Efficacy of Bovine Hydroxyapatite and Collagen Along With Platelet-Rich Fibrin as a Scaffold and Human Chorion as a Membrane for Ridge Preservation: A Case-Control Study
AIM: The present study aims to determine the efficacy of bovine hydroxyapatite and collagen (G-graft) mixed with platelet-rich fibrin (PRF) used as a scaffold and chorion membrane as a barrier in post-extraction sockets with extraction sites alone. METHODS AND MATERIAL Thirty individuals were randomly assigned into two groups. In the control group, after debridement of the extracted tooth socket, no additional treatment was done. In the test group, after debridement of the extracted tooth socket, the sockets were filled with bovine hydroxyapatite and collagen (G-graft) mixed with PRF. They were covered by a chorion membrane, and a non-absorbable suture material was used to secure the membrane in place. Clinical parameters assessed were plaque index, gingival index, buccolingual width, buccal bone plate height, and lingual bone plate height at baseline and at six months. RESULTS Clinically, there was a more significant reduction in the buccolingual width of the control group than the test group after six months. A statistically significant difference between the two groups for vertical ridge height at the mesial and distal socket sites was observed. No statistically significant difference in buccal and lingual bone plate height was observed between the two groups (p>0.05). CONCLUSIONS Both groups showed a significant reduction in the Buccolingual width, but it was less in the ridge preservation group. Thus, the use of G-graft with PRF and chorion membrane was highly effective in ridge preservation. Key messages: Natural bovine bone mineral, along with PRF and chorion as a membrane, can be utilized effectively for ridge preservation in extracted tooth sockets due to periodontal disease.
Increased local concentrations of growth factors from leucocyte- and platelet-rich fibrin do not translate into improved alveolar ridge preservation: an intraindividual mechanistic randomized controlled trial
Journal of clinical periodontology. 2022
AIMS: Leucocyte- and platelet-rich fibrin (L-PRF) has been tested for enhancing alveolar ridge preservation (ARP), but little is known about the local release profile of growth factors (GF) and the clinical equipoise related to its efficacy remains. This study compared the patterns of GF release, early soft tissue healing and alveolar ridge resorption following unassisted healing and L-PRF application in non-molar extraction sockets. MATERIALS AND METHODS Atraumatic tooth extraction of two hopeless teeth per patient was followed by unassisted healing or L-PRF placement to fill the socket in 18 systemically healthy, nonsmoking subjects. This intraindividual trial was powered to assess changes in horizontal alveolar ridge dimensions 1 mm below the crest of alveolar bone. GF concentrations in wound fluid were assessed with a multiplex assay at 6, 24, 72 and 168 hours. Early healing was evaluated with the wound-healing index and changes in soft tissue volumes on serial digital scans. Hard tissue changes were measured on superimposed CBCT images after 5 months of healing. RESULTS L-PRF resulted in higher GF concentrations in WF as compared to the control, but no differences in release patterns or time of peak were observed. No intergroup differences in early healing parameters were observed. Alveolar bone resorption was observed in both groups. No significant intergroup differences were observed in hard tissue healing 1, 3 or 5 mm apical to the original bone crest, or in ability to digitally plan a prosthetically guided implant with or without bone augmentation. CONCLUSIONS L-PRF increased the GF concentrations in wound fluid of extraction sockets without shifting the pattern observed in unassisted healing, while the increased delivery did not translate into clinical benefits in early wound healing or ARP. The current findings question the assumption that increased local concentrations of GF by L-PRF translate into improved clinical outcomes. Additional definitive studies are needed to establish the benefits of L-PRF in ARP. (clinicaltrials.gov NCT03985033).
Effectiveness of the Fibrinogen-Thrombin-Impregnated Collagen Patch in the Prevention of Postoperative Complications after Parotidectomy: A Single-Blinded, Randomized Controlled Study
Journal of clinical medicine. 2022;11(3)
We investigated whether a fibrinogen-thrombin collagen sponge patch reduces postoperative complications of parotid gland surgery. This single-blinded, randomized controlled study included 165 patients who underwent parotid surgery for benign tumors (2018-2019) at a tertiary center. Primary outcomes were postoperative drain amount, days until drain removal, and discharge. Patients were scheduled for follow-up at 1 and 4 weeks, and 3 months after surgery. Complications including surgical site infection, pain, seroma, sialocele, salivary fistula, facial nerve palsy, Frey's syndrome with subjective symptoms, and facial asymmetry were analyzed. After identifying confounding variables, multivariate approaches were used. Histologic analysis was performed in a mouse model of salivary gland surgery. In total, 162 patients (77, fibrinogen-thrombin collagen patch group; 85, controls) were included, with no significant between-group differences other than resected tissue. Among postoperative total drain amount and days until drain removal and discharge, the only postoperative total drain was significantly lower in the patch group than in the control group in the adjusted model. Additionally, although validation through robust trials with longer follow-up is needed, we found the potential benefit of the fibrinogen patch on Frey's syndrome and facial asymmetry. In conclusion, fibrinogen-thrombin-impregnated collagen patches in parotidectomy can reduce postoperative drainage and improve outcomes.
A Comparative Analysis of Intra-articular Injection of Platelet-Rich Plasma and Arthrocentesis in Temporomandibular Joint Disorders
Journal of maxillofacial and oral surgery. 2022;21(1):168-175
OBJECTIVES Temporomandibular joint disorders (TMDs) are progressive disorders which lead to development of arthralgia and functional disabilities of temporomandibular joint. The treatment of the TMDs is controversial; noninvasive and minimally invasive therapies have shown a success rate of 70 to 85% for its management. The objective of present study is to evaluate and compare the efficacy of intra-articular platelet-rich plasma (PRP) and arthrocentesis in management of TMDs. MATERIALS AND METHODS Twenty-four patients with complaint of reduced mouth opening, joint noise, pain, jaw deviation, not responding to medicinal treatment and coming under group II/III of RDC/TMD were included. Patients were randomly and equally divided in two groups. In group A, arthrocentesis was performed, whereas group B patients underwent intra-articular injections of PRP. Patients were clinically evaluated preoperatively to 12 months postoperatively. RESULT Both the groups showed significant improvement in painless mouth opening (P < 0.01), lateral movements towards unaffected side (P < 0.05) and reduction in pain complaint (P < 0.01). Arthrocentesis group also showed significant improvement in maximum mouth opening (P < 0.01). CONCLUSION On comparison, both groups were found to have effective treatment modality. However, arthrocentesis has higher success rate for pain elimination, and PRP is more effective in correction of joint noise and jaw deviation.
The effects of lyophilised platelet-rich plasma in third molar extraction sockets and its surrounding tissues
Journal of Taibah University Medical Sciences. 2022;17(2):289-296
OBJECTIVE To determine the effects of repeated placement of quantified lyophilised platelet-rich plasma (LPRP) on the soft and hard tissue components. METHODS Lyophilised platelet-rich plasma was topically placed, and later injected, into fresh sockets using the third molar surgical model, randomised according to the split-mouth approach. The control site received placebo. The application of LPRP was done intraoperatively, one month and two months postoperatively. The measured endpoints included post-operative pain, swelling, trismus, pocket depth at mid-distal adjacent second molar, soft tissue healing, and bone formation (which was assessed radiographically). Fifteen healthy young adults, aged between 21 and 35 years, visiting the Oral and Maxillofacial Surgery Clinic at the University of Malaya were recruited for this study. RESULTS There was no significant difference in post-operative pain, swelling size, trismus, and bone healing within their specific timelines during this study. However, the LPRP group showed significant reduction in pocket depth at the two-month post-operative period, suggesting that LPRP improves soft tissue healing. CONCLUSION Soft tissue healing, measured as the change of periodontal pocket depth, showed significant reduction, suggesting the benefit of LPRP for soft tissue healing. However, bone regeneration and reduction of post-operative sequelae showed no improvement even after quantification and repeated LPRP application.
Evaluation of the Efficacy of Platelet-Rich Plasma versus Platelet-Rich Fibrin in Alleviating Postoperative Inflammatory Morbidities after Lower Third Molar Surgery: A Double-Blind Randomized Study
West African journal of medicine. 2022;39(4):343-349
BACKGROUND Postoperative morbidities following impacted lower third molar (M3) surgery is of concern. The influence of platelets concentrates on postoperative inflammatory sequelae of M3 is promising. However, the comparative efficacy of platelet-rich fibrin (PRF) to platelet-rich plasma (PRP) in ameliorating postoperative morbidities remains controversial. OBJECTIVE The study aimed to compare the bioactive effects of PRP and PRF on postoperative pain, swelling, and trismus after impacted M3 surgery. SUBJECTS AND METHODS A randomized, parallel-group study of 50 subjects was designed. Preoperative and postoperative swelling, degree of mouth opening and pain were assessed on days 1, 3, and 7. Linear mixed model analysis was used to compare the effects of treatment, time-point assessment within the group, and treatment with time interaction. RESULTS Interaction estimates show statistically significant pain reduction with PRF (p = 0.00, 95% CI [-0.95, -0.25]. Trismus based on a time-point assessment within the PRP and PRF groups was significantly reduced (p =0.01, 95% CI [0.06, 0.38]) and (p = 0.00, 95% CI [0.12, 0.44]) respectively. Facial swelling within the PRP and PRF groups were significantly decreased (p = 0.00, 95% CI [-0.30, -0.06]) and (p = 0.00, 95% CI [-0.37, -0.13) respectively. There were no statistically significant differences between the groups for trismus and swelling. Age was a significant predictor of trismus in both groups (p = 0.04, 95% CI [-0.07, -0.01]). CONCLUSION PRF was more effective in reducing postoperative pain compared to PRP. Furthermore, the study shows that platelet concentrates positively modulate post-inflammatory sequelae of impacted M3 surgery.
Effect of an "Autogenous Leukocyte Platelet-Rich Fibrin Tooth Graft" Combination around Immediately Placed Implants in Periodontally Compromised Sites: A Randomized Clinical Trial
International journal of dentistry. 2022;2022:4951455
OBJECTIVE Autogenous tooth bone graft (ATBG) was suggested as a source for bone grafting materials, especially as they have similar chemical composition to bone. This study goal was to assess the clinical and radiographic consequences of ATBG with or without L-PRF on bone deposition around immediate implants placed in periodontally hopeless sites. MATERIALS AND METHODS 26 patients, with periodontally diseased teeth, underwent random assignment to receive the surgical protocol either with L-PRF over ATBG around immediately inserted implants (test group) or without it (control group). Clinical examination was observed. Radiographically, bone changes horizontally and vertically to determine marginal bone loss (MBL) and mesiodistal bone changes were made at the base line and 6 and 9 months after implant insertion. Statistical analysis utilizing paired Student's t-test was used for comparing results within the same group, whereas an independent-sample t-test was used for intergroup variable comparison. RESULTS All implants met the criteria of success without any complications at the follow-up period. Nonsignificant differences were detected between horizontal bone alterations in both groups at 6 and 9 months (P > .001). The test group showed statistically significant lower MBL than the control group (P < .001). The mesiodistal bone gain in the test group was significantly higher than that of the control group at the 6-month period (P < .001). The mesiodistal bone loss in the control group was significantly higher than that of the test group at the 9-month period (P < .001). CONCLUSION The ATBG- L-PRF combination therapy enhances new bone formation and appeared to be a favorable procedure with immediate implant placement, particularly in severe periodontitis cases.
Clinical and Radiographic Evaluation of Applying Atorvastatin 1.2% Bio Adhesive with Plasma Rich in Growth Factor (PRGF) for Treatment of Mandibular Class II Furcation Defects: a Randomized Clinical Trial
Journal of dentistry (Shiraz, Iran). 2022;23(2):86-94
STATEMENT OF THE PROBLEM Molar teeth with furcation involvement are one of the most common problems in patients with periodontal disease. Regeneration methods are of the most controversial treatment strategies for these lesions. PURPOSE The purpose of this study was to determine the effect of plasma rich in growth factors (PRGF) with 1.2% Atorvastatin (ATV) in the treatment of furcation involvement of mandibular molars. MATERIALS AND METHOD The present randomized clinical trial was conducted on 15 patients with moderate periodontitis and class II furcation involvements; 24 defects were located in four groups of six, including debridement, ATV1.2%, PRGF, PRGF with ATV1.2%. The parameters of vertical probing depth (VPD), vertical clinical attachment level (VCAL), gingival index (GI), horizontal probing depth (HPD) and gingival recession (GR) were measured at baseline (T0), immediately before surgery (T1), 3 (T2), and 6 (T3) months after surgery. Moreover, the bone conditions were evaluated by digital subtraction radiography before and six months after surgery. Data were analyzed using SPSS23 software. RESULTS No significant difference in radiographic parameters was observed among the groups (p= 0.08). There was no significant difference in the mean levels of VPD, VCAL and HPD among the groups at different times (p<0.05). Comparison of clinical parameters of VPD, VCAL and GI in the treatment groups compared to the baseline showed a significant improvement in each group (p< 0.05) but there was no significant difference among different groups (p< 0.05). CONCLUSION The use of PRGF with ATV 1.2% in grade II furcation involvement in mandi-bular molars was effective in the improvement of clinical and radiographic parameters six months after treatment, but this effect revealed no difference in comparison with the other groups.
Injectable platelet-rich fibrin as treatment for temporomandibular joint osteoarthritis: A randomized controlled clinical trial
Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery. 2022
The purpose of this study was to assess the treatment outcomes of intraarticular injection of injectable platelet-rich fibrin (i-PRF) after arthrocentesis in patients with temporomandibular joint osteoarthritis (TMJ-OA). Patients were randomly assigned to one of two treatment groups: those who received intraarticular injection of i-PRF after arthrocentesis procedure - the i-PRF group; and those who underwent the arthrocentesis procedure alone - the control group. The primary outcome variable was pain, the level of which was measured preoperatively and at 1, 2, 3, 6, and 12 months postoperatively. The secondary outcome variables included maximum mouth opening (MMO), and lateral and protrusive movements. Of the total of 36 patients, 18 were analyzed in the i-PRF group and 18 in the control group. There were significant differences between the groups in terms of pain levels and measurements of MMO, lateral movement, and protrusive movement over the 12 months of follow-up (p < 0.001). Significant increases in pain levels and decreases in measurements of MMO, lateral movement, and protrusive movement were observed in the control group from the 6th to 12th month postoperatively (p < 0.001). In contrast, no significant differences were found in both pain levels and measurements of MMO, lateral, and protrusive movements for the i-PRF group from the 2nd to the 12th month postoperatively. Within the limitations of the study it seems that intraarticular injection of i-PRF after arthrocentesis should be preferred whenever appropriate because when reducing pain intensity and improving functional jaw movement is the priority.
Evaluation of the effect of injectable platelet-rich fibrin (I-PRF) in reducing the resorption of fat graft during facial lipostructure: A randomized clinical trial
Dental and medical problems. 2022;59(1):131-136
BACKGROUND Fat graft is considered to be the ideal material for soft tissue augmentation. However, its disadvantage are unpredictable outcomes due to variable resorption. OBJECTIVES This study is the first clinical trial to evaluate the efficacy of adding injectable platelet-rich fibrin (I-PRF) to fat graft and to compare it with the conventional fat graft in terms of absorption rate. MATERIAL AND METHODS The study was designed as a double-blind, split-face, randomized, controlled clinical trial. Twenty patients were randomly assigned with regard to the right or left nasolabial folds into 2 groups (n = 10 in each group): group A (fat graft only); and group B (fat graft with I-PRF). Surgical lipostructure was performed in accordance with the protocols described by Coleman. The adipose tissue was extracted from the umbilical region. Then, for the I-PRF preparation, peripheral venous blood was collected into plastic tubes. The follow-up recall visits took place after 1 and 12 months. Five investigators evaluated the preand post-surgical intervention photographs based on the Modified Fitzpatrick Wrinkle Scale (MFWS). RESULTS The nasolabial fold depth scores were recorded at each of the study phases: before the intervention (1); after 1 month (2); and after 12 months (3). There were statistically significant differences between the scores at various study phases in each group. The Mann-Whitney U test was used to detect differences between the 2 groups. There was no statistically significant difference between the 2 groups regarding nasolabial fold depth 1 month after the intervention (p = 0.360). After 12 months, however, the patients in group A showed higher nasolabial fold depth scores as compared to group B; this difference was statistically significant (p = 0.000). CONCLUSIONS The study demonstrated the efficacy of I-PRF in reducing the resorption of fat graft, following facial lipostructure.