Platelet-rich Fibrin Membrane Research Articles

Second-Generation Platelet Concentrates (PRFs): Estimation of Cellular Content

We performed a study to evaluate the amount of Platelets and Leukocytes in a second-generation solid platelet concentrates in terms of Sensitivity, Specificity, Positive Predictive Value (VP+), Negative Predictive Value (VP-), False Negative Proportion, and False Positive Proportion of our Statistical Method. Blood was collected in anticoagulant-free PET tubes with silica for clot production and PRF membranes. The membranes and clots produced were examined. In a previous work, the authors, starting from the results obtained in Kitamura's work, wanted to elaborate a simpler and inexpensive system to calculate the exact amount of platelets and leukocytes contained in PRF, compared to the one present in whole blood, starting from a simple "haemochromocytometric examination". In this study, the authors have evaluated the Sensitivity, Specificity, Positive Predictive Value (VP+), Negative Predictive Value (VP-), False Negative Proportion, and False Positive Proportion of the "Statistical Method". Using the Statistical Method, we have that by reducing by 34.12% (±28.2) the value of leukocytes obtained from the CBC examination. We obtained the value of leukocytes contained in the PRF membrane by t-PA digestion and by reducing by 15.12% (±24.87) the value of platelets obtained by the same method, we obtained the value contained in solid platelet concentrates by t-PA digestion. The method thus proposed demonstrated a Se=0.75; Sp=0.86; VP+=0.75; VP-=0.86 for platelet counts, Se=0.47; Sp=0.66; VP+=0.80; VP-=0.30 for leukocyte counts. Conclusion: Our study sought to standardize the PRF preparation procedure by validating a statistical system to calculate the exact amount of platelets and leukocytes in second-generation solid platelet concentrates, making it easy to evaluate individual PRF arrays on time in the clinical setting. The Statistical method compared to the digestive method with t-PA for leukocyte and platelet counts demonstrated equal validity for platelets, but not so for leukocytes.

Platelet-rich fibrin to manage different periodontal defects combine with Flap surgery and other uses in dentistry. A descriptive review

In these days, periodontal diseases are very much common in Asian subcontinent especially in Bangladesh, due to some relevant factors that is more prevalent in this country. Most of the time patient neglect their condition and ultimately loss their teeth. Even after doing phase 1 therapy that is scaling, polishing with antimicrobial agents, it could not heal the periodontal condition with advanced bone destruction or clinical attachment loss. Therefore, after proper oral hygiene maintenance therapy, different flap surgery should consider. . In recent study, it is found that platelet rich fibrin (PRF) PREPARED From the patient’s Own blood and then placement within defect could enhance the early healing procedure. This PRF membrane is also used in a variety of discipline in dentistry, including regenerative surgery. This PRF membrane is now used in a variety of disciplines in dentistry, including regenerative surgery and enhancing early healing. The goal of this study is to critically analyze and appraise the currently available research with an emphasis on the use of PRF in regenerative periodontal surgery. An electronic search was conducted (PubMed/MEDLINE, Google Scholar, BanglaJOL, Cochrane library). Various combinations of the following keywords were used: ‘prf’, ‘prf membrane’, ‘periodontal regenerative surgery’, ‘prf in dentistry’, ‘systemic diseases and periodontitis’, ‘drawback of prf’, ‘platelet-derived growth factors’, ‘prf in oms’, ‘prf in orthodontics’. Articles were searched until August 2021 All of these studies reveal that the PRF membrane enhances the healing of various defects in a variety of periodontal diseases and in several fields of dentistry. Studies are going on pulp regeneration and socket healing after extraction with PRF in dentistry. More emphasis should have to give to the prevention of periodontal diseases as well as more concern should have to give on PRF with flap surgery to enhance healing and improve the social health of the general population by preventing tooth loss and for different research purposes on PRF in different other fields of dentistry in Bangladesh. Update Dent. Coll. j: 2021; 11(2): 43-51

Assessment of Dental Implant Stability Using Two Platelet-Rich Fibrin Proto-cols (A Comparative Clinical Study)

Aims: The current study aimed to compare implant stability of dental implants covered with one of two - platelet rich fibrin preparation protocols namely Standard-Platelet Rich Fibrin and Advanced-Platelet Rich Fibrin) using radiofrequency assessment. Materials and methods: A total of ten male patients with an age range of 28-51 years participated in this split-mouth clinical study. The patients were divided into two groups based on the platelet rich fibrin (PRF) protocol to be used with dental implant insertion into positive control (S-PRF) and study group (A-PRF). Each patient represented the two groups in which he received 2 dental implants; ten implants for each group (a total of 20 dental implants) of standard length and diameter in the posterior mandibular extraction sites of ipsilateral or contralateral side. In the positive control group, the standard PRF protocol was to be used to prepare the PRF clot. In the study group, the advanced PRF protocol was to be used to prepare the PRF clot. Both PRF membranes were to be instilled inside the osteotomy bed during dental fixture installation. Following the installation of dental implants; radiofrequency assessment using Osstell Mentor Device immediately after insertion, four, eight; twelve weeks post-operative as secondary outcomes were conducted. Results: When comparing ISQ means of dental implants between both group protocols, the Friedman test values of ISQ means showed no statistically significant difference between them at the immediate day of surgery, four weeks, eight weeks and twelve weeks post-surgery yet showed increased levels of ISQ at end of the trial. Conclusions: Both S-PRF and A-PRF, similarly enhanced and maintained dental implant stability hence maintain osseointegration (synergistic effect) throughout the period of study and as disclosed by ISQ values. The use of PRF in its current forms seems to be an accepted minimally invasive approach with good clinical results.

Platelet-Rich Fibrin Membrane for Pterygium Surgery: Literature Review and Feasibility Assessment.

Pterygium is a common ocular disease caused by abnormal cellular proliferation leading to abnormal fibrovascular growth of the conjunctiva. The main treatment is surgical removal; however, despite the improvement of surgical techniques and development of adjuvant therapies, postoperative recurrence, which can be as high as 89%, remains a challenge. Currently, pterygium excision with conjunctival autograft remains the preferred surgical technique, although there is no gold standard technique to prevent pterygium recurrence. We have conducted a thorough and comprehensive review of the scientific literature regarding the use of PRF membranes in pterygium surgery. We aim to assess the safety, effectiveness, and applicability of platelet-rich fibrin membrane for primary pterygium surgery and assess its possible benefits in resource-limited settings.

Treatment of Gingival Recession Class II Defect using Buccal Fat Pad versus Platelet Rich Fibrin using Vestibular Incision Subperiosteal Tunnel Access Technique

ABSTRACTAim of study: The aim of this study was to Compare the effectiveness of Non-pedicled buccal fat pad versus Platelet rich fibrin in treatment of Miller class II gingival recession using vistubular Incision Subperiosteal Tunnel Access TechniquePatients and methods:This study was conducted on 40 patients with class II gingival recession in anterior or premolar segment. The entire patients were selected from the out patient clinic of the Oral Medicine, Oral Diagnosis, and Periodontology Department. Faculty of Dentistry, Minya University.Forty patients with gingival recession class II were divided randomly into two groups:Group I: (20 defect) using VISTA technique with Non- pedicled buccal fat pad (NPBFP), Group II: (20 defect) using VISTA technique with platelet rich fibrin (PRF).Results: In both groups all clinical parameters were statistically significant from pre-operative period till 6 months follow up period. In the comparison between the two groups after 6 months follow up period, there were no statistically significant difference between two groups regarding all clinical parameters except percentage of root coverage; there was significant increase in percentage of root coverage after 3 and 6 months follow up period in group II with p value was less than 0.05.Conclusion: Both PRF membrane and NPBFP are effective in the management of Class II gingival recession defects using VISTA technique. PRF group has better results regarding percentage of root coverage than NPBPF group after 3 and 6 months follow up.

​Evaluation of Homologous Platelet Rich Plasma (PRP) Drop and Leucocyte Platelet Rich Fibrin (L-PRF) Membrane for Corneal Ulcer Healing in Dogs

Background: To evaluate use of homologous platelet rich plasma (PRP) drop and leucocyte-platelet rich fibrin (L-PRF) clot/membrane as regenerative therapy for healing of corneal ulcer in dogs and its subsequent comparison with conventional therapy. Methods: In this randomized study, 30 dogs were divided into three groups of 10 animals each. It was ensured each group had grade I, II and III ulcers. Group I received medicinal treatment with antimicrobial and non-steroidal anti-inflammatory eye drop. In Group II PRP drops and in Group III L-PRF membrane was used to evaluate corneal ulcer healing. Homologous platelet concentrates were prepared in laboratory and used for assessment of healing on various grades of corneal ulcer on basis on reduction in size and depth of ulcer, presence of stromal infiltration, scleral involvement, corneal opacity and vascularization. Result: Post treatment, the size of corneal ulcer started to reduce gradually from day 7 onwards. Significant (p≤0.05) reduction was observed from day 10 in group I after instillation of drops Moxifloxacin and Flurbiprofen and in group II after instillation of PRP. It was measured as 5.35 ± 0.63 and 5.20 ± 0.98 mm at day 0, which reduced significantly (p≤0.05) to 3.90 ± 0.50 and 3.10 ± 0.98 mm at day 10 in group I and group II respectively. In group III there was significant reduction in size of ulcer from day 0 to day 7 measuring 7.80 ± 1.05 and 0.20 ± 0.11mm respectively. Thereafter, from day 10 onwards complete sealing of ulcer was observed in all the cases. Post treatment there was no significant reduction in corneal opacity from day 0 to day 30 in group I dogs and corneal opacity persisted specially in grade II and grade III ulcers. There was significant reduction (p≤0.05) in opacity from 2.90 ± 0.35 to 2.10 ± 0.38 and 3.00 ± 0.37 to 2.40 ± 0.34 in group II and group III dogs from day 0 to day 10 respectively. In group I, II and III there was significant (p≤0.05) reduction in vascularization from 1.50±0.30 to 1.20±0.13, 1.30±0.37 to 0.60±0.22 and 1.40±0.31 to 0.40±0.31 from day 0 to day 15 respectively. There was a significant reduction in vascularization on day 15 in group II and group III compared to group I animals.

Effect of platelet-rich fibrin membrane on gingival crevicular fluid alkaline phosphatase levels in patients undergoing periodontally accelerated osteogenic orthodontics

BackgroundThe present study is aimed to compare the osteoblastic activity in periodontally accelerated osteogenic orthodontics (PAOO) with and without the platelet-rich fibrin (PRF) membrane by evaluating the gingival crevicular fluid (GCF), alkaline phosphate (ALP) levels and also to explore the efficiency of PRF membrane in terms of healing. MethodsA split-mouth randomized controlled trial, which comprised 16 sites, was randomly treated with PAOO + PRF membrane and PAOO alone. The primary outcome was to analyze the GCF ALP levels at baseline, 3rd, week, 5th week (2 weeks after surgery, 1 h before and after activation), 7th week (4 weeks after surgery), and 9th week (6 weeks after surgery). The clinical parameters (plaque index [PI], gingival index [GI], bleeding index [BI]) were assessed at baseline, 3rd week, 15th week, and 27th week. Healing index was recorded at 4th week (1 week after surgery), 5th week (2 weeks after surgery), and 7th week (4 weeks after surgery). ResultsThere was a statistically significant increase in GCF ALP levels (p < 0.05) in the test site (PAOO with PRF membrane) 2 weeks post-surgically compared to the control site. Improvement in the clinical measures (PI, GI, BI) was statistically significant at all time intervals. Adjunctive use of PRF resulted in statistically significant early healing in the first postoperative week compared to the control site (p < 0.05). ConclusionsWithin the limitations of this split-mouth study, PRF membrane showed significant osteoblastic activity in the 5th week (2 weeks after PAOO) with the increased GCF ALP levels and accelerated healing in the 1st week after PAOO. They also maintained post-orthodontic stability until 18 months.

Management of internal inflammatory root resorption using injectable platelet-rich fibrin revascularization technique: a clinical study with cone-beam computed tomography evaluation.

The current study evaluated clinically and radiographically the management of internal inflammatory root resorption (IIRR) in permanent anterior teeth with or without periapical lesions using injectable platelet-rich fibrin (i-PRF) regenerative approach. Ten systemically healthy patients, with thirteen anterior mature teeth diagnosed with IIRR were selected for the study. At the first visit, the tooth was anesthetized, access cavity opened, root canals were mechanically prepared then medicated with calcium hydroxide and temporarily sealed. After 2-4weeks, regenerative endodontic procedures were performed by preparing and applying i-PRF inside the canal, then a freshly prepared PRF membrane was placed over it. White mineral trioxide aggregate was placed over the PRF matrix, and the tooth was restored with a glass ionomer cement base and resin composite restoration. The patients were recalled for clinical and radiographic evaluation and follow-up every 3months for 12months. Cone-beam computed tomography (CBCT) imaging was performed preoperatively and after 12months. Clinical evaluation results showed resolution of signs and symptoms through the follow-up period in all of the cases. Both CBCT imaging readings of IIRR lesions and periapical lesions revealed a volumetric significant difference (p = 0.00) between the preoperative and the 12-month follow-up period. Usage of i-PRF could arrest and allow for healing of IIRR in permanent mature teeth and allow for periapical healing with successful clinical results. i-PRF revascularization technique proved to be a successful REP in the treatment of the IIRR, reducing the number of appointments and increasing patient compliance.

Comparison Study of the Histomorphometric Results after Socket Preservation with PRF and Allograft Used for Socket Preservation-Randomized Controlled Trials.

The aim of the present clinical study was to assess and compare the histomorphometric results and efficacy of freeze-dried bone allograft (FDBA) in combination with platelet-rich fibrin (PRF), and PRF as a sole grafting material for socket preservation. Ninety patients in need of tooth extraction and implant restoration were included in this study. The participants were randomly divided into three groups based on post-extraction clinical protocol: socket preservation procedure with allograft in combination with a PRF membrane (PRFm), PRF as a sole grafting material, and a control group. A total of 90 implants were placed four months post-extraction. During the surgical re-entry a bone biopsy was harvested with a trephine drill. Histological samples were prepared and analyzed for percentage vital bone and connective tissue. One-way ANOVA with Bonferroni post-hoc analysis were used to assess the results. Both test groups revealed a significantly higher percentage of vital bone formation compared to the control group. No statistically significant differences regarding vital bone formation and connective tissue quantity between the tested groups were observed (FDBA + PRFm: 3.29 ± 13.03%; and PRF: 60.79 ± 9.72%). From a clinical and histological point of view, both materials in the test groups are suitable for the filling of post-extraction sockets without bone defects. Both of the tested groups revealed a significantly higher percentage of vital bone formation compared to the control group.

Tetracycline Combined With PRF Membrane In A Periodontal Compromised Splinted Incisor To Enhances Soft Tissue Support Despite Poor Oral Hygiene: A Case Report With 1 Year Follow-Up

Tetracycline Combined With PRF Membrane In A Periodontal Compromised Splinted Incisor To Enhances Soft Tissue Support Despite Poor Oral Hygiene: A Case Report With 1 Year Follow-Up

Treatment of Medication-Related Osteonecrosis of the Jaw of a Patient with Immediate Implants

Abstract: The aim of this paper is to present the case of a 73 year old man with immediate implants who was admitted to the Clinic of Maxillofacial Surgery for treatment of medication-related osteonecrosis of the upper right jaw. The problem occurred after the extraction of two teeth, without considering that the patient is undergoing chemotherapy with Xgeva. The patient was diagnosed with prostate cancer in 2013. In 2015 were found metastases on the bones. According to the particular characteristics of the patient he underwent surgery under general anesthesia. The innovation in our case is that we used a placement of a PRF membrane and plastic closure of the wound. This is a new and alternative treatment method and there were no postoperative complications or wound infections, which are usually common in the postoperative period for people with medication-related osteonecrosis of the jaws.

Bone Ring Autogenous Graft and Immediate Implant Reconstruction in Atrophic Posterior Mandibular Area

Purpose: to evaluate clinical and radiographic outcome of bone ring grafting technique with immediate implant placement in fresh extraction socket in mandibular posterior area. Patients and methods: Clinical study was conducted on six patients, suffer from deficiency in vertical height at posterior mandibular area. Extraction and immediate implant reconstruction with symphyseal bone grafting in one-stage procedure. All steps of harvesting by trephine bur, implant osteotomy and placement within the socket were guided by computerized surgical stent for donor and recipient sites. Platelet Rich Fibrin (PRF) membrane was prepared to cover the implant at suture line. Patients were followed up clinically and radiographically by Cone Beam Computed Tomography (CBCT) at immediate,3 and 6 months postoperatively to evaluate the implant site and vertical bone height changes. Results: One successful case out of six showed excellent soft tissue healing with implant stability. Clinically one case showed sever infection at 2 weeks postoperatively with looseness of implant. Dehiscence and pain were found in 83.3% of the cases. Four cases had mild pain and one case suffered from severe pain, edema was mild in the majority of patients, numbness was found in 4 cases with 66.7%. CBCT results showed significant decrease in 3D dimensions of vertical bone height from immediate postoperative to 6 months with percentage of resorption (Buccally37.49±12.14, Lingually36.12±12.04, Mesially 39.55±15.05 and Distally10.92±0.76). Conclusion: From our study, Bone ring augmentation technique for fresh defective sockets with immediate implants at posterior mandibular area achieved low success rate, long procedure time and donor site morbidity.

Efficacy of platelet-rich fibrin and tacrolimus on facial nerve regeneration: an animal study

This study was performed to investigate the effect of platelet-rich fibrin membrane (PRFM), alone and with topical tacrolimus application, on regeneration of the crushed facial nerve (FN). Thirty healthy 7-week-old albino rats were used. The left FN was damaged by crushing in all rats. Three random groups of rats were formed: group 1, untreated; group 2, treated with PRFM; group 3, treated with PRFM plus topical tacrolimus. Functional recovery and histological and immunohistochemical evaluations were performed 4 and 8 weeks later. Anti-S100 was used to detect myelin sheath. At 4 weeks, blinking reflex recovery was more rapid in group 3 than in groups 2 and 1 (4.30 ± 0.48, 3.40 ± 0.52, and 2.20 ± 0.42, respectively); the difference was statistically significant (P = 0.001). Histologically, group 3 showed more apparent normal FN structures than the other groups. Immunohistochemical caspase-3 evaluation of the axon area revealed a significant difference between group 2 (PRFM alone; 8.67 ± 0.029) and group 3 (PRFM plus topical tacrolimus; 4.42 ± 0.028) (P = 0.001). Group 3 showed the greatest positive staining in the myelin sheath. Based on the results of this animal study, clinical studies should be performed to determine whether the combination of PRF and tacrolimus also improves the outcome of nerve regeneration in humans.

Regenerative medicine: characterization of human bone matrix gelatin (BMG) and folded platelet-rich fibrin (F-PRF) membranes alone and in combination (sticky bone)

During the last two decades autologous platelet and leukocyte rich products (PRP; PRF), opened new perspectives in regenerative medicine. In particular regenerative dentistry played a pioneer role in the application of these products in bone regenerative cases. Many aspects of cytokines, such as, growth factor release, blood cell content and its characterization were reported, but some practical questions are still unanswered in the preparation of PRF membranes and sticky bones. A new folding technique was introduced that created a good quality, pliable, and strong F-PRF membrane with a dense fibrin network and more homogenous blood cell distribution. F-PRF produced a very promising sticky bone combined with human freeze-dried cortical bone matrix gelatin (BMG). There hasn’t been much focus on the quality and character of the applied bone and the optimal membrane/bone particle ratio has not been reported. A 0.125 g BMG/ml plasma (1 g/8 ml) seems like the ideal combination with maximal BMG adhesion capacity of the membrane. Particle distribution of BMG showed that 3/4 of the particles ranged between 300–1000 µ, the remnant 1/4 was smaller than 300 µ. The whole F-PRF membrane and its parts were compared with conventional A-PRF membrane concerning their resistance against proteolytic digestion. The F-PRF was superior to A-PRF, which dissolved within 4–5 days, while F-PRF was destroyed only after 11 days, so this provides a better chance for local bone morphogenesis. The F-PRF pieces had similar resistance to the whole intact one, so they can be ideal for surgical procedures without risk of fast disintegration.

Comparison of the effect of tranexamic acid at various concentrations on the degradation time of platelet-rich fibrin

This study aimed to compare platelet-rich fibrin (PRF) membranes obtained using a conventional method and those obtained using the tranexamic acid-mixed method at various concentrations in terms of appearance, weight, and degradation period. In this in vitro study, 20 PRF membranes were divided into four groups, including a conventional group manipulated using the conventional method. The remaining groups were prepared using tranexamic acid at concentrations of 50, 150, and 200 mg. The PRF membranes were evaluated for gross weight, degradation period, and daily remaining weight for 28 days. There were no statistically significant differences in gross weight among all the groups (p = 0.985). The 150 and 200 mg groups had a longer degradation period (more than 28 days), which was significantly longer than that of the control and 50 mg groups (p = 0.048). The daily remaining weights of the 150 and 200 mg groups were significantly greater than that of the control group observed from day 13 to the end of the experiment. The tranexamic acid-mixed technique had no effect on the appearance and weight of the PRF membranes. Moreover, the technique could delay their degradation.

Clinical evaluation of platelet-rich fibrin membrane in the gingival depigmentation procedure: A case report

Gingival pigmentation, which is caused by the deposition of melanin pigment, may not be a medical problem but is still a primary esthetic concern for many people. Esthetic gingival depigmentation performed in such patients leads to excellent results. The platelet concentrate, which is often addressed as a windfall in the regenerative therapy in periodontology, accelerates wound healing by excellent neovascularisation. It also promotes fast cicatricle tissue remodeling. This case report highlights the effectiveness of Platelet-rich fibrin (PRF) membrane in the depigmentation procedure. Keywords: Gingival Depigmentation, Esthetics, Platelet-rich fibrin.

Platelet Rich Fibrin in the Treatment of Localised Gingival Recession: A Case Report

Root recession presents a matter of aesthetic concern in every dental practice. Also it may illicit sensitivity and is more prone to caries than the covered root surfaces. Platelet- rich fibrin is a second generation platelet concentrate. It is basically autologous leukocyte and platelet-rich fibrin biomaterial. The use of PRF in combination with coronally advanced flap in the treatment of gingival recession has shown promising results and is gaining immense popularity among the dental practitioners. This case reports the use of PRF membrane in root coverage on the labial surface of maxillary canine. Keywords: Coronally advanced flap, platelet rich fibrin, gingival recession, growth factors.

Autologous Platelet-Rich Fibrin Membrane to Augment Healing of Microfracture Has Better Macroscopic and Histologic Grades Compared With Microfracture Alone on Chondral Defects in a Rabbit Model

To determine the invivo effectiveness of a single-stage surgical procedure that combines microfracture and an autologous platelet-rich fibrin (PRF) membrane for cartilage repair in a rabbit model. Cartilage defects were created in the trochlear groove of the knees of adult white rabbits. Defects were divided into 2 treatment groups: microfracture only (control group) and microfracture covered by a PRF membrane (PRF group). To evaluate the repair cartilage, assessments were performed at 4, 12, and 24 weeks postoperatively using the International Cartilage Repair Society (ICRS) macroscopic scoring system and modified Wakitani histologic grading system. The mean ICRS macroscopic scores in the control and PRF groups were 4.1 and 5.8, respectively, at 4 weeks (P= .0623); 6.3 and 9.8, respectively, at 12 weeks (P= .006); and 6.5 and 10.3, respectively, at 24 weeks (P= .010). The mean modified Wakitani scores in the control and PRF groups were 4.0 and 3.9, respectively, at 4 weeks (P > .999); 5.3 and 10.4, respectively, at 12 weeks (P= .006); and 2.6 and 7.4, respectively, at 24 weeks (P= .012). The ICRS macroscopic scores and modified Wakitani scores showed that a single-stage surgical procedure combining microfracture and a PRF membrane was more effective than surgery with only microfracture for promoting cartilage repair. A single-stage surgical procedure combining microfracture and an autologous PRF membrane is a potentially beneficial treatment method for cartilage defects that does not require using any xenocollagen membrane.

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.

Clinical Trial on Solid Second-Generation Platelet-Concentrates in the Management of the Chronic Osteomyelitis: Advanced Bioregenerative Surgeries.

The supposition is that the usage of fibrin rich in leukocytes and platelets advanced (A-PRF) in ulcerative osteomyelitis of the diabetic foot allows rehabilitation from this critical illness. In this investigation, the focus was to normalize the use of platelet-rich fibrin (PRF) in patients with osteomyelitis not amputated, to use this second-generation platelet concentrate as a regeneration enabler. The researchers submitted and utilized A-PRF membranes (1300 g × 8 min) in 7 patients (all diabetics) with osteomyelitis and cutaneous injury for 6 months. The membranes, in combination with the supernatant fluid produced by stress, have been integrated into the skin lesion down to the bone after surgical debridement. The advancement of the lesions after some period of time has been analyzed. All 7 subjects had a probe-to-bone positive assay; magnetic resonance imaging indicated cortico-periosteal coagulation and/or foci of cortico-spongeous osteolysis contiguous to the lesion. Gram-positive bacteria were identified in our procedures in 52% of cases. Gram + Cocci, for example, Staphylococcus aureus (15.6%), β-hemolytic Streptococci (12.1%), Streptococcus viridans (7.1%), and Gram-negative bacteria, for example, Pseudomonas (10.6%), Proteus (7.8%), Enterobacter (5.7%) were present. Candida albicans was active in 2.8% of cases. The blood count showed no relevant differences. To date, cutaneous lesions have been cured in 6 of the 7 subjects treated (1 patient for more than 6 years) without any evidence of infection or recurrence. The results obtained on our subjects indicate that PRF membranes may be a therapeutic option in this problematic disease. In fact, this clinical approach may have the potential to promote the healing of diabetic skin lesions with osteomyelitis.