Aim
To analyse the regenerative potential of leucocyte‐ and platelet‐rich fibrin (L‐PRF) during periodontal surgery.
Materials and Methods
An electronic and hand search were conducted in three ...databases. Only randomized clinical trials were selected and no follow‐up limitation was applied. Pocket depth (PD), clinical attachment level (CAL), bone fill, keratinized tissue width (KTW), recession reduction and root coverage (%) were considered as outcome. When possible, meta‐analysis was performed.
Results
Twenty‐four articles fulfilled the inclusion and exclusion criteria. Three subgroups were created: intra‐bony defects (IBDs), furcation defects and periodontal plastic surgery. Meta‐analysis was performed in all the subgroups. Significant PD reduction (1.1 ± 0.5 mm, p < 0.001), CAL gain (1.2 ± 0.6 mm, p < 0.001) and bone fill (1.7 ± 0.7 mm, p < 0.001) were found when comparing L‐PRF to open flap debridement (OFD) in IBDs. For furcation defects, significant PD reduction (1.9 ± 1.5 mm, p = 0.01), CAL gain (1.3 ± 0.4 mm, p < 0.001) and bone fill (1.5 ± 0.3 mm, p < 0.001) were reported when comparing L‐PRF to OFD. When L‐PRF was compared to a connective tissue graft, similar outcomes were recorded for PD reduction (0.2 ± 0.3 mm, p > 0.05), CAL gain (0.2 ± 0.5 mm, p > 0.05), KTW (0.3 ± 0.4 mm, p > 0.05) and recession reduction (0.2 ± 0.3 mm, p > 0.05).
Conclusions
L‐PRF enhances periodontal wound healing.
Aim
The objective of this proof‐of‐concept study was to investigate the effects of a new guided bone regeneration technique with a tissue engineering approach.
Materials and Methods
This single ...cohort observational study evaluated the outcome of the leucocyte‐ and platelet‐rich fibrin (L‐PRF) Block for horizontal bone augmentation in the maxilla. The L‐PRF Block is prepared by mixing a particulated biomaterial with chopped L‐PRF membranes at a 50:50 ratio and adding liquid fibrinogen to glue all together. Horizontal augmentation was assessed linearly and volumetrically immediately after surgery and 5–8 months later by matching consecutive cone beam computed tomography (CBCTs).
Results
Ten patients (mean age of 50.7 years ±17.2) representing 15 sites with horizontal alveolar deficiencies were included. Superimposition of pre‐operative and posthealing CBCT scans showed an average linear horizontal bone gain of 4.6 mm (±2.3), 5.3 mm (±1.2) and 4.4 mm (±2.3), measured at 2, 6 and 10 mm from the alveolar crest, respectively. The volumetric gain was 1.05 cm3 (±0.7) on average. The resorption rate after 5–8 months was 15.6% (±6.7) on average.
Conclusions
L‐PRF Block may be a suitable technique to augment deficient alveolar ridges.
Aim
To investigate the influence of the use L‐PRF as a socket filling material and its ridge preservation properties.
Materials and Methods
Twenty‐two patients in need of single bilateral and closely ...symmetrical tooth extractions in the maxilla or mandible were included in a split‐mouth RCT. Treatments were randomly assigned (L‐PRF socket filling versus natural healing). CBCT scans were obtained after tooth extraction and three months. Scans were evaluated by superimposition using the original DICOM data. Mean ridge width differences between timepoints were measured at three levels below the crest on both the buccal and lingual sides (crest −1 mm (primary outcome variable), −3 mm and −5 mm).
Results
Mean vertical height changes at the buccal were −1.5 mm (±1.3) for control sites and 0.5 mm (±2.3) for test sites (p < 0.005). At the buccal side, control sites values were, respectively, −2.1 (±2.5), −0.3 mm (±0.3) (p < 0.005) and −0.1 mm (±0.0), and test sites values were, respectively, −0.6 mm (±2.2) (p < 0.005), −0.1 mm (±0.3) and 0.0 mm (±0.1). Significant differences (p < 0.005) were found for total width reduction between test (−22.84%) and control sites (−51.92%) at 1 mm below crest level. Significant differences were found for socket fill (visible mineralized bone) between test (94.7%) and control sites (63.3%).
Conclusion
The use of L‐PRF as a socket filling material to achieve preservation of horizontal and vertical ridge dimension at three months after tooth extraction is beneficial.
Aim
To analyse the effect of leucocyte‐ and platelet‐rich fibrin (L‐PRF) on bone regeneration procedures and osseointegration.
Materials and Methods
An electronic and hand search was conducted in ...three databases (MEDLINE, EMBASE and Cochrane). Only randomized clinical trials, written in English where L‐PRF was applied in bone regeneration and implant procedures, were selected. No follow‐up restrictions were applied.
Results
A total of 14 articles were included and processed. Three subgroups were created depending on the application: sinus floor elevation (SFE), alveolar ridge preservation and implant therapy. In SFE, for a lateral window as well as for the trans‐alveolar technique, histologically faster bone healing was reported when L‐PRF was added to most common xenografts. L‐PRF alone improved the preservation of the alveolar width, resulting in less buccal bone resorption compared to natural healing. In implant therapy, better implant stability over time and less marginal bone loss were observed when L‐PRF was applied. Meta‐analyses could not be performed due to the heterogeneity of the data.
Conclusions
Despite the lack of strong evidence found in this systematic review, L‐PRF might have a positive effect on bone regeneration and osseointegration.
Objectives
This prospective study analyzed the accuracy of implant placement with mucosa‐supported stereolithographic guides, executed by inexperienced surgeons supervised by an experienced ...colleague.
Material and methods
For the accuracy analysis, 75 OsseoSpeed implants™, placed in 17 fully edentulous jaws (16 patients) using a mucosa‐supported stereolithographic guide (IMPLANT SAFE Guide, DENTSPLY Implants) and the Facilitate™ protocol, were included. DICOM images of the pre‐surgical planning and the post‐surgical CBCT were matched using the Mimics® software (Materialise Dental). These data were compared with the data (12 jaws, 52 implants) of an experienced surgeon (Vercruyssen et al. Journal of Clinical Periodontology 2014; doi:10.1111/jcpe.12231).
Results
The global deviation at the coronal and apical point was 0.9 mm (SD 0.5) and 1.1 mm (SD 0.5), respectively. Depth deviations were 0.5 mm (SD 0.5) and 1.1 mm (SD 0.5), respectively, and the angular deviation was 2.8° (SD 1.5°). These deviations were statistically not inferior to the deviations of the experienced surgeon and also within the range of deviations reported by several systematic reviews.
Conclusion
Within the limitations of this study and for the above‐mentioned surgical protocol, inexperience of the surgeon had no influence on the accuracy of implant placement in fully edentulous jaws, when all steps needed for the procedure are supervised by experienced dentists.
Aim
To evaluate dimensional changes in the alveolar ridge and bone structure after tooth extraction when L‐PRF or A‐PRF+ was used in comparison to unassisted socket healing.
Materials and methods
...Twenty patients in need of at least three tooth extractions in the aesthetic zone were included. L‐PRF, A‐PRF+ or control was randomly assigned, leaving one empty socket/edentulous site between conditions. CBCT scans were obtained immediately after tooth extraction and after 3 months of healing. Horizontal and vertical dimensional changes of the ridge and socket fill were calculated. Histological and micro‐CT analysis of bone biopsies were used to evaluate post‐surgical bone structural healing.
Results
Mean horizontal and vertical changes at 1‐mm below the crest (buccal and palatal side) were similar for the three sites (p > 0.05). For the socket fill, L‐PRF (85.2%) and A‐PRF+ (83.8%) showed superior values than the control (67.9%). The histological and radiological analysis reported more newly formed bone for the PRF groups, without any significant differences between both.
Conclusions
PRF matrices failed to reduce the dimensional changes after multiple tooth extractions in the premaxilla. After 3‐month healing, both PRF matrices showed radiographically a significant superiority for the socket fill. Histologically, they seemed to accelerate new bone formation.
Aim
Alveolar ridge resorption following tooth extraction often renders a lateral bone augmentation inevitable. Some patients, however, suffer from severe early (during graft healing, Eres) and/or ...late (during follow‐up, Lres) graft resorption. We explored the hypothesis that the “individual phenotypic dimensions” may partially explain the degree of such resorptions.
Materials and Methods
Patients who underwent a guided bone regeneration (GBR) procedure were screened for inclusion according to the following criteria: (1) a relatively symmetrical maxillary arch; (2) an intact contra‐lateral alveolar bone dimension; (3) the availability of a pre‐operative cone‐beam CT (CBCT); (4) a CBCT taken immediately after GBR, and (5) at least one CBCT scan ≥6 months after surgery. CBCT scans from different timepoints were registered and imported into the Mimics software (Materialise, Leuven, Belgium). Bone dimensions of the contra‐lateral site of the augmentation, representing the “individual phenotypical dimension (IPD) of the alveolar crest”, were superimposed on the augmented site and registered accordingly. As such, Eres and Lres could be measured over time, in relation to the IPD (in two dimensions; per millimetre apically from the alveolar crest, in the centre of the GBR), as well as in three dimensions (the entire GBR, 2 mm away from the mesial, distal, and apical border for standardization).
Results
A total of 17 patients (23 augmented sites) were included. After Eres, the outline of the augmentation was in general located ±1 mm outside the IPD, but ≥1.5 years after GBR, it further moved towards the IPD (85% within 0.5 mm distance).
Conclusions
Within the limitations of this study, the results indicate that the dimensions of a lateral bone augmentation are defined by the “individual phenotypic bone boundaries” of the patient.
Aim
To investigate the influence of various surgical techniques for sinus augmentation on the volumetric changes of graft, membrane and the post‐operative discomfort.
Materials and Methods
Eighteen ...patients in need of bilateral sinus floor elevation (SFE) were assigned to lateral SFE, transcrestal SFE and intralift procedures. CBCT images taken at baseline, 1 week and 6 weeks were analysed for volumetric changes in graft and Schneiderian membrane. Questionnaires were used to analyse post‐op discomfort.
Results
The overall average graft volume obtained after 1 week was 1.87 cm3 (range 0.12–4.72 cm3). Volumes decreased after 6 weeks to an overall mean volume of 1.33 cm3 (range 0.10–4.29 cm3 – average decrease of 27.6%). After 6 weeks, the amount of graft volume decreased in every treatment option, ranging from −23.13% for the tSFE, over −24.55% for the lSFE, to −33.71% for the IL. Although all treatment options correspond in an increase in Schneiderian membrane volume, no statistically significant correlation between this increase and loss of graft volume could be obtained for all treatments (p = 0.97).
Conclusion
All SFE techniques provided sufficient graft volume for implant treatment. All techniques provoke a partially transient swelling of the Schneiderian membrane. All techniques resulted in a decrease in graft volume after 6 weeks; however, no significant differences were obtained between treatments. Furthermore, no statistical significant correlation between the post‐operative swelling of the Schneiderian membrane and reduction in graft volume at 6 weeks could be obtained.
The leukocyte- and platelet-rich fibrin block (L-PRF block) is a composite graft that combines a xenograft that is acting as a scaffold with L-PRF membranes that serve as a bioactive nodule with ...osteoinductive capacity. This study evaluated the properties of the L-PRF block and its components in terms of release of growth factors, cellular content, and structure.
The concentration of transforming growth factor-β1 (TGF-β1), vascular endothelial growth factor (VEGF), platelet-derived growth factor-AB (PDGF-AB) and bone morphogenetic protein-1 (BMP-1) released by a L-PRF membrane (mb) and a L-PRF block were examined with ELISA for five time intervals (0 to 4 hours, 4 hours to 1 day, 1 to 3 days, 3 to 7 days, 7 to 14 days). Those levels in L-PRF exudate and liquid fibrinogen were also evaluated. The cellular content of the liquid fibrinogen, L-PRF membrane and exudate was calculated. The L-PRF block was also analyzed by means of a microCT scan and scanning electron microscopy (SEM).
TGF-β1 was the most released growth factor after 14 days, followed by PDGF-AB, VEGF, and BMP-1. All L-PRF blocks constantly released the four growth factors up to 14 days. L-PRF membrane and liquid fibrinogen presented high concentration of leukocytes and platelets. The microCT and SEM images revealed the bone substitute particles surrounded by platelets and leukocytes, embedded in a dens fibrin network.
The L-PRF block consists of deproteinized bovine bone mineral particles surrounded by platelets and leukocytes, embedded in a fibrin network that releases growth factors up to 14 days.
Objective
To compare a pre-operatively, chair-side made, zinc-containing surgical stent (ZN) and suturing of a gelatin-based hemostatic agent (HA) on palatal wound healing and patient morbidity after ...free gingival graft surgery (FGG).
Materials and methods
Sixty patients requiring FGG were randomly divided into two groups to receive either a ZN or a sterile HA sutured on the surgical area. Patients were evaluated at 1st, 3rd, 7th, 14th, 28th, and 56th days following surgery. Overall surgical time, donor site surgical time, postoperative pain (PP), delayed bleeding (DB), changes in dietary habits (DH), burning sensation (BS), completion of re-epithelialization (CE), and patients’ discomfort (PD) were evaluated.
Results
Donor site surgical time, PP, DB, DH, BS were statistically significantly lower in the ZN group together with faster completion of re-epithelialization compared to the HA group.
Conclusion
Pre-operatively, chair-side made, zinc-containing surgical stents provided significant benefits for wound healing parameters and patients’ postoperative morbidity after FGG harvesting.
Clinical relevance
The results show that using Zn-containing palatal stent after free gingival graft surgery significantly reduces pain and patient morbidity during the postoperative period.
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