that no particular energy device preferred for transecting the liver parenchyma. For medical strategies, consensus recommends limiting the transfusion of PRC or any other blood components, antifibrinolytic's role as hemostatic agents, and using fibrin sealant and matrix coagulant sheets for hemostatic agents in liver surgery. These recommendations reflect current knowledge and can be reviewed if new findings are discovered. Hopefully, this consensus can be a valuable guide for surgeons, especially those practicing in Indonesia, to provide low mortality and morbidity in liver resection.

Multiprotocol treatment modality in chronic peri-implantitis utilizing decontaminating, single phase bio-ceramic and autologous fibrin matrix

Introduction: Peri-implant diseases are defined as pathological inflammatory reactions in the tissue surrounding osseointegrated implants. They are classified into two categories: mucositis—defined as peri-implant soft tissue inflammation and peri-implantitis—bone loss in the peri-implant region. Case Report: A clinical case of a 61-year-old woman with an implant in the 46 anatomical position presented with peri-implantitis after a 5-year follow-up. A probe depth of 5 mm and a bone defect length of 35% was observed. The Implacure Protocol was applied, with the main objective of eliminating the biofilm present on the exposed implant surface. There are multiple approaches to treat peri-implant diseases. While non-surgical treatment is essentially sufficient for mucositis control, the treatment in most cases of peri-implantitis should be surgery. Regenerative bone reconstruction promotes bone repair in the defect area and reduces bleeding during probing. To achieve that, autologous fibrin combined with Cerasorb M was used. Conclusion: The proposed approach in the presented clinical case involves the application of Implacure Protocol, whose combination of the physical decontamination technique, together with the use of chlorhexidine and orthophosphoric acid, added with the combination Piperacillin + Tazobactam together with hyaluronic acid, provided a base that allows to regenerate bone using platelet-rich fibrin with Cerasorb M and increase the implant survival time.

Clinical Evaluation of Coronally Advanced Flap With or Without Advance-Platelet Rich Fibrin Membrane in the Treatment of Miller's Class-II Localized Gingival Recession: A Clinical Study.

Periodontal treatment focuses on maintaining a patient's natural teeth and gums. The gingival margin recedes to a point apical to the tooth in 20%-100% of people. Coronallyadvanced flap (CAF) is one of several effective treatments for this condition. This surgery covers the tooth root with gingiva. The predictability of this surgery depends on the blood supply, donor tissue, and surgical skills. Platelet concentrates, which include platelet-rich fibrin (PRF), majority of the time is used for various regenerative therapies. Since no bovine thrombin or anticoagulant is needed, its manufacturing is simpler, cheaper, and less biochemically modified than PRP. Platelet-rich fibrin (PRF) is a fibrin matrix that progressively releases platelet cells and cytokines. The present study aimed to evaluate the efficacy of CAF with and without A-PRF in the treatment of Miller's class-II localized gingival recession. Twenty patients were chosen who had Miller's class-II localized gingival recession. A random number generator was used to place patients into either the "test" or "control" group. Treatment for both Groups A and B included a coronally advanced flap, but only Group A additionally got autologous platelet-rich fibrin (A-PRF). After receiving a detailed explanation of the treatment process, the patient signed an informed consent form. Complete medical and dental histories were taken to see whether there were any absolute or relative contraindications. Following treatment with either method in the current study, gingival thickness improved considerably. The percentage of root coverage did not change considerably between the two groups. The clinical result might likely have been different if other factors, such as platelet concentration and PRF consistency, had been examined in the current investigation. Furthermore, there was no histological examination of the healing process. As a result, we are unsure of the extent to which PRF affects how effectively connective tissue attaches. The additional use of A-PRF membrane did not provide additional benefits in terms of root coverage outcomes compared with CAF alone. The use of A-PRF membranes significantly reduced the recession depth.