Clinical evaluation of the treatment of multiple gingival recessions with connective tissue graft or concentrated growth factor using tunnel technique: a randomized controlled clinical trial
Clinical oral investigations. 2021
OBJECTIVE To assess the effectiveness of the combination of tunnel technique (TT) and concentrated growth factor (CGF) for root coverage in treating multiple gingival recessions (GR) and compare with the connective tissue graft (CTG). MATERIALS AND METHODS Forty patients with Miller Class I and II maxillary or mandibular GR were randomly divided into two groups as follows: TT + CTG and TT + CGF. The results at baseline and 6 months were evaluated for the following clinical parameters: complete root coverage (CRC), mean root coverage (MRC), gingival thickness (GT), gingival recession width (RW), gingival recession depth (RD), and keratinized tissue width (KTW). RESULTS At 6 months, a statistically significant difference was found in RD, RW, MRC, CRC, KTW, and GT compared with the baseline (p < 0.05). MRC was determined 89.52±16.36% in the TT + CTG and 76.60±24.10% in the TT + CGF (p < 0.05). CRC was achieved in 66.7% of the TT + CTG and 47.4% of the TT + CGF (p < 0.05). The increase in KTW and GT was significantly better in the TT + CTG group compared to the TT + CGF (p < 0.05). CONCLUSIONS The study showed that TT + CGF did not improve the results as much as TT + CTG in the treatment of Miller Class I and II GR. However, this finding is not sufficient to advocate the true clinical effects of CGF on GR treatment with TT. CLINICAL RELEVANCE CGF could not serve as a direct alternative biomaterial to the gold standard CTG. TRIAL REGISTRATION ClinicalTrials.gov Identification Number: NCT04561947.
Efficacy of Platelet-Rich Plasma in Enhancing the Osteogenic Potential of Bone Graft in Oral and Maxillofacial Region
Journal of maxillofacial and oral surgery. 2021;20(2):282-295
BACKGROUND Platelet-rich plasma (PRP) has been a breakthrough in the stimulation and acceleration of bone and soft tissue healing. It represents a relatively new biotechnology that is part of the growing interest in tissue engineering and cellular therapy. METHODS A prospective study was carried out in 50 patients. The cases were selected randomly in the age group of 8-50 years who needed bone grafts for alveolar cleft defects and surgical defects following removal of osteolytic jaw lesions. They were divided into study group with autologous PRP and control group without PRP. Bone density was calculated as per Hounsfield scale preoperatively and post-operatively for both the groups. RESULTS There was significant difference in the Hounsfield units at 06 months and 12 months post-operatively in both the groups showing good amount of bone regeneration. The preoperative volume of the defect and the post-operative volume of the regenerated bone were statistically analysed. The mean V2 was 0.7652 cc for the study group, whereas for control group, it was 0.4840 cc. The volume ratio for study group was 0.9070 and for control group was 0.6740. This showed greater bone regeneration in the study group. The results were statistically significant for both the groups. CONCLUSION PRP is a new application of tissue engineering and a developing area of interest for clinicians and researchers. It is a storage vehicle for growth factors, especially PDGF and TGF-b, both of which influence bone regeneration, and also eliminates the concerns about immunogenic reactions and disease transmission. PRP does enhance the healing of bone grafts in the maxillofacial region as shown by the increase in the density of bone.
Effect of Platelet-Rich Plasma on Bone Healing in Immediate Implants Analyzed by Cone Beam Computerized Tomography: A Randomized Controlled Trial
BioMed research international. 2021;2021:6685991
The possibility of platelet-rich plasma (PRP) on the improvement of bone and adjacent tissue recovery has previously been validated. However, there is insufficient data supporting the use of platelet-rich plasma to improve the healing of bone and adjacent tissues around an implant in the oral cavity. The purpose of this randomized controlled trial was to observe the effect of platelet-rich plasma (PRP) concentrate on marginal bone loss and bone density around immediate implant placement using Cone Beam Computerized Tomography (CBCT). This clinical study was conducted over a period of six months on 12 subjects, who were equally categorized into two groups. Group I was the control, whereas the subjects in Group II received PRP therapy at the surgical site. All subjects were given a standard treatment with a single implant system (DIO UFII hybrid sandblasted acid-etched implants). Inserted implants were analyzed through CBCT, and records were registered at baseline, at the 12(th) week before functional loading and the 26(th) week after functional loading. The bone loss was calculated at the proximal (mesial and distal) side of the implant and bone density at baseline, 12(th) week, and 26(th) week after implant placement. SPSS version 23.0 was used for statistical analysis of data. The changes in bone levels were measured and compared between the two groups using the Mann-Whitney U test, with no significant difference. Bone density was analyzed by an independent sample t-test, p value ≤ 0.05 was considered statistically significant. Again, no significant difference in bone density was observed between both groups at all three instances. Therefore, it can be concluded that local injection of PRP after immediate implant placement did not show any decrease in marginal bone loss or improvement in bone density. This trial is registered with NCT04650763.
Evaluation of the Histomorphometric and Micromorphometric Performance of a Serum Albumin-Coated Bone Allograft Combined with A-PRF for Early and Conventional Healing Protocols after Maxillary Sinus Augmentation: A Randomized Clinical Trial
Materials (Basel, Switzerland). 2021;14(7)
The aim of this study was to compare the microarchitecture of augmented bone following maxillary sinus augmentation (MSA) after healing periods of 3 (test) and 6 (control) months using the combination of advanced platelet-rich fibrin (A-PRF) and a serum albumin-coated bone allograft (SACBA). Twenty-six patients with 30 surgical sites who required two-stage MSA were enrolled and grafted with the combination of A-PRF and SACBAs. The surgical sites were randomly allocated to the test or control group. During implant site preparation, 17 bone core biopsy samples were collected from each study group for histological, histomorphometric and micromorphometric analysis. Resonance frequency analysis was performed at the time of implant placement and 6, 8, 10, and 12 weeks postoperatively. The percentage of newly formed bone was 44.89 ± 9.49% in the test group and 39.75 ± 8.15% in the control group (p = 0.100). The results of the µCT analysis showed no significant differences in morphometric parameters between the study groups. The implant stability quotient was not significantly different between the two groups at 10 and 12 weeks postoperatively. Based on these findings, the total treatment time may be reduced by 3 months with the use of A-PRF and SACBAs for two-stage MSA.
The Effectiveness of Advanced Platelet-Rich Fibrin in comparison with Leukocyte-Platelet-Rich Fibrin on Outcome after Dentoalveolar Surgery
International journal of dentistry. 2021;2021:6686857
METHODS The study included 60 patients according to sample size calculation, recruited from patients seeking tooth extraction at oral and maxillofacial surgery clinic at Umm Al-Qura University, Faculty of Dentistry. Patients were divided into three groups. Group Ӏ included 20 patients managed by advanced platelet-rich fibrin after extraction. Group ӀӀ included 20 patients managed by leukocyte-platelet-rich fibrin after tooth extraction. Group ӀII included 20 patients left without any addition. Each group was further subdivided into surgical and nonsurgical extraction. Afterwards, patients in each group were assessed for postextraction pain by VAS, number of analgesics, and early soft tissue healing by LWHI. RESULTS The study outcomes demonstrate that the use of A-PRF significantly reduces postoperative pain in the 1(st) and 2(nd) day. VAS pain scores on the first day were significantly higher in the control surgical extraction group and L-PRF nonsurgical extraction group. In early soft tissue healing. The Landry Wound Healing Index (LWHI) was used after 1 and 2 weeks of extraction to evaluate the extraction site. In first week, the A-PRF group and L-PRF group (nonsurgical extraction) had a better healing index when compared to control group, and A-PRF group (surgical extraction) had a best healing index when compared to L-PRF and control groups. In the second week, individuals in the A-PRF group (surgical and nonsurgical extraction) had a better healing index when compared to L-PRF and control groups.
Effect of injectable platelet-rich fibrin (i-PRF) on the rate of tooth movement: A randomized clinical trial
The Angle orthodontist. 2021
OBJECTIVES To evaluate the efficiency of injectable platelet-rich fibrin (i-PRF) in accelerating canine tooth movement and to examine levels of the matrix metalloproteinase-8 (MMP-8), interleukin-1β (IL-1β), receptor activator of nuclear factor kappa-light-chain-enhancer of activated B cells ligand (RANKL), and osteoprotegerin (OPG) in the gingival crevicular fluid during orthodontic treatment. MATERIALS AND METHODS Twenty patients (mean age = 21.4 ± 2.9 years) with Class II Division 1 malocclusion were included in a split-mouth study. The treatment plan for all patients was extraction of maxillary first premolars followed by canine distalization with closed-coil springs using 150 g of force on each side. The study group received i-PRF two times, with a 2-week interval, on one side of the maxilla. The contralateral side served as the control and did not receive i-PRF. Maxillary canine tooth movement was measured at five time points (T1-T5) on each side. Also, the activity of inflammatory cytokines was evaluated at three time points in the gingival crevicular fluid samples. RESULTS There was a significant difference in canine tooth movement between the two groups (P < .001). i-PRF significantly increased the rate of tooth movement, and stimulation in the levels of inflammatory cytokines supported this result (P < .001). The levels of cytokines changed in both groups between T1 and T2. The IL-1β, MMP8, and RANKL values were significantly increased in the study group compared with the control group, while the OPG values were significantly decreased. CONCLUSIONS i-PRF-facilitated orthodontics is an effective and safe treatment modality to accelerate tooth movement, and this method can help shorten orthodontic treatment duration.
Ultrasonographic evaluation of the titanium-prepared platelet-rich fibrin effect in free gingival graft procedures
Journal of periodontology. 2021
BACKGROUND Complications after free gingival graft (FGG) operations are generally related to the donor site. The titanium-prepared, platelet-rich fibrin (T-PRF) placement in the donor site accelerate the wound healing and prevent postoperative complications such as pain and haemorrhage. We aim to evaluate the effect of T-PRF regarding vascularization and tissue thickness and to report the advantages of the ultrasonography (US) in FGG. METHODS Ten individuals were divided to two groups as T-PRF and control. While the T-PRF membrane was placed at the donor site in T-PRF group, a gelatin sponge was placed in control group. All patients underwent US examination in terms of vascularization and tissue thickness of left and right donor sites. The correlation between the right and left donor sites was analyzed with the Pearson correlation test. Tissue thicknesses and Pulsatility index (PI) were analyzed with independent samples T-test. The results were evaluated statistically at the p<0.05 significance level. RESULTS The T-PRF group showed increased vascularity which can be interpreted to improve healing in soft tissue. However, not a difference, but a positively very high correlation was observed between the right and left tissue thicknesses (p = 0,00; r = +0,902). CONCLUSION Evaluation of tissue thickness and vascularization density of donor sites with US not only increases clinical success rate but also reduces the risk of complications during surgery and postoperative pain in FGG. Studies evaluating T-PRF membrane as palatal dressing after FGG are only clinically, however, the efficiency of T-PRF was evaluated radiologically in this study for the first time. This article is protected by copyright. All rights reserved.
Tranexamic Acid in Craniomaxillofacial Surgery: A Meta-Analysis and Systematic Review
Facial plastic surgery & aesthetic medicine. 2021
Objective: To compare the effectiveness of tranexamic acid (TXA) in reducing blood loss and decreasing surgery duration in craniomaxillofacial surgery. Methods: The literature was searched systematically for all comparative studies of the effect of TXA on craniomaxillofacial surgery with placebo to evaluate the efficacy of TXA in craniomaxillofacial surgery. The primary outcome was intraoperative blood loss, and secondary outcomes were postoperative hematocrit, postoperative hemoglobin, and operation duration. Results: This systematic review included 16 studies consisting of 958 patients. Meta-analysis revealed that compared with the placebo group, the TXA group showed a significant reduction in intraoperative blood loss of 139.81 mL (95% confidence interval, CI: -179.66 to -99.96 mL; p < 0.01), a shortening of the maxillary surgery duration of 15.48 min (95% CI: -21.03 to -9.92 min; p < 0.01), an elevation of the postoperative hemoglobin level of 0.74 mg/dL (95% CI: 0.42 to 1.07 mg/dL; p < 0.01), and a limited effect on increasing the postoperative hematocrit level of 1.77% (95% CI: 0.17 to 3.36; p = 0.03). Conclusion: The use of TXA in craniomaxillofacial surgery can effectively reduce intraoperative blood loss, maintain elevate postoperative hemoglobin and hematocrit levels, and reduce the operation duration.
Platelet-rich fibrin for wound healing of palatal donor sites of free gingival grafts: Systematic review and meta-analysis
Journal of clinical and experimental dentistry. 2021;13(2):e190-e200
BACKGROUND Platelet-rich fibrin (PRF) has been referred to as a second-generation platelet concentrate, associated with improvements on the healing of palatal wounds followed by FGG harvesting. The aim of this systematic review and meta-analysis was to assess the complete wound epithelialization and postoperative pain when PRF was used in palatal wounds following free gingival graft (FGG) harvesting. MATERIAL AND METHODS PubMed (Medline), EMBASE and Scopus were searched by two independent individuals up to and including March 2020 in order to identify controlled and randomized controlled clinical trials on the use of PRF at palatal donor sites of FGG. The outcomes assessed were epithelialization and postoperative pain. The risk of bias of the included studies was evaluated using Cochrane Collaboration's domain-based two-part tool. Random effects meta-analyses were conducted with 95% confidence intervals. RESULTS The search strategy identified 555 potentially eligible articles, of which 6 randomized controlled clinical trials were included. In the qualitative analysis, most studies (83.3%) reported lower postoperative pain in treatment groups, while all studies accessing epithelialization demonstrated earlier complete wound closure in groups treated with PRF. The discomfort and complete re-epithelialization were more favorable in groups PRF when compared to control groups (P<0.00001). CONCLUSIONS Within the limits of the present study, it can be concluded that the use of PRF for wound healing of palatal donor sites of FGG may decrease postoperative pain and induce earlier complete wound epithelialization. Key words:Wound healing, oral surgery procedures, pain, postoperative.
Allogeneic Bone Application in Association with Platelet-Rich Plasma for Alveolar Bone Grafting of Cleft Palate Defects
Contemporary clinical dentistry. 2021;12(2):143-149
AIM: The aim of this study is to compare allogeneic bone grafts associated with platelet-rich plasma (ALBGs-PRP) to autogenous bone grafts (ATBGs) for alveolar reconstructions in patients with cleft lip and palate (CLP). MATERIALS AND METHODS The Maxillofacial Surgery Service of the Comprehensive Care Center for CLP (CCCLP) in Curitiba (Paraná, Brazil). PATIENTS Thirty out of 46 patients with 8-12 years of age and pre- or trans-foramen unilateral clefts were operated by the same surgeon. Groups were selected randomly after coin-toss for the first surgery to be ALBG-PRP. INTERVENTIONS Pre- and post-surgery cleft defect severity was registered by a score system using superimposed digitalized peri-apical radiographs. The hypothesis indicated ABG-PRP to be similar to the ABG was proved. RESULTS There was no statistically significant difference (P < 0.05) in bone augmentation for the ABG-PRP group (79.88%) when compared to the ABG group (79.9%). CONCLUSION ABG-PRP is indicated as a successful treatment modality to reduce the need for additional donor sites and reduce morbidity and hospital stay.