Platelet-rich Fibrin Membrane Research Articles

Platelet rich fibrin is not a barrier membrane! Or is it?

Platelet-rich fibrin (PRF) is widely used in dentistry and other fields of medicine, and its use has become popular in dental implantology. In several published studies, PRF has been used as a barrier membrane. A barrier membrane is a sheet of a certain material that acts as a biological and mechanical barrier against the invasion of cells that are not involved in bone formation, such as epithelial cells. Among the basic requirements of a 'barrier membrane, occlusivity, stiffness, and space maintenance are the criteria that PRF primarily lacks; therefore, it does not fall under the category of barrier membranes. However, there is evidence that PRF membranes are useful in significantly improving wound healing. Does the PRF membrane act as a barrier? Should we think of adding or subtracting some points from the ideal requirements of a barrier membrane, or should we coin a new term or concept for PRF that will incorporate some features of a barrier membrane and be a combination of tissue engineering and biotechnology? This review is aimed at answering the basic question of whether the PRF membrane should be considered a barrier membrane or whether it is something more beyond the boundaries of a barrier membrane.

Comparative evaluation of modified triangular coronally advanced Flap alone or in combination with platelet rich fibrin or type I collagen membrane for treatment of Miller’s Class I and Class II gingival recession

The study aimed to clinically evaluate the outcome of modified triangular coronally advanced flap (mtCAF) alone or in combination with platelet rich fibrin or type I collagen membrane in Miller’s Class I and Class II gingival recession. 45 sites with Millers Class I or II gingival recession were recruited and allocated into 3 groups with 15 sites each. Group 1: mtCAF alone, Group II: mtCAF with PRF and Group III: mtCAF with bioresorbable collagen membrane (Bio-Gide®). Standardized Clinical Parameters such asPlaque Index (PI), Gingival Index (GI), Pocket Probing Depth (PPD), Clinical attachment level (CAL), Gingival Recession Depth (GRD) and Keratinized Tissue Height (KTH) were measured at baseline and 6 months. All the three groups showed improvement in clinical parameters but it was not statistically significant. However, a significant increase in keratinized tissue height was seen in Group III as compared to Group I and Group II. Modified triangular coronally advanced flap (mtCAF) alone or in combination with PRF and collagen membrane showed good clinical outcomes but better results were obtained in terms of keratinized tissue when collagen membrane was used.

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

Background: 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, 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. Methods: 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. Results: 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. Conclusions: The overall qualitative and quantitative analysis suggest that T-PRF has superior structural properties and thicker fibrin network for periodontal regenerative procedures.

Comparative analysis of coronally advanced flap using platelet-rich fibrin membrane and amniotic membrane in gingival recession

Comparative analysis of coronally advanced flap using platelet-rich fibrin membrane and amniotic membrane in gingival recession

COMPARATIVE EVALUATION OF MODIFIED TRIANGULAR CORONALLY ADVANCED FLAP IN COMBINATION WITH PLATELET RICH FIBRIN OR TYPE I COLLAGEN MEMBRANE FOR TREATMENT OF MILLERS CLASS I AND CLASS II GINGIVAL RECESSION

Background: The study aimed to clinically evaluate the outcome of modified triangular coronally advanced flap (mtCAF) alone or in combination with platelet rich fibrin or type I collagen membrane in the treatment of Millers Class I and Class II gingival recession. Methods: 45 sites with Millers Class I or II gingival recession were recruited and allocated into 3 groups with 15 sites each. Group 1: mtCAF alone, Group II: mtCAF with PRF and Group III: mtCAF with bioresorbable collagen membrane (Bio-Gide®). Standardized Clinical Parameters such as Plaque Index (PI), Gingival Index (GI), Pocket Probing Depth (PPD), Clinical attachment level (CAL), Gingival Recession Depth (GRD) and Keratinized Tissue Height (KTH) were measured at baseline and 6 months. Result: All the three groups showed improvement in clinical parameters but it was not statistically significant. However, a significant increase in keratinized tissue height was seen in Group III as compared to Group I and Group II. Conclusion Modified triangular coronally advanced flap (mtCAF) alone or in combination with PRF and collagen membrane showed good clinical outcomes but better results were obtained in terms of keratinized tissue when collagen membrane was used.

Using Platelet-Rich Fibrin in Combination With Allograft Bone Particles Can Induce Bone Formation in Maxillary Sinus Augmentation

Sinus pneumatization secondary to posterior maxillary tooth extraction can hinder proper implant installation. Maxillary sinus floor augmentation is a surgical procedure that has been proposed to overcome this issue. The aim of this study was to evaluate and compare the histomorphometric outcomes of sinus floor elevation using allograft bone particles with or without platelet-rich fibrin (PRF). This randomized clinical trial included patients scheduled for maxillary sinus floor elevation in the Implant Department of Mashhad Dental School. Healthy adults with an edentulous maxilla and residual alveolar bone height of 3mm or less were eligible to participate and were randomly allocated to intervention (A) or control (B) groups. Bone biopsies were obtained 6months postoperatively. The predictor variable was using a PRF membrane for maxillary sinus augmentation. In group A, sinus floor elevation was performed using PRF combined with bone allografts, while in group B only allograft particles were used. The primary outcome variables were the recorded postoperative histologic parameters, as in the area of newly formed bone, new bone marrow, and residual graft particles (μm2). The secondary outcome variables were the radiographically measured postoperative bone height and width at the graft site. Age and sex. Independent sample t-test was employed to compare the postoperative histomorphometric parameters between groups A and B. P value ≤ .05 was considered statistically significant. A total of 20 patients (10 per group) completed the study. The mean rate of new bone formation was 43.25±5.22% in group A and 38.25±7.01% in group B. This difference was statistically insignificant (P=.087). The mean amount of newly formed bone marrow was significantly more in group A compared to group B (6.81±2.19% vs 10.23±4.49%; P=.044). The average amount of remaining particles was also significantly less in group A patients (9.35±3.43% vs 13.18±3.67%; P=.027). Incorporating PRF as an adjunctive grafting material results in fewer residual particles of allograft and in more bone marrow formation and may serve as a treatment option for developing the atrophic posterior maxilla.

Comparative evaluation of the effectiveness of titanium platelet rich fibrin (T-PRF) membrane and collagen membrane combined with xenograft in the treatment of mandibular class II furcation defects –A Randomized Controlled Trial

Comparative evaluation of the effectiveness of titanium platelet rich fibrin (T-PRF) membrane and collagen membrane combined with xenograft in the treatment of mandibular class II furcation defects –A Randomized Controlled Trial

Comparative evaluation of the effectiveness of titanium platelet rich fibrin (T-PRF) membrane and collagen membrane combined with xenograft in the treatment of mandibular class II furcation defects –A Randomized Controlled Trial

Comparative evaluation of the effectiveness of titanium platelet rich fibrin (T-PRF) membrane and collagen membrane combined with xenograft in the treatment of mandibular class II furcation defects –A Randomized Controlled Trial

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

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

Patient-reported outcome measures (PROMs) of leucocyte and platelet-rich fibrin (L-PRF) or hemostatic agent application at palatal donor sites after free gingival graft harvesting: a randomized controlled clinical trial.

The aim of this study was to evaluate the patient's morbidity and post-surgical complications after treatment of palatal donor sites after free gingival graft (FGG) harvesting using Leucocyte-and Platelet Rich Fibrin (L-PRF) membranes or a hemostatic agent with oxidized and regenerated cellulose. Forty-two palatal donar sites after FGG haversting in 42 patients were randomly assigned to experimental (L-PRF membrane) or control procedure (hemostatic agent). The primary outcome was postoperative pain related to the wound located at palatal area, while the secondary outcomes were post-operative discomfort, inability to chew, post-operative stress, surgical chair time, thickness of palatal fibromucosa and thickness of FGG. The PROMs were recorded after one week. After one week, a statistically significant difference was found between groups in terms of post operative stress (p=0.0083). No statistically significant differences in terms of postoperative pain (p=0.326), patient discomfort (p=0.509), inability to chew (p=0.936), surgical chair time (p=0.932) were recorded between test and control group. No statistically significant differences were recorded in terms of thickness of palatal fibromucosa (p=0.647) and thickness of FGG (P=0.756) between groups. Post-surgical wound healing complications (i.e., necrosis or infections) were not observed in both groups. Within their limitations, the present outcomes indicated that the application of L-PRF membrane at palatal donor sites after FGG harvesting did not produce significant advantages for the patients.

Can platelet-rich fibrin act as a natural carrier for antibiotics delivery? A proof-of-concept study for oral surgical procedures

ObjectivesEvaluate the role of platelet-rich fibrin (PRF) as a natural carrier for antibiotics delivery through the analysis of drug release and antimicrobial activity.Materials and methodsPRF was prepared according to the L-PRF (leukocyte- and platelet-rich fibrin) protocol. One tube was used as control (without drug), while an increasing amount of gentamicin (0.25 mg, G1; 0.5 mg, G2; 0.75 mg, G3; 1 mg, G4), linezolid (0.5 mg, L1; 1 mg, L2; 1.5 mg, L3; 2 mg, L4), vancomycin (1.25 mg, V1; 2.5 mg, V2; 3.75 mg, V3; 5 mg, V4) was added to the other tubes. At different times the supernatant was collected and analyzed. Strains of E. coli, P. aeruginosa, S. mitis, H. influenzae, S. pneumoniae, S. aureus were used to assess the antimicrobial effect of PRF membranes prepared with the same antibiotics and compared to control PRF.ResultsVancomycin interfered with PRF formation. Gentamicin and linezolid did not change the physical properties of PRF and were released from membranes in the time intervals examined. The inhibition area analysis showed that control PRF had slight antibacterial activity against all tested microorganisms. Gentamicin-PRF had a massive antibacterial activity against all tested microorganisms. Results were similar for linezolid-PRF, except for its antibacterial activity against E. coli and P. aeruginosa that was comparable to control PRF.ConclusionsPRF loaded with antibiotics allowed the release of antimicrobial drugs in an effective concentration. Using PRF loaded with antibiotics after oral surgery may reduce the risk of post-operative infection, replace or enhance systemic antibiotic therapy while preserving the healing properties of PRF. Further studies are needed to prove that PRF loaded with antibiotics represents a topical antibiotic delivery tool for oral surgical procedures.

Comparative histological evaluation of two PRF formulations (PRF High and PRF Medium) on quality of life and healing outcome of apicomarginal defects: A randomized clinical trial

The objective of this randomized clinical trial was to investigate the effects of two PRF formulations (PRF High and PRF Medium) on quality of life and healing outcome (2D and 3D) of apicomarginal defects.Patients presenting with endodontic lesions and concomitant periodontal communication were randomly allocated to PRF High and PRF Medium groups. The treatment protocol in each group included a periapical surgical procedure with placement of PRF clot and membrane in the bony defect and on the denuded root surface, respectively. Quality of life was assessed for 1 week after surgery following a modified version of the patient's perception questionnaire. Postoperative pain was assessed using a visual analog scale. Clinical and radiographic evaluations were performed using Rud and Molven 2D criteria and Modified PENN 3D criteria. Buccal bone formation was assessed using sagittal and corresponding axial sections in CBCT. Histological analysis was performed using hematoxylin and eosin (H and E) staining and attaching primary antibodies to tissue sections.In total, 40 patients were enrolled in the trial (N = 20 per group). PRF Medium group patients reported significantly less swelling on the 1st (p = 0.036), 2nd (p = 0.034), and 3rd (p = 0.023) days, and average pain on the 2nd (p = 0.031), 3rd (p = 0.03), and 4th (p = 0.04) days postoperatively. The difference in success rate for periapical healing was non-significant between the PRF Medium group (89.5%) and PRF High group (90%), in both 2D and 3D imaging (p = 0.957). The formation of buccal bone was observed in five cases (26.3%) and four cases (20%) in the PRF Medium and PRF High groups, respectively, with a non-significant difference (p = 0.575). PRF Medium clots had a loose fibrin structure with a significantly higher number of neutrophils (473.79 ± 82.89 per mm2) than PRF High clots, which had a dense structure and fewer neutrophils (253.15 ± 63.86 per mm2) (p = 0.001). Autologous platelet concentrates (APCs) promoted satisfactory periapical healing, with no significant difference between the groups.Within the limitations of the study, it seems that PRF Medium should be preferred over PRF High when the patients’ quality of life is the priority.

Histological, Immunohistochemical, Biomechanical, and Wettability Evaluations of the Leukocyte- and Platelet-Rich Fibrin Membranes Derived from Canine Blood.

This study aimed to perform histological, immunohistochemical, biomechanical, and wettability assessments of leukocyte- and platelet-rich fibrin (L-PRF) membranes obtained from the blood of healthy dogs. Ten client-owned Labrador Retriever dogs were enrolled. Blood samples were obtained from the external jugular vein using a vacuum tube without anticoagulant, which was immediately centrifuged at 400g for 12 min in a dedicated centrifuge. The L-PRF clot was removed from the tube, and the red clot was released from the buffy coat using a spatula. The membrane was produced using a PRF box. Histological examination identified the three portions of the L-PRF membranes. The first portion was composed mainly of red blood cells with the presence of a low number of leukocytes among them. The second portion was composed of white blood cells, mainly neutrophils. The third portion was composed of the fibrin network which was characterized by acidophilic staining. The immunohistochemical analysis showed that vascular endothelial growth factor and platelet-derived growth factor were expressed in all samples at different intensities, both in cellular components and fibrin mesh. The tensile test and wettability assessments were measured in membranes 30 min and 3 h after production. The 30 min L-PRF membranes supported twice the ultimate tensile strength compared to 3 h L-PRF membranes. The wettability of the 30 min sample membranes was statistically higher than the 3 h sample membranes. In conclusion, the centrifugation protocol allowed production of the L-PRF membrane using canine blood and this was confirmed by histological and immunohistochemical analysis. The mechanical resistance and wettability of the L-PRF membrane were significantly reduced over time.

Evaluation of soft tissue and crestal bone changes around non-submerged implants with and without a platelet-rich fibrin membrane: A randomized controlled clinical trial.

Platelet-rich fibrin (PRF) membranes are known to enhance wound healing after periodontal surgeries and dental implant procedures. The aim of the present study was to examine the effect of PRF on soft tissue healing and the crestal bone level (CBL) around non-submerged dental implants. A total of 40 patients, aged 20-60 years, with partially edentulous posterior mandibular sites were divided into 2 groups of 20 patients each: group I received non-submerged implants with a PRF membrane; and group II was treated with non-submerged implants alone. The examined parameters included the modified plaque index (mPI), the gingival index (GI), the width of keratinized tissue (WKT), the thickness of keratinized tissue (TKT), and CBL, assessed using digital intraoral periapical radiography (IOPA). All parameters were measured at baseline (immediately post-op), and at 3-month and 6-month follow-ups. In comparison with baseline, statistically significant increases in WKT and TKT were observed in both groups at 3 and 6 months post-op (p < 0.05). Also, significant gains were noted in group I vs. group II (p < 0.05). The CBL increased significantly in both groups at 3 and 6 months post-op (p < 0.05), with no remarkable differences from 3 to 6 months. A decreased CBL was observed in group I vs. group II at the 3- and 6-month intervals (p < 0.05). The PRF membrane enhances peri-implant tissue wound healing, with gains in soft tissue width and thickness around non-submerged implants.

Evaluation of local delivered platelet-rich fibrin versus Melatonin gel on the osseointegration of dental implant

Background and aim Dental implant is a dental treatment that allow oral rehabilitation for partial and fully edentulous patients. Osseointegration is the factor that control success or failure of dental implant that can be improved by addition of different adjunctive biological materials. Platelet-rich fibrin (PRF) membrane plays a significant role in tissue regeneration and wound healing. Melatonin (MNL) is biological hormone that secreted from pineal gland and played an important role in human growth. Patients and methods The present controlled clinical trial was carried out to evaluate one-stage dental implant with local application of MNL gel versus PRF membrane as a biomimetic material clinically and radiographically. 30 female patients with missing mandibular premolars- molar were randomized to receive 30 dental implants. Group A (10 patient) control group with dental implant only, group B (10 patient) test group with application of PRF membrane and group C (10 patient) test group with application of MNL gel. Patients were followed up at baseline (before implant placement to record both gingival thickness and bone density and immediately after implant placement to record marginal bone loss), 2 weeks, and 6 months. Results At 6 months follow up, there were significant improvement in gingival thickness and bone density in PRF membrane and MNL gel groups, while the preservation of marginal bone level loss was significant in MNL gel group than other two groups. Conclusions The current results shown that PRF membrane and MNL gel can be used to improve both hard and soft tissue around implant with increased efficiency of MNL regarding marginal bone loss.

Effectiveness of Titanium Prepared Platelet Rich Fibrin Membrane vs Platelet Rich Fibrin Membrane in the Treatment of Multiple Gingival Recession Defects using M-VISTA Technique: Protocol for a Randomised Clinical Trial

Introduction: The focus of root coverage procedures is now shifting to minimally invasive surgical approaches. Periodontists are being required to adopt newer and more unique procedures to thoroughly cover the exposed roots. Due to the sensitivity of various techniques and the fact that it involves a wide variety of operations and their variants, periodontal plastic surgery provide a substantial challenge. A variety of minimally invasive techniques and platelet concentrates which are abundant in growth factors have been assimilated that provide the added benefit of better and rapid healing. Aim: This study aims to evaluate the effectiveness of TitaniumPrepared Platelet Rich Fibrin (T-PRF) and Platelet Rich Fibrin (PRF) membrane in Miller’s Class-I and Class-II multiple Gingival Recession (GR) using Modified-Vestibular Incision SupraPeriosteal Tunnel Access (M-VISTA) technique. Materials and Methods: The planned protocol would be randomised clinical trial and will be performed over a period of two years. Twenty-two patients will be selected according to the inclusion criteria, each having multiple GR (&gt;2 mm, Class I or II recession) on buccal/labial aspects of teeth in maxilla or mandible, and would be randomly distributed into the two groups (control and test). The M-VISTA technique would be carried out for root coverage using T-PRF (test group) and PRF (control), respectively as regenerative materials and their effectiveness will be compared by measuring the Pocket Probing Depth (PPD), Clinical Attachment Level (CAL), Relative Gingival Marginal Level (RGML), Recession Depth (RD) and Width of Keratinised Gingiva (WKG). Student’s paired and unpaired t-tests will be used to evaluate data from the baseline to 3 and 6 months for each group. Expected Results: The authors expect better results of root coverage using the M-VISTA technique in combination with T-PRF (test group). Better results in terms of PPD, CAL, RGML, RD, and increase in thickness of attached gingiva are expected. Conclusion: Combined effect of using T-PRF in the M-VISTA procedure is expected to improve the periodontal parameters including, the soft tissue outcomes and the plaque and bleeding index.

Effect of two different antifibrinolytic agents on platelet-rich fibrin

Background: Platelet-rich fibrin (PRF) is a potent autologous regenerative material used in periodontal regeneration. PRF collapses easily into the periodontal defect due to its faster resorption rate and lesser rigidity. The degradation time of PRF has a direct impact on the clinical outcome. Aim: This study aimed to compare and analyze the effect of two different antifibrinolytic agents on the degradability of PRF membranes. Materials and Methods: Twenty-one PRF membranes were randomly divided into three groups: Group 1 – Conventional PRF obtained by adding normal saline (Control), Group 2 – PRF obtained by adding 200 mg tranexamic acid (TXA), and Group 3 – PRF obtained by adding 250 mg epsilon aminocaproic acid (EACA). After storing at room temperature in normal saline, PRF membranes were retrieved at 1st, 2nd, and 3rd weeks and the percentage of remaining weight was calculated. ANOVA is used for the statistical comparison of the data between groups. Results: In comparison to the baseline, the mean PRF weight was decreased in all groups in the 1st, 2nd, and 3rd weeks. In the 1st, 2nd, and 3rd weeks, the mean percentage of the remaining weight of PRF membrane in Group 1, Group 2, and Group 3 were 69.53 ± 12.96, 36.23 ± 9.28, and 17.43 ± 4.75 respectively. The statistical significance with the percentage of the remaining weight of the PRF was obtained in 3rd week with a P = 0.029. Conclusion: TXA efficiently delayed the degradability of the PRF membrane compared to EACA under experimental conditions.

Comparative evaluation of healing after surgical excision of oral mucosal lesions using PRF and collagen membrane

Objectives The purpose of the comparative study was to evaluate the clinical parameters affecting healing after surgical excision of superficial, potentially malignant oral lesions using Platelet Rich Fibrin (PRF) and Collagen Membrane. Material and methods: A total of 100 patients requiring treatment for oral mucosal lesions (OML) were enrolled through a randomized selection of two different groups, where Group 1 (50 patients) received PRF while Group 2 (50 patients) received Collagen membrane following excisional biopsy. Parameters checked were Pain, Clinical Healing, Granulation Tissue, Epithelialization, Wound Contracture, and Complications postoperatively at 3rd, 7th and 30th day. Results: Group 1 showed better results with post-operative pain, clinical healing and granulation presence when compared to Group 2. Conclusion: PRF can be ascertained as a better dressing material than Collagen Membrane with better healing potential.

ENDODONTIC SURGICAL TREATMENT: LATERAL WINDOW APPROACH AND USE PRF. CASE REPORT

Abstract Endodontic treatment needs a complete root canal disinfection and perfect sealing for a good conservative prognostic. Those treatments are performed also to build new crown when tooth is destroyed. This prosthetic construction is mandatory to insure the good mechanical prognosis, and to restore a complete function. But sometimes, those treatments fail. Due to the lack of disinfection for example, a new endodontic cleaning should be done. We need to retreat, and when the root access is not possible by an orthograde way (large intracanal post, perfect coronal restauration to preserve for example) a surgical approach is necessary. One key point of those treatments is also the retro preparation and retro filling of the apical part of the roots. Removing the inflammatory lesion is not sufficient, the origins of the abscess are all the intra canal bacteria, they could not be reached by the immune system of the host (immune cells are into the blood, and no more blood circulation could occur in an endodontically treated tooth. Same for all antibiotics). This case shows a new and original way to access the apical lesion, and how a blood concentration and Platelet Rich Fibrin membrane could be used to seal the bone window. The benefits of such technic are numerous, less pain, bone preservation, rapid healing, controlled bleeding of the area and improve the success rate.

Comparative analysis of platelet-rich fibrin membrane and 0.2% hyaluronic acid gel on healing following gingival depigmentation procedure.

Platelet-rich fibrin (PRF) accelerates wound healing by promoting faster cicatricial tissue remodeling and excellent neovascularization. Hyaluronic acid (HA) being biocompatible, anti-inflammatory, and proangiogenic leads to improvement in the rate of wound healing. The aim of this study was to compare the effect of PRF membrane and 0.2% HA gel on wounds after gingival depigmentation surgery. This study was carried out on 30 systemically healthy individuals recruited from the pool of patients who visited the department of periodontology. After depigmentation procedure in every patient, the sites were divided into three even groups. Group A received PRF membrane and periodontal dressing, Group B received 0.2% HA gel application and periodontal dressing, and Group C served as a control group in which only periodontal dressing was placed. The individuals were evaluated for the healing index (HI) and Numerical Rating Scale (NRS) on the 3rd and 5th day. Epithelialization test (ET) was performed on the 5th day. Gingival biotype was reassessed and compared to preoperative value after 3 months. The clinical trial was expressed in terms of mean and standard deviation. Intra-group comparison and inter-group comparison were done through the Kruskal-Wallis ANOVA test. All statistical tests were performed through SPSS version 25.0 (IBM). The inter-group statistical analysis concerning NRS, HI, and ET showed statistically significant results in Groups A and B compared to Group C (P < 0.05), while gingival biotype showed statistically significant results in Group A compared to Groups B and C. The use of PRF membrane and HA gel to protect the raw wound site of depigmented gingiva proved to be an effective approach, resulting in faster healing.