Therapeutic Effectiveness of Leukocyte-and Platelet-rich Fibrin for Diabetic Foot Ulcers:A Retrospective Study

Objective Diabetic foot ulcer(DFU)is one of the most serious complications of diabetes.Leukocyte-and platelet-rich fibrin(L-PRF)is a second-generation autologous platelet-rich plasma.This study aims to investigate the clinical effects of L-PRF in patients with diabetes in real clinical practice.Methods Patients with DFU who received L-PRF treatment and standard of care(SOC)from 2018 to 2019 in Tongji Hospital were enrolled.The clinical information including patient characteristics,wound evaluation(area,severity,infection,blood supply),SOC of DFU,and images of ulcers was retrospectively extracted and analyzed.L-PRF treatment was performed every 7±2 days until the ulcer exhibited complete epithelialization or an overall percent volume reduction(PVR)greater than 80%.Therapeutic effectiveness,including overall PVR and the overall and weekly healing rates,was evaluated.Results Totally,26 patients with DFU were enrolled,and they had an ulcer duration of 47.0(35.0,72.3)days.The severity and infection of ulcers varied,as indicated by the Site,Ischemia,Neuropathy,Bacterial Infection,and Depth(SINBAD)scores of 2–6,Wagner grades of 1–4,and the Perfusion,Extent,Depth,Infection and Sensation(PEDIS)scores of 2–4.The initial ulcer volume before L-PRF treatment was 4.94(1.50,13.83)cm3,and the final ulcer volume was 0.35(0.03,1.76)cm3.The median number of L-PRF doses was 3(2,5).A total of 11 patients achieved complete epithelialization after the fifth week of treatment,and 19 patients achieved at least an 80%volume reduction after the seventh week.The overall wound-healing rate was 1.47(0.63,3.29)cm3/week,and the healing rate was faster in the first 2 weeks than in the remaining weeks.Concurrent treatment did not change the percentage of complete epithelialization or healing rate.Conclusion Adding L-PRF to SOC significantly improved wound healing in patients with DFU independent of the ankle brachial index,SINBAD score,or Wagner grade,indicating that this method is appropriate for DFU treatment under different clinical conditions.

Rescuing“hopeless”avulsed teeth using autologous platelet-rich fibrin following delayed reimplantation:Two case reports

BACKGROUND Tooth avulsion is one of the most severe types of dental trauma.Most avulsed teeth undergo long-term ankylosis and replacement resorption after delayed reimplantation and exhibit a poor prognosis.The aim of this work was to improve the success rate of avulsed teeth after delayed reimplantation using autologous platelet-rich fibrin(PRF).CASE SUMMARY Case 1 was a 14-year-old boy who fell and knocked out his left upper central incisor 18 h prior to his arrival at the department.The diagnoses were avulsion of tooth 21,lateral luxation of tooth 11 and alveolar fracture of teeth 11 and 21.In case 2,a 17-year-old boy fell 2 h prior to his presentation to the hospital,and his left upper lateral incisor was completely knocked out of the alveolar socket.The diagnoses included avulsion of tooth 22,complicated crown fracture of tooth 11and complicated crown-root fracture of tooth 21.The avulsed teeth were reimplanted along with autologous PRF granules and splinted using a semiflexible titanium preshaped labial arch.The root canals of the avulsed teeth were filled with calcium hydroxide paste,and root canal filling was performed 4 wk after reimplantation.The reimplanted teeth showed no symptoms of inflammatory root resorption or ankylosis at the 3-,6-,and 12-mo follow-up examinations after reimplantation with autologous PRF.In addition to the avulsed teeth,the other injured teeth were treated using corresponding conventional treatment methods.CONCLUSION These cases provide examples of the successful use of PRF to reduce pathological root resorption of the avulsed teeth,and the application of PRF may provide new healing opportunities for traditionally“hopeless”avulsed teeth.

Early therapeutic effect of platelet-rich fibrin combined with allogeneic bone marrow-derived stem cells on rats’ critical-sized mandibular defects

BACKGROUND Critically sized bone defects represent a significant challenge to orthopaedic surgeons worldwide.These defects generally result from severe trauma or resection of a whole large tumour.Autologous bone grafts are the current gold standard for the reconstruction of such defects.However,due to increased patient morbidity and the need for a second operative site,other lines of treatment should be introduced.To find alternative unconventional therapies to manage such defects,bone tissue engineering using a combination of suitable bioactive factors,cells,and biocompatible scaffolds offers a promising new approach for bone regeneration.AIM To evaluate the healing capacity of platelet-rich fibrin(PRF)membranes seeded with allogeneic mesenchymal bone marrow-derived stem cells(BMSCs)on critically sized mandibular defects in a rat model.METHODS Sixty-three Sprague Dawley rats were subjected to bilateral bone defects of critical size in the mandibles created by a 5-mm diameter trephine bur.Rats were allocated to three equal groups of 21 rats each.Group I bone defects were irrigated with normal saline and designed as negative controls.Defects of group II were grafted with PRF membranes and served as positive controls,while defects of group III were grafted with PRF membranes seeded with allogeneic BMSCs.Seven rats from each group were killed at 1,2 and 4 wk.The mandibles were dissected and prepared for routine haematoxylin and eosin(HE)staining,Masson's trichrome staining and CD68 immunohistochemical staining.RESULTS Four weeks postoperatively,the percentage area of newly formed bone was significantly higher in group III(0.88±0.02)than in groups I(0.02±0.00)and II(0.60±0.02).The amount of granulation tissue formation was lower in group III(0.12±0.02)than in groups I(0.20±0.02)and II(0.40±0.02).The number of inflammatory cells was lower in group III(0.29±0.03)than in groups I(4.82±0.08)and II(3.09±0.07).CONCLUSION Bone regenerative quality of critically sized mandibular bone defects in rats was better promoted by PRF membranes seeded with BMSCs than with PRF membranes alone.

Autologous peripheral blood-derived orthobiologics:Different types and their effectiveness in managing knee osteoarthritis

Knees are the most commonly impacted weight-bearing joints in osteoarthritis(OA),affecting millions of people worldwide.With increasing life spans and obesity rates,the incidence of knee OA will further increase,leading to a significant increase in the economic burden.Conventional treatment modalities utilized to manage knee OA have limitations.Over the last decade,the role of various autologous peripheral blood-derived orthobiologics(APBOs)for the treatment of knee OA has been extensively investigated.This editorial provided an overview and focused on defining and shedding light on the current state of evidence based on the most recent published clinical studies concerning the use of APBO for the management of knee OA.While numerous studies have demonstrated promising results for these preparations,a notable gap exists in the comparative analysis of these diverse formulations.This absence of head-to-head studies poses a considerable challenge for physicians/surgeons in determining the optimal preparation for managing knee OA and achieving sustained longterm results.Thus,more adequately powered,multicenter,prospective,doubleblind,randomized controlled trials with longer follow-ups are needed to establish the long-term efficacy and to aid physicians/surgeons in determining the optimal APBO for the management of knee OA.

Platelet-rich fibrin-induced bone marrow mesenchymal stem cell differentiation into osteoblast-like cells and neural cells

Bone marrow mesenchymal stem cells were allowed to develop for 14 days in a platelet-rich fibrin environment.Results demonstrated that platelet-rich fibrin significantly promoted bone marrow mesenchymal stem cell proliferation.In addition,there was a dose-dependent increase in Runt-related transcription factor-2 and bone morphogenetic protein-2 mRNA expression,as well as neuron-specific enolase and glial acidic protein.Results showed that platelet-rich fibrin promoted bone marrow mesenchymal stem cell proliferation and differentiation of osteoblast-like cells and neural cells in a dose-dependent manner.

Periodontally accelerated osteogenic orthodontics with platelet-rich fibrin in an adult patient with periodontal disease:A case report and review of literature

BACKGROUND In the clinical scenario,adult patients with periodontal diseases and dental malformation,characterized by dental crowding in lower anterior teeth with the thin biotype,often require orthodontic treatment.This case report aimed to evaluate the clinical and radiographic outcomes of periodontally accelerated osteogenic orthodontics(PAOO)combined with autologous platelet-rich fibrin(PRF)in an adult patient with class I malocclusion along with dental crowding,a thin periodontal biotype,and buccal plate deficiency.CASE SUMMARY A 32-year-old female complaining of dental crowding and gingival bleeding was referred to the orthodontic clinic.The patient underwent periodontal risk assessment prior to orthodontic treatment.She was diagnosed with a high risk of gingival recession due to dental crowding,root prominence,loss of buccal plates,and a thin gingival tissue biotype.The treatment regimen included PAOO combined with autologous PRF for alveolar augmentation and interproximal enamel reduction for moderate dental crowding.Clinically,PAOO-assisted orthodontic tooth movement in this case showed enhanced periodontium remodeling.Radiographic outcomes also showed statistically significant improvements(P<0.01)in the mandibular buccal alveolar bone.CONCLUSION This case report suggests the combination of autologous PRF with PAOO to enhance bone augmentation and long-term tissue support in adult orthodontic patients with periodontal disease.

Peri-implant keratinized gingiva augmentation using xenogeneic collagen matrix and platelet-rich fibrin:A case report

BACKGROUND Keratinized gingival insufficiency is a disease attributed to long-term tooth loss,can severely jeopardizes the long-term health of implants.A simple and effective augmentation surgery method should be urgently developed.CASE SUMMARY A healthy female patient,45-year-old,requested implant restoration of the her left mandibular first molar and second molar.Before considering a stage II,as suggested from the probing depth measurements,the widths of the mesial,medial,and distal buccal keratinized gingiva of second molar(tooth#37)were measured and found to be 0.5 mm,0.5 mm,and 0 mm,respectively.This suggested that the gingiva was insufficient to resist damage from bacterial and mechanical stimulation.Accordingly,modified apically repositioned flap(ARF)surgery combined with xenogeneic collagen matrix(XCM)and platelet-rich fibrin(PRF)was employed to increase the width of gingival tissue.After 1 mo of healing,the widths of mesial,medial,and distal buccal keratinized gingiva reached 4 mm,4 mm,and 3 mm,respectively,and the thickness of the augmented mucosa was 4.5 mm.Subsequently,through the second-stage operation,the patient obtained an ideal soft tissue shape around the implant.CONCLUSION For cases with keratinized gingiva widths around implants less than 2mm􀀀the soft tissue width and thickness could be increased by modified ARF surgery combined with XCM and PRF.Moreover,this surgery significantly alleviated patients’pain and ameliorated oral functional comfort.

Flapless immediate implant placement into fresh molar extraction socket using platelet-rich fibrin: A case report

BACKGROUND There are some challenges concerning immediate implant placement in the molar region.Platelet-rich fibrin(PRF),an autologous biomaterial,has been used widely for periodontal intra-bony defects,sinus augmentation,socket preservation,and gingival recession.However,the literature remains scarce for reports on immediate implants with PRF,particularly in the case of fresh molar extraction socket.CASE SUMMARY The patient was a 43-year-old woman with maxillary molar vertical crown-root fracture.She underwent flapless immediate implant placement into the fresh molar socket with PRF.At the follow-up visit 15 d post procedure,the vascularization of soft tissue was visible.There was no swelling or pain after the surgery.Six months postoperatively,the regeneration of bone and soft tissues was visible.Subsequently,the definitive restoration was placed.The patient was satisfied with the aesthetic outcomes.CONCLUSION The flapless immediate implant placement into the fresh molar socket with PRF is a feasible procedure.This case report demonstrates that PRF promotes bone and soft tissue regeneration apart from having an enhanced anti-inflammatory ability.Furthermore,the procedure involves a minimally invasive technique,thus reducing the surgical complexity.

Implant site development using titanium plate and platelet-rich fibrin for congenitally missed maxillary lateral incisors:A case report

BACKGROUND Bone deficiency and soft tissue atrophy in the absence of maxillary lateral incisors are among the most challenging problems for implant clinicians.Autologous bone grafting is the gold standard for bone augmentation,but not without limitations.Platelet-rich fibrin(PRF),a biodegradable autologous biomaterial,has been widely used for bone and soft tissue management.Moreover,titanium plate is an advantageous barrier due to its good space-maintaining ability.However,there is a lack of literature on implant site development using titanium plate and PRF for congenitally missing maxillary lateral incisors.CASE SUMMARY The patient was a 19-year-old girl with a congenitally missing tooth(#12).She underwent implant placement and simultaneous autologous bone grafting with titanium plate and PRF.At the follow-up visit 15 d post-procedure,the vascularization of soft tissue was visible.There was no swelling or pain after the surgery.Six months postoperatively,bone regeneration was evident.Subsequently,the definitive restoration was placed,and the patient was satisfied with the esthetic outcomes.CONCLUSION Implant site development using titanium plate and PRF for congenitally missing maxillary lateral incisors is a feasible procedure.In this case,the labial bone plate was displaced but remained connected to the base bone,ensuring blood supply.The titanium plate fixed the labial bone plate and maintained the osteogenic space,while the PRF provided growth factors and leukocytes for bone and soft tissue regeneration.Furthermore,the procedure reduced the surgical complexity and adverse reactions,displaying outstanding esthetic outcomes.

Autologous platelet-rich-fibrin-induced revascularization sequelae:Two case reports Autologous platelet-rich-fibrin-induced revascularization sequelae:Two case reports

BACKGROUND A key requirement for biomimetic regeneration of tissues is a 3D scaffold.The gold standard scaffold for revascularization is the blood clot,however,an adequate blood clot cannot always be achieved in narrow canals or mature roots.Hereby,we document the effects of platelet-rich fibrin(PRF)for the regenerative endodontic treatment(RET)of two immature permanent teeth with necrotic pulps for up to 48 mo.CASES SUMMARY The first patient was a 22-year-old female with history of trauma in tooth#9 with a sinus tract and a large periapical lesion.The second was a 9-year-old male presenting with a badly decayed tooth#14.Both cases were treated with RET and PRF prepared from the patients’blood.PRF and its extract were used as a scaffold for RET.Patients were followed-up to 9 and 48 mo(4 years),respectively.Both patients,were asymptomatic after treatment.At the 9-mo-follow-up of case#1,there was radiographic evidence of periapical bone healing,however,the root apex was still open.In case#2,the roots exhibited apical closure and normal periapical bone architecture at 12-mo follow-up,while no root lengthening was observed.After 48 mo,case#2 showed extensive intracanal calcification in all root canals that complicated conventional root canal treatment.CONCLUSION RET with PRF and its extract could be used in revascularization of immature permanent teeth.However,proper case selection to comply with long-term follow-up is necessary and adverse events such as calcification and canal obliteration should be planned for.

Comparative evaluation of effect of injectable platelet-rich fibrin with collagen membrane compared with collagen membrane alone for gingival recession coverage

BACKGROUND Collagen membrane and platelet-rich fibrin(PRF)have emerged as vital biomaterials in the field of periodontal regeneration.Minimally invasive techniques are being preferred by most periodontists,as it is patient compliant with fewer post-surgical complications as compared to conventional surgical techniques.Thus,in this study we have evaluated the effect of injectable PRF(i-PRF)with collagen membrane compared with collagen membrane alone using vestibular incision subperiosteal tunnel access(VISTA)technique for gingival recession coverage.AIM To compare the efficacy of VISTA using collagen membrane with collagen membrane soaked in injectable PRF for gingival recession coverage.METHODS A split mouth randomized controlled clinical trial was designed;13 subjects having at least 2 teeth indicated for recession coverage were enrolled in this study.The sites were randomly assigned to control group(VISTA using collagen membrane alone)and the test group(VISTA using collagen membrane with i-PRF).The clinical parameters assessed were pocket depth,recession depth(RD),recession width(RW),relative attachment level,keratinised tissue width(KTW),keratinised tissue thickness(KTT),and percentage root coverage.RESULTS RD showed a statistically significant difference between the test group at 3 mo(0.5±0.513)and 6 mo(0.9±0.641)and the control group at 3 mo(0.95±0.51)and 6 mo(1.5±0.571),with P values of 0.008 and 0.04,respectively.RW also showed a statistically significant difference between the test group at 3 mo(1±1.026)and 6 mo(1.65±1.04)and the control group at 3 mo(1.85±0.875)and 6 mo(2.25±0.759),with P values of 0.008 and 0.001,respectively.Results for KTW showed statistically significant results between the test group at 1 mo(2.85±0.489),3 mo(3.5±0.513),and 6 mo(3.4±0.598)and the control group at 1 mo(2.45±0.605),3 mo(2.9±0.447),and 6 mo(2.75±0.444),with P values of 0.04,0.004,and 0.003,respectively.Results for KTT also showed statistically significant results between test group at 1 mo(2.69±0.233),3 mo(2.53±0.212),and 6 mo(2.46±0.252)and the control group at 1 mo(2.12±0.193),3 mo(2.02±0.18),and 6 mo(1.91±0.166),with P values of 0.001,0.001,and 0.001,respectively.The test group showed 91.6%,81.6%,and 67%root coverage at 1 mo,3 mo,and 6 mo,while the control group showed 82.3%,66.4%,and 53.95%of root coverage at 1 mo,3 mo,and 6 mo,respectively.CONCLUSION The use of minimally invasive VISTA technique along with collagen membrane and injectable form of platelet-rich fibrin can be successfully used as a treatment method for multiple or isolated gingival recessions of Miller’s class-I and class-II defects.

Evaluating the Benefits of Platelet Rich-Fibrin in Periodontal Regeneration: A Literature Review

Introduction: Platelet Rich-Fibrin (PRF) is a biological matrix derived from a patient’s own blood, rich in growth factors and platelets. Its use in various periodontal and non-periodontal procedures is gaining recognition due to its potential in promoting tissue regeneration. The purpose of this review was to evaluate the benefits of using PRF in intra-bony defect regeneration, guided-bone regeneration, and sinus floor elevation. Methods: The study searched PubMed for manuscripts published between 2017 and 2022 to better understand the clinical and radiological effects of PRF. The manuscripts were divided into the following sections: intra-bony defect regeneration, guided-bone regeneration, and sinus floor elevation. Results: In intra-bony defects, PRF improved clinical and radiological parameters when compared with OFD alone, with a significant difference in wound healing at 7 days. In GBR, a CBCT evaluation shows no statistical difference between the PRF-autogenous bone complex group and the bovine bone-collagen membrane complex regarding volume change of the augmented bone with a 16% rate of bone loss following a 6-month healing period. Also, a slight increase in bone thickness has been seen when liquid PRF is used. In sinus floor elevation, results revealed no differences in graft volume between PRF group and control group at any of the evaluated time points. Although higher implant stability immediately postoperatively, higher new bone formation, the lesser amount of residual graft and earlier implant placement. Conclusion: Platelet Rich-Fibrin is widely accepted for use in periodontal surgery and dentistry due to its minimally invasive nature and low risk of adverse effects, with positive results in tissue regeneration. There is evidence that PRF leads to improved and faster healing, as well as cost-effective regenerative procedures compared to other treatments.

PLGA-Fibrin杂合支架构建及与脂肪源性干细胞复合成软骨的研究

目的：探讨在特定的软骨细胞诱导培养液中，由纤维蛋白（fibrin）修饰的聚乳酸／聚羟基乙酸共聚物（PLGA）杂合支架材料对脂肪源性干细胞成软骨的影响。方法：PLGA支架材料采用快速成形技术制备；PLGA-Fibrin杂和支架材料采用低温冷冻的方法制备。分离兔脂肪源性干细胞，分别种植在未修饰的PLGA支架材料和Fbirin修饰的PLGA上，并在特定软骨诱导液中培养至14d，分别应用SEM观察杂合支架材料的性能；生化方法检测硫酸软骨素的含量；支架材料的亲水性和细胞黏附能力也被检测。通过体内实验对两种支架材料与干细胞复合修复软骨缺损的性能进行形态学染色和评分。结果：体外研究表明，与未修饰的PLGA支架材料相比，Fibfn修饰的PLGA亲水性明显被提高，同时也提高了干细胞在杂合支架材料上的黏附性能和硫酸软骨素的含量。软骨损伤修复研究表明，脂肪源性干细胞与Fibirn修饰的PLGA支架材料复合后，具有良好的修复软骨缺损的功能，其性能明显优于单纯的PLGA材料复合干细胞。结论：Fibim修饰的PLGA支架材料可提高脂肪源性干细胞向软骨细胞分化的能力，促进缺损软骨的再生。

纤维蛋白原Bβ15-42肽在细胞水平对缺血再灌注急性肾损伤线粒体自噬的影响

目的探讨纤维蛋白原Bβ15-42肽(fibrin-derived peptide Bβ15-42,FgBβ15-42)在细胞水平对缺血再灌注急性肾损伤(acute kidney injury,AKI)线粒体自噬的影响。方法体外培养人肾小管上皮细胞,随机分为5组,即正常对照组(Control组)、缺氧复氧(hypoxia/reoxygenation,H/R)模型组(H/R组)、H/R模型+9μmol/L FgBβ15-42肽组(Fg组)、H/R模型+20μmol/L氯喹组(CQ组)、H/R模型+9μmol/L FgBβ15-42肽+20μmol/L氯喹组(Fg+CQ组)。Control组:将同质化细胞置于完全培养基中,在有氧(5%CO_(2),21%O_(2))条件下培养28h。H/R组:细胞用无糖、无血清DMEM/F12培养基在缺氧(5%CO_(2),1%O_(2)和94%N 2)条件下培养24h,再更换含血清的DMEM/F12培养基置于有氧(5%CO_(2),21%O_(2))环境中4h。Fg组:在复氧时加入FgBβ15-42肽9μmol/L进行干预。CQ组:在进行同质化处理时加入氯喹进行预处理(20μmol/L),后序步骤同H/R组。Fg+CQ组:按照上述CQ组及FgBβ15-42组在不同时间段的加药顺序、剂量,及H/R组的造模时间进行干预。干预结束后采用CCK-8法检测HK2细胞活力;电子显微镜观察线粒体形态、线粒体自噬体结构及数量;Western blot法检测自噬相关蛋白p62、LC3的表达水平。结果与Control组比较,H/R组细胞的存活率下降(P<0.01);线粒体损伤明显,出现了肿胀、棘断裂等,且线粒体自噬体的数目增多;自噬标志性蛋白LC-3Ⅱ/Ⅰ表达上调(P<0.05),自噬底物蛋白p62表达下调(P<0.01)。与H/R组比较,Fg组、CQ组、Fg+CQ组细胞的存活率回升(P<0.01),线粒体自噬体减少,LC-3Ⅱ/Ⅰ表达下调(P<0.01),p62表达上调(P<0.05),细胞自噬被抑制。结论FgBβ15-42肽干预后可降低H/R-AKI细胞中自噬及线粒体自噬水平,对HK2细胞H/R损伤有保护作用。

Platelet-rich plasma gel in combination with Schwann cells for repair of sciatic nerve injury

Bone marrow mesenchymal stem cells were isolated from New Zealand white rabbits, culture-expanded and differentiated into Schwann cell-like cells. Autologous platelet-dch plasma and Schwann cell-like cells were mixed in suspension at a density of 1 x 106 cells/mL, prior to introduction into a poly （lactic-co-glycolic acid） conduit. Fabricated tissue-engineered nerves were implanted into rabbits to bridge 10 mm sciatic nerve defects （platelet-rich plasma group）. Controls were established using fibrin as the seeding matrix for Schwann cell-like cells at identical density to construct tissue-engineered nerves （fibrin group）. Twelve weeks after implantation, toluidine blue staining and scanning electron microscopy were used to demonstrate an increase in the number of regenerating nerve fibers and thickness of the myelin sheath in the platelet-rich plasma group compared with the fibrin group. Fluoro-gold retrograde labeling revealed that the number of Fluoro-gold-positive neurons in the dorsal root ganglion and the spinal cord anterior horn was greater in the platelet-rich plasma group than in the fibrin group. Electrophysiological examination confirmed that compound muscle action potential and nerve conduction velocity were superior in the platelet-rich plasma group compared with the fibrin group. These results indicate that autologous platelet-rich plasma gel can effectively serve as a seeding matrix for Schwann cell-like cells to construct tissue-engineered nerves to promote perJpheral nerve regeneration.

Platelet-rich plasma,an adjuvant biological therapy to assist peripheral nerve repair

Therapies such as direct tension-free microsurgical repair or transplantation of a nerve autograft,are nowadays used to treat traumatic peripheral nerve injuries（PNI）,focused on the enhancement of the intrinsic regenerative potential of injured axons.However,these therapies fail to recreate the suitable cellular and molecular microenvironment of peripheral nerve repair and in some cases,the functional recovery of nerve injuries is incomplete.Thus,new biomedical engineering strategies based on tissue engineering approaches through molecular intervention and scaffolding offer promising outcomes on the field.In this sense,evidence is accumulating in both,preclinical and clinical settings,indicating that platelet-rich plasma products,and fibrin scaffold obtained from this technology,hold an important therapeutic potential as a neuroprotective,neurogenic and neuroinflammatory therapeutic modulator system,as well as enhancing the sensory and motor functional nerve muscle unit recovery.

Erbium-doped yttrium aluminum garnet laser and advanced plateletrich fibrin+in periodontal diseases:Two case reports and review of the literature

BACKGROUND The goal of periodontal disease treatment is to completely remove bacteria and promote wound healing.The erbium-doped yttrium aluminum garnet(Er:YAG)laser is commonly used to treat periodontal disease.Advanced platelet-rich fibrin+(A-PRF+)secrets growth factors that accelerates soft-and hard-tissue regeneration and wound healing.Herein I present 2 cases of patients with oral diseases treated with a combination of Er:YAG laser and A-PRF+.CASE SUMMARY Case 1 was a female with pocket depth bone loss over 8 mm and infection of tooth 31 and 41,and severe advanced periodontitis with grade III mobility.Case 2 was a male with tooth 22 root end apical swelling and infection and alveolar bony defects.Clinical outcomes were recorded at 6 and 36 mo.In case 1,the Er:YAG laser was used to perform open flap debridement(100 mJ/pulse,15 Hz)and remove calculus and granulation tissue(50 mJ/pulse,30 Hz).In case 2 the laser was used to create a semilunar full thickness flap incision(80 mJ/pulse,20 Hz)and eliminate the pathogen(100 mJ/pulse,15 Hz).In both patients,A-PRF+mixed with bone was used to fill bone defects,and A-PRF+autologous membranes were used to cover tension-free primary flaps.There was no recurrent infection at 36 mo,and tissue regeneration and would healing occurred.CONCLUSION Debridement with an Er:YAG laser followed by treatment with A-PRF+is effective for the treatment periodontal diseases with bone defects.

浓缩生长因子在口腔中骨缺损方向的应用进展

再生医学在医学领域是一门全新的热门学科。浓缩血小板凭借其所含丰富的生长因子,目前已被证明具有强大的再生潜力,广泛应用于拔牙后位点保存、牙槽骨缺损、牙周组织再生、根尖手术和种植等口腔治疗领域。第三代浓缩血小板-浓缩生长因子(Concentrated growth factors,CGF)是一种新型的口腔生物材料,具有来源便利、生物相容性强、安全性高等优势,目前在口腔临床应用中崭露头角,其在组织缺损、骨再生方面的作用倍受关注。笔者通过查阅有关浓缩生长因子的国内外文献,进而熟悉CGF的制取方式、作用机制、适用范围与条件,并且通过与第二代浓缩血小板-富血小板纤维蛋白(Platelet-rich fibrin,PRF)进行生长因子含量、临床应用效果的对比,更好地突出CGF在临床应用中的前景。本文进一步就CGF在口腔临床中骨缺损方向的应用进展展开论述,分别从颌骨缺损、引导骨组织再生(Guided bone regeneration,GBR)+、拔牙术后三个方面阐述诸多学者的研究结果,最终得出结论CGF在口腔临床成骨方面具有非常积极的影响,肯定了CGF在口腔牙槽外科治疗领域的应用意义。

基质细胞衍生因子-1α联合富血小板纤维蛋白在种植牙骨组织再生中的应用研究

目的探讨基质细胞衍生因子-1α联合富血小板纤维蛋白,在促进种植牙牙槽骨组织再生过程中的作用。方法以2019年6月至2020年12月收治的120例种植牙患者为研究对象,根据随机数字表法分为实验组(n=60)和对照组(n=60)。对照组采用富血小板纤维蛋白+人工骨粉,实验组采用基质细胞衍生因子-1α+富血小板纤维蛋白+人工骨粉。对比两组患者的骨密度、骨厚度、牙槽骨唇舌向宽度、牙龈健康情况、种植牙成功率、完全愈合率、局部感染率、种植体稳定系数(ISQ)、探诊深度(PD)、龈沟出血指数(SBI);术后7 d,酶联免疫吸附试验和Western blot检测龈沟液和骨屑中血小板衍生生长因子(PDGF)、转化生长因子-β(TGF-β)、骨形态发生蛋白2(BMP-2)表达水平。结果术后7 d,实验组PDGF、TGF-β、BMP-2蛋白表达水平高于对照组(P<0.05)。术后6个月,实验组骨密度、骨厚度、牙槽骨唇舌向宽度、种植体稳定系数高于对照组(P<0.05),探诊深度和龈沟出血指数低于对照组(P<0.05);两组患者种植牙成功率、完全愈合率和局部感染率对比,差异无统计学意义(P>0.05)。结论基质细胞衍生因子-1α联合富血小板纤维蛋白可以促进种植牙患者牙槽骨组织再生修复,相关作用机制可能与上调PDGF、TGF-β和BMP-2表达有关。

富血小板纤维蛋白渗出液对脂肪干细胞成骨分化及纳米羟基磷灰石支架生物相容性的影响

目的:观察Beagle犬脂肪干细胞在向成骨细胞分化过程中富血小板纤维蛋白(Platelet-richfibrin,PRF)渗出液的作用,及其与支架材料纳米羟基磷灰石支架生物相容性的实验研究。方法:酶消化法获得Beagle犬脂肪干细胞,将收集的富血小板纤维蛋白渗出液分为成骨诱导矿化液组(含成骨矿化液+5%PRF渗出液)、B组对照组(含成骨矿化液的10%FBS的DMEM)和C组空白组(普通10%FBS的DMEM培养液),观察PRF渗出液对成骨的影响,并用环境扫描电镜观察Beagle犬脂肪干细胞与经PRF渗出液孵育的纳米羟基磷灰石支架复合培养后的附着增殖情况。结果:在PRF渗出液的作用下,脂肪干细胞能够更加有效地向成骨细胞分化,形成更多的钙化结节,结节细小致密。环境扫描电镜观察,脂肪干细胞能在支架上充分地附着伸展。结论:PRF渗出液能够有效促进脂肪干细胞向成骨细胞分化,纳米羟基磷灰石三维支架材料具有很好的生物相容性。