Combination Of Platelet-rich Fibrin Research Articles

Comparative evaluation of autologous platelet-rich fibrin versus platelet-rich fibrin combined with demineralized freeze-dried bone allograft in the treatment of periodontal intrabony defects: A clinical & radiographic study

Aim: Demineralized freeze-dried bone allografts (DFDBA) are osteoinductive and platelet-rich fibrin (PRF) plays an essential role in wound repair. It also provides a matrix for migration of tissue-forming cells. Both entities may accelerate the bone healing process and soft tissues. The present study was aimed to compare the clinical and radiographic outcomes obtained with the combination of PRF and DFDBA to those obtained with PRF alone in the treatment of periodontal intrabony defects 9 months after surgical intervention. Materials and Methods: A split-mouth study was conducted in 20 subjects (40 sites - intrabony defect bilaterally). The sites had been randomly divided into two groups (Site A and Site B) in which one quadrant (Site A) received DFDBA+PRF whereas the other quadrant (Site B) received PRF alone. Clinical parameters gingival index (GI), probing depth (PD), clinical attachment level (CAL), gingival marginal level (GML), and radiographic parameters—crestal bone resorption and bone fill was measured at baseline, 3 and 9 months. Results: Over a period of 9 months, a significant reduction was observed in GI 0.88 ± 0.06 (P < 0.001)along with a greater reduction in PD(4.30 ± 1.38 mm), greater gain in CAL (4.35 ± 1.53 mm) as well as a greater bone fill (2.40 ± 0.99 mm) present with Site A (DFDBA+PRF) as compared to Site B (PRF alone). However, slight gingival recession and crestal bone resorption were observed with both groups which were not clinically significant but were statistically significant. Conclusion: The combination of PRF and DFDBA both clinically and radiographically showed much better results as compared to PRF alone in the treatment of periodontal 3 wall intrabony defects over a period of 9 months after surgical intervention.

Platelet rich fibrin in combination with bioabsorbable guided tissue regeneration (GTR) membrane and GTR membrane alone using double lateral sliding bridge flap for treatment of multiple gingival recession defects in humans: A randomized controlled clinical trail.

Background:Marginal tissue recession is a frequent clinical scenario that creates substantial compromise in esthetic appearance of the patient. The current randomized, double-blind interventional trial aims to evaluate the effectiveness of the combination of “platelet rich fibrin (PRF)” membrane with bioresorbable guided tissue regeneration (GTR) membrane as compared to GTR membrane alone utilizing “double lateral sliding bridge flap (DLSBF) technique” for the management of simultaneous GR defects in human subjects.Materials and Methods:Twenty subjects were randomly allotted in two groups: Group 1 (test): 10 subjects treated with PRF + GTR membrane using DLSBF technique and Group 2 (control): 10 subjects treated with GTR membrane alone using DLSBF technique. Clinical measurements such as relative gingival marginal level, “relative clinical attachment level (R-CAL),” “probing pocket depth (PPD),” “gingival recession (GR),” and “width of keratinized gingiva (WKG) and gingival thickness (GT)” were evaluated at the initiation of the study and 6 months thereafter.Results:Two groups showed statistically significant differences with respect to probing depth reduction, CAL gain, and increase in WKG and GT. No significant result was observed with mean root coverage (RC) and complete RC for test (84.80% ± 19.53% and 54.99% ± 38.53%) and control group (75.69% ± 18.86% and 35.83% ± 39.29%), respectively.Conclusions:The combination of PRF membrane used along with GTR membrane provides no additional benefits over GTR membrane alone. However, the DLSBF technique convincingly shows simultaneous elimination of multiple problems associated with GR, shallow vestibule, hypersensitivity, and aberrant frenum pull in a single stage with meticulous performance.

Non‐surgical management of oro‐antral communication using platelet‐rich fibrin: A review of the literature

AbstractOro‐antral communication (OAC) is an opening between the maxillary sinus and the oral cavity, which can provide a pathway to cause an infection of the maxillary sinus. Although surgical techniques propose many advantages, several drawbacks have been reported in the previous studies. Bioactive modifiers such as platelet‐rich fibrin (PRF) are widely being used in oral surgery. Various studies have been conducted for closure of OACs using PRF. Due to the heterogeneity of the techniques found, we opted for a literature review to highlight the variety of techniques discussed in the literature. A comprehensive search of the PubMed, Google Scholar and Cochrane databases was performed for published articles between 2014 and 2021. Keywords for OAC management and repair and inclusion criteria were used to screen articles for final review. Out of 195 articles found, 12 articles were included to the study. Eight studies performed simple direct application of PRF clots, 2 studies used PRF in combination with collagen membrane and in 2 studies the treatment plan was to use buccal advancement flap reinforced by PRF. There were several variations among approaches to the closure of OAC using PRF in terms of treatment planning, pre‐ and post‐operative medication and preparation of PRF. Despite the mentioned variations, review of recent studies showed that all of the cases experienced full epithelialisation of OAC. This technique, without manipulation of any additional flaps and auto‐grafts, has several advantages. However, further research, both experimental and clinical, is necessary to unravel the success rate of using PRF in the management of OACs.

A new innovation in topical diabetic foot ulcer; hyaluronic acid platelet-rich fibrin (HAPRF) gel - a study in inflammation and angiogenesis

Background: Indonesia ranks 6th out of ten countries with the highest number of diabetes patients. An increase followed this condition in the prevalence of diabetic foot ulcers by around 15%. This study demonstrated the ability of combination of Platelet Rich Fibrin (PRF) and Hyaluronic Acid (HA) to reduce inflammation in diabetic foot ulcer (DFU) healing.Methods: In the baseline, all patients received the same treatment including wound debridement. There were 20 subjects divided into two groups; HAPRF and PRF. A part of sample was processed into lysate and stored in -80oC. The rest is applied as a topical therapy in DFU base on intervention. We analyzed the inflammation using two methods; swab in DFU and fibrin gel of HAPRF or PRF and ELISA on day-3 and day-7. We also measure the granulation index by digital photograph and analyze use ImageJ at the same time.Result: There were 20 diabetic patients with DFUs, performed analysis of IL-6 lysate gel HAPRF decrease significantly compare with PRF on day 3 (p= 0.038) and day-7 (p = 0.034). Granulation index evaluation, in HAPRF increase on day-3 (p = 0.043), day-7 (p = 0.049), and day-14 (p = 0.041).Conclusion: A-PRF +HA administration leads to reduce IL-6 levels, and accelerated wound healing of DFUs patients. HAPRF directly aids epithelialization and granulation index.

From Blood to Regenerative Tissue: How Autologous Platelet-Rich Fibrin Can Be Combined with Other Materials to Ensure Controlled Drug and Growth Factor Release.

The purpose of this review is to examine the latest literature on the use of autologous platelet-rich fibrin as a drug and growth factor carrier system in maxillofacial surgery. Autologous platelet-rich fibrin (PRF) is a unique system that combines properties such as biocompatibility and biodegradability, in addition to containing growth factors and peptides that provide tissue regeneration. This opens up new horizons for the use of all beneficial ingredients in the blood sample for biomedical purposes. By itself, PRF has an unstable effect on osteogenesis: therefore, advanced approaches, including the combination of PRF with materials or drugs, are of great interest in clinics. The main advantage of drug delivery systems is that by controlling drug release, high drug concentrations locally and fewer side effects within other tissue can be achieved. This is especially important in tissues with limited blood supply, such as bone tissue compared to soft tissue. The ability of PRF to degrade naturally is considered an advantage for its use as a “warehouse” of controlled drug release systems. We are focusing on this concentrate, as it is easy to use in manipulations and can be delivered directly to the surgical site. The target audience for this review are researchers and medical doctors who are involved in the development and research of PRFs further studies. Likewise, surgeons who use PRF in their work to treat patients and who advice patients to take the medicine orally.

Effectiveness of treating segmental bone defects with a synergistic co-delivery approach with platelet-rich fibrin and tricalcium phosphate

Several studies have applied tricalcium phosphate (TCP) or autografts in bone tissue engineering to enhance the clinical regeneration of bone. Unfortunately, there are several drawbacks related to the use of autografts, including a risk of infection, blood loss, limited quantities, and donor-site morbidities. Platelet-rich fibrin (PRF) is a natural extracellular matrix (ECM) biomaterial that possesses bioactive factors, which can generally be used in regenerative medicine. The goal of the present investigation was to develop osteoconductive TCP incorporated with bioactive PRF for bio-synergistic bone regeneration and examine the potential biological mechanisms and applications. Our in vitro results showed that PRF plus TCP had excellent biosafety and was favorable for initiating osteoblast cell attachment, slow release of bioactive factors, cell proliferation, cell migration, and ECM formation that potentially impacted bone repair. In a rabbit femoral segmental bone defect model, regeneration of bone was considerably augmented in defects locally implanted by PRF plus TCP according to radiographic and histologic examinations. Notably, the outcomes of this investigation suggest that the combination of PRF and TCP possesses novel synergistic and bio-inspired functions that facilitate bone regeneration.

English

Periapical surgery is the treatment of choice for a large periapical lesion with bone loss that occurs due to long standing untreated teeth affected by trauma, caries or in situations where there is an endodontic treatment failure. Failure of nonsurgical endodontic treatment may be due to peri radicular tissues incorporating with infections, foreign body response to filling materials, over instrumentation or over obturation which might have prevented complete periapical healing. We present here 2 case reports wherein, combination of platelet-rich fibrin (PRF) and the hydroxyapatite (HA) graft was used to achieve rapid healing of large periapical lesions, and the treatment outcome concluded that PRF and hydroxyapatite bone graft accelerated the wound healing and induced the rapid rate of bone formation, which was confirmed radiographically. Untreated non-vital teeth generally result in bone destruction in periapical region, which may occur due to the spread of infection following pulpal necrosis, trauma or failed endodontic treatment. Surgical intervention is essential when endodontic treatment has failed and retreatment is not possible. Periapical surgery, Apicoectomy or root end resection endodontic surgery is a safe and well documented treatment alternative when teeth with periapical pathosis are not responding to conventional endodontic treatment.1 Periapical surgery removes periapical pathosis resulting in optimal wound healing with regeneration of the bone and periodontal tissue.

Randomised clinical trial: Effect of administering platelet-rich fibrin to autologous fat tissue in injection laryngoplasty for vocal cord paralysis

The vocal cord in humans is essential in producing voice used in communication and interaction between us. Vocal cord paralysis causes dysphonia, which interferes with communication, causing disruptions towards social activity and daily activities. One of the managements for vocal cord paralysis is medialization and augmentation of the vocal cord through injection laryngoplasty. Autologous fat is one of the best fillers used in this procedure, but it is highly absorbable and can be reabsorbed very quickly when injected into body tissues. Platelet Rich Fibrin (PRF) is a biomaterial consisting of growth factors that are thought to improve fat tissue viability by increasing adipogenesis and angiogenesis. Improvement in fat viability will improve clinical outcomes after the laryngoplasty procedure, potentially reducing the number of repeated injections needed to achieve a satisfactory resolution to vocal cord paralysis. The study evaluates a combination of PRF and autologous microlobular fat compared with autologous microlobular fat alone on laryngoplasty. This single-blinded randomised control trial recruit a total of 18 patients, which are then randomised into the treatment and control groups. The evaluation was done via computerized acoustic analysis/Multidimensional Voice Program (MDVP) parameters and maximum phonation time. The MDVP results and maximum phonation time in both groups showed clinical improvement after the operation with no statistically significant differences.

Histomorphological characteristics of bone replacement in rabbits with hydroxyapatite ceramics and Platelet-Rich Fibrin

The results of a histomorphological study of bone regenerates in rabbits after osteosubstitution with platelet-rich fibrin and its combination with hydroxyapatite granules with β-tricalcium phosphate in spongy and compact bone tissue at different periods of reparative osteogenesis are presented. Three groups of rabbits were formed. In the control group, the defects were left to heal under the blood clot. Bone lesions in the first experimental group were filled with platelet-rich fibrin, in the second – with a combination of platelet-rich fibrin and hydroxyapatite with β-tricalcium phosphate. All animals were kept in the same conditions of feeding and housing, had unlimited access to water. During the study, the rabbits were monitored clinically. The animals were taken out of the experiment on the 14th, 21st and 42nd days, samples of bone tissue were taken, they were fixed, decalcified, dehydrated in alcohols of increasing concentration and embedded in paraffin. In the presented study, it is most likely that the newly formed bone tissue is formed precisely due to osteoinduction in the experimental groups. When using granules of hydroxyapatite and β-tricalcium phosphate with platelet-rich fibrin, bone regenerate is between the composite granules and is not associated with contact with the maternal bone. Its cells appear in different places of the defect. In the spongy bone tissue on the 21st day, regeneration proceeded more fully and faster in the second experimental group, as evidenced by the significant density of cells of the osteoblastic row, the thickness of the bone trabeculae and their volume, filling the site of the defect. On the 42nd day, in the second experimental group, when using a combination of autobiomaterial and hydroxyapatite granules with β-tricalcium phosphate, the regenerate contained a significantly larger number of osteogenic cells in the thickness of the trabeculae, which indicated a more intensive course of reparative osteogenesis in comparison with the first experimental and control groups. In the compact bone on day 21, regeneration was more complete and faster in the second experimental group. On the 42nd day, according to the degree of maturity of the bone regenerate, calcium-phosphate ceramics in combination with platelet-rich fibrin optimizes reparative osteogenesis most clearly. According to the degree of intensity of the osteoregeneration process, the groups can be placed in the following sequence: control ˂PRF˂PRF+HA/β-TCP–700. According to histomorphological characteristics, the combination of hydroxyapatite with β-tricalcium phosphate and platelet-rich fibrin gives greater osteoinduction to the composite material, which is confirmed by the high cell density, namely of osteoblasts and osteocytes. The use of PRF in combination with other materials may become promising for the correction of reparative osteogenesis in conditions of limited or reduced regenerative potential of bone tissue.

Platelet-Rich Fibrin in Combination with Local Antibiotics Optimizes Wound Healing After Deep Sternal Wound Problems and Prevents Reinfection

Objective: Disturbed wound healing is a significant problem in patients after cardiac surgery. Problems with deep sternal wound healing are rare, but can be quite difficult to treat. Furthermore, the therapy is highly expensive and consumes many of the patient’s personal resources. Another major obstacle in this patient group is reinfection after secondary wound closure. We examined how to prevent early reinfection through the use of growth factors in combination with local antibiotics. Methods: Our study included 232 patients with a deep sternal wound healing problem. After initial vacuum therapy, we planned secondary wound closure. During wound closure, we used only platelet-rich fibrin in a PRF group (109 patients). In another group (123 patients), we covered the wounds intraoperatively with a combination of PRF and local antibiotics (PRF CoDelivery). All patients were observed for 30 days for signs of early surgical site infection. Results: After 30 days, 22 patients (20.2%) in the PRF group showed a persistent problem with wound healing with or without reinfection. In contrast, only 12 patients (9.8%) in the PRF CoDelivery group had this problem (p=0.023 PRF vs. PRF CoDelivery). Conclusion: The combination of growth factors and antibiotics was associated with a significantly reduced incidence of early reinfection and thus can be expected to have a positive impact on wound healing in complicated scenarios. Furthermore, the combination of PRF and local antibiotics was easy to use. Further studies are needed to verify these initial findings.

Effectiveness of Silicon Platelet-Rich Fibrin and Autologous Bone on Bone Regeneration in Rabbit Calvarian Defects: A Radiological and Histological Study

Repairing bone defects in oral surgery often requires the use of bone regeneration techniques. Silicon is an element that has been employed as regeneration material in several studies. In our study, silicon was combined with autologous bone and platelet-rich fibrin (PRF) membranes to analyse the behaviour of this element in bone regeneration. Four circumferential defects were created in the cranial vault of five New Zealand rabbits. The following elements were applied to the regeneration of the defects: (P): PRF; (S): silicon and (B): autologous bone, with the following distribution of study groups: Group 1 (PSB); Group 2 (PS); Group 3 (SB) and Group 4 (CONTROL): unregenerate group. The animals were sacrificed after 3 weeks. Computed microtomography studies (μ-CT) were carried out, as well as histomorphometric ones. The ANOVA statistical test was used with a Bonferroni post-hoc test to compare the results (p ≤ 0.05). Radiologically, groups PSB and SB were better as far as quantity and percentage of healthy bone observed, but not significantly compared to the control group. The PS group was significantly worse. The histological test revealed that the PSB group was the one to present the largest area, percentage and perimeter of mineralised bone. On evaluating the forming bone (osteoid), no difference was observed across the groups with the exception of the bone perimeter, where the SB group was significantly better. The bone height variable showed no significant differences. In conclusion we can state that the combination of PRF, autologous bone and silicon provides good results at 3 weeks whilst the PS group shows the worst results. This highlights the importance of autologous bone forming part of the graft material in order for the bone to mineralise.

Possible Implications for Improved Osteogenesis? The Combination of Platelet-Rich Fibrin With Different Bone Substitute Materials.

Bone substitute materials (BSM) are widely used in oral regeneration, but sufficient angiogenesis is crucial for osteogenesis. The combination of BSM with autologous thrombocyte concentrations such as platelet-rich fibrin (PRF) may represent a clinical approach to overcome this limitation. This study analyzes the early influence on osteoblast (HOB) in vitro. Here, four different BSM (allogeneic, alloplastic, and two of xenogeneic origin) were combined with PRF. After the incubation with osteoblasts for 24 h, cell viability, migration, and proliferation were assessed. Next, marker of proliferation, migration, and differentiation were evaluated on gene and protein levels in comparison to the native BSM and osteoblast alone. Addition of PRF increased viability for both the xenogeneic BSM (p = 0.0008, p = 0.032, respectively) in comparison to HOB and vs. native BSM (p = 0.008), and led to a tendency for increased cell proliferation and migration for all BSM (each p > 0.05). On gene basis, allogeneic and alloplastic BSM displayed a significantly increased RUNX2 expression (each p = 0.050). Expression of alkaline phosphatase for alloplastic (p = 0.050) and collagen-1 for xenogeneic BSM (p = 0.05) were significantly increased in combination with PRF. In addition, bone morphogenic protein was expressed significantly higher when xenogeneic material was combined with PRF in comparison to HOB alone (each p = 0.05). In summary, the combination of PRF with different BSM increases initial viability and may influence early proliferation and migration potential of osteoblast via RUNX2, alkaline phosphatase, collagen, and BMP2 especially in combination with alloplastic and xenogeneic BSM. Biofunctionalization of BSM using PRF might improve osteogenesis and extend the range of indications.

Platelet-Rich Fibrin Enhances Fracture Healing in Tibial Long Bone: An Experiment in Rabbit

Background: Fracture on long bone is a complicated case to manage. Bone graft procedure involving growth factors has been widely studied with promising results. Recently, platelet-rich fibrin (PRF) has been introduced as having potential in healing process. This study aimed to explore the quality of fracture healing on long bones treated with bone graft with and without PRF combination. Methods: This study was conducted between October to November 2018 on 18 rabbits that were divided into 2 groups. A 5 mm fracture was created on tibial bones and the fracture was stabilized using a 2.0 mm mini plate. The defect was then treated by an autogenic bone graft with and without PRF. Histological analysis was conducted 3 weeks after the treatment and a scoring was performed using the Salkeld system. The quality of union; cortex development and remodeling; and bone graft incorporation and new bone formation were then analyzed. Results: There were significant differences between fractures in rabbits given PRF than those without PRF in terms of union quality (p 0.040), cortex growth and remodeling (p 0.0001), bone graft and new bone union (p 0.0001), as well as in the total Salkeld score (p 0.0001). Conclusion: PRF given with bone graft therapy can enhance the quality of fracture healing of a long bone. Further studies on how the PRF content influences fracture healing process needs to be performed to further explore this effect.

Impact of Periodontal Pocket Depth on the Efficiency of Surgical Treatment of Generalized Periodontitis

The paper is aimed at increasing the efficiency of surgical treatment by using a combination of platelet-rich fibrin, a synthetic hydroxyapatite Kergap, minimizing the body’s response to operative wound, and improving diagnostic and therapeutic approaches in surgical treatment of stage II-III generalized periodontitis.&#x0D; The objective of the research was to study the efficiency of using the combination of platelet-rich fibrin, synthetic hydroxyapatite Kergap, magnesium preparation in comprehensive treatment of stage II-III generalized periodontitis at various stages and in different depths of the periodontal pockets.&#x0D; Materials and Methods. The efficiency of surgical treatment was evaluated using clinical (periodontal pocket depth, attachment level, gingival bleeding, tooth mobility) and laboratory methods (X-ray, computed tomography) 3, 6, and 12 months after surgical treatment.&#x0D; Results. The clinical picture was characterized by positive changes in all clinical indicators 3, 6 and 12 months after treatment. The best results by clinical and laboratory findings were obtained in case of an average pocket depth of 5-7 mm.&#x0D; Conclusions. There was demonstrated a high clinical efficiency of using the combination of platelet-rich fibrin, synthetic hydroxyapatite Kergap and magnesium preparation in comprehensive treatment of stage II-III generalized periodontitis.

Three-dimensional assessment of the extraction sockets, augmented with platelet-rich fibrin and calcium sulfate: A clinical pilot study

ObjectivesThis clinical study assessed and compared the linear and volumetric changes of extraction sockets grafted with a combination of Platelet-Rich Fibrin (PRF) and Calcium Sulfate (CS) (PRF-CS), and extraction sockets grafted with a combination of PRF and xenograft (X) (PRF-X). MethodsFive single maxillary premolar extraction sockets received PRF-CS grafts and five single maxillary premolar sockets received PRF-X grafts. Linear (horizontal and vertical) measurements were accomplished using Cone Beam Computed Tomography (CBCT) images and volumetric changes were assessed using MIMICS software. Soft tissue level changes were measured using Stonecast models. All measurements were recorded at baseline (before extraction) and at 5-months post-extraction. ResultsSignificant reduction in vertical and horizontal dimensions were observed in both groups except for distal bone height (DBH = 0.44 ± 0.45 mm, p = 0.09) and palatal bone height (PBH = 0.39 ± 0.34 mm, p = 0.06) in PRF-X group. PRF-CS group demonstrated mean horizontal shrinkage of 1.27 ± 0.82 mm (p = 0.02), when compared with PRF-X group (1.40 ± 0.85 mm, p = 0.02). Vertical resorption for mesial bone height (MBH = 0.56 ± 0.25 mm, p = 0.008), buccal bone height (BBH = 1.62 ± 0.91 mm, p = 0.01) and palatal bone height (PBH = 1.39 ± 0.87 mm, p = 0.02) in PRF-CS group was more than resorption in PRF-X group (MBH = 0.28 ± 0.14 mm, p = 0.01, BBH = 0.63 ± 0.39 mm, p = 0.02 and PBH = 0.39 ± 0.34 mm, p = 0.06). Volumetric bone resorption was significant within both groups (PRF-CS = 168.33 ± 63.68 mm3, p = 0.004; PRF-X = 102.88 ± 32.93 mm3, p = 0.002), though not significant (p = 0.08) when compared between groups. In PRF-X group, the distal soft tissue level (DSH = 1.00 ± 0.50 mm, p = 0.03) demonstrated almost 2 times more reduction when compared with PRF-CS group (DSH = 1.00 ± 1.00 mm, 0.08). The reduction of the buccal soft tissue level was pronounced in PRF-CS group (BSH = 2.00 ± 2.00 mm, p = 0.06) when compared with PRF-X group (BSH = 1.00 ± 1.50 mm, p = 0.05). ConclusionsPRF-CS grafted sites showed no significant difference with PRF-X grafted sites in linear and volumetric dimensional changes and might show clinical benefits for socket augmentation.The study is officially registered with ClinicalTrials.gov Registration (NCT03851289).

Treatment of mandibular grade III furcation involvement using platelet-rich fibrin and allogenic graft with 12-month follow-up — A case report

IntroductionFurcation involvement (FI) in multi-rooted teeth is challenging for proper oral hygiene, clinical treatment, and leads to poor prognosis. Traditional treatment modalities often result in sacrificing periodontal bone. Multiple regenerative approaches have been attempted to treat furcation defects, but complete regeneration of the periodontal apparatus in grade III furcation has not been reported. Platelet rich fibrin (PRF) shows great potential in enhancing tissue regeneration, angiogenesis, and prevention of infection. This case report introduces a treatment combining allogenic bone grafts with PRF to treat mandibular grade III furcation lesions with a one-year follow-up. Case presentationTwo patients presented with grade III FIs of the mandibular first molars, with intrabony defects requiring guided tooth regeneration (GTR). PRF was collected from each patient to serve as biologics, by mixing with allogenic bone graft, and packed into the furcation and intrabony defects. The PRF membranes were also used for space maintenance. The twelve-month postoperative follow-up demonstrated quicker tissue healing, significant pocket reduction, clinical attachment gain, as well as radiographic bone fill in both cases. ConclusionSuccessful periodontal regeneration of grade III furcation defects can be achieved by using PRF in combination with bone allograft.

Novel transplant of combined platelet-rich fibrin Releasate and bone marrow stem cells prevent bone loss in Ovariectomized osteoporotic mice

BackgroundOsteoporosis is a metabolic bone disorder characterized by deterioration in the quantity and quality of bone tissue, with a consequent increase susceptibility to fracture.MethodsIn this study, we sought to determine the efficacy of platelet-rich fibrin releasates (PRFr) in augmenting the therapeutic effects of stem cell-based therapy in treating osteoporotic bone disorder. An osteoporosis mouse model was established through bilateral ovariectomy on 12-week-old female ICR (Institute of Cancer Research) mice. Eight weeks postoperatively, the ovariectomized (OVX) mice were left untreated (control) or injected with PRFr, bone marrow stem cells (BMSCs), or the combination of BMSCs and PRFr. Two different injection (single versus quadruple) dosages were tested to investigate the accumulative effects of BMSCS and PRFr on bone quality.Eight weeks after injection, the changes in tibial microstructural profiles included the percentage of bone volume versus total tissue volume (BV/TV, %), bone mineral density (BMD, g/cm3), trabecular number (Tb.N, number/mm), and trabecular separation (Tb.Sp, mm) and bony histology were analyzed.ResultsPostmenopausal osteoporosis model was successfully established in OVX mice, evidenced by reduced BMD, decreased BV/TV, lower Tb.N but increased Tb.Sp. Eight weeks after injection, there was no significant change to BMD and bone trabeculae could be detected in mice that received single-injection regimen. In contrast, in mice which received 4 doses of combined PRFr and BMSCs, the BMD, BV/TV, and TB.N increased, and the TB.Sp decreased significantly compared to untreated OVX mice. Moreover, the histological analysis showed the trabecular spacing become narrower in OVX-mice treated with quadruple injection of BMSCs and combined PRFr and BMSCs than untreated control.ConclusionThe systemic administration of combined BMSCs and PRFr protected against OVX-induced bone mass loss in mice. Moreover, the improvement of bony profile scores in quadruple-injection group is better than the single-injection group, probably through the increase in effect size of cells and growth factors. Our data also revealed the combination therapy of BMSCs and PRFr has better effect in enhancing osteogenesis, which may provide insight for the development of a novel therapeutic strategy in osteoporosis treatment.

Use of Platelet-Rich Fibrin in the Treatment of Grade 2 Furcation Defects: Systematic Review and Meta-Analysis.

In periodontitis patients, furcation defects are crucial sites to regenerate due to their complex anatomy. Various modern surgical techniques and use of biomaterials have been suggested in the literature. Among all, platelet-rich fibrin (PRF) has potential in tissue regeneration thanks to its role in the release of growth factors. Therefore, the purpose of this study was to evaluate the beneficial effect of the addition of PRF to open flap debridement (OFD) or as an adjuvant to other biomaterials such as bone grafts in the treatment of grade 2 mandibular furcation defects. Systematic research was carried out on the databases Medline, Scopus, Embase, and Cochrane Library and registered on PROSPERO (CRD42020167662). According to the PICO guidelines by Cochrane, randomized trials and prospective non-randomized trials were evaluated, with a minimum follow-up period of 6 months. The inclusion criteria were the absence of systemic diseases, non-smoking patients, and a population aged from 18 to 65 years. Vertical pocket probing depth (PPD), vertical clinical attachment level (VCAL), and gingival recession (REC) were the primary outcomes. Vertical furcation depth (VFD), and the percentage of bone defect fill (%v-BDF) were considered as secondary outcomes. A meta-analysis of the primary and secondary outcomes was performed. Publication bias was assessed through a funnel plot. Eighty-four articles were initially extracted. Eight randomized clinical trials were analyzed according to the exclusion and inclusion criteria. The Quality assessment instrument (QAI) revealed four articles at low risk of bias, one at moderate, and three at high risk of bias. The metanalysis showed significant data regarding PPD, VCAL, VFD and %v-BDF in the comparison between PRF + OFD vs. OFD alone. The adjunct of PRF to a bone graft showed a significant difference for VCAL and a not statistically significant result for the other involved parameters. In conclusion, the adjunctive use of PRF to OFD seems to enhance the periodontal regeneration in the treatment of grade 2 furcation defects. The combination of PRF and bone graft did not show better clinical results, except for VCAL, although the amount of literature with low risk of bias is scarce. Further well-designed studies to evaluate the combination of these two materials are therefore needed.

Treatment of Intrabony Defect Using Platelet Rich Fibrin Combined with Bioactive Glass: A Case Report of a Maxillary Central Incisor

The ultimate goal of periodontal therapy is to regenerate the lost periodontal tissues caused by periodontitis. Platelet rich fibrin (PRF), a rich source of autologous growth factors and cytokines, is an upcoming therapeutic approach in the management of periodontal osseous defects. Combination of autologous PRF and the alloplastic bone substitutes holds a promising potential of enhanced bone regeneration. This case report includes the management of an intrabony osseous defect in relation to #21 with a combination of Platelet Rich Fibrin &amp; bioactive glass (calcium phosphosilicatealloplast) with the clinical and radiographic evaluations using cone beam computed tomography (CBCT) for a 9 months follow up period.

Dynamics of hematological parameters, macromorphological and radiological results of reparative osteogenesis in rabbits for the use of platelet concentrates and hydroxyapatite ceramics

The results of the dynamics of the morphological parameters of the blood of a rabbit with model defects of the opening of the spongy and compact bone tissue at diff erent periods of reparative osteogenesis are presented. Formed 4 groups of rabbits. Bone lesions in the fi rst experimental group were fi lled with injectable platelet-rich fi brin, in the second - platelet-rich fi brin, in the third - a combination of platelet-rich fi brin, and hydroxyapatite with β-tricalcium phosphate.In the control group, the defects remained healed under a blood clot. All animals were in the same conditions of feeding and keeping, had unlimited access to water. During the study, rabbits were clinically observed. Blood was taken for morphological examination before surgery and on the 3rd, 7th, 14th, 21st, 42nd day. Animals were taken from the experiment on the 14th, 21st and 42nd days, an X-ray examination was carried out, bone tissue samples were taken. It was established that trauma of bone tissue leads to a number of reactions of the body aimed at restoring the damaged area. Against the background of the general picture of the obtained morphological results, the level of platelets signifi cantly changes compared to the physiological norm, while the number of red blood cells and white blood cells does not go beyond it. There is a slight increase in hemoglobin levels, especially in the experimental groups on the twenty-fi rst and forty-second day. Signifi cant changes in the number of red blood cells, white blood cells, platelets and hemoglobin concentration in the experimental groups were noted compared with the control group at diff erent periods of reparative osteogenesis.The use of various types of platelet concentrates aff ects the overall reaction of the body. On radiographs of the radial bones (compact bone tissue) on the twenty-fi rst day in the second and third experimental groups, where fi brin enriched with platelets and its combination with hydroxyapatite materials with β-tricalcium phosphate were used to replace bone defects, the infl ammatory reaction was manifested to a lesser extent. There was no signifi cant formation of bone callus compared with the fi rst, in which model defects were fi lled with injectable platelet-rich fi brin and the control group. Each of the types of platelet concentrates and their combination with hydroxyapatite ceramics have a diff erent eff ect on the restoration of bone defects and is accompanied by the appearance of a number of reactions, both local and general. According to the degree of intensity of this process, they can be placed in the following sequence: i-PRF ˂ PRF ˂ PRF+GT. Macromorphologically and radiologically signifi cant diff erences were not detected for diff erent types of bone tissue due to the use of each of the substances that concentrates platelets. The combination of hydroxyapatite granules with β-tricalcium phosphate and platelet-rich fi brin proved to be the best option for repairing the damaged area. Its use provides a signifi cantly smaller manifestation of the local infl ammatory reaction and causes the formation of optimal bone marrow. Key words: PRF, i-PRF, granules, centrifuges, growth factors, bone marrow.