Platelet-rich Fibrin Membrane Research Articles

Tomographic assessment of bone changes in atrophic maxilla treated by split-crest technique and dental implants with platelet-rich fibrin and NanoBone® versus platelet-rich fibrin alone: Randomized controlled trial

BackgroundThis study evaluated the clinical benefits of adding NanoBone® with split-crest technique and simultaneous implant placement covered with platelet-rich fibrin membrane in horizontally deficient maxillary ridges in terms of crestal and horizontal bone changes and patient morbidity.MethodsForty patients indicated for maxillary ridge splitting and simultaneous implant placement were assigned randomly to the study groups: control group (Platelet Rich Fibrin membrane) and test group (Platelet Rich Fibrin membrane + Nanobone®). The Cone Beam Computed Tomography Fusion technique was utilized to assess crestal and horizontal bone changes after five months of the surgical procedure. Patient morbidity was recorded for one week post-surgical.ResultsFive months post-surgical, buccal crestal bone resorption was 1.26 ± 0.58 mm for the control group and 1.14 ± 0.63 mm for the test group. Lingual crestal bone resorption was 1.40 ± 0.66 mm for the control group and 1.47 ± 0.68 mm for the test group. Horizontal bone width gain was 1.46 ± 0.44 mm for the control group and 1.29 ± 0.73 mm for the test group. There was no significant statistical difference between study groups regarding crestal and horizontal bone changes and patient morbidity.ConclusionsThe tomographic assessment of NanoBone® addition in this study resulted in no statistically significant difference between study groups regarding crestal and horizontal bone changes and patient morbidity. More randomized controlled clinical trials on gap fill comparing different bone grafting materials versus no grafting should be conducted.Clinicaltrials.gov registration numberNCT02836678, 13th January 2017.

Clinical efficacy of titanium prepared platelet rich fibrin in periodontal regeneration: A systematic review and meta-analysis.

Periodontal regeneration therapies frequently involve autologous platelet concentrates (APCs). They can be used in sinus lift surgeries and socket preservation, among other clinical settings. Platelet rich fibrin (PRF) membrane has been used to treat gingival recession in individuals or groups of individuals using a coronally progressed or lateral pedicle flap. In the treatment of mixed periodontic endodontic lesion/furcation defect, PRF functions as a healing and interpositional biomaterial, filling a cystic cavity. PRF is known to help the bone regeneration process. In the last few years, efforts have been made to enhance the PRFs characteristics and quality. One of them is titanium platelet rich fibrin (T-PRF). Third-generation platelet concentrate no longer contains silica, and its preparation in glass vacuum containers, that no longer creates any known concerns. The effectiveness PRF's has been evaluated in connective tissue and bone repair. The aim of this study is to compare T-PRF to other platelet concentrates and different treatment modalities for periodontal regenerative procedures. A protocol of this systematic review have been registered in prospero (CRD42022293545). The online database searched were PUBMED, COCHRANE for published articles up to November 2022 without language restrictions. Studies in trial registers, handsearching, bibliographic references of relevant articles were also checked. Data collection and analysis was done by individual authors. Independent eligibility assessments were conducted by four review authors. Then, using the standard Cochrane methodology, four review authors extracted the data and evaluated the risk of bias for individual studies. We developed "Summary of findings" tables and used GRADE to evaluate the evidence. Three studies were included for meta-analysis. Results of meta-analysis supported that T-PRF is effective for correction of both hard and soft tissue defects. The overall qualitative and quantitative analysis suggest that T-PRF has superior structural properties and thicker fibrin network for ensuring predictable success periodontal regenerative procedures.

Autologous Platelet-rich Fibrin as a Three-dimensional Structural Scaffold in the Healing of Contracted Orbital Sockets.

Evaluation of platelet-rich fibrin as an adjuvant in surface healing of contracted orbital sockets. Prospective, interventional, and comparative study of 25 patients with moderate to severe contracted sockets conducted over 2 years (February 2020-February 2022). Group 1 underwent a dermis-fat graft with fornix forming sutures supplemented by a platelet-rich fibrin membrane, while group 2 received a dermis-fat graft with fornix forming sutures only. Patients over 18 years were evaluated as per prefixed inclusion and exclusion criteria. Assessments were conducted at 1, 3, and 12 months postsurgery, focusing on wound evaluation, socket epithelialization, postoperative pain, prosthesis rehabilitation, and complications, if any. Wound evaluation and pain intensity were assessed utilizing the wound evaluation score and visual analog scale, respectively. Socket epithelization was documented clinically at every visit. The study showed a mean age of 38.8 ± 8.8 years, with a 2:1 male-to-female ratio. Group 1 consistently scored higher on wound evaluation score than group 2 at all follow-up points. In group 1, 81.8% achieved a maximum wound evaluation score at 4 weeks and 100% at 3 and 12 months, compared to group 2's 42.8%, 50%, and 57.1%, respectively (p < 0.05). Postoperative contracture occurred in 3 group 2 patients at the final follow-up, with 6 showing unsatisfactory appearance. Group 1 demonstrated significantly lower pain intensity on postoperative day 1 (p = 0.03), and greater epithelization at 4 weeks. platelet-rich fibrin appears to be an effective solution for enhancing wound healing during socket reconstruction, attributed to its sustained release of growth factors and mesenchymal stem cells.

Platelet Rich Fibrin Membrane as Nerve Guidance Conduit for Reconstruction Case with Nerve Repair Based Morphometric and Electrophysiologic Parameters: A Systematic Review and Meta-Analysis

Introduction: Motor or sensory nerve injury is a major surgical and clinical challenge, often with disappointing results and impairing sensory and motor function. Now there are some studies to looking for ways to accelerate nerve regeneration. Platelet-rich fibrin (PRF) is made from an autologous platelet concentrate that contains progenitor cells that are essential for the healing process, along with neurotrophic factors and several growth factors. Additionally, PRF can be manufactured in the membrane form that can be wrapped around nerves in the form of tubes which tubulation has many advantages such as guiding growth within the tubular shape to improve regenerative capacity. Methods: This systematic review and meta-analysis was conducted as per the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. A systematic, detailed search was carried out by the authors in the electronic databases, including PubMed, Cochrane, Research Gate, Elsevier, and PRS Journal. Studies were selected and compared based on outcome measures like Morphometric (Axon Area and Myelin Sheath Thickness) and Electrophysiologic (Amplitude and Nerve Conduction Velocity). Statistical analysis was performed using a random- effect model, pooled standard mean difference and I2 heterogeneity. Result: Four randomized studies with analyzed 4 parameters, those are Morphometric (Axon Area and Myelin Sheath Thickness) and Electrophysiologic (Amplitude and Nerve Conduction Velocity). Pooled analysis for the outcome like Myelin Sheath Thickness, Axon Area, and Amplitude showed a significant result in groups with PRF. Pooled analysis for outcome of Nerve Conduction Velocity showed no significant difference between the groups with PRF and without PRF (SMD: 0.01; 95% CI: -0.64. 0.65) with P = 0.99. Conclusion: This Meta-analysis shows that PRF membrane as nerve guidance conduit is promising method and can improve function outcome in nerve repair specially in Morphometric and Electrophysiologic parameters but outcome of Nerve Conduction Velocity showed no significant in this study.

Endoscopic transcanal underlay myringoplasty using a platelet-rich fibrin (PRF) membrane

BackgroundTympanic membrane perforations are among the most common indications for otological surgery. Surgeons from all around the world have made accidental and intentional contributions to find the perfect graft material and the best approach to perform tympanoplasty. Platelet-rich fibrin (PRF) use in myringoplasty has been popular in the last decade among many surgeons. We aimed to evaluate the efficacy of using PRF only as a graft material in myringoplasty.MethodsWe conducted a prospective study including 20 patients with dry central tympanic membrane perforations. The patients underwent endoscopic transcanal myringoplasty using a platelet-rich fibrin membrane by underlay technique. Follow-up was done 3 months postoperatively regarding graft uptake and hearing outcome by audiological assessment using pure tone audiometry.ResultsSixty percent of patients were surgically successful with complete healing of the tympanic membrane, 10% were partially successful with partial healing of the tympanic membrane, and 30% failed with complete loss of graft. The mean air-bone gap closure was 3.5 dB. No major complications were reported.ConclusionEndoscopic myringoplasty using platelet-rich fibrin alone can be performed in cases with tympanic membrane perforations as an alternative to using other autologous grafts. It is a new reliable method for myringoplasty, as well as being an easy, time-saving procedure that avoids the need for any skin incision.

Evaluation of platelet-rich fibrin versus collagen membrane for enhancing healing of secondary grafted alveolar cleft: a randomised controlled trial

The purpose of this study was to compare the efficiency of using autologous platelet-rich fibrin versus a resorbable collagen membrane in secondary alveolar bone grafting. Patients were randomly allocated to the three treatment groups: Group 1 - twelve children in whom the nasal layers of the alveolar clefts were repaired using autologous platelet-rich fibrin with autogenous chin bone; Group 2 - twelve children in whom the nasal layers of the alveolar clefts were repaired using bovine collagen membrane type I (Colla-D) with autogenous chin bone; and Group 3 - twelve children in whom the bony alveolar clefts were grafted with autogenous chin bone after construction of a watertight nasal floor had been completed. The study population comprised 36 patients with alveolar clefts, ranging in age from seven to 12 years. At the last follow-up period all groups had stable healing conditions and good radiological outcomes in terms of the alveolar bone height bordering the teeth (both mesially and distally) and the incorporation of grafting material with the surrounding bone. The use of either a PRF membrane and a collagen membrane as an interpositional layer between the nasal layer and the autogenous chin bone graft enhanced bone formation and density in alveolar clefts compared with the control group.

Advancement in Tympanic Membrane Repair: Exploring the Potential of Platelet Rich Fibrin.

To assess the effectiveness of the autologous plasma-rich fibrin plug technique for repairing small tympanic membrane perforations. Platelet rich fibrin (PRF) is also called second generation platelet rich plasma due to its high amount of growth factors which could be used in tympanic perforation closure. Being autologous, it is readily available with no immunogenic reactions. PRF membrane has a strong elastin fibrin structure containing growth factors and hence can be considered as an ideal sealing material or an adjuvant to the graft in repairing tympanic membrane perforations. Ours is a prospective study. A total of 52 patients with dry small tympanic membrane perforation were included in the study. In this technique, 10ml of blood is withdrawn from the patient, processed in a centrifuge machine, and platelet-rich fibrin (PRF) is separated from the mixture for use in the repair of small tympanic membrane defects. Out of the 52 patients, 42 experienced successful repair (full closure) of the tympanic membrane. The mean time of closure of the perforation was around 2weeks. However, five of them encountered failure. Although the size of the perforation decreased compared to the preoperative size. Additionally, two patients developed granulations on the tympanic membrane. No major side effects were noted. Autologous PRF is a product derived from whole blood through the process of centrifugation. It is safe and effective in promoting the natural process of wound healing by incorporating a high concentration of platelet-derived growth factors as well as fibrin into the graft mixture. This facilitates the rapid healing of tympanic membrane perforation.

Comparison of α-Smooth Muscle Actin (α-SMA) and Collagen Type III Expression after Conjunctival Excision Between Platelet-Rich Fibrin (PRF) Membrane and Conjunctival Autograft Treatment: An Animal Model Experimental Study on Oryctolagus cuniculus

Purpose: To evaluate the impact of Platelet-Rich Fibrin (PRF) membrane and conjunctival autografts on α-Smooth Muscle Actin (α-SMA) and type III collagen expression following conjunctival excision in Oryctolagus cuniculus. Study Design: Experimental study with a randomized post-test only design. Place and Duration of Study: Airlangga University, Surabaya in November 2022. Methods: Twenty rabbit eyes were categorized into two groups: those sutured with PRF membrane and those sutured with conjunctival autografts after temporal conjunctival excision. The study assessed α-SMA and type III collagen expression through the Immunoreactive Score (IRS) method.Data analysis is conducted using appropriate statistical methods, such as the t-test or Mann-Whitney U test, to compare the expression of α-SMA and collagen type III between the two groups. Results: The data for each sample represented the average IRS value observed at 200x magnification. In the conjunctival autograft group, the mean IRS of α-SMA expression was 5.52 ± 0.84,

Evaluation of collagen versus platelet rich fibrin membrane on the osteogenic potential of bone marrow aspirate concentrate for lateral Sinus floor augmentation: A Randomized Clinical Trial.

Evaluation of collagen versus platelet rich fibrin membrane on the osteogenic potential of bone marrow aspirate concentrate for lateral Sinus floor augmentation: A Randomized Clinical Trial.

Lateral Sinus Floor Elevation in Cases of an Intact and Perforated Schneiderian Membrane

The study comprised 20 lateral sinus floor elevation cases performed in 18 patients. During surgery, in four cases, a perforation of the Schneiderian membrane was detected. An attempt to suture the perforated membrane may increase the risk of enlarging the perforation. Therefore, we suggest a more conservative protocol be applied in all four cases where perforation occurred. The procedure consists of the 3-layer technique: an absorbable oxidized cellulose gauze moisturized with Dicynone was placed in this area. Under it, as a second layer, a PRF membrane is applied and then covered with a slow-resorbable collagen membrane. At that point, the surgery continues with the placement of the bone substitute material, and the sinus-lifting is finalized according to the selected protocol.&#x0D; The clinical studies demonstrate that the bone graft has a slower healing rate in areas with perforation, which is a proof of the osteogenic properties of the Schneiderian membrane. The cases described reveal that using this surgical protocol is risk-free and has a high success rate.

Treatment of Multiple RT1 Gingival Recessions Using a Coronally Advanced Flap Associated with L-PRF or Subgingival Connective Tissue Graft from Maxillary Tuberosity: A Randomized, Controlled Clinical Trial.

The goal of plastic periodontal surgery is to obtain complete root coverage, increasing gingival thickness (GT), a positive prognostic factor for gingival margin stability over time. The aim of this study was to compare the effectiveness of the Coronally Advanced Flap (CAF) in RT1 (GR; gingival recession with no loss of interproximal attachment) when associated with a connective tissue graft from the maxillary tuberosity (tCTG) or with leukocyte and platelet-rich fibrin (L-PRF) membranes in obtaining root coverage and increasing the thickness and width of the keratinized tissue, along with aesthetic improvement, taking into account a number of patient-related outcomes. Thirty patients with two adjacent RT1 GRs (GRs with no loss of interproximal attachment) were each treated using CAF associated with tCTG (15 patients) or L-PRF. The main outcome was a GT increase; secondary outcomes were keratinized tissue width (KT), gingival recession (GR), probing depth (PD), clinical attachment level (CAL), root coverage percentage (RC%), complete root coverage (CRC), and root coverage esthetic score (RES). Patient-reported outcomes were discomfort (D), dentine hypersensitivity (DH), patient-related esthetic score (PRES), and overall treatment satisfaction (OTS). After 12 months, clinical and patient-reported parameters did not show significant differences between groups, with the only exception being a GT gain, which was significantly greater in the CAF + tCTG group. Our results showed that both techniques were effective in treating RT1 GRs, with comparable patient-related outcomes. However, the use of tCTG produces significantly thicker tissue, covering the exposed root surface.

Delayed centrifugation weakens the in vitro biological properties of platelet-rich fibrin membranes.

To investigate how delayed blood centrifugation affects the composition of the resultant platelet rich fibrin membrane (PRF, a concentrated growth factor preparation) and its biological effects towards gingival fibroblasts. Blood samples were collected from 18 healthy individuals and centrifuged immediately (T-0), or after a 1-6-minute delay (T-1-6, respectively), to generate PRF. Each PRF membrane was weighed. T-0 and T-6 membranes were incubated for 48h in cell culture medium at 37°C to create PRF "releasates" (soluble factors released from the PRF). Human gingival fibroblasts were incubated for 48h with or without the releasates, followed by RNA isolation and real-time polymerase chain reaction to measure expression of select genes associated with granulation tissue formation, angiogenesis and wound contraction. Additional T-0 and T-6 membranes were used for visualization of leucocyte nuclei and platelets by immunostaining. Immediate centrifugation (T-0) resulted in the largest membranes, T-6 membranes being on average 29% smaller. Leucocytes and platelets were significantly more abundant in T-0 than in T-6 samples. Majority of the fibroblast genes studied were consistently either upregulated or downregulated by the T-0 PRF releasates. However, centrifugation after a 6-minute delay significantly weakened the fibroblast responses. Delayed centrifugation resulted in smaller PRF membranes with fewer leucocytes and platelets and also significantly reduced on the expression of a set of healing-related gingival fibroblast genes. The higher expression of wound healing-related genes in gingival fibroblasts by the immediately-centrifuged PRF membranes may increase their biological properties in clinical use.

Root Coverage Using the Tunnel Technique Associated with Conjunctive Tissue Graft or Leukocyte- and Platelet Rich Fibrin Membranes: A Randomized Clinical Trial

Root Coverage Using the Tunnel Technique Associated with Conjunctive Tissue Graft or Leukocyte- and Platelet Rich Fibrin Membranes: A Randomized Clinical Trial

Management of type III Dens Invaginatus with a periapical lesion in a maxillary lateral incisor: A case report

Dens Invaginatus (DI) is a developmental abnormality, usually affecting the maxillary incisor teeth, particularly lateral incisors. These cases usually present technical difficulties concerning their management owing to their aberrant canal morphology. Conventional root canal therapy, periapical surgery, and extraction have been reported as treatment modalities for such anomalies. The following case report depicts surgical endodontic management of an Oehler’s Type III DI involving a maxillary lateral incisor associated with periapical lesion aided by cone beam computed tomography (CBCT) and with the use of mineral trioxide aggregate (MTA), hydroxyapatite bone graft and platelet-rich fibrin (PRF) membrane. At 12 months post-treatment, the patient did not report any eventful episodes, and the size of the periapical lesion was markedly reduced.

Autotransplantation of an impacted migrated mandibular canine using platelet-rich fibrin and physio-dispenser system: a report of two cases

Canine impaction and migration is conventionally managed by fixed orthodontic treatment with surgical exposure; however this is not always possible, thus requiring clinicians to explore other treatment options. Autotransplantation of the tooth has been recognized as an alternative treatment option. This article reports on two cases where a migrated canine was asymptomatic, and accidentally diagnosed during routine examination. The procedure undertaken was autotransplantation of the canine using a physio-dispenser system and a platelet-rich fibrin (PRF) membrane to promote bone and soft tissue healing and regeneration. After a 2-year follow up, the autotransplanted canines showed no signs or symptoms of clinical or radiological failure. On radiographic examination, a patent periodontal ligament space was also appreciated. CPD/Clinical Relevance: Use of a physio-dispenser system and PRF during autotransplantation of a migrated and impacted canine may improve the clinical outcome.

Antimicrobial effects of clindamycin-loaded platelet-rich fibrin (PRF)

ObjectivesRecent research has demonstrated that platelet-rich fibrin (PRF) is an appropriate carrier for ampicillin/sulbactam. The aim of the study was to investigate whether PRF is also a suitable bio-carrier for clindamycin (CLI).MethodsPRF membranes were produced from 36 patients receiving intravenous therapy with CLI (e.g. due to the diagnosis of an osteonecrosis of the jaw or infections). Concentrations of CLI in PRF membranes were measured with liquid chromatography-tandem mass spectrometry, and the antimicrobial effects were investigated in vitro in agar diffusion tests with fresh PRF and PRF stored for 24 h. Storage was performed in an incubator at 36 °C to simulate the in-vivo situation.ResultsThe mean concentration of CLI in plasma was 1.0 ± 0.3 μg/100 mg plasma; in resulting PRF membranes 0.7 ± 0.4 μg/100 mg PRF. Agar diffusion tests were performed with Staphylococcus aureus, Streptococcus pneumoniae, Streptococcus mitis, Porphyromonas gingivalis, and Fusobacterium nucleatum. Mean inhibition zones, in mm, for fresh PRF were 17.3, 12.2, 18.8, 17.1, 25.8 and 18.1, 12.7, 19.2, 17.3, and 26.3 for stored PRF, respectively.ConclusionThe results demonstrate that PRF is a suitable bio-carrier for CLI when administered systemically to patients. The concentration in PRF generated from patients after infusion of 600 mg CLI dose suffices to target clinically relevant bacteria.Clinical relevanceUsing PRF as a carrier for local antibiotic application can prevent infections in oral and maxillofacial surgery. Within the study limitations, the findings could expand the scope of PRF application by adding CLI as a new antibiotic to the spectrum of PRF therapy.

Clinical Evaluation of Coronally Advanced Flap with or without a Platelet-Rich Fibrin Membrane for the Root Coverage

ABSTRACT Aim: To evaluate “coronally advanced flap” with or without “a platelet-rich fibrin membrane for the root coverage.” Materials and Methods: All the clinical parameters were assessed at different time intervals (at baseline, 1, 3, and 6 months) in both experimental and control group. Following “clinical parameters” were recorded using “UNC-15” “Probe-Plaque Index (PI)” (Silness and Loe, 1964), “Gingival Index” (GI) (Loe and Silness, 1963), “Recession depth (RD),” “Recession width (RW),” “Clinical attachment level (CAL),” and “Width of keratinized gingiva (WKG)”. Results: At final evaluation (i.e., mean change from baseline to 6 months), “the decrease in Plaque Index was 2.5% higher in Group B (66.0%) as compared to Group A (63.5%). The decrease in Gingival Index was 6.1% higher in Group B (91.4%) as compared to Group A (85.3%), and the decrease in recession width was 4.0% higher in Group B (75.2%) as compared to Group A (71.2%). The decrease in clinical attachment level was 4.4% higher in Group B (53.2%) as compared to Group A (48.4%). The increase in width of keratinized gingiva was 1.9% higher in Group A (28.8%) as compared to Group B (26.9%).” Conclusion: The controlled, randomized, split mouth design showed that CAF surgery, either by alone or in combination with PRF, is an efficient treatment method for covering denuded roots. “This design was used to treat bilateral isolated Miller’s class I and II recessions in gingival part. When compared to the CAF approach, the results from a combination of CAF and PRF after a 6-month period showed additional advantages in addition to mean root coverage in the treatment of Miller’s classes I and II recessions in gingival part.”

Fibrin Network and Platelets Densities in Platelet-Rich Fibrin (PRF) Membranes Produced from Plastic Tubes Without Additives: A New Approach to PRF Clinical Use.

The present study aimed to investigate plastic tubes without additives as alternatives to glass and silica-coated plastic tubes, in the production of PRF membranes. Nine blood samples were collected from eight volunteers (n = 8) separated into three groups, according to tube material: glass, silica-coated plastic, and plastic without additives. In each group, the samples were centrifuged using different relative centrifugation forces: L-PRF (700g/12min), A-PRF (200g/14min), and A-PRF + (200g/8min). The generated membranes were evaluated by histomorphometry, considering the fibrin network, platelet aggregates, and cellular morphology, by light microscopy. The ultrastructural cellular morphology integrity was evaluated by transmission electron microscopy. The L-PRF (p < 0.019) and A-PRF (p < 0.001) membranes showed a significantly lower fibrin network density in plastic tubes without additives compared to glass and silica-coated plastic tubes. Plastic tubes without additives revealed a significantly higher platelet percentage, regardless of the protocol (p < 0.005). In all groups, TEM analysis showed preserved normal morphological ultrastructure, maintaining the integrity of cellular components. Plastic tubes without additives offer a viable alternative for producing PRF membranes. They exhibited a higher platelet density and demonstrated fibrin network and cellular morphology similar to those of glass and silica-coated plastic tubes, irrespective of the centrifugation protocol.

Surgical Treatment of Multiple Bone Cysts Using a Platelet-Rich Fibrin and BoneAlbumin Composite Graft: A Case Report

Promising research results have been obtained on the tissue-regeneration properties of PRF (platelet-rich fibrin) in dentistry and maxillofacial surgery. PRF presumably promotes healing and accelerates ossification. In this case report, the patient had a history of Gorlin–Goltz syndrome, also called nevoid basal cell carcinoma syndrome, an autosomal dominant neurocutaneous disease that was known for many years. As a consequence, cysts were detected in both the mandible and maxilla. We performed decompression on this 37-year-old patient, followed by a cystectomy on an extensive lesion in the right angle of the mandible. One cyst from each side of the body mandible and one from the maxilla were completely enucleated, as determined using an intraoral exploration. The resulting bone defect was filled with a composite graft composed of a mixture of A-PRF and a serum albumin-coated bone allograft (BoneAlbumin). The wound was then covered with a PRF membrane. The surgical sites were closed per primam. The postoperative period was uneventful. Biopsies were performed after three and six months of healing for histological micromorphometry analyses. Dental implants were placed at the sampling site. Three months after the implantation, the ossified implants were fitted with superstructures. To date, no complications have appeared with the bone augmentation. The authors interpret from the findings that the combination of A-PRF and BoneAlbumin can be validated as a prosperous bone substitute. It can be safely implanted after a 3-month ossification period.

Evaluation of the Use of Highly Concentrated Autologous Platelet-Rich Plasma and Platelet-Rich Fibrin Membrane to Improve the Outcome in the Management of Severe Dry Eye Disease, Corneal Neurotrophic Ulcer and Corneal Burn.

The aim of this study was to evaluate the use of highly concentrated platelet-rich plasma (PRP) subconjunctival injections, in combination with eye drops (eye PRP, or E-PRP), in treating dry eye disease (DED) and the use of platelet-rich fibrin (PRF) membrane in treating corneal burns and neurotrophiculcers for the restoration of the homeostasis of the tear film and the morphology and function of the cornea. We studied 16 patients (n=32 eyes) with severe DED. The disease was graded as severe according to the Oxford Grading Scale.There were 12 males (75%) and four females (25%) with a mean age of 56 years; these patients were treated with monotherapy, which involved a single subconjunctival injection of 0.2-0.3 mL of PRP prepared from autologous blood, followed by application of autologous PRP eye drops four times a day for 15 days between September 2019 and December 2020 in the same geographic area. All patients gave written informed consent before undergoing the outlined treatment protocol. We evaluated best corrected visual acuity (BCVA), Schirmer test score, tear film breakup time (TBUT) and corneal staining with fluorescein (Oxford Grading Scale) before and after six to eight weeks of treatment. Subjective normalization was defined by a decrease in the Ocular Surface Disease Index (OSDI) score to 10 or less, an objective normalization of the TBUT to five to six seconds, improvement in the Schirmer test score and Oxford grading and the BCVA gain of at least one line in the vision chart (Snellen chart). Furthermore, we report on the results from different variants of platelet concentrate-based treatments in five cases of corneal diseases: neurotrophic ulcers and corneal burns due to different causes (e.g., chemical burns) using E-PRP and PRF membrane with regard to normalization of morphology and function. The OSDI score decreased to normalization in 75% of the patients (p=6.545× 10-15). TBUT was restored significantly in 20 of 32 eyes from 2.78±0.55 to 5.43±0.71 (p=1.612× 10-24). The Schirmer test score showed an improvement from 4.46±0.67 to 10.28±1.18 (p=3.411 ×10-29), and BCVA improved by 43.75%, from 0.15±0.19 to 0.09±0.16 (logMAR, p=0.2331). Oxford grading changed to Scale I in 75% and Scale 0 in 25% of the patients. No complications or adverse reactions occurred in the five cases of corneal injuries. We observed a restoration of the morphology and function of the cornea with PRP injections or PRF+PRP application in 7-12 days, depending on the severity of the initial finding. PRP treatment is a new approach in ophthalmology with impressive results. Although patients show good compliance and acceptance of the treatment protocol, studies with larger sample sizes are needed to confirm and optimize its use.