Sole Grafting Material Research Articles

Platelet rich fibrin as a sole grafting material For the treatment of periodontal Intrabony defects.

Platelet-rich fibrin (PRF) is a second-generation platelet concentrate enriched with platelets and growth factors which found to be beneficial for periodontal regeneration. The purpose of this case report is to clinically and radiographically evaluate the efficacy of PRF for the treatment of periodontal intrabony defects (IBD). A 38- year old Indian female presented with periodontal IBD in relation to 21. The probing pocket depth (PPD), clinical attachment level (CAL) and Mean bone defect were found to be 13mm,14mm and 17.30 mm respectively in relation to 21. The affected lesion was treated surgically by placement of PRF which showed significant reduction in PPD, gain in CAL and radiographic bone formation after six months, thus supporting the role of various growth factors present in the PRF in accelerating the soft and hard tissue healing.

Management of Peri-Implantitis with PRF as a Sole Grafting Material: A Case Report

PRF was used as a sole grafting material for surgically treatment of a 8 mm pocket around an implant that had 3 threads of bone loss, BoP, and exudate, and the patient was followed up for 1 year. Surgical treatment with the help of PRF, home care reinforcement, clinical indices records, and radiographic examination was done. The patient was monitored frequently for the first 3 months. Subsequently, maintenance visits were scheduled at 3 month intervals. The patient had a decreased probing pocket depth and a negative BoP index compared to initial clinical data, and the results were stable after a year. After 1 year of follow up visit, there appeared to be rebound of the bone level radiographically.

Sinus Augmentation by Platelet-Rich Fibrin Alone: A Report of Two Cases with Histological Examinations.

In sinus floor augmentation of an atrophic posterior maxilla, platelet-rich fibrin (PRF) has been used as a graft material. We herein report two cases with histological evaluations of PRF after the surgery. The first case was a 28-year-old female with an atrophic right posterior maxilla who was treated with sinus floor augmentation and simultaneous implant placement using PRF as the sole graft material in our hospital. Twenty-four months after surgery, the implant was unfortunately removed because of occlusal overloading by parafunctional habits. During implant replacement, a tissue sample was obtained from the site of augmentation with PRF and was evaluated histologically. The second case was a 58-year-old man with severe alveolar atrophy of the right maxilla who underwent lateral sinus augmentation using only PRF in a two-stage procedure in our hospital. Samples were obtained at the second-stage surgery and histological examinations were performed. As a result, new bone formation was confirmed histologically in both cases. Our findings show that the use of PRF as a graft material during sinus floor augmentation induces natural bone regeneration.

Maxillary anterior ridge augmentation with recombinant human bone morphogenetic protein 2.

No human studies exist on the use of recombinant human bone morphogenetic protein 2 (rhBMP-2) on an absorbable collagen sponge (ACS) as a sole graft material for lateral ridge augmentation in large ridge defect sites. This series evaluates the treatment outcome of maxillary anterior lateral ridge augmentation with rhBMP-2/ACS. Twenty patients were treated with rhBMP-2/ACS and fixation screws for space maintenance. Cone beam volumetric tomography measurements were used to determine gain in ridge width, and a bone core biopsy was obtained. The mean horizontal ridge gain was 1.2 mm across sites, and every site gained width.

Platelet-rich plasma as filling material in open sinus lift surgery

Background Many biomaterials are used during the open sinus lift surgery, beneath the elevated scheniderian membrane and maxillary sinus bony floor but the search for Ideal material continues. Methods In the maxillary posterior atrophic ridges with the bone height less than four millimeters the open sinus lift surgery performed. The autologous Platelet-rich plasma (PRF) was used as the sole grafting material. Dental implant insertion was not attempted at the same cession. Results Three month after surgery, good density of the bone was observed in OPG. Conclusion Use of Platelet-rich plasma as grafting material in open sinus lift should be considered. It has benefit of omitting the need for donor site for bone grafting. Keywords: Platelet-rich, plasma, sinus

Simultaneous sinus lift and implantation using platelet-rich fibrin as sole grafting material

Recently, several authors have shown that simultaneous sinus lift and implantation using autologous platelet-rich fibrin as the sole filling material is a reliable procedure promoting bone augmentation in the maxillary sinus. The aim of this study was to examine the effect of simultaneous sinus lift and implantation using platelet-rich fibrin as the sole grafting material on bone formation in a canine sinus model. An implant was placed after sinus membrane elevation in the maxillary sinus of six adult female mongrel dogs. The resulting space between the membrane and sinus floor was filled with autologous platelet-rich fibrin retrieved from each dog. The implants were left in place for six months. Bone tissue was seen at the lower part of the implants introduced into the sinus cavity. The height of the newly formed bone around the implants ranged from 0 mm to 4.9 mm (mean; 2.6 ± 2.0 mm) on the buccal side and from 0 mm to 4.2 mm (mean; 1.3 ± 1.8 mm) on the palatal side. The findings from this study suggest that simultaneous sinus lift and implantation using platelet-rich fibrin as sole grafting material is not a predictable and reproducible procedure, especially with respect to the bone formation around the implants in the sinus cavity.

Effect of Xenograft (ABBM) Particle Size on Vital Bone Formation Following Maxillary Sinus Augmentation: A Multicenter, Randomized, Controlled, Clinical Histomorphometric Trial

The purpose of this study was a histomorphometric comparison of vital bone formation following maxillary sinus augmentation with two different particle sizes of anorganic bovine bone matrix (ABBM). Bilateral sinus floor augmentations were performed in 13 patients. Trephine bone cores were taken from the lateral window areas of 11 patients 6 to 8 months after augmentation for histologic and histomorphometric analysis. Bone samples from both the large and small particle size groups showed evidence of vital bone formation similar to that seen in previous studies, confirming the osteoconductivity of ABBM. Significant bone bridging was seen creating new trabeculae composed of the newly formed bone and residual ABBM particles. Histologic evaluation revealed the newly formed bone to be mostly woven bone with some remodeling to lamellar bone. Osteocytes were seen within the newly formed bone as well as osteoblast seams with recently formed osteoid. Isolated osteoclasts were observed on the ABBM surfaces. Vital bone formation (primary outcome measure) was more extensive in the large particle grafts compared with the small particle grafts (26.77% ± 9.63% vs 18.77% ± 4.74%, respectively). The histologic results reaffirm the osteoconductive ability of ABBM when used as the sole grafting material in maxillary sinus augmentation. The histomorphometric results at 6 to 8 months revealed a statistically significant increase (P = .02) in vital bone formation when the larger particle size was used. Additional studies should be performed to confirm these results.

The Use of Platelet-Rich Fibrin in Combination With Biphasic Calcium Phosphate in the Treatment of Bone Defects: A Histologic and Histomorphometric Study

BackgroundPlatelet-rich fibrin (PRF) is a leukocyte and platelet concentrate containing many growth factors. Its potential for hard tissue augmentation as a sole grafting material or in combination with other grafting materials has been investigated in many studies. ObjectiveThe aim of this histologic study was to evaluate the efficacy of PRF mixed with biphasic calcium phosphate (BCP) on bone regeneration in surgically created bone defects. MethodsDefects 5 mm in diameter were created in both tibias of 6 sheep. The defects were left empty or grafted with BCP, PRF, or BCP+PRF. Animals were killed at 10, 20, and 40 days. The specimens underwent histologic and histomorphometric analysis. ResultsNone of the groups displayed any signs of necrosis. Inflammation was observed in all groups at 10 days; 2 specimens of PRF+BCP and all empty defects showed inflammatory cell infiltration at 20 days. During the 40-day evaluation period, the PRF+BCP group showed the highest ratios of new bone. The other 3 groups showed statistically similar results. In the BCP and PRF+BCP groups, the residual graft ratios were decreased at consecutive time intervals. The difference between the 2 groups was not statistically significant during follow-up. ConclusionsThe current study revealed a histomorphometric increase in bone formation with the addition of PRF to BCP in surgically created defects in sheep tibia.

Evaluation of Sinus Floor Augmentation with Simultaneous Implant Placement Using Platelet-Rich Fibrin as Sole Grafting Material

The objective of this study was to evaluate sinus floor augmentation with simultaneous implant placement using platelet-rich fibrin (PRF) as the only grafting material. This study included patients who underwent sinus floor augmentation with simultaneous implant placement using PRF as the sole filling material between July 2009 and January 2011 at the Department of Oral and Maxillofacial Surgery, Nagasaki University Hospital. For each patient, presurgical and postsurgical (6 months after the surgery) radiography and computed tomographic scanning were performed to assess bone formation at the implant sites. The density (in Hounsfield units [HU]) of the newly formed bone and the bone height from the sinus floor to the alveolar crest where implants were inserted were measured using implant planning software (Simplant, Materialise Dental). Nine sinus floor augmentations were performed, and 17 implants were placed in six patients. The mean residual bone height between the sinus floor and alveolar crest was 4.28 ± 1.00 mm (range, 1.9 to 6.1 mm) prior to surgery and 11.8 ± 1.67 mm (range, 9.1 to 14.1 mm) after surgery. The alveolar bone ridge was wide enough for implant placement in all cases. The mean density of the newly gained bone around the implants was 323 ± 156.2 HU (range, 185 to 713 HU). All implants were clinically stable at the time of abutment insertion, 6 months after sinus augmentation. Sinus elevation with simultaneous implant placement using PRF as the only filling material may promote natural bone regeneration.

Clinical application of platelet-rich fibrin as the sole grafting material in periodontal intrabony defects

Background/purpose Platelet-rich fibrin (PRF) obtained by Choukroun’s technique is a healing biomaterial that concentrates in a single autologous fibrin membrane, mostly of platelets and cytokines from blood harvest, and without any artificial biochemical modification. However, no data are presently available concerning the use of PRF for the treatment of periodontal intrabony defects. This report was to present the clinical and radiographic changes of a patient with periodontal intrabony defects treated with PRF. Material and methods The left mandibular first molar (#36) and left maxillary second molar (#27) with intrabony defects were filled with PRF as the sole grafting material in a 38-year-old female patient. The primary outcomes evaluated in this study included changes in probing depth, attachment level, and radiographic bone density between baseline and 6 months postoperatively. Results The results showed that the application of PRF as the sole grafting material in intrabony defects exhibited pocket reduction and gain in clinical attachment after 3 months and 6 months. Using National institute of health program, the 6 months postoperative radiographic density of images for #27 and #36 showed an increase of 1.6 and 1.3 fold compared with each preoperative radiography, respectively. Conclusions From a clinical and radiologic point of view at 6 months after surgery, the use of PRF as the sole grafting material seems to be an effective modality of regenerative treatment for periodontal intrabony defects.

Clinical and histologic evaluations of healing in an extraction socket filled with platelet-rich fibrin

Platelet-rich fibrin (PRF) is an immune and platelet concentrate that contains all constituents of a blood sample favorable to healing and immunity on a single fibrin membrane. However, limited information is currently available concerning the histologic healing of extraction sockets using PRF. This report presents the clinical and histologic characteristics of a patient who underwent a tooth extraction which was filled with PRF. The right mandibular second molar was removed from a 47-year-old male patient, and the socket was filled with PRF as the sole grafting material in preparation for placing an implant after wound healing. The extraction site was reentered surgically for implant placement. A cylindrical sample core of the newly formed tissue was collected from the socket for histological evaluation. During clinical healing, neither infectious episodes nor untoward clinical symptoms were seen. At the time of implant insertion, the socket was completely filled by a hard material, which on probing exhibited the consistency of bone. A histological exanimation of the core taken from the socket revealed new bone formation. There was also no evidence of inflammatory infiltrates. The clinical and histological findings suggest that filling a fresh extraction socket with PRF provides a viable therapeutic alternative for implant site preparation.

Simultaneous Sinus-Lift and Implantation Using Microthreaded Implants and Leukocyte- and Platelet-Rich Fibrin as Sole Grafting Material: A Six-Year Experience

To assess the relevance of simultaneous sinus-lift and implantation with leukocyte- and platelet-rich fibrin (L-PRF, Choukroun's technique) as sole subsinus filling material. Twenty-three lateral sinus elevations (SA4 sinus) were performed on 20 patients with simultaneous implant placement. Seven patients were treated with 19 Astra implants (AstraTech, Mölndal, Sweden) and 13 patients with 33 Intra-Lock implants (Intra-Lock Ossean, Boca Raton, FL). L-PRF membranes were used to cover the Schneiderian membrane, the implant tips served as "tent pegs" for the L-PRF-patched sinus membranes, and the subsinus cavity was finally filled with L-PRF clots. Clinical and radiographic follow-up was performed just after implant placement, after 6 months, 1 year and each following year. Six months after surgery, all implants were clinically stable during abutment tightening. The maximum follow-up was 6 years, and all patients were followed up for a minimum of 2 years. No implant was lost during this 6-year experience, and the vertical bone gain was always substantial, between 8.5 and 12 mm bone gain (10.4 ± 1.2). The final level of the new sinus floor was always in continuation with the implant apical end, and the periimplant crestal bone height was stable. The use of L-PRF as sole filling material during simultaneous sinus-lift and implantation seems to be a reliable surgical option promoting natural bone regeneration.

Sinus Floor Augmentation With Simultaneous Implant Placement Using Choukroun's Platelet‐Rich Fibrin as the Sole Grafting Material: A Radiologic and Histologic Study at 6 Months

Sinus augmentation with simultaneous implant placement without bone graft material is a hotly debated technique. This technique could be improved and secured by the use of an autologous leukocyte- and platelet-rich fibrin (PRF) (Choukroun's technique) concentrate. The objectives of this study were to assess the relevance of PRF clots and membranes as the sole filling material during a lateral sinus lift with immediate implantation using radiologic and histologic analyses in a case series. Twenty-five sinus elevations with simultaneous implantation were performed on 20 patients with Choukroun's PRF as the sole filling biomaterial. For each patient, a presurgical exam and a 6-month post-surgical radiologic exam were performed with a panoramic x-ray and three-dimensional volumetric computed radiography (VCR) to evaluate the subsinus residual bone height and the final bone gain around the implants. In nine patients, 6 months after the sinus lift, bone biopsies were collected on the buccal wall of the alveolar ridge at the level of the osteotomy window, and evaluated by histomorphometry. In this study, 41 implants from three different systems with different screw designs (Biomet 3I Nanotite, MIS Seven, Intra-Lock Ossean) were placed. All implants were inserted in residual bone height between 1.5 and 6 mm (mean +/- SD: 2.9 +/- 0.9 mm). The final bone gain was always very significant (between 7 and 13 mm [mean +/- SD: 10.1 +/- 0.9 mm]). No implant was lost. After radiologic analyses, the position of the final sinus floor was always in the continuation of the end of the implant. All biopsies showed well organized and vital bone. From a radiologic and histologic point of view at 6 months after surgery, the use of PRF as the sole filling material during a simultaneous sinus lift and implantation stabilized a high volume of natural regenerated bone in the subsinus cavity up to the tip of the implants. Choukroun's PRF is a simple and inexpensive biomaterial, and its systematic use during a sinus lift seems a relevant option, particularly for the protection of the Schneiderian membrane.

Endoscopic Reconstruction of Large Anterior Skull Base Defects using Acellular Dermal Allograft

Endoscopic repair of small- to medium-sized anterior skull base (ASB) defects using bone, cartilage, fascia, fibrin glue, lipolized dura, and, more recently, acellular dermal allograft have all been described with equal efficacy. The purpose of this study was to review our experience with the use of acellular dermis as the sole graft material in endoscopic reconstruction of large ASB defects. A retrospective chart review of all patients who underwent endoscopic repair of ASB defects at the University of Miami between the years of 2001 and 2006 was conducted. Fifty-six patients were identified who met these criteria. All repairs were performed by a transnasal, endoscopic approach. Outcome measures included success of graft take and incidence of major and minor complications. Dural defect size was defined as small (<0.4 cm), intermediate (0.4-2.0 cm), and large (>2.0 cm). AlloDerm (AlloDerm. LifeCell Corp. Woodlands, TX) was used as the primary graft material in 30/55 (55%) cases; 16/55 (29%) of the repaired defects were classified as large. Graft success was 97% in the AlloDerm group and 92% in the non-AlloDerm group. The incidence of major and minor complications in the AlloDerm group was 0 and 3.3%, respectively. In the non-AlloDerm group, the incidence of major and minor complications was 4 and 12%, respectively. There were no statistical differences in the complication rates based on the type of repair or defect size. Alloderm can be used successfully to repair ASB defects, including large defects that are >2 cm in size with little or no morbidity.

Similarities and Differences in the Treatment of Spine Trauma Between Surgical Specialties and Location of Practice

Questionnaires administered to practicing orthopedic and neurosurgical spine surgeons from various regions of the United States and abroad. To determine similarities and differences in the treatment of spinal trauma. Spinal trauma is generally referred to subspecialists of orthopedic or neurosurgical training. Prior studies have suggested that there is significant variability in the management of such injuries. Questionnaires based on eight clinical scenarios of commonly encountered cervical, thoracic, and lumbar injuries were administered to 35 experienced spinal surgeons. Surgeons completed profile information and answered approximately one dozen questions for each case. Data were analyzed with SPSS software to determine the levels of agreement and characteristics of respondents that might account for a lack of agreement on particular aspects of management. Of the 35 surgeons completing the questionnaire, 63% were orthopedists, 37% were neurosurgeons, and 80% had been in practice for more than 5 years. Considerable agreement was found in the majority of clinical decisions, including whether or not to operate and the timing of surgery. Of the differences noted, neurosurgeons were more likely to obtain a MRI, and orthopedists were more likely to use autograft as a sole graft material. Physicians from abroad were, in general, more likely to operate and to use an anterior approach during surgery than physicians from the northeastern United States. More commonalities were identified in the management of spinal trauma than previously reported. When found, variability in opinion was related to professional and regional differences.

Immediate implant placement: a procedure without incisions.

Primary socket closure in immediate implantation may be difficult, due to the opening left by the extracted tooth. The absolute need for bone augmentation and primary flap closure for implants placed into fresh extraction sites has never been proven. The hypothesis of the present study was that immediate implants can succeed without primary flap closure. A technique that does not require any incisions during immediate implant placement is described. No barrier membranes were used and the sole grafting material used were autogenous bone chips. Full soft tissue coverage was achieved 1 week to 2 months postimplantation. Clinical osseointegration was achieved with minimal gingival recession and papillae preservation. Immediate implant placement in the anterior maxilla can be successful for replacing a single tooth even without primary closure.