Leukocyte- And Platelet-rich Fibrin Group Research Articles

Leukocyte- and Platelet-Rich Fibrin versus Commercially Available Fibrin Sealants in Elective Cranial Surgery: A Cost-Minimization Analysis

BackgroundPrevious findings from a clinical trial demonstrated non-inferiority of Leukocyte- and platelet-rich fibrin (L-PRF) compared to commercially available fibrin sealants in preventing postoperative cerebrospinal fluid (CSF) leakage, necessitating intervention. This cost-effectiveness evaluation aims to assess the value-for-money of both techniques for dural closure in supratentorial and infratentorial surgeries. MethodsCost-effectiveness was estimated from a healthcare payer’s perspective alongside a randomized clinical trial comprising 328 patients. The analysis focused on clinical and health-related quality of life (HRQOL) outcomes, as well as direct medical costs including inpatient costs, imaging and laboratory costs, and outpatient follow up costs up to twelve weeks after surgery. ResultsClinical and HRQOL data showed no significant differences between L-PRF (EQ5D 0.75 ± 0.25, SF-36 63.93% ± 20.42) and control (EQ5D 0.72 ± 0.22, SF-36 60.93% ± 20.78) groups. Pharmaceutical expenses during initial hospitalization were significantly lower in the L-PRF group (€190.4, IQR 149.9) than in the control group (€394.4, IQR 364.3), while other cost categories did not show any significant differences, resulting in an average cost advantage of €204 per patient favoring L-PRF. ConclusionThis study demonstrates L-PRF as a cost-effective alternative for commercially available fibrin sealants in dural closure. Implementing L-PRF can lead to substantial cost savings, particularly considering the frequency of these procedures.

Leukocyte- and platelet-rich fibrin in cranial surgery: a single-blinded, prospective, randomized controlled noninferiority trial.

CSF leakage is a major complication after cranial surgery, and although fibrin sealants are widely used for reinforcing dural closure, concerns exist regarding their safety, efficacy, and cost. Leukocyte- and platelet-rich fibrin (L-PRF), an autologous platelet concentrate, is readily available and inexpensive, making it a cost-effective alternative for commercially available fibrin sealants. This study aimed to demonstrate the noninferiority of L-PRF compared with commercially available fibrin sealants in preventing postoperative CSF leakage in supra- and infratentorial cranial surgery, with secondary outcomes focused on CSF leakage risk factors and adverse events. In a single-blinded, prospective, randomized controlled interventional trial conducted at a neurosurgery department of a tertiary care center (UZ Leuven, Belgium), patients undergoing elective cranial neurosurgery were randomly assigned to receive either L-PRF (active treatment) or commercially available fibrin sealants (control) for dural closure in a 1:1 ratio. Among 350 included patients, 328 were analyzed for the primary endpoint (44.5% male, mean age 52.3 ± 15.1 years). Six patients (5 in the control group, 1 in the L-PRF group) presented with CSF leakage requiring any intervention (relative risk [RR] 0.20, one-sided 95% CI -∞ to 1.02, p = 0.11), confirming noninferiority. Of these 6 patients, 1 (in the control group) presented with CSF leakage requiring revision surgery. No risk factors for reconstruction failure in combination with L-PRF were identified. RRs for adverse events such as infection (0.72, 95% CI -∞ to 1.96) and meningitis (0.36, 95% CI -∞ to 1.25) favored L-PRF treatment, although L-PRF treatment showed slightly more bleeding events (1.44, 95% CI -∞ to 4.66). Dural reinforcement with L-PRF proved noninferior to commercially available fibrin sealants, with no safety issues. Introducing L-PRF to standard clinical practice could result in important cost savings due to accessibility and lower cost. Clinical trial registration no.: NCT03812120 (ClinicalTrials.gov).

Antibacterial effects of platelet-rich fibrin produced by horizontal centrifugation

Platelet-rich fibrin (PRF) has been widely used owing to its ability to stimulate tissue regeneration. To date, few studies have described the antibacterial properties of PRF. Previously, PRF prepared by horizontal centrifugation (H-PRF) was shown to contain more immune cells than leukocyte- and platelet-rich fibrin (L-PRF). This study aimed to compare the antimicrobial effects of PRFs against Staphylococcus aureus and Escherichia coli in vitro and to determine whether the antibacterial effects correlated with the number of immune cells. Blood samples were obtained from eight healthy donors to prepare L-PRF and H-PRF. The sizes and weights of L-PRF and H-PRF were first evaluated, and their antibacterial effects against S. aureus and E. coli were then tested in vitro using the inhibition ring and plate-counting test methods. Flow-cytometric analysis of the cell components of L-PRF and H-PRF was also performed. No significant differences in size or weight were observed between the L-PRF and H-PRF groups. The H-PRF group contained more leukocytes than the L-PRF group. While both PRFs had notable antimicrobial activity against S. aureus and E. coli, H-PRF demonstrated a significantly better antibacterial effect than L-PRF. Furthermore, the antimicrobial ability of the PRF solid was less efficient than that of wet PRF. In conclusion, H-PRF exhibited better antibacterial activity than L-PRF, which might have been attributed to having more immune cells.

Tomographic and histomorphometric evaluation of socket healing after tooth extraction using leukocyte- and platelet-rich fibrin: A randomized, single-blind, controlled clinical trial

The use of platelet concentrate in alveolar ridge preservation has been broadly studied. However, no randomized clinical trials with histomorphometric analysis and low risk of bias are available in the literature. We conducted a prospective, single-blind, parallel, randomized, controlled clinical trial to evaluate the efficacy of leukocyte- and platelet-rich fibrin (L-PRF) in socket preservation after tooth extraction. Additionally, the effect of L-PRF on bone formation was analyzed histologically using bone biopsy specimens obtained during implant placement.A total of 48 subjects who underwent a non-molar tooth extraction were randomly assigned to the L-PRF group (n = 24) or the control group (n = 24). Cone-beam computed tomographies were performed immediately after tooth extraction and at 3 months after tooth extraction, prior to implant surgery. A significant difference in bone resorption was registered 1 mm below the crest: 0.93 ± 0.9 mm for the L-PRF group and 2.27 ± 1.2 mm for the control group (p = 0.0001). Histomorphometric analysis showed a higher percentage of new bone formation in the L-PRF group compared with the control group. The values were 55.96 ± 11.97% and 39.69 ± 11.13%, respectively (p = 0.00001). These findings indicate that the administration of L-PRF should always be considered when socket preservation is planned (Clinicaltrials.gov NCT03408418).

Effect of autogenous growth factors released from platelet concentrates on the osteogenic differentiation of periodontal ligament fibroblasts: a comparative study.

BackgroundPlatelet concentrates have been used in tissue regeneration. The purpose of this study was to examine effects of growth factors released from leukocyte- and platelet-rich fibrin (L-PRF) and concentrated growth factor (CGF) on the osteogenic differentiation of periodontal ligament fibroblasts (PDLFs).MethodsLeukocyte- and platelet-rich fibrins, CGFs and PDLFs were obtained from New Zealand rabbits. The release of basic fibroblast growth factor (bFGF), bone morphogenetic protein 2 (BMP-2) and transforming growth factor β1 (TGF-β1) from L-PRFs and CGFs was measured at 5 h and 1, 3, 5, 7 days, using the enzyme linked immunosorbent assay. The PDLFs were treated with exudates of L-PRF or CGF. After the treatment, cell counting kit-8 assay was performed at day 1, 3, 5 and 7. Alkaline phosphatase (ALP) assay and Western blotting were applied at day 7. Three blocking antibodies were used to neutralize the proteins of bFGF, BMP-2 and TGF-β1.ResultsLeukocyte- and platelet-rich fibrin and CGF showed different growth factor release pattern, but similar accumulated concentration of these growth factors. PDLFs proliferation was significantly promoted by both L-PRF and CGF at day 1, 3 and 7, and CGF group was superior to L-PRF group at day 1 and 3. Both L-PRF and CGF significantly enhanced PDLFs ALP activity and protein expression of osteogenic markers. The osteopontin level was higher in CGF group than in L-PRF group, but no significant differences were found between two groups for ALP activity. Three blocking antibodies significantly downregulated both L-PRF and CGF induced osteogenic markers expression.ConclusionBoth CGF and L-PRF can promote the proliferation and osteogenic differentiation of PDLFs. The bFGF, BMP-2 and TGF-β1 are involved in both L-PRF and CGF induced osteogenic differentiation of PDLFs.

The effect of platelet-rich fibrin exudate addition to porous poly(lactic-co-glycolic acid) scaffold in bone healing: An in vivo study.

Bone grafting procedures have been widely utilized as the current state-of-the-art for bone regeneration, with autogenous bone graft being the gold-standard bone reconstructive option. However, the use of autografts may be limited by secondary donor-site comorbidities, a finite amount of donor supply, increased operating time, and healthcare cost impact. Synthetic materials, or alloplasts, such as the polymeric material, poly(lactic-co-glycolic acid) (PLGA) has previously been utilized as a transient scaffold to support healing of bone defects with the potential to locally delivery osteogenic additives. In this study a novel procedure was adopted to incorporate both the dissolved contents and mechanical components of leukocyte- and platelet-rich fibrin (L-PRF) into an PLGA scaffold through a two-step method: (a) extraction of the L-PRF membrane transudate with subsequent immersion of the PLGA scaffold in transudate followed by (b) delivering a fibrin gel as a low-viscosity component that subsequently polymerizes into a highly viscous, gel-like biological material within the pores of the PLGA scaffold. Two, ~0.40 cm3 , submandibular defects (n = 24) were created per side using rotary instrumentation under continuous irrigation in six sheep. Each site received a PLGA scaffold (Intra-Lock R&D, Boca Raton, FL), with one positive control (without L-PRF exudate addition [nL-PRF]), and one experimental (augmented with PLGA/L-PRF Blocks [L-PRF]). Animals were euthanized 6 weeks postoperatively and mandibles retrieved, en bloc, for histological analysis. Histomorphometric evaluation for bone regeneration was evaluated as bone area fraction occupancy (BAFO) within the region of interest of the cortical bone (with specific image analysis software) and data presented as mean values with the corresponding 95% confidence interval values. Qualitative evaluation of nondecalcified histologic sections revealed extensive bone formation for both groups, with substantially more bone regeneration for the L-PRF induced group relative nL-PRF group. Quantitative BAFO within the defect as function of the effect of L-PRF exudate on bone regeneration, demonstrated significantly (p = .018) higher values for the L-PRF group (38.26% ± 8.5%) relative to the nL-PRF group (~28% ± 4.0%). This in vivo study indicated that L-PRF exudate has an impact on the regeneration of bone when incorporated with the PLGA scaffold in a large translational model. Further studies are warranted in order to evaluate the L-PRF exudate added, as well as exploring the preparation methods, in order to facilitate bone regeneration.

Hard and Soft Tissue Evaluation of Different Socket Preservation Procedures Using Leukocyte and Platelet-Rich Fibrin: A Retrospective Clinical and Volumetric Analysis

The extraction of a tooth is followed by hard and soft tissue changes that can compromise implant placement. The aim of the present retrospective study was to compare the clinical and radiographic outcomes of different ridge preservation procedures based on the use of leukocyte and platelet-rich fibrin (L-PRF). The study population consisted of all patients who had undergone surgery from January 1, 2017 to January 1, 2018 for alveolar ridge preservation on single posterior teeth using 3 clinical protocols: L-PRF alone, L-PRF mixed with a bone xenograft, and bone xenograft alone. Clinical and radiographic measures were recorded preoperatively and at 6months postoperatively to determine the horizontal and vertical ridge resorption. A total of 45 patients were included in the present study. All the surgeries were performed successfully, and no intraoperative complications developed. The L-PRF group experienced significantly greater horizontal and vertical bone resorption. The L-PRF plus bone xenograft group had less vertical and horizontal bone resorption than the bone xenograft alone group. Statistically significant differences in postoperative pain and wound healing were observed, with the bone xenograft alone group, in particular, having higher values for pain and experiencing delayed wound healing. Within the limitations of the present retrospective study, the use of a bone xenograft alone or L-PRF combined with a bone xenograft to perform alveolar ridge preservation procedures significantly limited bone resorption.

Comparison of the effect of advanced platelet-rich fibrin and leukocyte- and platelet-rich fibrin on outcomes after removal of impacted mandibular third molar: A randomized split-mouth study.

In this study, it was aimed to investigate and compare the postoperative effects of leukocyte- and platelet-rich fibrin (L-PRF) and advanced platelet-rich fibrin (A-PRF) in terms of pain, swelling, and trismus after mandibular third molar surgery. The study included a total of 27 patients with bilateral impacted mandibular third molar, which surgically operated at different times. Patients were evaluated in two randomly separated groups. For the first and second group, A-PRF and L-PRF were applied into the tooth socket, respectively. The outcome variables were pain, swelling, the number of analgesics taken, and trismus. These variables were also assessed based on first, second, third, and seventh days following the operation. The data were collected and analyzed with unpaired Student's t-test and Mann-Whitney U test. The study was conducted with 27 patients, consisting of 15 females and 12 males between ages of 18-26. The visual analog scale pain scores of the L-PRF group during first (P < 0.05), second, and third days and total values (P < 0.01); the number of analgesics on days 2 (P < 0.01) and 3; and their total values (P < 0.05) were significantly higher than the A-PRF group. There was no significant difference between swelling, trismus, and the duration of operation (P > 0.05). The results of this study showed that the use of A-PRF after mandibular third molar extraction significantly reduces postoperative pain and the patients need to take analgesics of A-PRF group compared to L-PRF group.

Effects of leukocyte- and platelet-rich fibrin alone and combined with hyaluronic acid on early soft tissue healing after surgical extraction of impacted mandibular third molars: A prospective clinical study

PurposeIn this prospective, randomized, double-blind, controlled study, we evaluated the effects of leukocyte- and platelet-rich fibrin (L-PRF) alone and combined with hyaluronic acid (HA) sponge on early healing of soft tissue after mandibular third molar (M3) surgery. Patients and methodsIn total, 60 patients aged 18–30 (mean 22.3), 22 male and 38 female, were included in this study. After surgical extraction of the impacted M3, L-PRF was applied to the socket in the L-PRF group (n = 20), and a combination of L-PRF and HA was applied in the L-PRF + HA group (n = 20). Nothing was applied in the control group (n = 20). The primary outcome variable was healing score for the mucosa over the extraction socket on the 7th, 14th, and 21st days. Secondary outcome variables were frequencies of postoperative complications: hemorrhagic complications, alveolar osteitis (AO), and postoperative wound infection. ResultsMean healing scores for the mucosa on the 7th, 14th, and 21st days for both the L-PRF group and the L-PRF + HA group were significantly better than those for the control group. The ratio of alveolar osteitis for the control group was 1:20 and the ratio of postoperative wound infection for the control group was 1:20. There were no cases of alveolar osteitis or postoperative wound infection in the L-PRF and L-PRF + HA groups. No hemorrhagic complications were observed in this study. ConclusionThe results of this study suggest that L-PRF alone and when combined with HA can be an effective way to improve soft tissue healing, and could be used to prevent postoperative alveolar osteitis and infection after M3 surgery. Further studies with larger study groups are necessary.

Effects of Leukocyte- and Platelet-Rich Fibrin Alone and Combined With Hyaluronic Acid on Pain, Edema, and Trismus After Surgical Extraction of Impacted Mandibular Third Molars

In this prospective, randomized, double-blind controlled study, we evaluated the effects of leukocyte- and platelet-rich fibrin (L-PRF) alone and combined with a hyaluronic acid (HA) sponge on pain, edema, and trismus after mandibular third molar surgery. In total, 60 patients were included in this study. The patients were randomly divided into 3 groups: L-PRF group (L-PRF was applied to the socket), L-PRF-plus-HA group (L-PRF combined with HA was applied to the socket), and control group (nothing was applied). The primary outcome variables were edema (tragus to pogonion, tragus to labial commissure, and angulus mandibulae to lateral canthus), trismus on postoperative days 2 and 7, and postoperative pain scores on a visual analog scale from hour 6 to day 7. After extraction, the tragus-to-pogonion values were significantly higher in the control group both on day 2 (higher than L-PRF-plus-HA group) and on day 7 (higher than both groups). The mean increase in tragus-to-labial commissure values on day 2 was significantly higher in the control group than in the L-PRF-plus-HA group. The mean increase in angulus mandibulae-to-lateral canthus values on days 2 and 7 was significantly higher in the control group than in the L-PRF and L-PRF-plus-HA groups. There was no significant difference among groups in trismus and visual analog scale pain scores. Analgesic intake on the day of surgery in the L-PRF-plus-HA group was significantly lower. Our results imply that L-PRF, particularly when combined with HA, can be used to minimize postoperative edema after mandibular third molar surgery. However, further studies with larger samples are required.

Comparison of the Mechanical Properties of Early Leukocyte- and Platelet-Rich Fibrin versus PRGF/Endoret Membranes.

Objectives. The mechanical properties of membranes are important factors in the success of treatment and clinical handling. The goal of this study was to compare the mechanical properties of early leukocyte- and platelet-rich fibrin (L-PRF) versus PRGF/Endoret membrane. Materials and Methods. In this experimental study, membranes were obtained from 10 healthy male volunteers. After obtaining 20 cc venous blood from each volunteer, 10 cc was used to prepare early L-PRF (group 1) and the rest was used to get a membrane by PRGF-Endoret system (group 2). Tensile loads were applied to specimens using universal testing machine. Tensile strength, stiffness, and toughness of the two groups of membranes were calculated and compared by paired t-test. Results. The mean tensile strength and toughness were higher in group 1 with a significant difference (P < 0.05). The mean stiffness in group 1 was also higher but not statistically significant (P > 0.05). Conclusions. The results showed that early L-PRF membranes had stronger mechanical properties than membranes produced by PRGF-Endoret system. Early L-PRF membranes might have easier clinical handling and could be a more proper scaffold in periodontal regenerative procedures. The real results of the current L-PRF should be in fact much higher than what is reported here.

Increased vascularization during early healing after biologic augmentation in repair of chronic rotator cuff tears using autologous leukocyte- and platelet-rich fibrin (L-PRF): a prospective randomized controlled pilot trial

We hypothesized that arthroscopic rotator cuff repairs using leukocyte- and platelet-rich fibrin (L-PRF) in a standardized, modified protocol is technically feasible and results in a higher vascularization response and watertight healing rate during early healing. Twenty patients with chronic rotator cuff tears were randomly assigned to 2 treatment groups. In the test group (N = 10), L-PRF was added in between the tendon and the bone during arthroscopic rotator cuff repair. The second group served as control (N = 10). They received the same arthroscopic treatment without the use of L-PRF. We used a double-row tension band technique. Clinical examinations including subjective shoulder value, visual analog scale, Constant, and Simple Shoulder Test scores and measurement of the vascularization with power Doppler ultrasonography were made at 6 and 12 weeks. There have been no postoperative complications. At 6 and 12 weeks, there was no significant difference in the clinical scores between the test and the control groups. The mean vascularization index of the surgical tendon-to-bone insertions was always significantly higher in the L-PRF group than in the contralateral healthy shoulders at 6 and 12 weeks (P = .0001). Whereas the L-PRF group showed a higher vascularization compared with the control group at 6 weeks (P = .001), there was no difference after 12 weeks of follow-up (P = .889). Watertight healing was obtained in 89% of the repaired cuffs. Arthroscopic rotator cuff repair with the application of L-PRF is technically feasible and yields higher early vascularization. Increased vascularization may potentially predispose to an increased and earlier cellular response and an increased healing rate.

P.244 Infraorbital modiflcation of the Weber-Ferguson flap

In this prospective, randomized, double-blind controlled study, we evaluated the effects of leukocyte- and platelet-rich fibrin (L-PRF) alone and combined with a hyaluronic acid (HA) sponge on pain, edema, and trismus after mandibular third molar surgery.In total, 60 patients were included in this study. The patients were randomly divided into 3 groups: L-PRF group (L-PRF was applied to the socket), L-PRF–plus–HA group (L-PRF combined with HA was applied to the socket), and control group (nothing was applied). The primary outcome variables were edema (tragus to pogonion, tragus to labial commissure, and angulus mandibulae to lateral canthus), trismus on postoperative days 2 and 7, and postoperative pain scores on a visual analog scale from hour 6 to day 7.After extraction, the tragus-to-pogonion values were significantly higher in the control group both on day 2 (higher than L-PRF–plus–HA group) and on day 7 (higher than both groups). The mean increase in tragus–to–labial commissure values on day 2 was significantly higher in the control group than in the L-PRF–plus–HA group. The mean increase in angulus mandibulae–to–lateral canthus values on days 2 and 7 was significantly higher in the control group than in the L-PRF and L-PRF–plus–HA groups. There was no significant difference among groups in trismus and visual analog scale pain scores. Analgesic intake on the day of surgery in the L-PRF–plus–HA group was significantly lower.Our results imply that L-PRF, particularly when combined with HA, can be used to minimize postoperative edema after mandibular third molar surgery. However, further studies with larger samples are required.