Effect of Platelet-Rich Fibrin Application on Non-Infectious Complications after Surgical Extraction of Impacted Mandibular Third Molars
International journal of environmental research and public health. 2021;18(16)
Due to the frequent development of non-infectious complications after surgical removal of the third lower impacted tooth, many techniques are used to reduce their severity. Among them is the technique of applying platelet-rich fibrin to the post-extraction alveolus. The study included 90 consecutively enrolled patients. Eligible patients were randomly assigned to two groups: patients with and without platelet-rich fibrin introduced into the postoperative alveolus. Pain, swelling, trismus, and temperature were evaluated after the procedure. Pain intensity was significantly higher in the control group than in the study group at 6 h, 1, and 3 days after surgery. PRF application did not significantly affect the intensity of swelling. Body temperature was significantly higher in the control group than the study group on day two after surgery. The trismus was significantly higher in the control group than in the study group at one, two, and seven days after surgery. Application of the PRF allows for a faster and less traumatic treatment process. It will enable for speedier recovery and return to active life and professional duties.
Effect of the piezoelectric device on intraoperative hemorrhage control and quality of life after endodontic microsurgery: a randomized clinical study
Journal of endodontics. 2021
INTRODUCTION The purpose of this study is to evaluate the effect of the piezoelectric device on intraoperative hemorrhage control during surgery and the quality of life of patients after the endodontic microsurgery. METHODS A total of 40 patients were randomly divided into the piezo group (n=20) and the control group (n=20). In the piezo group after flap reflection bone cutting, granulation tissue removal, and root-end resection were performed using the piezoelectric surgical device and surgical carbide burs and curettes were used in the control group. The quality of life of patients was evaluated daily for one week postsurgery for limitations of oral and general functions, pain, and other symptoms. Limitation of functions and other symptoms were recorded by a modified version of the patient's perception questionnaire using a five-point Likert scale for mouth opening, chewing, speaking, sleeping, daily routine, missed work, swelling, nausea, bad taste/breath and VAS was adopted for pain. Hemorrhage control during surgery was independently assessed by the surgeon and two blinded observers and recorded as 0(No hemorrhage control), 1(intermittent control), and 2(complete control).Chi(_)square test was used to assess hemorrhage control. For variables related to function and symptoms other than pain, and analgesics taken Fisher exact test was used. For assessment of pain between two groups, Mann-Whitney was used. RESULTS For parameters of quality of life piezo group showed significantly less swelling on 1(st),2(nd)& 3(rd)day and pain on 1(st)& 2(nd) day as compared with the control group "p<0.05." Analgesics taken were also significantly less in the piezo group "p<0.05". In the Piezo group, complete hemorrhage control was achieved in 10 patients, and in the control group, it was achieved only in 1 patient "P < .05." CONCLUSIONS Piezoelectric surgery resulted in improved quality of life of patients in the first weekpostsurgery with lower levels of pain and swelling as well as the number of analgesics taken and better hemorrhage control during surgery.
Guided bone regeneration simultaneous with implant placement using bovine-derived xenograft with and without liquid platelet-rich fibrin: a randomized controlled clinical trial
Clinical oral investigations. 2021
OBJECTIVE To assess augmentation success after guided bone regeneration (GBR) carried out simultaneously with implant placement using bovine-derived xenograft alone and in combination with liquid platelet-rich fibrin (liquid-PRF). METHODS This randomized controlled clinical trial was conducted on patients with horizontal bone deficiency in the posterior regions of the mandible. After implant placement, GBR procedures were randomly performed using liquid-PRF-enriched bovine-derived xenograft (for the test group) and with bovine-derived xenograft alone (for the control group). To assess the change in augmentation thickness, the primary outcome of the study, cone beam computed tomography was carried out at the implant sites on completion and 6 months after surgery. The secondary outcomes were marginal bone level and implant survival rate at prosthetic delivery and at 6 months, 1 year, and 2 years follow-up after loading. The significance level was set at p<0.05 for all analysis. RESULTS Twenty patients with 50 implants were analyzed for the test group and 20 patients with 48 implants for the control group. At 6 months postoperatively, the mean values of augmentation thickness were 1.63 ± 0.21 mm, 2.59 ± 0.34 mm, and 3.11 ± 0.36 mm for the test group and 1.34 ± 0.14 mm, 2.49 ± 0.24 mm, and 2.97 ± 0.24 mm for the control group at 2 mm, 4 mm, and 6 mm below to the implant shoulder (p < 0.001, p = 0.007, and p = 0.036, respectively). The mean marginal bone loss was found to be less than 1 mm for both study groups during the 2 years of follow-up after prosthetic loading. Implant survival rate was 100% for both study groups. CONCLUSION Bovine-derived xenograft alone and in combination with liquid-PRF are both successful in achieving bone augmentation around the implants and produce a small change in marginal bone level and a high implant survival rate after loading. CLINICAL RELEVANCE There is a lack of evidence in the literature regarding the augmentation success of liquid-PRF used in combination with bone graft substitutes. This study indicates that liquid-PRF could be used as a supportive material with bovine-derived xenograft in GBR procedures carried out simultaneously with implant placement.
Autologous Platelet Concentrate of 2(nd) and 3(rd) generations efficacy in the surgical treatment of gingival recession: an overview of systematic reviews
Journal of Indian Society of Periodontology. 2021;25(6):463-479
BACKGROUND Autologous platelet concentrate (APC)/platelet-rich fibrin (PRF) of second and third generations has increased use in periodontics to optimize wound healing. Few systematic reviews (SRs) have reported improved clinical outcomes, while other studies reported significantly better results for the connective tissue graft (CTG). There is still unclear clinical evidence about APC/PRF use to treat gingival recession (GR) defects. Then, the purpose of this SR was to evaluate the use of APC/PRF membranes (2(nd) and 3(rd) generations) in root coverage (RC) procedures and assess its efficacy as a substitute biomaterial. MATERIALS AND METHODS An electronic search was conducted in PubMed, Cochrane Central, Web of Science, Google Scholar, BookSC databases, and gray literature. The search strategy, without date restriction up to April 2020, included keywords as "platelet-rich fibrin," "autologous platelet concentrates," "blood," "systematic review," "periodontics," "surgery," "tissue," "gingiva," "gingival recession," "connective tissue," "graft," and "root coverage." The methodological quality was evaluated through the AMSTAR2, and a population, index test, comparator, outcome strategy was used to assess specific clinical parameters such as recession depth, clinical attachment levels, and RC outcomes. RESULTS Nine SRs were included. Only three articles described the technique of APC/PRF production. Three studies reported unfavorable outcomes using APC, while six reported favorable results and postoperative discomfort reduction. Articles included in this SRs that provided information about APC/PRF membranes (n = 13) showed no significant difference between APC/PRF and the control group for the parameters analyzed. CONCLUSIONS This implies that APC/PRF may be considered a feasible substitute biomaterial for treating GR defects, although the CTG still provides superior outcomes. Further long-term and controlled studies are needed to verify this finding.
Effect of hydroxyethyl cellulose soluble hemostatic gauze on hemostasis in facial contouring surgery
BACKGROUND In facial contour surgery, due to the narrow field of vision in the oral approach and the abundant blood supply to the maxillofacial area, hemostasis is not easy. The purpose of this study was to evaluate the hemostatic effect of soluble hemostatic gauze. METHODS We organized a prospective randomized study of 282 patients receiving facial contouring surgery (4 types of procedures in total) during 2016.1.1 to 2018.12.30. For each type of procedure, patients were randomly divided into study group (received hemostatic gauze) and control group (received sterile gauze). Two groups were compared for each type of procedure regarding 5 major perioperative variables: intraoperative blood loss, operation time, 24-hour postoperative drainage volume, total postoperative drainage volume, and postoperative drainage time. Correlation between variables was analyzed. RESULTS Compared with control group, the study group had higher amount of intraoperative blood loss in mandibular angle ostectomy (MAO) (P < .01) and mandibular angle-body-chin curved ostectomy procedures (P < .05), less total postoperative drainage volume in MAO (P < .01) but not in malarplasty with MAO and partial masseter muscle resection along with MAO procedures. No significant difference was observed between respective study and control groups regarding operation time, 24-hour postoperative drainage volume, and postoperative drainage time in any of the 4 types of surgery. In all 4 types of procedures, a strongly positive correlation was observed between total drainage volume and 24-hour drainage volume in both the study and control groups (r: 0.88-0.97, P < .01). CONCLUSION The effect of hydroxyethyl cellulose soluble hemostatic gauze on hemostasis in facial contouring surgery is associated with the type of surgery, which can reduce the risk of postoperative bleeding in MAO. However, for surgery with relatively large amount of intraoperative and postoperative bleeding, the hemostatic gauze had a limited postoperative hemostasis efficacy, which needs further evaluation.
The effects of platelet-rich fibrin on post-surgical complications following removal of impacted wisdom teeth: A pilot study
Journal of Taibah University Medical Sciences. 2021;16(4):521-528
OBJECTIVES Platelet-rich fibrin (PRF) is a fibrin matrix composed of cells, cytokines, and growth factors, which may be liberated from blood at specific times and act as a resorbable membrane. Many studies have demonstrated the benefits of PRF for bone healing in oral and maxillofacial implant surgery. Our study assesses the impact of PRF on postoperative complications following the extraction of impacted wisdom teeth. METHODS Twenty patients were recruited in this blind controlled randomised clinical trial, i.e. ten patients in the study group and ten patients in the control group. The patients were aged between 18 and 40 years. Surgical removal of impacted teeth #38 and #48 was performed in all the patients. The study group underwent dentoalveolar surgery with the use of PRF, while the control group underwent surgery without PRF. RESULTS All patients in the study group reported significantly less postoperative pain (p = 0.02) and excellent soft tissue healing during the follow-up period (p = 0.021). In contrast, only 80% of patients in the control group exhibited sufficient soft tissue healing. The difference in postoperative swelling between the two groups was not statistically significant. Additionally, 69% of patients in the study group reported comfortable night sleep during the first 24 h after the operation compared to 31% in the control group. This difference was statistically significant (p = 0.02). CONCLUSION Based on the outcomes of our study, implanting PRF into surgical extraction sites can be helpful in reducing postoperative pain and improving soft tissue healing. The use of PRF in extraction sockets is simple and biologically safe. The beneficial effects of PRF support its possible application in the field of dental surgery.
Clinical effectiveness of a topical subgingival application of injectable platelet-rich fibrin as adjunctive therapy to scaling and root planing: a double-blind, split-mouth, randomized, prospective, comparative controlled trial
Quintessence international (Berlin, Germany : 1985). 2021;0(0):0
OBJECTIVE The purpose of this randomized, controlled, split-mouth clinical trial was to clarify the clinical efficacy of using injectable platelet-rich fibrin (i-PRF) as an adjunctive subgingival irrigation to scaling and root planing (SRP) in the treatment of periodontitis. METHOD AND MATERIALS The study was conducted in 15 patients suffering from stage II to III with grade B to C periodontitis with bilateral periodontal pockets (≥ 5 mm) on a minimum of two teeth without degree II or III of furcation involvement or tooth mobility. The evaluated clinical parameters were: Plaque Index (PI), bleeding on probing (BOP), probing pocket depth (PPD), clinical attachment level (CAL), and gingival recession at baseline and after 3 months. After full-mouth supra- and subgingival SRP, the sites were randomly divided into test sites receiving the subgingival application of i-PRF and controls treated with saline. The Wilcoxon test and Mann-Whitney U test were used for intra- and inter-group comparisons, respectively. RESULTS In total, 726 sites were treated (388 test group and 338 control group) with no uneventful healing effects. Statistically significant decreases in PI (P = .001), BOP (P = .001 for both groups), PPD (P = .001 and P = .000 for test and control groups, respectively), CAL (P = .015 and P = .001 for test and control groups, respectively) between pretreatment and 3 months posttreatment were noted in both test and control groups. For inter-group comparisons, there was no statistically significant difference in all clinical indices (P > .05). CONCLUSION In this study, both groups were clinically effective as nonsurgical periodontal treatments, without any clinical benefits of using i-PRF.
Effects of platelet-rich fibrin combined with guided bone regeneration in the reconstruction of peri-implantitis bone defect
American journal of translational research. 2021;13(7):8397-8402
OBJECTIVE To investigate the clinical effect of platelet-rich fibrin (PRF) combined with guided bone regeneration (GBR) in the reconstruction of peri-implantitis bone defect. METHODS This prospective study included 80 patients with peri-implantitis who underwent implant restoration in the Department of Stomatology in our hospital. The eligible patients were randomly divided into control group and observation group, with 40 cases in each group. Patients in the control group were treated with flap curettage combined with GBR, while those in the observation group received a mixture of PRF and bone powder implanted with GBR and covered with PRF biofilm. The differences of pain 24 hours after surgery, bleeding at 7 days after surgery, and the degree of bone defect between the two groups at 60 days after surgery were compared. At 60 days and 120 days after surgery, separately, the regenerated bone density of patients in the two groups was measured, analyzed and compared. The degree of regenerated bone defect in transverse and longitudinal directions after 60 days was compared between the two reconstruction procedures. RESULTS The pain at 24 hours after surgery and the bleeding at 7 days after surgery in the observation group were milder than those in the control group (P<0.001). There was significant difference in the degrees of bone defect at 60 days after surgery (P<0.05). Compared with the control group, the regenerated bone density of the observation group was significantly higher both at 60 days and 120 days after surgery (P<0.001). CONCLUSION The combination of PRF and GBR technology has an obvious effect in repairing bone defects in patients with peri-implantitis, and can reduce the pain of patients during the repair process.
The efficacy of inorganic bovine bone combined with leukocyte and platelet-rich fibrin or collagen membranes for treating unfavorable periodontal infrabony defects. Randomized noninferiority trial
Journal of periodontology. 2021
BACKGROUND Growing evidence shows the efficacy of platelet concentrates in periodontal therapy. This study aimed to demonstrate that an inorganic bovine bone graft (IBB) in combination with a leukocyte and platelet rich fibrin (L-PRF) is noninferior to a combination with a collagen membrane (CM) when managing unfavorable infrabony defects (IBDs). METHODS All patients exhibited at least one unfavorable IBD; they were randomly assigned to two groups, 31 treated with L-PRF+IBB and 31 with CM+IBB. A clinical and radiographic examination was carried out at baseline and 12 months later. Clinical attachment level (CAL), gingival recession (GR), probing pocket depth (PPD), and radiographic defect bone level (DBL) post-therapy changes were compared between the two treatments. A non-inferiority margin = 1mm was set to determine the efficacy of the test treatment (-1mm for GR); a second non-inferiority margin = 0.5mm (-0.5mm for GR) was chosen for clinical relevance. RESULTS Twelve months after surgery a significant improvement of clinical and radiographic parameters was observed at both experimental sites. The 90% CIs of the CM+IBB - L-PRF+IBB mean difference for CAL gain [-0.810mm (-1.300 to -0.319)] and DBL gain [-0.648mm (-1.244 to -0.052)] were below the 0.5 mm non-inferiority margin; GR Increase [1.284mm (0.764 to 1.804)] remained above the -0.5mm, while PPD reduction [0.499mm (0.145 to 0.853)] crossed its 0.5mm margin. CONCLUSIONS The L-PRF+IBB treatment of unfavorable IBDs offers non-inferior efficacy for CAL gain, showing less GR and more DBL gain too, while for PPD reduction it is inferior to the CM+IBB treatment. This article is protected by copyright. All rights reserved.
Stability of biomaterials used in adjunct to coronally advanced flap: A systematic review and network meta-analysis
Clinical and experimental dental research. 2021
AIM: The objective of this network meta-analysis was to rank different biomaterials used in adjunct to coronally advanced flap (CAF), based on their performance in root-coverage for Miller's Class I and II gingival recessions. MATERIALS AND METHODS An electronic database search was carried out in PUBMED, CENTRAL, SCOPUS, and EMBASE to identify the eligible articles and compiled into the citation manager to remove the duplicates. The primary outcome was keratinized gingival tissue width (KGW) and percentage of root coverage (%RC). The treatment effect of different biomaterials was estimated using predictive interval plots and ranked based on biomaterials performance, using multidimensional scale ranking. RESULTS CAF + connective tissue graft (CTG), CAF + platelet concentrate matrix (PCM) and acellular dermal matrix (ADM) ranked at the top positions in performance in improving KGW. The highest ranked materials in improving percentage of root coverage in gingival recession were CAF + collagen matrix (CM) + gingival fibroblasts (GF), CAF + ADM + platelet rich plasma (PRP) and CAF + ADM, as compared to CAF alone. CONCLUSION CTG, ADM, platelet concentrates, and CM + GFs, when used in adjunct to CAF, showed improved stability over ≥12 months of follow-up, better percentage of root coverage, and improved keratinized gingival width.