Clinical effects of using PRF in socket preservation

Introduction: Preservation of the post-extraction socket, as part of guided bone regeneration, is recommended to create the biological foundation for future implant-prosthetic or prosthetic construction. For this purpose, are used many graft materials, alone or in combination. A-PRF as an autologous blood derivative has been increasingly used in recent years due to its properties in angiogenesis, epithelialization and hemostasis. Easy preparation, low cost and no use of anticoagulants and bovine fibrin are advantages for its widespread use. Aim: To evaluate the effectiveness of the two methods used in the preservation of hard and soft tissues volume, bone quality and the impact of A-PRF on postoperative morbidity. Material and method: Two case studies are described, the one using a combination of A-PRF with xenograft, and the other one using solo A-PRF as post-extraction socket preservation methods. Results: Clinical measurements of the height and width of the post-extraction alveolus and the height of the interdental papilla were performed, and the density of the newly formed bone was measured through CBCT, noted in a tabular view. Postoperative morbidity was also evaluated. Conclusion: From the results obtained in the two case reports shown, it can be concluded that A-PRF, is an economical, autologous and simple autologous graft material is recommended for use in the of a post-extraction socket preservation, as a solo graft material, or in combination with a particulate graft. The volume-preserving properties were confirmed, with better quality and architectonics of the de nuovo formed bone, as well as an easier period of postoperative convalescence are confirmed

Free Gingival Graft versus Mucograft: Histological Evaluation

INTRODUCTION: The correction of the gingival recession is of esthetical and functional significance, but the tissue regeneration can only be confirmed by a histological examination.AIM: This study aims to make a comparison between the free gingival graft and the autograft.MATERIAL AND METHODS: This study included 24 patients with single and multiple gingival recessions. Twelve patients were treated with a free gingival graft and the other twelve with a micrograft. Six months after the surgical procedure, a micro-punch biopsy of the transplantation area was performed. The tissue was histologically evaluated, graded in 4 categories: immature, mature, fragmented and edematous collagen tissue. The elastic fibres were also examined and graded in three categories: with a normal structure, fragmented rare and fragmented multiplied.RESULTS: Regarding the type of collagen tissue that was present, there was a significant difference between the two groups of patients, with a larger number of patients treated with a micrograft showing a presence of mature tissue, compared to the patients treated with a free gingival graft. A larger number of patients in both of the groups displayed elastic fibres with a rare fragmented structure; 33.3% of the patients showed a normal structure; 50% demonstrated a normal structure.CONCLUSION: The patients treated with a free gingival graft showed a larger presence of fragmented collagen tissue and fragmented elastic fibres, whereas a mature tissue was predominantly present in the surgical area where a Geistlich Mucograft was placed

Effectiveness of the impact of second-generation platelet-rich fibrin prf in the treatment of localized individual gingival recessions miller I and II (case report)

The muco-gingival surgical modality SCTG + CAF(subepithelial connective tissue graft-SCTG + coronary positioned flap-CAF) in the treatment of Miller I and II gingival recessions is considered the “gold standard” technique for predictive and complete root coverage of the gingival defects, with long-term clinical stability of the results obtained. The counterpart of this type of technique is the relatively young PRF + CAF operating mode, which recently has a large number of supporters, primarily due to the biological characteristics of this autologous platelet concentrate-PRF (angiogenesis, mitogenesis, osteopromotion, immunomodulation and stem cell entrapment). Aim: The aim of this paper is to evaluate the clinical efficiency of the CAF + PRF combined technique in the treatment of localized individual gingival recessions Miller I and II, by comparing the values of periodontal clinical parameters measured preoperatively and 1 month postoperatively, as well as by the obtained immunohistochemical analysis of the biopsy material taken from the recipient site (the area of the grafted gingival defect), 1 month postoperatively. Material and method: Case report: A 37-year- old man was admitted to the Clinic “St. Panteleimon-Skopje, at the Oral Surgery department for surgical treatment of localized maxillary gingival recession Miller II, tooth 31. Preoperative measurements of periodontal clinical parameters were performed: vertical dimension of gingival recession (RD / VGR), depth of periodontal pocket (PPD/PD) keratinized / attached gingival level (CAL), keratinized gingival width (KTW/ KMW) and gingival thickness (GT) all measured in mm, including gingival biotype. CAF + PRF therapeutic modality is used to treat gingival defect. One month postoperatively, re-measurements of the values of the clinical periodontal indices were performed and they were compared with the measurements obtained preoperatively. Results: Significant reduction of RD, PPD and CAL values were determined on the measurements 1 month postoperatively. Conclusion: Insignificant values of KTW and GT were noted one month post.opp. There are no changes in gingival biotype before and postoperatively. PRF as a second generation of autologous concentrate is not only an adjuvant and / or replacement of the SCTG- “gold standard” in the treatment of Miller I and II, but is also a superior alternative in the surgical treatment of this type of superficial mucogingival defects

Second generation platelet concentrate (platelet-rich fibrin) in its application in oral surgery

The development of bioactive surgical additives, which are being used to regulate the inflammation and increase the speed of healing process, is one of the great challenges in oral surgery. Platelet-rich fibrin (PRF) is a second-generation platelet concentrate who was defined as an autologous leukocyte and PRF biomaterial, in which, platelets and leukocytes are collected with high efficiency such that the growth factors will able to release gradually during at least 1 week. The biologic effect of this fibrin matrix is: angiogenesis, immune control, harnessing the circulating stem cells, and wound protection by epithelial cover. The following article attempts to summarize our clinical cases regarding the technique of using PRF, focusing on its preparation, advantages of using it in oral surgery. Three cases with different clinical diagnoses were taken for this study in order to show the possible ways of application of PRF in the surgical field. In the first case, it is a 53 year-old female patient who has been diagnosed with osteonecrosis of the alveolar ridge during the examination in the projection of the first lower right molar. In the second case, PRF application was administered to a 41 year-old female patient diagnosed with radicular cyst on the upper left second incisor. The third case involved a 47 year-old male patient with diagnosed gangrenous roots in the upper right first and second premolars ant the second molar in which the PRF application was intended to achieve alveolar bridge augmentation. PRF was prepared with blood drawn from individuals using technique du to PRF protocol. Both types of PRF (I and A-PRF) were applied independently in the first case, and in the second and third cases a bone graft was placed together with PRF. The soft and bone tissue management in all our cases show process of neovascularization through the PRF clot and the epithelial covering development. In spite of the infectious and inflammatory statement of such sockets, rapid healing of the wound was observed without pain, dryness, or purulent complications. The results of the observed cases showed that biologic effect of PRF was revealed trough achieved angiogenesis, immune control, harnessing the circulating stem cells, and wound protection by epithelial cover. PRF alone or in combination with other biomaterials seems to have several advantages and indications in oral surgery, due it is a minimally invasive technique with low risks and satisfactory results. Key words: Platelet-rich fibrin, Blood platelet, Bone regeneration, Soft tissue regeneration

Second generation platelet concentrate (platelet-rich fibrin) and it's application in oral surgery

The development of bioactive surgical additives, which are being used to regulate the inflammation and increase the speed of healing process, is one of the great challenges in oral surgery. Platelet-rich fibrin (PRF) is a second-generation platelet concentrate who was defined as an autologous leukocyte and PRF biomaterial, in which, platelets and leukocytes are collected with high efficiency such that the growth factors will able to release gradually during at least 1 week. The following article attempts to summarize our clinical cases regarding the technique of using PRF, focusing on its preparation, advantages of using it in oral surgery. This technique requires neither anticoagulant nor bovine thrombin (nor any other gelling agent). It is nothing more than centrifuged blood without any addition. The biologic effect of this fibrin matrix is: angiogenesis, immune control, harnessing the circulating stem cells, and wound protection by epithelial cover. The soft and bone tissue management in all our cases show process of neovascularization through the PRF clot and the epithelial covering development. In spite of the infectious and inflammatory statement of such sockets, rapid healing of the wound is observed without pain, dryness, or purulent complications. PRF alone or in combination with other biomaterials seems to have several advantages and indications in oral surgery, due it is a minimally invasive technique with low risks and satisfactory results. Keywords: Platelet-rich fibrin, blood platelet, bone regeneration, soft tissue regeneration

Oral surgery treatment in the patients with combination syndrome

Introduction: Combination syndrome is periodicly associated in wearers with removable dentures, were upper is complete denture and lower is partial denture with some of the anterior natural teeth still in the mouth. Material and method: The study was provided on five patients with removable dentures at the Department of prosthodontics in the period of last three years. Three of them have weared the dentures more then ten years, and came to the clinic for new one. Another two patients have weared removable dentures between two and four years, and came because in the frontal part of the upper jaw appeared swollen. By clinical examination in all patients we noticed: hyperplastic tissue in the pre-maxillary region, reduction of the residual ridge on the frontal part of the maxilla as a result of the increasing pressure from the anterior teeth of thelower jaw.This tissue was removed by oral surgery (laser removing of hyperplastic tissue). Also we noticed periodontal changes and extrusion of natural lowerfrontal teeth and increased reduction of mandibular residual ridge. Results and conclusion: After healing period we made: new dentures in the three patients which were covered by the HIFM andin another two patients we made indirect relining on the upper denture, re-occlusion and re-articulation achieving a weak contacts between the lower natural teeth and upper teeth of the complete denture. We cautioned the patients not to bite food with anterior teeth and to avoid chewing very hard food which tends to imprint and displace dentures and of course to came to regular controls. Keywords removable dentures, combination sindrom, hyperplastic tissue, oral surgery treatment