Influence of Leukocyte- and Platelet-Rich Fibrin (L-PRF) in the Healing of Simple Postextraction Sockets: A Split-Mouth Study

Gaetano Marenzi, Francesco Riccitiello, Mariano Tia, Alessandro di Lauro, Gilberto Sammartino, Gaetano Marenzi, Francesco Riccitiello, Mariano Tia, Alessandro di Lauro, Gilberto Sammartino

Abstract

The aim of this study was to evaluate the effects of leukocyte- and platelet-rich fibrin (L-PRF) on the pain and soft tissue healing after tooth extractions. Twenty-six patients (9 males and 17 females) were treated with multiple extractions (2 to 8), with a total of 108 extractions. This was an exploratory single blinded randomized clinical trial with a split-mouth design. The pain after the surgery was assessed in each patient by the VAS scale (1 to 10) at intervals of 24-48-72-96 hours. The soft tissue healing was clinically evaluated at 3, 7, 14, and 21 days after surgery by the same examiner surgeon, using the modified Healing Index (4 to 12). The mean value of postextraction pain was 3.2 ± 0.3 in the experimental sides and 4.1 ± 0.1 in the control sides. After 7 days from the extractions, the values of modified Healing Index in the experimental and control groups were, respectively, 4.8 ± 0.6 and 5.1 ± 0.9. The use of L-PRF in postextraction sockets filling can be proposed as a useful procedure in order to manage the postoperative pain and to promote the soft tissue healing process, reducing the early adverse effects of the inflammation.

Figures

Figure 1
Figure 1
Presurgery clinical occlusal view. For orthodontic motive, this patient needed the bilateral extraction of the upper first premolars.
Figure 2
Figure 2
The postextraction sockets.
Figure 3
Figure 3
The upper right socket (study site) was filled with L-PRF, while the upper left socket (control site) had to follow natural healing. Both sites were sutured.
Figure 4
Figure 4
Clinical occlusal view 3 days after surgery. In the study site, the epithelialization process was more advanced than in the control site. In the study site, the inflammatory reaction was reduced.
Figure 5
Figure 5
Clinical occlusal views 7 days after surgery. The sutures were removed. Both postextraction socket cavities presented a decreased volume and appeared epithelialized.
Figure 6
Figure 6
Clinical follow-up at 14 days after surgery. Both postextraction sockets were completely closed with the soft tissues.
Figure 7
Figure 7
At 21 days after surgery, both postextraction healing sites were completely closed with the soft tissues.

References

    1. Bielecki T., Dohan Ehrenfest D. M. Leukocyte- and platelet-rich Plasma (L-PRP)/fibrin (L-PRF) in medicine—past, present, future. Current Pharmaceutical Biotechnology. 2012;13(7):1–2. doi: 10.2174/138920112800624274.
    1. Gruber R., Varga F., Fisher M. B., Watzek G. Platelet stimulate proliferation of bone cells:involvement of platelet-derived growth factor, microparticles and membranes. Clinical Oral Implants Research. 2002;13:529–535.
    1. Carlson N. E., Roach J. R. B. Platelet-rich plasma: clinical application in dentistry. The Journal of the American Dental Association. 2002;133:1383–1386.
    1. Sanchez A. R., Sheridan P. J., Kupp L. I. Is platelet-rich plasma the perfect enhancement factor? A current review. The International Journal of Oral & Maxillofacial Implants. 2003;18:93–103.
    1. Anitua E., Andia I., Ardanza B., et al. Autologous platelets as a sourge of proteins for healing and tissue regeneration. Thrombosis and Haemostasis. 2004;91:4–15.
    1. Marx R. E., Carlson E. R., Eichstaedt R. M., Schimmele S. R., Strauss J. E., Georgeff K. R. Platelet-rich plasma: growth factor enhancement for bone grafts. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics. 1998;85(6):638–646. doi: 10.1016/s1079-2104(98)90029-4.
    1. Everts P. A. M., Hoogbergen M. M., Weber T. A., Devilee R. J. J., van Monftort G., de Hingh I. H. J. T. Is the use of autologous platelet-rich plasma gels in gynecologic, cardiac, and general, reconstructive surgery beneficial? Current Pharmaceutical Biotechnology. 2012;13(7):1163–1172. doi: 10.2174/138920112800624346.
    1. Yuan T., Guo S.-C., Han P., Zhang C. Q., Zeng B. F. Applications of leukocyte- and platelet-rich plasma (L-PRP) in trauma surgery. Current Pharmaceutical Biotechnology. 2012;13(7):1173–1184. doi: 10.2174/138920112800624445.
    1. del Fabbro M., Bortolin M., Tascheri S. Is autologous platelet concentrate beneficial for post-extraction socket healing? A systematic review. International Journal of Oral and Maxillofacial Surgery. 2011;40:891–900.
    1. Esposito M., Grusovin M. G., Rees J., et al. Effectiveness of sinus lift procedures for dental implant rehabilitation: a Cochrane systematic review. European Journal of Oral Implantology. 2010;3:7–26.
    1. Dohan Ehrenfest D. M., Sammartino G., Shibli J. A., Wang H. L., Zou D. R., Bernard J. P. Guidelines for the publication of articles related to platelet concentrates (Platelet-Rich Plasma—PRP, or Platelet-Rich Fibrin—PRF): the international classification of the POSEIDO. POSEIDO. 2013;1(1):17–27.
    1. Dohan Ehrenfest D. M., Bielecki T., Jimbo R., et al. Do the fibrin architecture and leukocyte content influence the growth factor release of platelet concentrates? An evidence-based answer comparing a pure platelet-rich plasm (P-PRP) gel and a leukocyte- and platelet-rich fibrin (L-PRF) Current Pharmaceutical Biotechnology. 2012;13(7):1145–1152. doi: 10.2174/138920112800624382.
    1. del Corso M., Vervelle A., Simonpieri A., et al. Current knowledge and perspectives for the use of platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) in oral and maxillofacial surgery part 1: periodontal and dentoalveolar surgery. Current Pharmaceutical Biotechnology. 2012;13(7):1207–1230. doi: 10.2174/138920112800624391.
    1. Simonpieri A., del Corso M., Vervelle A., et al. Current knowledge and perspectives for the use of platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) in oral and maxillofacial surgery. Part 2. Bone graft, implant and reconstructive surgery. Current Pharmaceutical Biotechnology. 2012;13(7):1231–1256. doi: 10.2174/138920112800624472.
    1. Geurs N., Ntounis A., Vassilopoulos P., van der Velden U., Loos B. G., Reddy M. Using growth factors in human extraction sockets: a histologic and histomorphometric evaluation of short-term healing. The International Journal of Oral & Maxillofacial Implants. 2014;29(2):485–496. doi: 10.11607/jomi.3408.
    1. Kaur P., Maria A. Efficacy of platelet rich plasma and hydroxyapatite crystals in bone regeneration after surgical removal of mandibular third molars. Journal of Maxillofacial and Oral Surgery. 2013;12(1):51–59. doi: 10.1007/s12663-012-0382-6.
    1. Weibrich G., Kleis W. K. G., Hafner G. Growth factor levels in the platelet-rich plasma produced by 2 different methods: curasan-type PRP kit versus PCCS PRP system. International Journal of Oral & Maxillofacial Implants. 2002;17(2):184–190.
    1. Borzini P., Balbo V., Mazzucco L. Platelet concentrates for topical use: bedside device and blood transfusion technology. Quality and versatility. Current Pharmaceutical Biotechnology. 2012;13(7):1138–1144. doi: 10.2174/138920112800624454.
    1. Rivera C., Monsalve F., Salas J., Morán A., Suazo I. Platelet-rich plasma, plasma rich in growth factors and simvastatin in the regeneration and repair of alveolar bone. Experimental and Therapeutic Medicine. 2013;6(6):1543–1549. doi: 10.3892/etm.2013.1327.
    1. Sammartino G., Tia M., Bucci T., Wang H. L. Prevention of mandibular third molar extraction-associated periodontal defects: a comparative study. Journal of Periodontology. 2009;80(3):389–396.
    1. Chang Y. C., Zhao J. H. Effect of platelet-rich fibrin on human periodontal ligament fibroblasts and application forperiodontal infrabony defects. Australian Dental Journal. 2011;56:365–371.
    1. Toeroek R., Dohan Ehrenfest D. M. The concept of Screw-Guided Bone Regeneration (S-GBR). Part 3: fast screw-guided bone regeneration (FS-GBR) in the severely resorbed preimplant posterior mandible using allograft and leukocyte- and platelet-rich fibrin (L-PRF): a 4-year follow-up. POSEIDO. 2013;1(2):93–100.
    1. Zumstein M. A., Berger S., Schober M., et al. Leukocyte- and platelet-rich fibrin (L-PRF) for long-term delivery of growth factor in rotator cuff repair: review, preliminary results and future directions. Current Pharmaceutical Biotechnology. 2012;13(7):1196–1206. doi: 10.2174/138920112800624337.
    1. Dohan Ehrenfest D. M., de Peppo G. M., Doglioli P., Sammartino G. Slow release of growth factors and thrombospondin-1 in Choukroun's platelet-rich fibrin (PRF): a gold standard to achieve for all surgical platelet concentrates technologies. Growth Factors. 2009;27(1):63–69.
    1. Passaretti F., Tia M., D'esposito V., et al. Growth-promoting action and growth factor release by different platelet derivatives. Platelets. 2014;25(4):252–256. doi: 10.3109/09537104.2013.809060.
    1. Dohan Ehrenfest D. M., Vazquez L. Pulling out, extraction or avulsion? Implant Dentistry. 2008;17(1):p. 4. doi: 10.1097/id.0b013e31816760b4.
    1. Sammartino G., Dohan Ehrenfest D. M., Carile F., Tia M., Bucci P. Prevention of hemorrhagic complications after dental extractions into open heart surgery patients under anticoagulant therapy: the use of leukocyte- and platelet-rich fibrin. The Journal of Oral Implantology. 2011;37(6):681–690. doi: 10.1563/aaid-joi-d-11-00001.
    1. Mozzati M., Gallesio G., di Romana S., Bergamasco L., Pol R. Efficacy of plasma-rich growth factor in the healing of postextraction sockets in patients affected by insulin-dependent diabetes mellitus. Journal of Oral and Maxillofacial Surgery. 2014;72(3):456–462. doi: 10.1016/j.joms.2013.10.010.
    1. Dohan Ehrenfest D. M., del Corso M., Inchingolo F., Charrier J. B. Selecting a relevant in vitro cell model for testing and comparing the effects of a Choukroun's platelet-rich fibrin (PRF) membrane and a platelet-rich plasma (PRP) gel: tricks and traps. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology. 2010;110(4):409–413. doi: 10.1016/j.tripleo.2010.05.056.
    1. Choukroun J., Diss A., Simonpieri A., et al. Platelet-rich fibrin (PRF): a second-generation platelet concentrate. Part IV: clinical effects on tissue healing. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics. 2006;101:56–60.
    1. Kang Y.-H., Jeon S. H., Park J.-Y. Platelet-rich fibrin is a bioscaffold and reservoir of growth factors for tissue regeneration. Tissue Engineering Part A. 2011;17:349–359.
    1. Bielecki T., Dohan Ehrenfest D. M., Everts P. A., Wiczkowski A. The role of leukocytes from L-PRP/L-PRF in wound healing and immune defense: new perspectives. Current Pharmaceutical Biotechnology. 2012;13(7):1153–1162. doi: 10.2174/138920112800624373.

Source: PubMed

Sponsorer og samarbejdspartnere

Medicinske tilstande

Narkotikainterventioner

3
Abonner