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Abstract

The extraction of mesioangular impacted third molars may cause multiple periodontal defects at the distal root of the second molar. Platelet-rich plasma (PRP) is a material containing many autologous growth factors that may be used in repairing and preventing periodontal complications at the distal root of the second molar adjacent to the extracted third molar. We analyzed the effects of autologous PRP on periodontal tissues after extraction of the third molar in 18 young patients (age, 21-26 years). Inclusion criteria were the presence of a pocket distal to the mandibular second molar with a probing depth>or=7.5 mm and a probing attachment level>or=6 mm. We observed, at 12 weeks after surgery, a notable reduction in the probing depth and an improvement in the probing attachment level in those cases treated with PRP compared with the controls, as well as formation of new bone tissue in the bone defect. We showed that PRP is effective in inducing and accelerating bone regeneration for the treatment of periodontal defects at the distal root of the mandibular second molar after surgical extraction of a mesioangular, deeply impacted mandibular third molar.

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... [21] There are several reports which support the positive role of PRP in the healing of the extraction socket. [21][22][23][24][25] For example, Alissa et al. studied the effect of PRP on the healing of extraction socket in terms of pain level, analgesic consumption, oral function (such as the ability to eat food, and swallowing), patient satisfaction, soft and hard tissue healing, and other factors. They used the Landry scale for the assessment of the healing rate and demonstrated that PRP caused an improved healing of the soft tissue of the extraction sockets. ...
... [23] Lindeboom et al. [26] have shown that PRP has a strong stimulatory effect on wound healing and capillary regeneration, especially during the first 7 days after the surgery. [25] These findings are proved by the investigations of Pierce [27] and Pierce and Mustoe. [28] Monica Caceres also reported that PRP causes several cell responses that have a potential role in wound healing. ...
... Several studies claimed that PRP could increase the thickness of the repaired tissue. [25,26] The results of the current study revealed an insignificant difference between the study groups in this regard. Huang et al. ...
Article
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Objective It has been proved that platelet-rich plasma (PRP) can promote wound healing. In this way, PRP can be advantageous in periodontal plastic surgeries, free gingival graft (FGG) being one such surgery. Materials and Methods In this randomized split-mouth controlled trial, 10 patients who needed bilateral FGG were selected, and two donor sites were randomly assigned to experience either natural healing or healing-assisted with PRP. The outcome was assessed based on the comparison of the extent of wound closure, Manchester scale, Landry healing scale, visual analog scale, and tissue thickness between the study groups at different time intervals. Statistical Analysis Used Repeated measurements of analysis of variance and paired t-test were used. Statistical significance was P ≤ 0.05. Results Significant differences between the study groups and also across different time intervals were seen in all parameters except for the changes in tissue thickness. Conclusion PRP accelerates the healing process of wounds and reduces the healing time.
... PRF is biocompatible, effective, and safe because it is derived from the patient's own blood 16 . Recent reports suggested rapid epithelization and faster bone regeneration with PRF [17][18][19][20][21][22][23][24] . A few reports have noted the use of PRF in the extraction socket showing better healing and reduced incidence of dry socket or prevention of dry socket incidence 18,19,21 . ...
... Recent reports suggested rapid epithelization and faster bone regeneration with PRF [17][18][19][20][21][22][23][24] . A few reports have noted the use of PRF in the extraction socket showing better healing and reduced incidence of dry socket or prevention of dry socket incidence 18,19,21 . Our study showed effective pain reduction with patients showing reduced intake of analgesic within 24 hours. ...
... We were able to appreciate wound closure by the seventh day without any pain or infection. PRF is a potential novel treatment modality for dry socket 13,[20][21][22][23][24] , and the PRF mixture has shown to be a good scaffold for bone regeneration in rats 25 . ...
Article
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Objectives Dry socket may occur secondary to the removal of any tooth. However, most dry socket cases develop in the third molar region. Dry socket is multifactorial in nature and has been treated using various modalities with varying success rates. This study assessed the efficacy of platelet rich fibrin (PRF) in established dry socket. Materials and Methods Ten patients of either sex aged from 41 to 64 years with established dry socket according to established criteria were treated using PRF. Evaluation was performed by observing the reduction of pain using visual analogue scale, analgesic tablet use over the follow-up period, and healing parameters. Results Pain was reduced on the first day in all patients with decreased analgesic use. Pain was drastically reduced during follow-up on the first, second, third, and seventh days with a fall in pain score of 0 to 1 after the first day alone. The pain scores of all patients decreased to 1 by the first day except in one patient, and the scores decreased to 0 in all patients after 48 hours. Total analgesic intake ranged from 2 to 6 tablets (aceclofenac 100 mg per tablet) over the follow-up period of 7 days. Healing was satisfactory in all patients by the end of the seventh day. Conclusion PRF showed early pain reduction in established dry socket with minimal analgesic intake. No patients had allergic reactions to PRF as it is derived from the patient's own blood. PRF showed good wound healing. Our study suggests that PRF should be considered as a treatment modality for established dry socket.
... 3,4,10 Bone grafts and other osteo-regenerative materials have consistently found use in repairing the empty sockets created in the aftermath of traditional extractions. 18,19,[21][22][23] Their use in complete third molar removal has been linked to marked decreases in the second molar distal pocket depths and at least somewhat of an improvement in the attachment levels. 18,19,[21][22][23] Improvements in at least 1 of these categories indicate improved periodontal health and the structural stability of the second molar. ...
... 18,19,[21][22][23] Their use in complete third molar removal has been linked to marked decreases in the second molar distal pocket depths and at least somewhat of an improvement in the attachment levels. 18,19,[21][22][23] Improvements in at least 1 of these categories indicate improved periodontal health and the structural stability of the second molar. Because extraction and coronectomy share broad postoperative similarities, it was plausible that bone grafting also could increase post-coronectomy bone levels especially on the distal portion of the adjacent second molar. ...
Article
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Purpose: To report the long-term outcomes of 78 adult patients who underwent coronectomy with bone grafting (CWG) of the bony crypt. Materials and methods: Seventy-eight patients with follow-up of at least 5 to 9 years underwent CWG. Preoperative imaging and probing depths were recorded, as were yearly follow-up radiographs or cone-beam computed tomograms and yearly postoperative probing depths. Results: Periodontal probing depths and bone levels on the distal surfaces of adjacent mandibular molars showed marked improvement compared with preoperative probing depths and bone levels. All retained roots maintained their immediate postoperative positions with no migrations and no reoperations required. Conclusion: CWG is a predictable procedure that should be considered for patients at risk for developing sensory disturbances or for those with deeper (>4 mm) preoperative probing depths on the distal surfaces of the adjacent molars. Adding bone graft appears to aid in preventing root migration and decreasing probing depths on the distal surfaces of adjacent molars.
... 20,21 However, most longitudinal studies have found conflicting results, suggesting that the aforementioned conclusions may be because of lack of well-designed clinical studies. 22 Other studies have reported on the spontaneous periodontal healing of M2 distal defects, indicating the potential therapeutic benefit of extracting M3 18,19,[22][23][24][25] : leaving impacted M3 in placed may allow for M2 rooth resorption, distal caries, pericoronitis, dysodontiasis, and recurrent abscesses, all of which can contribute to M2 periodontal impairment. 6,8 Nevertheless, current scientific literature calls for further clinical standardized research to identify potential periodontal factors that may influence healing outcomes. ...
... Because some reports highlighted the possibility that age could influence socket healing, age was studied as a predictor of healing not only in a linear way (see above) but also was used as a variable to divide the studied sample in two. [22][23][24][25][26][27][28][30][31][32] The study sample was divided into two age groups: younger than 25, and older than 25, following Kugelberg et al. 20 than 20 years old and older than 30 have different periodontal healing potential. Sample size was calculated to be 64 according to the sample for proportion formula, estimating that at least 20% of subjects with a PPD equal or greater than 4 mm would have a PPD, 6 months after surgery, lower than 4mm, with a precision level setting at 0.07. ...
Article
Background : The periodontal health distal of second molars (M2) is often compromised due to third molar (M3) impactions. The aim of this study was to evaluate healing and periodontal status of mandibular M2 after M3 surgical extraction. Methods : Eighty‐nine consecutive patients with 89 asymptomatic M3 who needed surgical extraction of one fully‐ or semi‐impacted M3 entered this study. Clinical measurements, probing pocket depth (PPD), clinical attachment level (CAL), plaque index (PI), gingival index (GI) and bleeding on probing (BOP), were compared for M2 at baseline (T0) and six‐months (T1) post‐surgical extraction. Multiple logistic regression analysis assessed different risk factors for post‐operative changes of periodontal parameters. Results : Six‐month M2 PPD improved at disto‐vestibular (T0‐5.2/T1‐3.0mm) and disto‐lingual (T0‐5.4/T1‐3.2mm) sites. The average attachment gains at T1 were 1.9mm and 2mm, respectively (p < 0.05). BOP, PI and GI showed significant clinical improvements after extractions. Fifty‐three out of 72 (73.6%) M2 presenting a PPD ≥ 4mm at baseline healed at six months recall without periodontal pockets. Older age (mean 55 years, SD 16.7; range 26–81) and mean distal PPD at baseline of 7mm was more likely to be associated with PPD≥4mm six months post‐extraction (p < 0.05). Past history of periodontitis patients were 41 times more likely to present PPD≥4mm after healing (OR = 41.4; 95%CI = 10.9‐156.5, p < 0.05). Conclusion Mandibular M3 extractions seem to improve overall periodontal health distal of M2 History of periodontitis, preoperative deep pockets and older age are independent risk factors for poorer healing and residual pockets after M3 surgical extraction. This article is protected by copyright. All rights reserved
... Evidencing hemostatic and healing properties, PRP is able to hold tissues or materials in a required configuration 19 . PRP has been used in humans in different kinds of transplant procedures such as dentistry, maxillofacial surgery, and ophthalmology [20][21][22][23] . In addition, PRP may be considered as a carrier for biologically active agents and a healing substance causing less post-surgical pain 24,25 . ...
... Acta Cir Bras. 2017;32(1):[22][23][24][25][26][27] ...
Article
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Purpose: To assess the effectiveness of heparin, platelet-rich plasma (PRP), and silver nanoparticles on prevention of postoperative adhesion in animal models. Methods: Sixty males Albino Wistar rats aged 5 to 6 weeks were classified into five groups receiving none, heparin, PRP, silver nanoparticles, PRP plus silver nanoparticles intraperitoneally. After 2 weeks, the animals underwent laparotomy and the damaged site was assessed for peritoneal adhesions severity. Results: The mean severity scores were 2.5 ± 0.9, 2.16 ± 0.7, 1.5 ± 0.5, 2.66 ± 0.88, and 2.25 ± 0.62 in the control, heparin, PRP, silver and PRP plus silver groups, respectively with significant intergroup difference (p = 0.004). The highest effective material for preventing adhesion formation was PRP followed by heparin and PRP plus silver. Moreover, compared to the controls, only use of PRP was significantly effective, in terms of adhesion severity (p = 0.01) . Conclusion: Platelet-rich plasma alone may have the highest efficacy for preventing postoperative peritoneal adhesions in comparison with heparin, silver nanoparticles and PRP plus silver nanoparticles.
... [21,22] Nevertheless, Sammartino et al. postulated that the combination of PRP with Bio-Gide membrane is beneficial in healing bone defects of extracted third molar sites compared to the other control groups. [23] According to the available literature so far, there is no quite similar previous research to ours. Many combinations of PRP, autogenous platelet concentrate, beta-tricalcium phosphate and GTR are reported with contrasting results. ...
... [18] Similar to Sharma and Pradeep and on the contrary to Anitua and Sammartino et al., a definite role and conclusive results could not asserted based on our findings. [12,[23][24][25] These may be due to some reasons: • Previously, Weibrich and Kleis pointed out that not all available machines provide acceptable performance. [26] We used a single-spin device. ...
Article
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Background: The treatment of furcation area defects remained as a challenging issue in periodontal treatments. Regeneration treatment of furcation defects is the most discussed periodontal treatment. Although not completely hopeless in prognosis, the presence of the furcation involvement significantly increases the chance of tooth loss. The current research was conductedeto compare theeadditive effect of combined guided tissue regeneration (GTR) and platelet-rich growth factor (PRGF) on the treatment of furcation bony defects. Materials and Methods: A randomized, triple-blinded, split-mouth study was designed. It included patients with a moderate to severe chronic periodontitis with bilateral Grade II furcation involvement of first or second mandibular molars. Each side of mouth was randomly allocated for the treatment with either Bio-Gide American Society of Anesthesiologists GTR or a PRGF or PRGF by itself. Plaque index, gingival index, vertical clinical attachment level, vertical probing depth, recession depth (REC), horizontal probing depth, fornix to alveolar crest (FAC), fornix to base of defect (FBD), furcation vertical component and furcation horizontal component (FHC) were recorded. The current research was conducted to compare the additive effect of combined GTR and PRGF on treatment of furcation bony defects. Altman's nomogram, Kolmogorov–Smirnov test, Friedman test, general linear model, repeated measures, and paired t-test were used as statistical analysis in this research. P < 0.05 was considered statistically significant. Results: Eight patients were finally enrolled for this study. Overly, general and specific clinical and furcation parameters were improved except REC that was deteriorated insignificantly and FAC improved not significantly. Intergroup comparison revealed better improvement of FHC in GTR/PRGF group (P = 0.02). Conclusion: A significant improvement in the Grade II furcation defects treated with either GTR or PRGF/GTR was noticed. Further large-scale trials are needed to reveal differences of mentioned treatment in more details.
... PRP has been used to induce and accelerate bone regeneration in the treatment of periodontal defects at the distal root of the mandibular second molar after the surgical extraction of a mesioangular impacted mandibular third molar. A notable reduction in the probing depth and an improvement in the probing attachment level have been found [41]. ...
... Main articles included in the literature review. PRP was not beneficial in accelerating osseointegrationBroggini N. et al., 2011 [34] Histological study PRP did not lead to greater bone remodeling Torres J. et al., 2008[35] Morphometric study PRP was not beneficial in osseous regeneration Simonpieri et al, 2009[36] Clinical study PRF was helpful for periosteum healing and maturation Sammartino et al., 2005[41] Clinical study PRP was effective in accelerating bone regenerationThorat M. et al., 2011 [42] Clinical study PRF improved intra-bony defect fillSommeling et al., 2013 [48] Systematicreview PRP enhanced bone graft regeneration Picard F. et al., 2015 [5] Literature Review PRP may be beneficial in diabetic chronic wounds Knighton D.R. et al., 1986 ...
Article
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Non-transfusional hemocomponents for surgical use are autogenous products prepared through the centrifugation of a blood sample from a patient. Their potential beneficial outcomes include hard and soft tissue regeneration, local hemostasis, and the acceleration of wound healing. Therefore, they are suitable for application in different medical fields as therapeutic options and in surgical practices that require tissue regeneration.
... By the end of 6 months blending of margins, trabecular bone formation is seen in all the 30 cases. These results are correlated with studies done by Praveen Reddy B (2010) 6 11 . Whereas in 4 cases, trabecular bone that is formed at 6 th month was not complete and there was a radiolucent area in the radiograph at the center of the lesion which was similar to the finding of Lacoste et al (2003) 12 who suggested that the main reason for the inferior effect of PRP on bone regeneration is that high concentration of thrombin used in clinical practices caused fast release of mitogens. ...
... with improved bone quality and better patient-related outcomes (Ogundipe et al., 2011, Alissa et al., 2010, Celio-Mariano et al., 2012, Vivek and Sripathi Rao, 2009, Dutta et al., 2015, Gawande and Halli, 2009, Rutkowski et al., 2010, Antonello Gde et al., 2013 (Appendix 3). In particular, several studies reported significantly reduced pain scores and enhanced soft tissue healing up to 14 days postextraction (Ogundipe et al., 2011, Vivek and Sripathi Rao, 2009, Dutta et al., 2015 and that PRP placed in third molars' extractions sockets positively influenced periodontal parameters on second molars (Sammartino et al., 2005). ...
Article
Aim This review critically appraises the available knowledge on the pre‐clinical and clinical use of bioactive factors for bone regeneration in the cranial and maxillo‐facial area. Materials and Methods The use of growth factors, amelogenins and autologous platelet concentrates (APCs) for bone regeneration was reviewed in a systematic manner. More specifically, preclinical and clinical studies on ridge preservation, alveolar ridge augmentation, regeneration of peri‐implant defects and sinus augmentation models were considered. Results Amongst different bioactive factors, the highest pre‐clinical and clinical evidence of a positive effect on bone formation is associated with BMP‐2 and the lowest with amelogenins. While APCs seem to accelerate clinical healing and reduce postoperative discomfort, there is insufficient and contrasting evidence of a significant effect on hard tissue regeneration for the different clinical applications. Conclusions Although there is increasing evidence that bioactive factors might enhance the bone regeneration process, the great heterogeneity of the available studies and the limited number of RCTs do not allow to draw robust conclusions. Issues that still need to be investigated include the optimal carriers for bioactive agents (direct vs. indirect), the dosage, the timing of administration, as well as the possibility of combining different agents to promote synergistic effects. This article is protected by copyright. All rights reserved.
... PRP extracted from autologous whole blood contains a wide range of autologous growth factors, namely PDGF, TGF-β, IGF-1, VEGF, and bFGF. It is beneficial for tissue healing and is being broadly used in oral and maxillofacial surgery [192,193]. With this in mind, Zhang et al. [194] studied the effect of clotting natural porous coral disks with PRP on the bone formation of marrow stromal cells (MSCs). ...
Article
Full-text available
Bone is a vascularized and connective tissue. The cortical bone is the main part responsible for the support and protection of the remaining systems and organs of the body. The trabecular spongy bone serves as the storage of ions and bone marrow. As a dynamic tissue, bone is in a constant remodelling process to adapt to the mechanical demands and to repair small lesions that may occur. Nevertheless, due to the increased incidence of bone disorders, the need for bone grafts has been growing over the past decades and the development of an ideal bone graft with optimal properties remains a clinical challenge. This review addresses the bone properties (morphology, composition, and their repair and regeneration capacity) and puts the focus on the potential strategies for developing bone repair and regeneration materials. It describes the requirements for designing a suitable scaffold material, types of materials (polymers, ceramics, and composites), and techniques to obtain the porous structures (additive manufacturing techniques like robocasting or derived from marine skeletons) for bone tissue engineering applications. Overall, the main objective of this review is to gather the knowledge on the materials and methods used for the production of scaffolds for bone tissue engineering and to highlight the potential of natural porous structures such as marine skeletons as promising alternative bone graft substitute materials without any further mineralogical changes, or after partial or total transformation into calcium phosphate.
... PRP extracted from autologous whole blood contains a wide range of autologous growth factors, namely PDGF, TGF-, IGF-1, VEGF and bFGF. It is beneficial for tissue healing and is being broadly used in oral and maxillofacial surgery [177,178]. With this in mind, Zhang et al. [179] studied the effect of clotting natural porous coral disks with PRP on the bone formation of marrow stromal cells (MSCs). ...
Preprint
Full-text available
Bone is a dynamic tissue with the capacity of repair and regeneration in specific conditions. Nevertheless, due to the increased incidence of bone disorders, the need of bone grafts has been growing over the past decades and the development of an ideal bone graft with optimal properties remains a clinical challenge. This review addresses the bone properties (morphology, composition and their repair and regeneration capacity) and puts the main focus on the potential strategies for developing bone repair and regeneration materials. It describes the requirements for designing a suitable scaffold material, types of materials (polymers, ceramics and composites) and techniques to obtain the porous structures (additive manufacturing techniques/robocasting or derived from marine skeletons) for bone tissue engineering applications. The main objective of this review is to gather the knowledge on the materials and methods for the production of scaffolds for bone tissue engineering and highlighting the potential of natural porous structures such as marine skeletons as promising alternative bone graft substitute materials without any further mineralogical changes, or after partial or total transformation into calcium phosphate. The suitability of the marine-derived porous bone graft substitutes for the intended applications will be also discussed.
... However, the authors evidenced that the results in question needed to be interpreted with caution because they were supported by limited amount of evidence which was also poor quality [1,13]. PRP topical application was suggested as a valid technique for promoting bone regeneration on the distal surface of the mandibular second molar [100][101][102][103][104][105]. The literature is controversial about this clinical opportunity, but considered the PC socket application able to control postextraction bleeding, pain and swelling [106,107]. ...
Article
Background Platelet concentrates (PC) are blood-derived products for local application able to stimulate regeneration in soft and hard tissues, mimicking the physiological healing process. Their efficacy in oral surgical procedures is controversial and limited. Objective The study aims to critically analyze the available evidence for the effect of autogenous PC on wound healing of different oral surgical sites reported by more recent clinical studies. Methods Electronic and manual searches in three databases (Medline, Web of Science, Scopus) were performed to identify the clinical studies from January 2017 to December 2017 which reported the actual oral surgical indications and the benefit of local application of PC. All human studies evaluating PRP or PRF in a randomized controlled trial, case series, case report and systematic review were included. All animal, histologic and in vitro studies were excluded. Results Fifty-two studies were selected. The use of PRF was proposed in treating many oral surgical sites. Data availability with regard to the effect of PRF on new bone formation in GBR and horizontal/ vertical bone augmentation procedures varied from abundant to absent. Positive results concerning the effect of PRF on potential post-surgical complication (pain, swelling and trismus) were reported. Conclusion Few clinical indications could be determined: the literature on the topic was contradictory and the published data were difficult to interpret. Positive results were generally recorded for soft tissues and periodontal wound healing. No real benefit of PC application on bone regeneration was evidenced.
... Several studies have shown that growth factors can positively affect cell proliferation, cell differentiation, chemotaxis and intracellular matrix synthesis (Debiais et al. 1998;Strayhorn et al. 1999;Jiang et al. 1999;Villars et al. 2000;Lee et al. 2001;Choi et al. 2002). All these processes are involved in wound healing and tissue regeneration; thus, PRP as a source of growth factors can be used in periodontal regenerative therapies (Marx 2004;Okuda et al. 2005;Sammartino et al. 2005). ...
Article
Full-text available
In the original publication of this article, the affiliation of the corresponding author has been published incorrectly. Now the correct affiliation has been provided in this erratum.
... Our group 18 has shown in a pilot study that guided bone regeneration using a bovine bone substitute and a resorbable collagen membrane placed at the site of coronectomy could reduce root migration and periodontal probing depth at the distal aspect of the second molar. Other groups have also reported a reduction in probing depth at the distal surface of the adjacent second molars 4 months after total third molar removal with platelet-rich plasma gel inserted into the socket 19 or 1 year after third molar coronectomy with grafting of the socket. 20 Thus, the modified coronectomy technique might reduce the incidence of third molar root remnant exposure and also the risk for periodontal complications at the distal aspect of the second mandibular molars. ...
Article
This prospective study in patients with a follow-up of 4-8.5years aimed to describe the long-term, three-dimensional changes of coronectomized lower third molar roots. Pre- and postoperative cone beam computed tomography (CBCT) scans were compared. The distance of root migration, the direction of root translation and rotation, and the amount of bone regeneration at the adjacent second molar and superficially to the third molar root were recorded. Age, gender, time elapsed following surgery, the status of the retained root including, impaction pattern and depth of impaction were tested to check if they were influencing factors for the above outcomes. A total of 57 coronectomized third molars from 44 patients were included. The distance of the mean root migration was 2.82mm, and they predominantly translated mesially (76.8%). Age negatively correlated with the distance of migration. Root remnants with a soft tissue coverage had less bone regenerated at the adjacent second molar (1.27mm vs. 2.95mm) in comparison to their impacted counterparts. Based on the present radiographic results and the absence of any pathological findings, coronectomy can be recommended for selected cases of third molar removal as a safe procedure with favourable long-term outcomes.
... 18 PRP is used as a complement to specialised tissue-regeneration procedures, including oral and maxillofacial surgery, orthopaedics and plastic surgery. [19][20][21][22] In any eyedrop-intensive treatment regimen, the safety and efficacy of the eye-drops must be maintained during storage. As AS and PRP eye-drops do not ...
Article
Background/aims This study aimed to assess the efficacy and sterility of stored platelet-rich plasma (PRP) eye-drops for corneal epithelial wound healing compared with those of autologous serum (AS) eye-drops. Methods At our single institution, PRP and AS eye-drops were prepared using peripheral blood obtained from six healthy volunteers and stored at 4°C. Platelet and leucocyte counts and transforming growth factor (TGF)-β1, epidermal growth factor (EGF), and fibronectin levels were assessed during storage for up to 4 weeks. Sterility was assessed by culturing 4-week poststorage samples. PRP, AS, and phosphate-buffered saline (PBS) eye-drop efficacies were compared using corneal epithelial wound healing assays in vitro and in vivo and monitoring wound areas under a microscope every 3 hours. Results Higher platelet and lower leucocyte counts were seen in PRP than in whole blood on the day of preparation. After storage, TGF-β1, EGF, and fibronectin levels were significantly higher in PRP than in AS eye-drops. In vitro and in vivo , PRP eye-drops used on the day of preparation significantly promoted corneal epithelial wound healing compared with PBS. Moreover, PRP eye-drops stored for 4 weeks significantly promoted corneal wound healing compared with PBS and AS eye-drops. Conclusion PRP eye-drops stored at 4°C for 4 weeks promoted corneal epithelial wound healing with higher levels of growth factors than those observed in AS eye-drops, while maintaining sterility, suggesting that this preparation satisfies the unmet medical needs in the treatment of refractory keratoconjunctival epithelial disorders.
... The value of the periodontal pocket depth in the control group was significantly larger when compared to the test group. This result is supported by a study conducted by Sammartino et al. [21] where notable reduction in probing depth was observed at 12 and 18 weeks in those extraction cases treated with PRP compared to controls where PRP was not used. ...
Article
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Aim and Objective The aim of this study is to compare the efficacy of autologous platelet-rich plasma (PRP) in the third molar impactions, with respect to: pain, swelling, healing, and periodontal status distal to the second molar in patients who need surgical removal of bilateral impacted mandibular third molars. Materials and Methods Twenty-five patients of both sexes aged between 16 and 60 years who required bilateral surgical removal of their impacted third molars and met the inclusion criteria were included in the study. After surgical extraction of the third molar, primary closure was performed in the control group, whereas PRP was placed in the socket followed by primary closure in the case group. The outcome variables were pain, swelling, wound healing, and periodontal probe depth that were follow-up period of 2 months. Quantitative data are presented as mean. Statistical significance was checked by t-test. Results There was a difference in the pain (0.071) and facial swelling (0.184), reduction between test and control on day 3, but it was not found to be significant. Periodontal pocket depth (0.001) and wound healing (0.001) less in case group compared with the control group was found to be significant. Conclusion The use of PRP lessens the severity of immediate postoperative sequelae and decreases preoperative pocket depth.
... Several studies have shown that growth factors can positively affect cell proliferation, cell differentiation, chemotaxis and intracellular matrix synthesis (Debiais et al. 1998;Strayhorn et al. 1999;Jiang et al. 1999;Villars et al. 2000;Lee et al. 2001;Choi et al. 2002). All these processes are involved in wound healing and tissue regeneration; thus, PRP as a source of growth factors can be used in periodontal regenerative therapies (Marx 2004;Okuda et al. 2005;Sammartino et al. 2005). ...
Article
Full-text available
Platelet-rich plasma (PRP) contains growth factors which positively affect cell proliferation, cell differentiation, chemotaxis and intracellular matrix synthesis. All these processes are involved in wound healing and tissue regeneration; thus, PRP as a source of growth factors can be used in periodontal regenerative therapies. The purpose of the present study was to assess the effect of various concentrations of activated and non-activated PRP on proliferation of osteoblasts and fibroblasts in vitro. PRP was obtained from three healthy volunteers. 75, 50, 25, and 10% concentrations of f PRP were prepared by dilution in Dulbecco’s modified Eagle’s medium. In activated PRP groups, PRP concentrations were activated by adding calcium gluconate. Human gingival fibroblast (HGF) cell line and MG-63 (osteosarcoma) human osteoblast-like cell line were used in the study. The MTT proliferation assay was used to assess the effect of different types of PRP concentrates on proliferation of HGF and MG-63 cells, in 24, 48 and 72 h. After 24, 48, and 72 h, the proliferation rate of both cell lines was higher in the positive control group, except in 72 h in HGF cell lines, that 10% non-activated PRP group and 10 and 25% activated PRP groups has higher proliferation rate than the positive control group, which it was not significant. Proliferation rate in cells with 10% activated PRP was highest among samples containing PRP. The current study failed to show the significant effect of activated or non-activated PRP on proliferation of HGFs or MG-63 osteoblast-like cells. However, our results showed that activated PRP had a greater effect than non-activated PRP.
... Studies by ANITUA 28 and SAMMARTINO et al., 29 on the bone healing of extraction sockets treated with PRP only reported that there are no definitive conclusions about the biologic effect of PRP when it is used alone. ...
... Studies by ANITUA 28 and SAMMARTINO et al., 29 on the bone healing of extraction sockets treated with PRP only reported that there are no definitive conclusions about the biologic effect of PRP when it is used alone. ...
... In recent years, intraarticular injections of MSCs [13], PRP [14], or the combination of MSCs and PRP [15] has been investigated for the treatment of OA and other bone injuries. Positive results demonstrate the safety and efficacy of PRP application in general surgeries, oral and maxillofacial surgeries, plastic surgeries and soft tissue healing in tendons, ligaments and muscles have been reported [2,3,16]. On the other hand, no beneficial efficacies of PRP treatment were reported in the healing of human Achilles tendinopathy [17], human Achilles tendons [18], or for canine bone formation [19]. ...
Article
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Background Reported efficacy of platelet-rich plasma (PRP) in regenerative medicine is contradictory. We validated the effects of PRP on proliferation of canine bone marrow-derived multipotent mesenchymal stromal cells (K9BMMSCs) in vitro. PRP was extracted from blood of six dogs with osteoarthritis. K9BMMSCs were established from bone marrow and characterized for CD90 and CD19 expression by immunocytochemistry. Effects of PRP concentrations on viability of matching autologous K9BMMSCs were validated using MTS assay. Results Positive CD90 and negative CD19 expression confirmed MSC origin. PRP at 40% volume/volume concentration increased, while PRP at 80 and 100% v/v concentrations suppressed viability of tested K9BMMSCs. Conclusion PRP concentration plays an important role in K9BMMSCs viability, which could affect tissue repairs in vivo.
... Studies by Sammartino et al. 12 and Célio-Mariano et al. 13 support the use of PRP in third molar surgery. Randomized clinical trials conducted by Célio-Mariano et al. 13 , Alissa et al. 14 , and Antonello et al. 15 show that bone regeneration in extraction sockets saw statistically significant enhancement when PRP was used. ...
Article
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Objectives: This study examined the effects of plasma-rich growth factors (PRGF) on accelerating bone regeneration/repair in fresh extraction sockets, and determined the quality and quantity of bone by assessing the bone density using cone-beam computed tomography (CBCT). Materials and methods: Twenty patients, who had undergone bilateral extractions, were included in this study. In one extraction socket, PRGF was used and covered with an autologous fibrin plug. Nothing was used in the opposite side extraction socket. Thirteen weeks post extraction, the level of bone regeneration was evaluated on both sides with CBCT. Results: At the end of the study, the mean bone density according to the Hounsfield units (HU) in the control group and PRGF group was 500.05 HU (type III bone type) and 647.95 HU (type II bone type), respectively. Conclusion: This study recommends the use of PRGF in post extraction sites to accelerate the rate of bone regeneration and improve the quality of regenerated bone. The technique to process PRGF was simple compared to previously mentioned techniques used for platelet-rich plasma (PRP) preparation. PRP preparation requires a two-cycle centrifugation procedure, leading to a longer processing time.
... 26 Some authors have reported an improvement of clinical attachment level (CAL) gain of periodontal defects at the distal aspect of the second molar using PRP after impacted third molar removal in combination or not with a resorbable membrane. 27,28 The purpose of the present study was to compare clinical outcomes in the treatment of periodontal pockets at the distal aspect of second mandibular molar after extraction of impacted third molar using L-PRF or blood clot alone. ...
Article
Objectives: Presence of clinical attachment loss on the distal aspect to the second molar may be associated with malposi-tion of the third molar. The aim of this study was to evaluate the reduction of clinical attachment loss at the distal aspect of the second molar after third molar extraction and application of leukocyte-and platelet-rich fibrin (L-PRF). Method and materials: Eighteen subjects with a clinical attachment loss on the distal site to the second molar associated with impacted third molar in both sides of the jaw were recruited for the study. For each subject the teeth were randomly allocated in test and control groups. After surgical removal of the impacted third molar, the L-PRF was inserted in the fresh alveolar socket of test sites; in the control sites no graft was inserted after extraction. Full-mouth plaque score, full-mouth bleeding score, clinical attachment level (CAL), probing depth, and gingival recession were assessed at baseline and 6 months later. Results: After 6 months, mean CAL change was 1.99 ± 1.18 mm in the test group and 1.15 ± 1.01 mm in the control group; probing depth change was 1.33 ± 0.87 mm in the test group and 0.50 ± 0.63 mm in the control group. Statistically significant differences (P < .05) were observed between groups in terms of CAL and probing depth changes. No differences were found in gin-gival recession changes. Conclusion: Within the limits of the present study, the sites treated by means of application of L-PRF after impacted third molar extraction showed better results in terms of CAL gain and probing depth reduction when compared with control sites. (Quintessence Int 2020;51:204-211; doi: 10.3290/j.qi.a43947)
... [5] Previous studies have shown L-PRF to produce a significant reduction in the probing depth with increased bone levels post use of autogenous PRP. [12,13] Our results showed a similar trend in probing depth values with statistically significant difference in values on control and test sides, however no statistically significant improvement was seen in bone levels post use of PRF. ...
Article
Background: Successful management of patients reporting with extreme sensitivity in second molar after surgical extraction of deeply impacted mandibular third molar poses a big challenge to oral surgeons and periodontists worldwide. A variety of grafts, barrier membranes, and guided tissue regeneration techniques have been used postsurgically for soft- and hard-tissue formation. In the current study, platelet-rich fibrin (PRF), a second-generation platelet aggregate, was assessed for its effectiveness in promoting hard- and soft-tissue healing. Objective: The aim of the study was to evaluate the efficacy of PRF in hard- and soft-tissue healing after extraction of mandibular third molar. Materials and methods: Bilateral surgical disimpaction of mandibular third molar was done on 25 patients. In every patient, randomly allocated test side received PRF and the other side acted as control. Pain, edema, tenderness, sensitivity, Sulcus Bleeding Index (SBI), Plaque Index, clinical attachment level (CAL), probing depth, and bone height were measured at different intervals for a maximum period of 6 months. Results: There was a statistically significant improvement in patients' signs and symptoms of pain, tenderness, edema, and sensitivity with the use of PRF. A statistically significant improvement was seen in SBI, Plaque Index, and probing depths, while CALs and bone height were not influenced by PRF use. Conclusion: PRF is a very viable and useful biomaterial for soft-tissue healing and relieving patient symptoms, however, it does not help in hard-tissue healing with respect to cortical bone.
... In order to prevent periodontal complications and assist the bone reconstruction of the sites after the surgical removal of M3s in such cases, and especially for patients older than 26 years, clinicians might need to implement additional measures, and guided bone regeneration techniques with the use of bone grafts are commonly considered for the reconstruction of the M3 extraction socket [1,3,[10][11][12][13][14][15][16][17]. ...
Article
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Mandibular third molar (M3) surgical extraction may cause periodontal complications on the distal aspect of the root of the adjacent mandibular second molar (M2). Patients older than 26 years with periodontal pathology on the distal surface of the M2 and a horizontal/mesioangular impacted M3 may benefit from bone regenerative therapy at the time of surgery. In this prospective case series, an alloplastic fully resorbable bone grafting material, consisting of beta-tricalcium phosphate (β-TCP) and calcium sulfate (CS), was used for the treatment of the osseous defects after the removal of horizontal or mesioangular M3s in 4 patients older than 26 years. On presentation, the main radiological finding in all patients, indicating periodontal pathology, was the absence of bone between the crown of the M3 and the distal surface of the root of the M2. To evaluate the treatment outcome, bone gain (BG) was assessed by recording the amount of bone defect (BD) at the time of surgical removal (T0) and at the time of final follow-up (T1) 1 or 2 years post-operatively. The healing in all cases was uneventful, with no complications associated with the use of the alloplastic grafting material. Clinical and radiological examination at T1 revealed that all extraction sites were adequately restored, with significant BG of 6.07 ± 0.28 mm. No residual pathological pockets on the distal surface of the M2 were detected. Pocket depth (PD) at T1 was 2 ± 0.71 mm. Within the limitations of this case series, the results suggest that β-TCP/CS can support new bone formation at M3 post-extraction sites where bone regeneration methods are indicated, thus reducing the risk of having persistent or developing new periodontal problems at the adjacent M2.
... [21,22] The use of PRF and PRP has shown to be a valid technique for promoting soft tissue healing, hard tissue healing following extraction of impacted third molars. [23,24] The present study compares the clinical effectiveness of PRF along with time-tested PRP, where both show significant improvement in clinical as well as radiographic parameters. Different parameters such as pain, swelling, trismus, periodontal pocket depth, and bone formation were considered. ...
Article
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Objective: The objective is to compare the efficacy of platelet-rich fibrin (PRF) and platelet-rich plasma (PRP) in the third molar extraction socket and also comparative evaluation of pain, swelling, trismus, periodontal health, and quality of bone healing between PRF and PRP. Study Design: A total of 15 individuals with the age group of 18-40 years with bilateral impacted lower third molars were the study subjects and divided into two groups-Group (A) where extraction socket was placed with PRF and Group (B) where extraction socket placed with PRP.
... The difference in the preoperative pocket depth among patients of group I and group II was not found to be statistically significant (p = 0.827) (Tables 8 and 9). A similar result was found in the study of Sammartino et al. 20 and Kumar et al. 16 Platelet-derived growth factor and TGF-β in PRP can influence periodontal regeneration, although it is not yet completely acknowledged. Some in vitro studies have suggested that PDGF acts principally on osteoblastic proliferation. ...
Article
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Aim: The aim of the study was to compare the healing and osseous regeneration of mandibular third molar extraction sockets with and without platelet-rich plasma (PRP) with the evaluation of clinical objectives such as pain, swelling, trismus, soft tissue healing, pocket depth distal to second molar and radiological evaluation of the bony density in the postextracted third molar socket. Materials and methods: In this prospective study, 100 patients were selected by the random sampling method from the outpatient department of oral and maxillofacial surgery in the year 2016-2017. Patients were equally allocated into intervention (transalveolar extraction followed by PRP placement) and nonintervention (transalveolar extraction without PRP placement) group as group I and group II, respectively, and evaluation parameters were considered accordingly. The statistical analysis was done using SPSS (Statistical Package for Social Sciences) Version 15.0 (IBM, USA) statistical analysis software. Results: The pain score of patients of group I (non-PRP) was found to be higher as compared to group II (with PRP). Mean trismus of patients of group II was found to be higher than that of group I at postoperative day 7, but this difference was not found to be statistically significant. Swelling at T-Sn (Tragus-Subnasale) and T-Pog (Tragus-Pogonion) was higher among patients of group I as compared to group II. Healing in group II was two to three times faster than group I. Healing among patients of group I and group II was found to be statistically significant. The mean pocket depth of patients of group I was found to be significantly higher than that of group II at follow-up of 1 and 2 months. The bone density of patients of group II was found to be significantly higher than that of group I at 3 months and 6 months follow-up. Conclusion: The procedure of PRP preparation is simple and cost-effective, and can be prepared at the point of care. It had a significant impact on the postoperative healing of the third molar socket. Clinical significance: The use of PRP application increases the bone density, healing process, and improvement in the pain and swelling, and there was a definite reduction in trismus and periodontal probing depth after the impacted mandibular wisdom teeth extraction.
... This is of high importance, especially when the number of cells in the place of tissue injury is reduced. [5] Among the biomaterials being used, which are based on the function of platelets, are platelet-rich plasma (PRP) and platelet-rich fibrin (PRF). [6,7] PRF basically consists of a fibrin matrix polymerized in a tetramolecular structure, with incorporated platelets, leukocyte, cytokines, and circulating stem cells along with leukocyte derived cytokines, platelet-derived growth factor (PDGF), transforming growth factor-beta (TGF-b), epidermal growth factor (EGF), fibroblast growth factor (FGF), KGF, insulin-like growth factor (IGF), platelet-derived EGF, interleukin 8 (IL-8), tumor necrosis factor (TNF ) alpha, connective tissue growth factor (CTGF), and granulocyte macrophage-colony-stimulating factor. ...
... A number of authors suggest significant bone formation in extraction sockets treated with PRP, which is consistent with our finding [4,[29][30][31]. In addition to this, using an inorganic substrate will provide better results, alone or in combination of PRP. ...
Article
Objectives This prospective study was designed to assess the efficacy of autologous PRP gel in healing of extraction socket after surgical extraction of impacted mandibular third molar. Methods A total of 100 patients necessitating treatment were randomly allocated in two groups; experimental and control. In experimental group, PRP gel was placed in the extraction socket after extraction, whereas in control group the similar procedure was carried out without application of PRP gel. The outcome variables were pain, swelling, and maximum mouth opening, which were assessed on 1st, 3rd, 5th, 7th and 14th day following extraction. Socket healing was analyzed radiographically by allocating scores for overall density and trabecular pattern on 4th, 10th and 16th week postoperatively. Results Results showed significant lower pain scores, reduced facial swelling and improved interincisal opening in experimental group postoperatively when compared to control group. The bone density and trabeculae pattern in both groups didnot show any difference at 4th week. However, highly significant difference (P value < 0.005) was observed between both groups radiographically at 10th and 16th weeks following extraction. Conclusions The present study concludes that the use of simple, cost- effective method of autologous PRP gel may be beneficial to enhance the wound healing process and promotes bone regeneration.
... Three studies reported no significant effect of platelet concentrate on bone regeneration (39,40,42) . The remaining four reported a favorable effect on healing (44,(62)(63)(64) . ...
... 26 Some authors have reported an improvement of clinical attachment level (CAL) gain of periodontal defects at the distal aspect of the second molar using PRP after impacted third molar removal in combination or not with a resorbable membrane. 27,28 The purpose of the present study was to compare clinical outcomes in the treatment of periodontal pockets at the distal aspect of second mandibular molar after extraction of impacted third molar using L-PRF or blood clot alone. ...
Article
Objectives: Presence of clinical attachment loss on the distal aspect to the second molar may be associated with malposition of the third molar. The aim of this study was to evaluate the reduction of clinical attachment loss at the distal aspect of the second molar after third molar extraction and application of leukocyte- and platelet-rich fibrin (L-PRF). Method and materials: Eighteen subjects with a clinical attachment loss on the distal site to the second molar associated with impacted third molar in both sides of the jaw were recruited for the study. For each subject the teeth were randomly allocated in test and control groups. After surgical removal of the impacted third molar, the L-PRF was inserted in the fresh alveolar socket of test sites; in the control sites no graft was inserted after extraction. Full-mouth plaque score, full-mouth bleeding score, clinical attachment level (CAL), probing depth, and gingival recession were assessed at baseline and 6 months later. Results: After 6 months, mean CAL change was 1.99 ± 1.18 mm in the test group and 1.15 ± 1.01 mm in the control group; probing depth change was 1.33 ± 0.87 mm in the test group and 0.50 ± 0.63 mm in the control group. Statistically significant differences (P < .05) were observed between groups in terms of CAL and probing depth changes. No differences were found in gingival recession changes. Conclusion: Within the limits of the present study, the sites treated by means of application of L-PRF after impacted third molar extraction showed better results in terms of CAL gain and probing depth reduction when compared with control sites.
... It has been shown, however, that surgical removal of impacted mandibular third molars may result in intrabony defects (IBDs) at the distal aspect of the second molar. [3][4][5][6][7][8] These complications might be greater in older patients due to reduced bone volume, slow healing, or other diseases present such as periodontitis or osteoporosis. 9 Kugelberg and colleagues found that 2 years after surgery, 43.3% of cases exhibited probing pocket depths exceeding 7 mm, and 32.1% showed IBDs of more than 4 mm. 10 In another study by Kugelberg, periodontal healing was compared at 2 and 4 years after impacted mandibular third molar extraction. ...
Article
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Bone loss at the distal aspect of mandibular second molars frequently is reported after extraction of impacted third molars. Typically, osseous grafting of the extraction site is not routinely performed. This study examined osseous healing following guided bone regeneration treatment of osseous defects distal to mandibular second molars after surgical removal of impacted mesioangularly or horizontally inclined third molars using the processed third molar as the graft material. For the study, 13 patients who required impacted third molar extractions were selected based on angulation of impaction. Patients requiring bilateral extractions were designated for a split-mouth study, while others were selected based on impaction angulation as a random study group. After surgical extraction of the third molars, the extracted teeth were stripped of any soft tissue, including the periodontal ligament, then ground and disinfected using a dentin grinding protocol to produce an autogenous dentin graft (ADG). This graft was then placed into the extraction socket and covered with a hemostatic sponge prior to site closure. Patients in the control group underwent the same procedure as those in the study group except that no ADG was placed in the socket and only a hemostatic sponge was placed prior to wound closure. Clinical and radiological examinations were performed, including panoramic radiographs and probing depths at 3 months and 12 months postoperatively. The alveolar bone level distal to the second molar was established by both probing depths and radiographic evaluation, which were compared between the two groups. At 12 months postoperative the study group showed probing distal to the second molar with a mean depth of 1.15 mm, whereas the control group showed probing with a mean depth of 4.45 mm. The authors conclude that autogenous dentin grafting is a viable option for use in the treatment of osseous defects distal to mandibular second molars following extraction of impacted third molars.
... Hence, We concluded that there was faster bone formation in the extracted sockets with PRF as compared to controls. In studies conducted by Sammartino et al. [17] and Choukroun et al. [18] who performed histological evaluation of the test sites after an interval of 3 months found the presence of bone tissue newly formed with a high density of osteoblast. Our study had a prime focus on the alveolar bone density which was measured on the specific and most crucial area, i.e., distal to the second molar in any type of impaction. ...
Article
Purpose: Platelet-rich fibrin (PRF) is a new platelet concentrate concept consisting of an autologous fibrin gel having accumulation of platelets and the released cytokines in a fibrin clot. The study aims to evaluate the efficacy of autologous PRF in accelerating bone regeneration and repair in fresh third molar extraction sockets. The investigators hypothesized the cicatricial properties and accumulation of growth factors in a single clot which will improve bone density and quality. Materials and methods: PRF results from a natural and progressive polymerization occurring during centrifugation. Two groups were made with bilaterally impacted third molar patients. PRF was obtained and surgical extraction was carried out under aseptic conditions. Quantitative data are presented as mean. Statistical significance was inferred at P < 0.05. Results: Results obtained were evaluated statistically and found a significant difference between the groups in improvement in alveolar bone density of regenerate measured radiographically. The study demonstrates a faster bone formation in the extracted sockets with PRF as compared to control. Conclusion: PRF proved to be an autologous biomaterial with useful features that allowed efficient postextraction bone defect filling and faster bone regeneration.
Article
Free full text: https://authors.elsevier.com/a/1VRgI-GwNlzcf Purpose: The true benefit of autologous platelet concentrates (APCs) for enhancing the healing of postextraction sites is still a matter of debate, and in recent years several clinical trials have addressed this issue. The purpose of this study was to determine the effectiveness of an APC adjunct in the preservation of fresh extraction sockets. Materials and methods: An electronic search was performed on Medline, Embase, Scopus, and the Cochrane Central Register of Controlled Trials. Only controlled clinical trials or randomized clinical trials were included. Selected articles underwent risk-of-bias assessment. The outcomes were complications and adverse events, discomfort and quality of life, bone healing and remodeling assessed by histologic and radiographic techniques, and soft tissue healing. Results: Thirty-three comparative studies were included. Nine articles had a parallel design and 24 had a split-mouth design. Twenty studies were considered to have a low risk of bias and 13 were considered to have a high risk. Overall, 1,193 teeth were extracted from 911 patients. Meta-analysis showed that soft tissue healing, probing depth at 3 months, and bone density at 1, 3, and 6 month were statistically better for the APC group. Qualitative analysis suggested that APCs might be associated with a decrease in swelling and trismus. However, no relevant difference among groups was found for probing depth at 1 month, incidence of alveolar osteitis, acute inflammation or infection, percentage of new bone, and indirect measurement of bone metabolism. Conclusion: APCs should be used in postextraction sites to improve clinical and radiographic outcomes such as bone density and soft tissue healing and postoperative symptoms. The actual benefit of APCs on decreasing on pain in extraction sockets is still not quantifiable.
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ABSTRACT Objectives: Dry socket is a common post-extraction complication. It is possible to occur following immediate implant placement. This study was designed to assess the efficacy of PRF for the management of established dry socket following immediate implant placement. Materials and Methods: Twenty patients with established dry sockets following immediate implant placement were included. Patients were divided randomly, patients of group I were treated by socket curettage and irrigation, while in group II PRF was inserted in the space around the implant and filled the socket. Pain and granulation tissue formation score has been used to assess both groups. Results: The pain score was 6 to 10 on the day zero, 3 to 6 on the day four and 1 to 3 on the day seven in group I, while in group II the pain score was 6 to 10 on the day zero, 0 to 3 on the day four and 0 to 1 on the day seven (p 0.001). On group II the formations of granulation tissue appeared earlier than group I. Four implants failed, three implants in group I and one implant in group II. Conclusion: This study suggests that the use of PRF for the management of dry socket following immediate implant placement relieves pain, accelerates the process of wound healing and increases implant success rate. KEY WORD: Dry socket, Immediate implant placement, PRF.
Article
It has become more common that after a mandibular third molar impaction operation, platelet concentrates have been shown to be useful in aiding the healing process. The patients were examined on day 1, day 2, day 3, day 7, the first month, and the second month following surgery. There was a slew of parameters to investigate and tally up. Materials and methods: A total of 15 people with impacted mandibular third molars were included in the research. Patients' own blood platelets were used to make the transfusion more effective. One of the sockets was selected at random to serve as the test side. Instead of the other connector, the control socket was utilized. Results: There was no statistical difference between the test and control groups when it came to pain or soft tissue healing, according to a Mann-Whitney U test used to analyze the data. T test was performed to check for edema and density in the bones. Bone density measurements on the test side were significant, whereas measurements of edema on the test side were not. There was no alveolar osteitis on any of the subjects' limbs. Conclusion: Bone and soft tissue healing may be aided by platelet-rich plasma (PRP). Several growth components are included, which aid in the healing process.
Article
The aim of this paper is to highlight the classification and indications of different bone grafting materials and barrier membranes for everyday clinical practice of contemporary work in the field of oral surgery and periodontology. Bone resorption after tooth extraction can make the procedure of dental implantation difficult. Thus, the socket preservation concept was implemented to minimize bone resorption after tooth extraction and preserve the alveolar bone by means of different bone graft materials filled into the socket immediately after tooth extraction. Number of different growth factors are used together with graft materials. Among these are platelet rich plasma (PRP) and platelet-rich fibrin (PRF). With the simplified technique, an autologous fibrin matrix, which contains platelets and leucocyte growth factors, is acquired.
Chapter
Evaluation and management of impacted teeth are among the most frequent services offered by oral and maxillofacial surgeons. Although the third molar is the most commonly impacted tooth, any other tooth may be impacted if space for its eruption is compromised. For third molars, the most common removal indications are periodontitis, pericoronitis, and caries. Patient age, general health, and unusual local risk factors must be considered and may contraindicate surgery. Non-third molar teeth may be exposed and orthodontically brought into occlusion or removed if necessary. Observing well-established principles for surgical technique and perioperative care minimizes complications.KeywordsImpacted teethThird molarTreatment planningSurgical managementComplications
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Objective To determine the effects of repeated placement of quantified lyophilised platelet-rich plasma (LPRP) on its 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.
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Objective: Analysis of opinions and attitudes of a group of private-practice dentists from the urban environment in Romania, related to the concept of shortened dental arch (S.D.A.) based on a directly addressed questionnaire and the comparison of the results with similar study results. Method: A questionnaire with a series of questions regarding the shortened dental arch was designed for this study and sent to a group of dentists. Results: The rate of participation rate to the study was 83%. Most of the answers show that the participating dentists have enough experience and knowledge on the shortened dental arch. Mastication, comfort and aesthetics, in the context ofshorteneddental archwere rated asgood–satisfactory by the doctors.Patients‟ reactiontothe proposedtreatmentincludingshorteneddental archvaries fromfrequentacceptancetodenial. Conclusions: The participating doctors‟ attitude is generally positive regarding the concept of S.D.A.; caution was noted in assessing functionality in the S.D.A context. Key words: shortened dental arch, geriatric patients, functional dentition
Article
Aim: To evaluate the potential of advanced platelet-rich fibrin (A-PRF) as a regenerative biomaterial for bone regeneration and postoperative sequelae after impacted third molar extractions. Materials and methods: This was a split-mouth, randomized, double-blind clinical trial. A total of 10 female patients in King Abdulaziz University Dental Hospital with bilateral impacted third molars were recruited into the study. Surgical extractions were performed on both sides of the mandible. Randomization was done by a coin toss; A-PRF was placed on the one side while the other side did not receive any intervention. Each patient acted as their own control. Both the patients and the investigators were blinded about the A-PRF side. The outcome on periodontal regeneration was made measuring pocket depth (PD), gum recession (GR), and clinical attachment level (CAL) before and at 1- and 3-months postoperatively. Pain, swelling, and healing were assessed on the 7th postoperative day. p value less than 0.05 was considered statistically significant. Results: An estimated 10 patients completed the study. There were no significant differences in PD, CAL, and GR between the two groups at any time point, although the data obtained were slightly favoring the A-PRF. However, a statistically significant reduction in pain and swelling was observed in the A-PRF group compared to the controls (p < 0.05). Conclusion: The findings of this study demonstrate A-PRF as a potential biomaterial for lessening the severity of pain and swelling after third molar surgery. Long-term trials with a larger sample size and more methodically sound assessment tools are needed to obtain more meaningful results on periodontal regeneration. Clinical significance: Placement of A-PRF clot in the extraction socket could lessen postoperative pain and increase patient comfort after third molar extraction. Trial registration: NCT03703479. Registered 8 October 2018 How to cite this article: Zahid TM, Nadershah M. Effect of Advanced Platelet-rich Fibrin on Wound Healing after Third Molar Extraction: A Split-mouth Randomized Double-blind Study. J Contemp Dent Pract 2019;20(10):1164-1170.
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Background: To evaluate the use of guided bone regeneration with xenograft to prevent periodontal defect in the distal aspect of the second molar after the surgical removal of the mandibular third molar. Material and methods: Three electronic databases (Pubmed, Cochrane Library and Scopus) were searched in April 2020. Randomized clinical trials in non-smokers and healthy patients, with at least six months follow-up, comparing periodontal probing depth, clinical attachment level, alveolar bone level and adverse events were selected by two independent investigators. The risk of bias assessment of the selected studies was evaluated by means of the Cochrane Collaboration's Tool. Finally, a meta-analysis of the outcomes of interest was performed. Results: Despite 795 articles were found in the initial search, only three randomized controlled clinical trials were included. Pooled results favoured the use of the xenograft plus collagen membrane over the spontaneous healing in terms of periodontal probing depth gain (MD=2.36; 95% CI 0.69 to 4.03; P=0.005) and clinical attachment level gain (MD=2.52; 95% CI 0.96 to 4.09; P=0.002). No other statistically significant differences were found. Conclusions: Within the limitations of the present review, the xenograft plus collagen membrane exhibited better periodontal results than spontaneous healing without increasing postoperative complications. However, future well-designed studies with larger samples are required to confirm our results.
Article
INTRODUCTION The purpose of this randomized controlled trial was to evaluate the role of platelet rich plasma (PRP) in the healing of through-and-through periapical lesions using both 2-dimensional (2D) periapical radiograph and 3-dimensional (3D) cone beam computed tomography (CBCT). METHODS 34 patients after confirmation of through-and-through periapical lesion were enrolled and randomly assigned to either the control or PRP group. Periapical surgery was performed and grafting of the bone defect with PRP was done in the PRP group prior to suturing and follow up was scheduled at 12 months for clinical and radiographic analysis based on Molven’s criteria, modified PENN 3D criteria and RAC indices. The absolute area and volume of the lesions were measured preoperatively and at follow up using Corel draw X7(64-bit) and ITK Snap software respectively. RESULTS 32 patients were available at follow up. A success rate of 93.7% was observed for both the control and PRP group on 2D evaluation while the PRP group exhibited a significantly higher success rate (87.5%) than the control (50%) on 3D assessment. A significantly higher percentage reduction in the lesion volume was documented in the PRP (92.30±4.72) group than the control (83.04±12.82). RAC indices revealed a significantly higher scoring at resected plane and cortical plate parameter in the PRP group. Overall analysis documented the faster reestablishment of palatal cortical plate than buccal cortical plate in through-and-through lesions. CONCLUSIONS These results suggests that PRP improves the healing outcome in through-and-through lesions. CBCT provides better healing assessment after periapical surgery over periapical radiographs in such lesions.
Article
The purpose of this manuscript was to provide a better understanding of patients with intralenticular foreign bodies (FBs) and also to review the reported cases, including clinical presentation, diagnosis, management, and visual outcome. A 50-year-old male was referred to our clinic with suspected intraocular FB. Under slit-lamp examination, a full-thickness corneal wound with localized corneal edema at the temporal lower peri-limbal area was revealed. Seidel test did not indicate any wound leakage. The corresponding iris was depigmented, but there was no penetrating hole. The anterior chamber was deep with cells, but the lens, vitreous, and fundus were normal. B-scan ultrasonography and orbital computed tomography were performed, but no intraocular FB was detected. On the 2 nd day, a zonal cortical cataract and posterior subcapsular cataract formed rapidly. Left-eye bare vision dramatically decreased from 20/100 to counting fingers. One month later, the patient received elective extracapsular cataract extraction. A fine metal thread was completely embedded in the lens; the lens and FB were removed together during the operation. The posterior capsule was not injured; an intraocular lens was implanted in the capsular bag. Two months postoperatively, left-eye vision had returned to 20/25. No adverse events were noted during the follow-up period. In addition to the case report, some 28 previously reported cases of intralenticular FB are reviewed here. Patient demographics, time and course of management, and visual outcome are all summarized and compared. © 2019 Wolters Kluwer Medknow Publications. All Rights Reserved.
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Introduction: Autologous platelet-rich plasma (PRP) is the fraction of blood plasma, with increased concentration of platelets, from baseline serum level. Growth factors (GFs) in PRP expedite the soft tissue and bony healing. However, estimation of their levels and role in healing had not been studied extensively. This study gives an insight to the quantification of platelet-derived GF-BB (PDGF-BB) present in PRP and its correlation with the clinical wound healing and bone regeneration. Aims: This study aims to quantify PDGF-BB levels in PRP with its subsequent correlation with healing in dental regenerative surgeries. Settings and design: This was an experimental study including patients undergoing various dental regenerative surgeries. Subjects and methods: Autologous thrombin-activated PRP in the form of PRP gel was used in study group (n = 39) whereas no such intervention was given in control group (n = 30). PDGF-BB quantification was done in PRP samples using enzyme-linked immunosorbent assay. Clinicoradiological evaluation of healing was done in both the groups. Statistical analysis used: Descriptive analysis, independent Z-test, Correlation regression analysis, and ANOVA. Results: Mean platelet concentration achieved in PRP was 5.79 times the baseline count. Mean PDGF-BB concentration in PRP was 31.92 ± 10.47 ng/ml which significantly correlated (P < 0.05) with the PRP platelet count. Study group showed significant healing clinically (P < 0.05). Significant bone fill observed in study group at 3 and 6 months when compared to the baseline as well as control group. Furthermore, bone fill at 6 months showed linear correlation with PGDF-BB levels (r = 0. 80). Conclusions: PRP led to enhanced bone regeneration and soft-tissue healing with former being directly related to higher concentration of PDGF-BB.
Article
Introduction Contemporary published data present confounding results on use of PRF in soft- and hard-tissue healing in the oral cavity, and many authors have suggested for further studies to reach the definitive conclusion. Aim Our main objective therefore was to evaluate soft-tissue healing and osseous regeneration (by using VIXWIN PRO software) in extraction sites of mandibular third molars with substantial sample size to understand the effect of PRF in bony defects. Methodology Sixty patients had their bilaterally impacted third molars (120 sites) extracted in the split mouth study, following which platelet-rich fibrin was placed in one of the sockets. Patients were followed up clinically and radiographically, and pain score, presence of infection, exudation of graft and VIXWIN PRO software were used to evaluate healing of soft tissue and bone. Result and Conclusion Our study advocates the use of PRF for enhanced soft- and hard-tissue healing. Though the osseous regeneration could be differentiated in both the groups at second month interval only, pain scores were better with PRF at most instances. Subsequent phase to the research should include histopathological investigations for ancillary support.
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It has been previously shown that transforming growth factor beta (TGF beta) is capable of stimulating fibroblast collagen and fibronectin biosynthesis. The purpose of this study was to examine the mechanisms involved in TGF beta stimulation of fibroblast biosynthetic activity. Our results indicate that TGF beta causes a marked enhancement of the production of types I and III collagens and fibronectin by cultured normal human dermal fibroblasts. The rate of collagen production by fibroblasts exposed to TGF beta was 2-3-fold greater than that of control cells. These effects were associated with a 2-3-fold increase in the steady-state amounts of types I and III collagen mRNAs and a 5-8-fold increase in the amounts of fibronectin mRNAs as determined by dot-blot hybridization with specific cloned cDNA probes. In addition, the increased production of collagen and fibronectin and the increased amounts of their corresponding mRNAs remained elevated for at least 72 h after removal of TGF beta. These findings suggest that TGF beta may play a major role in the normal regulation of extracellular matrix production in vivo and may contribute to the development of pathological states of fibrosis.
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https://deepblue.lib.umich.edu/bitstream/2027.42/142112/1/jper0209.pdf
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Platelet-rich plasma is an autologous source of platelet-derived growth factor and transforming growth factor beta that is obtained by sequestering and concentrating platelets by gradient density centrifugation. This technique produced a concentration of human platelets of 338% and identified platelet-derived growth factor and transforming growth factor beta within them. Monoclonal antibody assessment of cancellous cellular marrow grafts demonstrated cells that were capable of responding to the growth factors by bearing cell membrane receptors. The additional amounts of these growth factors obtained by adding platelet-rich plasma to grafts evidenced a radiographic maturation rate 1.62 to 2.16 times that of grafts without platelet-rich plasma. As assessed by histomorphometry, there was also a greater bone density in grafts in which platelet-rich plasma was added (74.0% ± 11%) than in grafts in which platelet-rich plasma was not added (55.1% ± 8%; p = 0.005).
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Wound healing in an incisional wound is a highly predictable process which has been studied extensively hour-by-hour and day-by-day. Healing in a periodontal defect following gingival flap surgery is, conceptually, a more complex process as one wound margin consists of calcified tissue, including the avascular and rigid root surface. Another complicating factor in this wound healing is the transgingival position of the tooth. Experimental studies, however, have indicated that healing at a dento-gingival interface under optimal conditions occurs at the same rate as in a skin wound. Generally, periodontal healing is characterized by maturation of gingival connective tissue, limited regeneration of alveolar bone and cementum, and the formation of a long junctional epithelium. Such observations have nurtured the hypothesis that the epithelium of the surgical flap needs to be prevented from early access to the root surface during the healing period to achieve connective tissue repair of the root surface-gingival flap interface. Recent experimental findings suggest, however, that connective tissue repair to the root surface following reconstructive periodontal surgery is a function of the establishment and maintenance of a root surface-adhering fibrin clot. Since fibrin adherence to the wound margins is a natural event, it is additionally suggested that apical migration of the gingival epithelium in periodontal surgical wounds may only follow interruption of the adherence of the fibrin clot to the root surface.
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A multifactorial approach has been used to identify some predictors of postoperative intrabony defects (IBD) on the distal surface of the adjacent second molar (M2) after impacted lower third molar (M3) surgery. The material consisted of 215 lower third molar removals, performed on 144 persons (age range 16-53 years; mean 27.2 years). The postoperative examination took place 2 years after impaction surgery and included both clinical and radiographic variables. Statistically significant (5% significance level) predictors of IBD found in stepwise multiple regression analyses were: (1) preoperative intrabony defect M2 distal; (2) age at the time of surgery; (3) size of contact-area M3/M2; (4) root resorption M2 distal; (5) probing dept distal surface of adjacent first molar postoperatively; (6) pathological follicle M3. The regression model with IBD as regressand produced a total R2 of 0.45. When the regressand was the difference between IBD and the preoperative intrabony defect, the regression analysis explained 62% of the variance (R2 = 0.62). These regression models explained the variance in terms of the size of the remaining postoperative intrabony defect as well as in terms of periodontal healing after impacted lower third molar surgery.
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The long-term effects on periodontal tissues of impacted lower 3rd molar surgery have been investigated in a retrospective study comprising 51 cases. The postoperative examinations took place 2 and 4 years after the surgical treatment and included both clinical and radiographic variables. Assessments were made regarding the oral hygiene status, gingival condition and periodontal tissue breakdown in terms of increased probing depths and intrabony defects. Comparing the results of the two examinations, no significant changes of the incidence of plaque and gingivitis were seen on the distal surface of the 2nd molar, nor any significant change concerning the probing depth. The proximal bone level distal to the second molar was recorded by radiographic examination with a cut-off periodontal probe as indicator. Two years postoperatively, 16.7% of the cases aged less than or equal to 25 years showed intrabony defects exceeding 4 mm, compared with 40.7% in the age group greater than or equal to 26 years. At the 4-year re-examination, the corresponding figures were 4.2% and 44.4%, respectively. The improvement concerning the alveolar bone level was mainly seen in individuals under 25 years. Some factors affecting the periodontal healing after impacted lower 3rd molar surgery are discussed.
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The supporting tissues of the distal surfaces of mandibular second molars in 33 patients with impacted and semi-impacted third molars were studied preoperatively, immediately after removal of the third molars, and 12 months postoperatively. The same tissues were studied in a group of 11 patients with congenital absence of mandibular third molars. Geometrically reproducible radiographs were obtained. In enlargements of the radiographs the height of the bony septum distal to the second molars was measured. Notes were made of the amount of plaque, the severity of gingival inflammation and the depth of the gingival pockets. Twelve months after operation no change was found in the supporting bony tissue, but significant improvements were noted in the clinical variables studied. No significant difference in the supporting bony tissue was found between age-matched groups of patients with and without impacted or semi-impacted third molars, but the clinical condition of the periodontium was significantly worse in the group with third molars. Prophylactic removal of impacted and semi-impacted mandibular third molars would seem to be indicated.
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Previous studies indicated that connective tissue attachment to the root surface appeared to be dependent upon a chronologic healing sequence related to fibrin and collagen interactions. It was the purpose of the present study to try and substantiate this hypothesis by using histologic techniques designed to differentiate between fibrin and collagen during healing at the root surface interface. In four squirrel monkeys, 24 normal teeth were extracted and reimplanted after either (i) surgically denuding the coronal root surface of connective tissue fibers and cementum by root planing or, (ii) surgical denudation followed by topical application of citric acid (pH = 1; 3 minutes). Three specimens were available for histological analysis 1, 3, 7 and 21 days after reimplantation. Mallory's phosphotungstic acid hematoxylin staining technique was used to differentiate between fibrin and collagen. Epithelium migrated rapidly along the denuded, non-acid-treated, root surfaces, had reached the alveolar crest at 3 days, and was within the ligament space to the level of root denudation at 21 days. Epithelium did not migrate apically along denuded root surfaces treated with citric acid. At 1 and 3 days, inflammatory cells were enmeshed in a fibrin network which appeared to be attached to the root surface by arcade-like structures. At 7 and 21 days, the region had repopulated with connective tissue cells, and collagen fibers had replaced the fibrin. It was concluded that collagen fiber attachment to the root surface was preceded by fibrin linkage, and that the linkage process occurred as an initial event in the wound healing response.
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Recent reports provide evidence of increased attachment levels when using guided tissue regeneration (GTR) techniques for the treatment of periodontal defects. Periodontal defects frequently occur at the distal aspect of mandibular 2nd molars which are next to mesioangular impacted 3rd molars that have oral communication. The purpose of this study was to determine whether the use of GTR can enhance probing attachment levels (PALs) following extraction of mesioangular impacted third molars. 12 patients with bilateral soft tissue impacted mandibular 3rd molars entered this split mouth study. After extractions, the previously exposed distal root surface of the 2nd molars were debrided. The defects on the randomly selected experimental sites were covered with expanded polytetraflouro-ethylene (e-PTFE) membrane and the tissue was replaced to cover the membrane. Membranes were removed after 6 weeks. Control sites were treated identically except no membrane was placed. GI, P1I, PD, PAL and BOP records were obtained at 0, 3 and 6 months. The use of barrier material did not provide statistically-significant differences in PAL when comparing experimental versus control sites. Nevertheless, PAL gain was consistently greater at 3 and 6 months when GTR techniques were used in sites with deep impactions.
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The preparation and use of platelet gel, an autologous formulation of fibrin glue, are described. The unique features of this biologic sealant are that it is derived from autologous blood collected in the immediate preoperative period by the anesthesiologist, it contains a high concentration of platelets, and it can be used in patients who are not candidates for blood bank donation. Platelet gel has been used successfully in the area of reconstructive oral and maxillofacial surgery in conjunction with ablative surgery of the maxillofacial region, mandibular reconstruction, surgical repair of alveolar clefts and associated oral-antral/ oral-nasal fistulas, and adjunctive procedures related to the placement of osseointegrated implants.
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Platelet-rich plasma is an autologous source of platelet-derived growth factor and transforming growth factor beta that is obtained by sequestering and concentrating platelets by gradient density centrifugation. This technique produced a concentration of human platelets of 338% and identified platelet-derived growth factor and transforming growth factor beta within them. Monoclonal antibody assessment of cancellous cellular marrow grafts demonstrated cells that were capable of responding to the growth factors by bearing cell membrane receptors. The additional amounts of these growth factors obtained by adding platelet-rich plasma to grafts evidenced a radiographic maturation rate 1.62 to 2.16 times that of grafts without platelet-rich plasma. As assessed by histomorphometry, there was also a greater bone density in grafts in which platelet-rich plasma was added (74.0% +/- 11%) than in grafts in which platelet-rich plasma was not added (55.1% +/- 8%; p = 0.005).
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The goal of periodontal regenerative therapies is to reconstruct periodontal tissues such as bone, cementum, and periodontal ligament cells (PDL). The need to establish predictable treatment modalities is important for reconstruction of these tissues. The aim of this study was to determine the effects of a low molecular extract of bovine bone protein (BP) containing bone morphogenetic proteins (BMPs) 2, 3, 4, 6, 7, 12, and 13, alone or in combination with platelet-derived growth factor (PDGF) and/or insulin-like growth factor (IGF) on osteoblast differentiation in vitro. BP, mixed with a collagen matrix, was added to a poly (DL-lactide-co-glycolide) polymer (PLG) and placed at orthotopic sites in the skullcaps of Sprague-Dawleys rats. At day 28, rats were sacrificed for histological analysis. All sites treated with the polymer/BP produced bone while control sites (without BP) showed no bone formation. Having established the biological activity of BP, in vitro studies were initiated using MC3T3-E1 cells, a mouse osteoprogenitor cell line. The ability of BP and other growth factors to alter cell proliferation was determined by Coulter counter, and differentiation was determined by Northern analysis for specific genes. When compared with cells treated with 2% serum alone, PDGF enhanced cell numbers at 10 and 20 ng/ml; IGF produced no significant effect at these doses; and BP at 10 and 20 microg/ml decreased cell proliferation. Northern analysis revealed that PDGF blocked gene expression of osteopontin (OPN) and osteocalcin (OCN), while BP and IGF promoted gene expression of bone sialoprotein (BSP) and OPN. The combination of BP and IGF enhanced expression of OPN beyond that of either BP or IGF alone. PDGF was able to block the effects of IGF on gene expression, but not those of BP. These results indicate that BP, PDGF, and IGF influence cell activity differently, and thus raise the possibility that combining factors may enhance the biological activity of cells.
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The role of polypeptide growth factors in periodontal regeneration has been documented through animal and human studies. Human platelets contain platelet-derived growth factor (PDGF) and transforming growth factor-beta (TGF-beta) in their alpha granules. PDGF has been shown to play a role in periodontal regeneration. It has been demonstrated that TGF-beta has a very potent effect on cells associated with bone. The case reports presented demonstrate a new biotechnology in which platelet gel is used in combination with demineralized freeze-dried bone allografts for the treatment of periodontal osseous defects. The treated teeth presented with severe bone loss and a guarded prognosis. Platelet gel biotechnology was used as a novel treatment modality. A significant reduction in probing depths was noted, and radiographically significant amounts of new bone were visible as early as 2 months postoperative. Results up to 2 years postoperative are presented.
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A combination of platelet-rich plasma (PRP), bovine porous bone mineral (BPBM), and guided tissue regeneration (GTR) has been shown to be effective in promoting reduction in probing depth, gain in clinical attachment, and defect fill in intrabony periodontal lesions. The individual role played by PRP, BPBM, and GTR in this combined therapy is unclear and needs to be elucidated. The purpose of this study was to compare the clinical effectiveness of 2 regenerative techniques for intrabony defects in humans: a combination of PRP/BPBM/GTR versus a combination of PRP/BPBM. Twenty-one patients participated in the study. Using a split-mouth design, interproximal bony defects were surgically treated with either a combination of PRP/BPBM/GTR or PRP/BPBM. The primary outcomes of the study included changes in probing depth, attachment level, and defect fill as revealed by reentry surgeries at 6 months post-treatment. At 6 months postoperatively, clinical examination of the treated defects revealed that both treatment modalities resulted in significant probing depth reduction and clinical attachment gain compared to baseline values. Probing depth improvement was 3.98 +/- 1.02 mm on buccal and 3.94 +/- 0.94 mm on lingual sites for the PRP/BPBM group and 4.19 +/- 0.88 mm on buccal and 4.21 +/- 0.92 mm on lingual sites for the PRP/BPBM/GTR group. Gain in clinical attachment was 3.78 +/- 0.72 mm on buccal and 3.84 +/- 0.76 mm on lingual sites for the PRP/BPBM group and 4.12 +/- 0.78 mm on buccal and 4.16 +/- 0.83 mm on lingual sites for the PRP/BPBM/GTR group. Reentry surgeries revealed similar defect fill for both treatment groups (PRP/BPBM group: 4.82 +/- 1.34 mm on buccal and 4.74 +/- 1.30 mm on lingual sites; PRP/BPBM/GTR group: 4.96 +/- 1.28 mm on buccal and 4.78 +/- 1.32 mm on lingual sites). None of the differences between the 2 treatment groups was statistically significant. The results of this study show that both combinations of PRP/BPBM/GTR and PRP/BPBM are effective in the treatment of intrabony defects present in patients with advanced chronic periodontitis. The results also suggest that GTR adds no clinical benefit to PRP/BPBM. Further studies are necessary to assess the individual role played by PRP and BPBM in the clinical outcome achieved with their combination.
Article
A combination of platelet-rich plasma (PRP), bovine porous bone mineral (BPBM) and guided tissue regeneration (GTR) has been shown to be effective in promoting clinical signs of periodontal regeneration in intrabony defects. As an initial attempt to clarify the role played by each of the three treatment components, this study was performed to compare the clinical effectiveness of two regenerative techniques for intrabony defects in humans: a combination of PRP/BPBM/GTR vs. GTR. Eighteen patients participated in the study. Using a split-mouth design, interproximal bony defects were surgically treated with either an absorbable membrane made of polylactic acid for GTR or a combination of PRP/BPBM/GTR. Changes in pocket depth, attachment level and defect fill as revealed by 6-month reentry surgeries were evaluated. Both treatment modalities resulted in significant pocket depth reduction and clinical attachment gain as compared to baseline values. Pocket depth reduction was 4.98 +/- 0.96 mm on buccal and 4.93 +/- 0.92 mm on lingual sites of the PRP/BPBM/GTR group and 3.62 +/- 0.81 mm on buccal and 3.54 +/- 0.88 mm on lingual sites of the GTR group. The gain in clinical attachment observed was 4.37 +/- 1.31 mm on buccal and 4.28 +/- 1.33 mm on lingual sites of the PRP/BPBM/GTR group and 2.62 +/- 1.23 mm on buccal and 2.44 +/- 1.21 mm on lingual sites of the GTR group. The amount of defect fill observed was 4.78 +/- 1.26 mm on buccal and 4.66 +/- 1.32 mm on lingual sites of the PRP/BPBM/GTR group and 2.31 +/- 0.76 mm on buccal and 2.26 +/- 0.81 mm on lingual sites of the GTR group. All differences between the two groups were statistically significant in favor of the PRP/BPBM/GTR group. The results of this study suggest that PRP and BPBM provide an added regenerative effect to GTR in promoting the clinical resolution of intrabony defects on patients with severe periodontitis.
Growth factors regu-late expression of osteoblast-associated genes The use of autologous growth factors in periodontal surgical therapy: Platelet gel biotechnology–Case reports
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Strayhorn CL, Garrett JS, Dunn RL, et al: Growth factors regu-late expression of osteoblast-associated genes. J Periodontol 70:1345, 1999 14. de Obarrio JJ, Arauz-Dutari JI, Chamberlain TM, et al: The use of autologous growth factors in periodontal surgical therapy: Platelet gel biotechnology–Case reports. Int J Periodont Restor-ative Dent 20:486, 2000
Significance of early healing events on periodontal repair
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