Comparison of Bone Morphogenic Proteins’ and Platelet Rich Fibrins’ Effectiveness in Socket Preservation

The dentist faces a difficult challenge in preserving the quantity and quality of gum and bone tissues. Furthermore, the processes adopted should meet these objectives while posing no substantial future issues. In current dental and maxillofacial surgery, a variety of materials as Morphogenic Protein of Bone (BMP) and Platelet Rich Fibrins (PRF) are employed to repair and reconstruct bone tissue. The purpose of this review was to compare the efficiency of both BMP’s and PRF’s in Socket preservation. Reviewing the literature was conducted by using the following search strategies: Bone Morphogenic Proteins, Platelet Rich Fibrins, socket preservation approach, comparison of BMPs and PRFs, Bone Morphogenic Proteins and effectiveness in socket preservation and Platelet Rich Fibrins’ effectiveness in socket preservation. In conclusion, BMPs have been studied more completely than PRFs, and they have higher impacts on hard tissue regeneration and repair, according to the research. The fact that PRFs increase soft tissue healing shows how promising they are. Especially when we consider that soft tissue healing is more important than socket care in implant dentistry.

Soft Tissue Healing and IL-6 Cytokine Levels in Microsurgical and Conventional Open Flap Debridement in Patients with Chronic Periodontitis - A Randomized Clinico-Biochemical Trial

BACKGROUND The present study was conducted to compare clinical outcomes and gingival crevicular fluid (GCF) interleukin (IL)-6 cytokine levels in microsurgical and conventional open flap debridement procedure. METHODS Thirty sites in chronic periodontitis patients were randomly assigned into Group I (microsurgical) and Group II (conventional) open flap debridement in a split-mouth design. Gingival bleeding index (GBI), probing pocket depth (PPD), relative attachment level (RAL) were recorded at baseline and 3 months. GCF IL-6 cytokine levels were assessed at baseline and on 3rd day postoperatively. Pain perception using visual analog score (VAS) and soft tissue healing using early healing index (EHI) were assessed after on 7th day post-surgery. RESULTS There was a significant reduction in gingival bleeding index, probing pocket depth, relative attachment level within both the groups. Intergroup gingival bleeding index scores were statistically significant at the end of 3 months. The difference in visual analog scores between the two groups was found to be statistically insignificant whereas early healing index scores between the groups was found to be statistically significant. Group I showed lower levels of IL-6 on 3rd day postoperatively. It was also found that there was positive correlation of IL-6 levels with clinical parameters such as PPD and RAL. CONCLUSIONS Open flap debridement using microsurgical approach can substantially improve clinical parameters and wound healing compared with conventional macrosurgical approach. IL-6 levels were lower in microsurgical group indicating less invasive surgical approach. KEY WORDS Open Flap Debridement, Periodontal Microsurgery, Wound Healing, IL-6, Cytokine, GCF.

Platelet Rich Fibrin - A Saviour for Replanted Teeth – A Review

The periodontal ligament is a unique specialised connective tissue between the cementum covering the tooth root and the alveolar bone. It is believed that periodontal ligament cells are responsible for not only osteogenesis and osteoclasia of the alveolar bone but also for fibrogenesis and fibroplasia of the ligament itself, as well as cementogenesis and the presence of cementoblasts on the root surface. Injury to the periodontal ligament (PDL) and its compromised healing (external inflammatory resorption and replacement resorption) has been cited as one of the major reasons for the failure of transplantation and replantation procedures. The necessity of having a healthy PDL so that the tooth can re-attach and be retained in the socket determines the prognosis of replanted teeth. Thus, the importance of maintaining the periodontal viability has led to an increased interest in the development of platelet concentrates, which have been considered as autologous biomaterials having the ability to potentiate healing, repair, and regenerate. PRF (platelet rich fibrin) is a living biomaterial derived from human blood containing fibrin, platelets, growth factors, leukocytes and stem cells entrapped in a fibrin-based scaffold / matrix, which has been documented to promote bone and soft tissue healing and regeneration. PRF technology has grabbed the attention of clinicians because it is readily available, is easy to prepare, can be produced immediately at the chairside, is easy to use, and widely applicable in dentistry, while being financially realistic for the patient and the clinician. Thus, the purpose of this review is to enumerate the biologic, chemical and physical properties of PRF and highlight the essential role it plays in periodontal regeneration and repair, which can be highly beneficial in improving the treatment success rate of transplantation and replantation procedures. KEY WORDS Platelet Rich Fibrin, Replantation, Transplantation, Periodontal Ligament, Periodontal Regeneration

The Effect of Platelet Rich Plasma on Tissue Healing after Mandibular Third Molar Surgery

Introduction: This study aimed, effect of platelet-rich plasma (PRP) on soft tissue healing after mandibular third molar surgery. Materials & Methods: In this semi-blinded clinical trial study,30 selected patients requiring surgical extraction of soft tissue impacted mandibular third molar participated from cases referred to the Department of Surgery, Faculty of Dentistry, Isfahan Azad University 2017.Patients divided into both test and control groups. PRP was placed in the extracted socket of the test group, whereas the control group had no PRP. Arzhangian standard kit utilized for preparation of PRP. The outcome variables in this study were pain, swelling, inter incisal mouth opening, wound dehiscence, dry socket, bleeding, and tissue color. The collected data analyzed using statistical tests followed independent T-test, Mann-Whitney, and fisher (p value < 0.05). Results: The mean postoperative pain score (Visual Analog Scale) lowered for the test group after several wound dehiscence on the third and seventh days after surgery which was statistically significant (p value < 0.001). Although the mean bleeding time on the third day after surgery decreased in the test group, this difference was not statistically significant (p value = 0.59). There were no statistically significant between both groups for The dry socket incidence on the seventh day and the mean of inter incisal mouth opening in the third and seventh days after surgery as well. Conclusion: The usage of topical PRP has beneficial advantages on soft tissue healing after mandibular third molar surgery. Unlike the control group, The PRP group provided reduced pain and better soft tissue healing.

Topical Review: Bone Marrow Aspirate Concentrate and Its Clinical Use in Foot and Ankle Surgery

Bone marrow aspirate concentrate (BMAC) is now commonly used in orthopedic surgery. Animal studies showed promising results for cartilage, bone, and soft tissue healing; however, many of these outcomes have yet to be translated to human models. While there has been an increase in the use of BMAC in foot and ankle procedures, the associated clinical evidence is limited. The purpose of this review is to analyze the existing literature in order to evaluate the safety and efficacy of BMAC in foot and ankle surgery.

The Role of Hypericum Lydium Boiss. (Hypericaceae) in Soft Tissue Healing and its Capacity to Prevent Infections after Dental Extraction

The genus Hypericum sp. has a number of uses in traditional medicine like curing the burns, ulcers, haemorrhoids and wound healing. The species Hypericum lydium Boiss. (Hypericaceae), however, has not been known to have any properties related to the healing of injuries or antimicrobial working against the oral microorganisms. The present study was aimed to evaluate the efficiency of H. lydium in soft tissue healing and its capacity to prevent infections after dental extraction. H. lydium was extracted with ethanol and the obtained extract was tested for its inhibition ability on extracellular matrix-degrading enzymes; collagenase, hyaluronidase and elastase. To determine the cytotoxicity and wound healing capacity of the extract, MTT and in vitro scratch wound healing assay were performed using the NIH-3T3 fibroblast cells, respectively. Antimicrobial activity was investigated by microdilution method against oral pathogenic microorganisms. The highest enzyme inhibition activity was determined against elastase (80.27±0.1%). According to the cytotoxic activity results, the IC50 value of the H. lydium was found to be 82.20±4.05 μg/mL. Scratch wound healing assay of the extract exhibited a significant enhancement at 24 h with a closed wound area when compared with the control. The extract showed potent antimicrobial properties against oral pathogenic microorganisms. The results of the study revealed out that H. lydium can be considered as a natural compound for dental industry to improve soft tissue healing and to prevent the possible infections after dental extraction.

The Effectiveness of Advanced Platelet-Rich Fibrin in comparison with Leukocyte-Platelet-Rich Fibrin on Outcome after Dentoalveolar Surgery

Background and Purpose. Some physiological changes may occur following tooth extraction, and symptoms during the postextraction period may affect the patient’s quality of life. Many techniques have been developed to improve postextraction pain and soft tissue healing. Accordingly, this study will compare the postextraction pain and early soft tissue healing characteristics of extraction sites treated with leukocyte-platelet-rich fibrin (L-PRF) and advanced platelet-rich fibrin (A-PRF). The aim is to evaluate the effect of advanced PRF in comparison with L-PRF on soft tissue healing and pain after teeth extraction and to advice dental practitioner to use the advanced PRF in clinic to enhance soft tissue healing and decrease pain. Methods. The study included 60 patients according to sample size calculation, recruited from patients seeking tooth extraction at oral and maxillofacial surgery clinic at Umm Al-Qura University, Faculty of Dentistry. Patients were divided into three groups. Group Ӏ included 20 patients managed by advanced platelet-rich fibrin after extraction. Group ӀӀ included 20 patients managed by leukocyte-platelet-rich fibrin after tooth extraction. Group ӀII included 20 patients left without any addition. Each group was further subdivided into surgical and nonsurgical extraction. Afterwards, patients in each group were assessed for postextraction pain by VAS, number of analgesics, and early soft tissue healing by LWHI. Results. The study outcomes demonstrate that the use of A-PRF significantly reduces postoperative pain in the 1st and 2nd day. VAS pain scores on the first day were significantly higher in the control surgical extraction group and L-PRF nonsurgical extraction group. In early soft tissue healing. The Landry Wound Healing Index (LWHI) was used after 1 and 2 weeks of extraction to evaluate the extraction site. In first week, the A-PRF group and L-PRF group (nonsurgical extraction) had a better healing index when compared to control group, and A-PRF group (surgical extraction) had a best healing index when compared to L-PRF and control groups. In the second week, individuals in the A-PRF group (surgical and nonsurgical extraction) had a better healing index when compared to L-PRF and control groups.