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1.
Two-dimensional radiographs and CBCT assessment of concentrated growth factor and platelet-rich fibrin scaffolds in regenerative endodontic treatment of immature incisors with periapical radiolucency: a randomized clinical trial
Elheeny, A. A. H., Tony, G. E.
Journal of endodontics. 2024
Abstract
INTRODUCTION The primary aim of this study was to compare the radiographic changes of immature incisors with periapical radiolucency after treatment with platelet-rich fibrin (PRF) and concentrated growth factor (CGF) platelet concentrate scaffolds as well as assessment of the clinical success rate over 12 months. The secondary aim was to monitor the radiographic changes in terms of reduction of periapical lesion diameter (PALD), root dentine thickness (RDT), root length (RL), and apical foramen width (AFW). The tertiary aim was to assess and pulp responses, after 12 months METHODS Fifty six children withseventy necrotic, single-rooted maxillary incisors with periapical radiolucency were treated with either CGF or PRF scaffolds (35 teeth per group). Two patients with four teeth (two teeth in each group) failed to attain the follow-up recalls. Radiographic changes in terms of reduction of periapical lesion diameter (PALD), root dentine thickness (RDT), root length (RL), and apical foramen width (AFW) were monitored using a two-dimensional radiograph and CBCT scan. The clinical performance of teeth receiving both scaffolds was assessed after 6 and 12 months. Categorical and continuous data were analyzed using the chi-square test and the t-test, respectively. The time and group effects on the means of different radiographic dimensions were tested using the general linear model (GLM). Bland-Altman plots were used to assess the level of agreement between the 2D radiographs and CBCT. The level of significance was defined at 0.05 and a 95% CI. RESULTS The means of PALD and RL showed significant enhancement in the CGF group compared to the PRF group (p< 0.05). While the difference between the two scaffolds in terms of RDT and AFW was not significant (p> .05). The findings of the 2D radiograph and CBCT were consistent. Clinically, both scaffold success rates were similar (93.9%) over the follow-up intervals. The influence of study independent variables had no significant effect on the success of the REPs outcome (p> 0.05). There was no significant difference in the positive pulp responses to the thermal and electric pulp tests after one year of treatment (p> 0.05). CONCLUSIONS According to the short-term follow-up, PRF and CGF were successful in treating immature teeth with periapical radiolucency by regenerative endodontics. Both scaffold systems induced periapical healing and root lengthening with significant superiority of CGF.
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Clinical study on the role of platelet-rich plasma in human acellular dermal matrix with razor autologous skin graft repair of giant congenital pigmented nevus in children
Jin, F., Li, X., Chen, J., Liu, J., Wang, Y.
Journal of plastic, reconstructive & aesthetic surgery : JPRAS. 2024;90:305-314
Abstract
BACKGROUND NA OBJECTIVE Evaluate the safety and feasibility of platelet-rich plasma (PRP) in the treatment of giant congenital melanocytic nevi (GCMN) in children with human acellular dermal matrix (HADM) transplantation. PATIENTS AND METHODS A total of 22 children with GCMN were included in the study. They were divided into an experimental and a control group. The experimental group used the method of HADM with Razor Autologous Skin Graft combined with PRP to repair skin and soft tissue defects after giant nevus resection (Group A, n = 11). The control group was treated with HADM with Razor Autologous Skin Graft (Group B, n = 11) only. To compare the survival rate of skin grafts, we used the Vancouver Scar Scale (VSS) for the postoperative skin graft area and the Patient and Observer Scar Assessment Scale (POSAS) to compare the two groups of patients. RESULTS There was no statistically significant difference in age, gender, location of giant nevi, and pathological classification between Group A and Group (P > 0.05). The survival rate of skin grafting and the VSS and POSAS scores of scar tissue in group A were superior to those of group B (P < 0.05). CONCLUSIONS PRP has improved the survival rate of composite skin grafting in children with GCMN, and long-term satisfactory prognosis of scar healing. Therefore, we consider this treatment method a valuable contribution to clinical practice.
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Does the application of autologous injectable Platelet-Rich Fibrin (i-PRF) affect the patient's daily performance during the retraction of upper canines? A single-centre randomized split-mouth controlled trial
Zeitounlouian, T., Haddad, R., Brad, B., Ballouk, M. A., Fudalej, P.
BMC oral health. 2023;23(1):872
Abstract
BACKGROUND Previous studies have assessed different aspects concerning the applications of i-PRF in the oral cavity. However, nothing is known regarding patients' perceptions of the injection of autologous platelet-rich fibrin (i-PRF). OBJECTIVES To investigate patients' perceptions after injecting platelet-rich fibrin (i-PRF) in the course of retracting upper canines. METHODS Twenty-one patients, whose treatments required extractions of both upper first premolars, were recruited. Extraction side was randomly allocated to the intervention or control sides. After the alignment phase, i-PRF was injected twice with a one-month interval on the buccal and palatal aspects of the extraction sites (intervention side). Patients' perceptions were evaluated with two questionnaires: the first was used to assess the level of pain, discomfort, swelling, eating and swallowing difficulties as well as jaw movement restriction after 1 h (T1), 2 h (T2), 6 h (T3), 24 h (T4) and 48 h (T5) of the second injection; the second questionnaire was used to assess the acceptance of the i-PRF injection and overall satisfaction with this technique at the end of canine retraction phase. Visual Analogue Scale (VAS) was adopted for this purpose. Wilcoxon Signed Rank Test was used to compare between both sides at all time points while Friedman's Test was the selected test for detecting variables' changes over time. Post-hoc Wilcoxon Matched-Pairs Signed-Rank Tests were applied when any of the results were significant. As to the multiplicity of tests, Bonferroni Correction was implemented. RESULTS Pain and swelling levels were significantly higher on the experimental compared to the control sides at T1, T2, and T3 (P < 0.05), whereas they declined sharply and went back to almost normal values at T4 (after 24 h). At T5 they were 0. Discomfort and difficulty in mastication on intervention sides were significant only at T1 and T2. Pain, swelling, and chewing difficulties were significant (P < 0.001) during the 4 assessed time points. The increase was insignificant regarding swallowing difficulties and jaw movement limitations at all time intervals. CONCLUSIONS Injecting autologous (i-PRF) during orthodontic canine retraction is a well-perceived and well-tolerated method due to the limited discomfort which significantly diminishes 24 h afterwards. TRIAL'S REGISTRATION ClinicalTrials.gov (Identifier Number: NCT03399422. 16/01/2018).
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Comparative Evaluation of the Regenerative Potential of Blood Clot and Platelet-rich Fibrin in Young Permanent Teeth Based on the Revised American Academy of Endodontics Clinical Considerations for Regenerative Procedure: 2016
Prakash, A. J., Naik, S. V., Attiguppe, P.
International journal of clinical pediatric dentistry. 2023;16(Suppl 2):149-154
Abstract
AIM: To compare and evaluate the regenerative potential of blood clots and platelet-rich fibrin (PRF) in IYNPT based on the revised American Academy of Endodontics (AAE) clinical considerations for regenerative endodontics 2016. MATERIALS AND METHODS A total of 20 patients (7-12 years) with immature young necrotic permanent teeth were included and irrigation and disinfection were done using the revised AAE protocol. Teeth were randomly categorized into PRF scaffolding and conventional bleeding technique. The cases were followed up for 1, 3, and 6 months for clinical and radiographic evaluation. RESULT At 6 months there was no significant difference between the groups in terms of clinical healing and periapical healing. A significant statistical difference was noted at the end of 6 months with respect to apical closure within the PRF group. A significant difference was seen in the increase in dentin thickness between groups with PRF showing more increase. CONCLUSION The PRF scaffold can be used as it induces the regenerative potential of stem cells at the apex. HOW TO CITE THIS ARTICLE Prakash AJ, Naik SV, Attiguppe P. Comparative Evaluation of the Regenerative Potential of Blood Clot and Platelet-rich Fibrin in Young Permanent Teeth Based on the Revised American Academy of Endodontics Clinical Considerations for Regenerative Procedure: 2016. Int J Clin Pediatr Dent 2023;16(S-2):S149-S154.
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The effectiveness of using platelet-rich concentrate with iliac bone graft in the repair of alveolar cleft: a meta-analysis of randomized controlled trials
Li T, Wang YY, Liu C
International journal of oral and maxillofacial surgery. 2023
Abstract
The purpose of this study was to review the existing evidence from randomized controlled trials (RCTs) on the effect of autogenous bone grafts combined with a platelet-rich concentrate on alveolar clefts. An electronic search was conducted in the PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, Embase, and ClinicalTrials.gov databases for studies published between January 2000 and April 2022. This study included six RCTs to evaluate bone quantity (bone formation ratio, %) and quality (bone density in Hounsfield units, HU), as well as complications as a way to assess the safety of the technique. Two independent reviewers assessed the risk of bias. There was no statistically significant difference in bone formation ratio at 6 months of follow-up between the use of autologous bone alone for alveolar bone grafting or adding platelet-rich plasma (PRP) (mean difference (MD) 14.33%, 95% confidence interval (CI) - 7.19% to 35.85%; P = 0.196) or platelet-rich fibrin (PRF) (MD 9.38%, 95% CI -2.36% to 21.12%; P = 0.123) to autologous bone. The MD for the change in bone density at 6 months was in favour of PRP added to autologous bone graft (MD 155.69 HU, 95% CI 99.29-212.09 HU; P < 0.001); however, this result was based on only two studies, one of which had a high risk of bias. Patients who received autologous bone graft with PRP were significantly less likely to experience complications (odds ratio (OR) 0.21, 95% CI 0.05-0.92; P = 0.038), but this was no longer statistically significant after a sensitivity test (OR 0.24, 95% CI 0.04-1.56; P = 0.138). In conclusion, this systematic review and meta-analysis appears to show no benefit to using a platelet-rich concentrate combined with autologous bone for alveolar cleft grafting in terms of bone volume, bone density, or complications.
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Evaluation of the efficacy of injectable platelet-rich fibrin versus platelet-rich plasma in the regeneration of traumatized necrotic immature maxillary anterior teeth: A randomized clinical trial
Abo-Heikal, M. M., El-Shafei, J. M., Shouman, S. A., Roshdy, N. N.
Dental traumatology : official publication of International Association for Dental Traumatology. 2023
Abstract
BACKGROUND/AIM: This study aimed at comparing the regenerative potential of injectable platelet-rich fibrin (i-PRF) (Group 1) and platelet-rich plasma (Group 2) scaffolds. MATERIALS AND METHODS Twenty-three patients, aged from 9 to 24 years, having 24 immature traumatized necrotic maxillary anterior teeth, were enrolled. Teeth trauma was confirmed by patients' history. Preoperative three-dimensional scans were done. In the first visit, canals were irrigated with 1.5% sodium hypochlorite then medicated with calcium hydroxide. After 2 weeks, patients were randomly assigned into one of the treatment groups (n = 12). The platelet concentrate was applied after centrifuging 10 mL of autologous venous blood with respect to the centrifugation protocol for each platelet concentrate. Patients were recalled at 6 and 12 months posttreatment, during which clinical and radiographic examinations and assessment of pulp sensitivity were done. Three-dimensional scanning was done after 12 months. The increase in root length and decrease in root canal diameters were calculated at three canal levels. Statistical analysis was done using the paired t-test and the independent t-test. The significance level was set at p < .05. RESULTS There was no statistically significant difference between both groups regarding the increase in root length, decrease in coronal and middle canal diameters and the response to the electric pulp tester. Group (1) showed significantly greater decrease in apical canal diameter than Group (2) (p = .008). CONCLUSION I-PRF can be considered as a valid regenerative scaffold for clinical use and with regards to the easier preparation technique, it is more recommended than platelet-rich plasma.
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A randomized trial of the effects of platelet- rich plasma on postoperative complications after meningomyelocele sac repair
Arabacı, Ö, Akyol, M. E., Çelikkaleli, E., Sönmez, B., Çetin, E., Beger, B.
European review for medical and pharmacological sciences. 2023;27(12):5552-5558
Abstract
OBJECTIVE Meningomyelocele is a common congenital neural tube defect. To reduce complications, we need early surgery and a multidisciplinary approach. In this study, we administered platelet-rich plasma (PRP) to babies with meningomyelocele following corrective surgery to minimize cerebrospinal fluid (CSF) leakage and accelerate the healing of the immature pouch tissue. We compared these with a control group that did not receive PRP. PATIENTS AND METHODS Of the 40 babies who had surgery with the diagnosis of meningomyelocele, 20 patients received PRP after surgical repair, and 20 were followed up without PRP. In the PRP group, 10 of the 20 patients underwent primary defect repair, the other 10 underwent flap repair. In the group that did not receive PRP, primary closure was performed in 14 patients and flap closure in six. RESULTS In the PRP group, CSF leakage occurred in one (5%) patient, and none developed meningitis. Partial skin necrosis occurred in three (15%) patients and wound dehiscence in three (15%) patients. In the group that did not receive PRP, CSF leakage occurred in nine (45%) patients, meningitis in seven (35%), partial skin necrosis in 13 (65%), and wound dehiscence in seven (35%) patients. The rate of CSF leakage and skin necrosis in the PRP group was significantly (p<0.05) lower than that in the PRP group. Furthermore, wound closure and healing were also improved in the PRP group. CONCLUSIONS We have shown that PRP treatment of postoperative meningomyelocele infants facilitates healing and lowers the risk of CSF leakage, meningitis, and skin necrosis.
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Pulp Revascularization/Revitalization of Bilateral Upper Necrotic Immature Permanent Central Incisors with Blood Clot vs Platelet-rich Fibrin Scaffolds-A Split-mouth Double-blind Randomized Controlled Trial
Rizk HM, Salah Al-Deen MS, Emam AA
International journal of clinical pediatric dentistry. 2020;13(4):337-343
Abstract
OBJECTIVES Clinical and radiographic evaluation of the regeneration of bilateral necrotic upper permanent central incisors with open apex using blood clot (BC) and platelet-rich fibrin (PRF) scaffolds. TRIAL DESIGN Split-mouth double-blind parallel arm randomized controlled clinical trial. MATERIALS AND METHODS Randomization and blinding: The study started with 15 patients with bilateral necrotic upper permanent central incisors with open apex. Computer-generated tables were used to allocate treatments. The two maxillary central incisors were randomly assigned to either the control (BC scaffold) or the examined (PRF scaffold) groups. Participants: Thirteen patients aged 8-14 years fulfilled the study requirements. Follow-up was performed for 3, 6, 9, and 12 months. Standardized radiographs were collected each 3 months, and difference in measurements was calculated using Image J software. Primary outcomes measured were sinus/fistula formation, pain complaint, mobility grade, and swelling presence/absence. Radiographic: Root length elongation and increase in root thickness. Secondary outcomes were sensibility test and crown color change. Radiographic: Change in bone density and apical diameter. Radiographs that were standardized used during the follow-up time, and occurred changes were calculated using Image J software. RESULTS One patient was lost during follow-up; therefore, 24 treated teeth were analyzed, they showed 100% success rate. Platelet-rich fibrin teeth displayed a statistically significant growth in radiographic root length and width, increased periapical bone density, and a reduction in apical diameter when compared with BC. At the end of the follow-up period, all treated teeth were negative to sensibility test. Blood clot displayed greater crown discoloration in comparison to PRF group. CONCLUSION For teeth with open apex and necrotic pulp, revascularization using PRF is an appropriate substitute to BC. HOW TO CITE THIS ARTICLE Rizk HM, Salah AL-Deen MS, Emam AA. Pulp Revascularization/Revitalization of Bilateral Upper Necrotic Immature Permanent Central Incisors with Blood Clot vs Platelet-rich Fibrin Scaffolds-A Split-mouth Double-blind Randomized Controlled Trial. Int J Clin Pediatr Dent 2020;13(4):337-343.
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Haemostasis and analgesia with autologous platelet-rich plasma in tonsillectomy
Chettri MN, Jayagandhi SK, Konyak Y, Sobita P, Singh MM, Singh AM
The Journal of laryngology and otology. 2019;:1-7
Abstract
OBJECTIVE A single-centre, single-blinded prospective experimental study was conducted to determine the effectiveness of autologous platelet-rich plasma applied to the tonsillar bed post-operatively in reducing post-operative pain and haemorrhage. METHODS Platelet-rich plasma, prepared prior to surgery, was applied with calcium gluconate to one randomly chosen tonsillar fossa. Pain and haemorrhage were analysed, using a visual analogue scale and a pre-defined grading scale respectively, four times on the day of surgery at 2-hourly intervals, and thrice on the following day. RESULTS The pain score and haemorrhage grade on the test side were lower than on the control side. These findings were statistically significant. CONCLUSION This pilot study, conducted in India, revealed valid positive results for a promising new technology. The manual preparation of platelet-rich plasma could be automated in the future to allow a larger sample size.
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Autologous platelet-rich plasma covering urethroplasty versus dartos flap in distal hypospadias repair: A prospective randomized study
Mahmoud AY, Gouda S, Gamaan I, Baky Fahmy MA
International journal of urology : official journal of the Japanese Urological Association. 2019
Abstract
OBJECTIVE To compare the outcome and complication rate of the platelet-rich plasma applied as a coverage layer and dartos flap layer during primary repair of distal hypospadias. METHODS A prospective randomized study was carried out comprising 180 boys (age range 12-65 months) from October 2011 to December 2016 at Al-Azhar University Hospitals, Cairo, Egypt. A single surgeon carried out all urethroplasty. Patients were randomly divided into two groups: group A (tubularized incised plate urethroplasty with platelet-rich plasma coverage layer) and group B (ventral dartos flap). Complication rates were compared between two groups. RESULTS There was a significant difference in the occurrence of complications between the two groups. A total of 36 (20%) complications were recorded in 26 patients, just 12 (13.3%) reported in group A, but 24 (26.7%) complications were reported in group B. Urethrocutaneous fistula was observed in nine patients (10%) in group A, and 12 (13.3%) in group B. Partial glans dehiscence occurred in one patient in group A, and four patients in group B. No patient in group A had a superficial wound infection, compared with six patients in group B. One case of meatal stenosis and urethral stricture was recorded in each group, all of which were managed conservatively. The resultant urinary stream was single and good in 154 patients of both groups. CONCLUSIONS Platelet-rich plasma sheet might be considered as an alternative coverage layer for distal hypospadias repair, especially in the absence of a healthy layer.