Efficacy of platelet-rich fibrin in promoting the healing of extraction sockets: a systematic review

Purpose To address the focused question: in patients with freshly extracted teeth, what is the efficacy of platelet-rich fibrin (PRF) in the prevention of pain and the regeneration of soft tissue and bone compared to the respective control without PRF treatment? Methods After an electronic data search in PubMed database, the Web of Knowledge of Thomson Reuters and hand search in the relevant journals, a total of 20 randomized and/or controlled studies were included. Results 66.6% of the studies showed that PRF significantly reduced the postoperative pain, especially in the first 1–3 days after tooth extraction. Soft tissue healing was significantly improved in the group of PRF compared to the spontaneous wound healing after 1 week (75% of the evaluated studies). Dimensional bone loss was significantly lower in the PRF group compared to the spontaneous wound healing after 8–15 weeks but not after 6 months. Socket fill was in 85% of the studies significantly higher in the PRF group compared to the spontaneous wound healing. Conclusions Based on the analyzed studies, PRF is most effective in the early healing period of 2–3 months after tooth extraction. A longer healing period may not provide any benefits. The currently available data do not allow any statement regarding the long-term implant success in sockets treated with PRF or its combination with biomaterials. Due to the heterogeneity of the evaluated data no meta-analysis was performed.

Preliminary Study with the Use of a Titanium Mesh as Space Maker and Implant Primary Stabilization for One-Stage Sinus Lift in Cases with Less Than 1.5 mm Residual Bone

(1) Background: In the lateral area of the maxilla, the alveolar bone can lose significant volume due to maxillary sinus pneumatization following teeth extractions. This preliminary study evaluated the effectiveness of a novel technique for one-stage sinus lifting and simultaneous implant placement in cases with less than 1.5 mm residual alveolar bone. The subsequent survival rate at 1-year post-occlusal loading was assessed. (2) Methods: 15 patients were selected, the main inclusion criteria were the partially edentulous area in the posterior maxilla with alveolar bone height of less than 1.5 mm below the sinus. All of the patients underwent one-stage sinus lifting, along with simultaneous implant placement using a “butterfly” anchorage device to optimize the primary stability and xenograft bone as graft material. At 6 to 9 months after surgery, the anchorage device was removed and implants were loaded. Panoramic x-ray images were used to assess the new bone formation, while the biological stability was measured using resonance frequency analysis. (3) Results: 15 implants were inserted. The mean implant stability quotient (ISQ) value was 71.3 (SD = ±2.51) and the mean healing period was 7.3 (SD = ±1.23) months. The mean bone height after the healing period was 14.4 (SD = ±2.05). A statistically significant correlation was found between the healing period and the ISQ value (Spearman rho = 0.684, sig. = 0.005). No statistically significant correlation was found between the ISQ value and the new regenerated bone height (Person r = 0.389, sig. = 0.152). Smoking was identified as a risk factor involved in postoperative complications. (4) Conclusions: The results of the present preliminary study demonstrated that the proposed “butterfly” technique was effective when performing one-stage sinus lifting and simultaneous implant placement in cases with less than 1.5 mm of residual alveolar bone. The survival rate was 100% at 1-year post occlusal loading.

Prevalence of Kinesiophobia in Post Spinal Surgery Patients

Background: The spinal column is a highly complex system of bones and connective tissues that provide support for the body and protect the delicate spinal cord and nerves. Back surgery carries higher risks than some other types of surgery because it is done closer to the nervous system. The most serious of these risks include paralysis and infections. Fear of movement/(re)injury is described as “a specific fear of movement and physical activity that is (wrongfully) assumed to cause reinjury”. In the extreme situation of fear of movement, the expression “kinesiophobia” is used. Tampa Scale for Kinesiophobia (TSK) was developed by Miller, Kori and Todd 1990 in order to assess fear of movement/(re)injury. It is a valid, reliable tool is used to assess Kinesiophobia.(1) Aim: The present study was done to Assess Prevalence of Kinesiophobia In patients undergone Spinal Surgery using Tampa Scale (6- 10 weeks post surgery). Method: In this study a total of 100 patients answered Tampa scale of kinesiophobia and were evaluated according to their level of kinesiophobia after post spinal surgical period 6- 10 weeks, that is after the healing period. Result: There was a high degree of kinesiophobia which was observed after post spinal surgical period 6-10 weeks in 61% of the participants. Conclusion: This study showed Prevalence of High Degree of Kinesiophobia noted after 6-10 weeks in 61% of the Post- Spinal Surgery patients even after 4-6 weeks of healing period. Key words: Kinesiophobia, Fear-avoidance, Spinal surgery, Tampa scale.

Experimental studies on the development of a self-healing cementitious matrix for repair and retrofitting of concrete structures

PurposeSelf-healing concrete is a revolutionary building material that will generally reduce the maintenance cost of concrete constructions. Self-healing of cracks in concrete structure would contribute to a longer service life of the concrete and would make the material more durable and more sustainable. The cementitious mortar with/without incorporating encapsulates at different percentages of slag replacement with the cement mix improves autogenous healing at different ages. Therefore, this study’s aim is to develop a self-healing cementitious matrix for repair and retrofitting of concrete structures.Design/methodology/approachIn the present work, waste straw pipes are used as a capsule, filled with the solution of sodium hydroxide (NaOH), sodium silicate (Na2SiO3) and colloidal nano-silica as self-healing activators. An artificial micro-crack on the control and blended mortar specimens at different percentages of slag replacement with cement (with/without encapsulation) is developed by applying a compressive load of 50% of its ultimate load-carrying capacity. The mechanical strength and ultrasonic pulse velocity, water absorption and chloride ion penetration test are conducted on the concrete specimen before and after the healing period. Finally, the self-healing activity of mortar mixes with/without encapsulation is analysed at different ages.FindingsThe encapsulated mortar mix with 10% of slag content has better self-healing potential than all other mixes considering mechanical strength and durability. The enhancement of the self-healing potential of such mortar mix is mainly due to hydration of anhydrous slag on the crack surface and transformation of amorphous slag to the crystalline phase in presence of encapsulated fluid.Research limitations/implicationsThe self-healing activities of the slag-based cementitious composite are studied for a healing period of 90 days only. The strength and durability performance of the cracked specimen may be increased after a long healing period.Practical implicationsThe outcome of the work will help repair the cracks in the concrete structure and enhances the service life.Originality/valueThis study identifies the addition encapsulates with a self-healing activator fluid that can recover its strength after minor damage.

Histological investigation of the effects of western diet on pressure wound healing period

Objective: The stages of skin wound healing are a dynamic process and it is thought to be related to nutrition. Carbohydrates, proteins and fats have particular importance in different periods of recovery process. Our study has aimed to examine the effects of a western diet with high protein, fat, and carbohydrate content on pressure ulcer healing. Material and Methods: In this study, we used 22 healthy male Sprague Dawley rats weighing 100-185 g. We randomly divided the rats into two groups. The rats were fed according to the indicated diets (standard diet and western diet). On the first day of the fourth week, ischemia skin by histopathological examinations of the wound tissue samples on the 7th and 14th days of the wound healing period. Results: Statistically significant differences were observed in histological and immunohistochemical parameters in the tissue samples on the 7th and 14th days. On the 7th day, there were re-epithelialization (P=0.003), granulation cell density (P=0.004), inflammation (P=0.004), and angiogenesis (P= 0.003). We found re-epithelialization (P=0.001), granulation cell density (P=0.002), inflammation (P=0.002), and angiogenesis (P=0.001) on the 14th day. On the 7th and 14th days, we found the p-value between Ki-67 immunohistochemical staining percentages as P= 0.003 and the p-value for VEGF as P=0.002. Conclusion: We determined that in short-term wound healing, the western type diet was more effective on pressure wound healing than the standard diet.

Influence of Removing or Leaving the Prosthesis after Regenerative Surgery in Peri-Implant Defects: Retrospective Study: 32 Clinical Cases with 2 to 8 Years of Follow-Up

Purpose: The aim of this retrospective study was to compare the influence of removing or not removing a prosthesis after regenerative surgery on peri-implant defects. Methods: Two different groups were compared (Group 1: removing the prosthesis; Group 2: maintaining the prosthesis), analyzing radiographic bone filling (n = 32 implants) after regenerative treatment in periapical radiographs. The peri-implant defects were measured before and after regenerative treatment using Bio-Oss® (Geistlich Pharma, Wohhusen, Switzerland) and a reabsorbable collagen membrane (Jason®, Botis, Berlin, Germany), the healing period was two years after peri-implant regenerative surgery. Statistical analysis was performed, and a Chi square test was carried out. To determine the groups that made the difference, corrected standardized Haberman residuals were used, and previously a normality test had been applied; therefore, an ANOVA or Mann–Whitney U test was used for the crossover with the non-normal variables in Group 1 and Group 2. Results: The results obtained suggest that a regenerative procedure with xenograft, resorbable membrane, and detoxifying the implant surface with hydrogen peroxide form a reliable technique to achieve medium-term results, obtaining an average bone gain at a radiographic level of 2.84 mm (±1.78 mm) in patients whose prosthesis was not removed after peri-implant bone regenerative therapy and 2.18 mm (±1.41 mm) in patients whose prosthesis was removed during the healing period. Conclusions: There are no statistically significant differences in the response to treatment when removing or keeping the prosthesis after regenerative surgery in peri-implant defects.

The effect of synthetic bone graft substitutes on bone formation in rabbit calvarial defects

The aim of this study was to evaluate the influence of the intensity of the biomimetic hydroxyapatite (HA) coating of α-tricalcium phosphate (α-TCP) on biomaterial degradation and bone formation. Twenty-four female NZW rabbits of approximately 12 weeks of age were used. Critical size defects were randomly treated with 3%:97% HA:α-TCP (BBCP1), 12%:88% HA:α-TCP (BBCP2), and 23%:77% HA:α-TCP (BBCP3), respectively or sham. All defects were covered with a resorbable collagen membrane. Animals were euthanized after 3 and 12 weeks of healing and samples were investigated by micro-CT and histologic analysis. Ingrowth of newly formed woven bone from the original bone at 3-week healing period was observed in all samples. At the 12-week healing period, the new bone in the peripheral area was mainly lamellar and in the central region composed of both woven and lamellar bone. New bony tissue was found on the surface of all three types of granules and at the interior of the BBCP1 granules. Samples with 3% HA showed significantly less residual biomaterial in comparison to the other two groups. Furthermore, BBCP1 significantly promoted new bone area as compared to other three groups and more bone volume as compared to the control. Within its limitations, this study indicated the highest degradation rate in case of BBCP1 concomitant with the highest rate of bone formation. Hence, formation of new bone can be affected by the level of biomimetic HA coating of α-TCP.

Stent-Induced Vascular Remodeling in Two-Step Stent-Assisted Coiling Treatment of Brain Aneurysms: A Closer Look Into the Hemodynamic Changes During the Stent Healing Period

Stenting has become an important adjunctive tool for assisting coil embolization in complex-shaped intracranial aneurysms. However, as a secondary effect, stent deployment has been related to both immediate and delayed remodeling of the local vasculature. Recent studies have demonstrated that this phenomenon may assume different roles depending on the treatment stage. However, the extent of such event on the intra-aneurysmal hemodynamics is still unclear; especially when performing two-step stent-assisted coiling (SAC). Therefore, we performed computational fluid dynamics (CFD) analysis of the blood flow in four bifurcation aneurysms focusing on the stent healing period found in SAC as a two-step maneuver. Our results show that by changing the local vasculature, the intra-aneurysmal hemodynamics changes considerably. However, even though changes do occur, they were not consistent among the cases. Furthermore, by changing the local vasculature not only the shear levels change but also the shear distribution on the aneurysm surface. Additionally, a geometric analysis alone can mislead the estimation of the novel hemodynamic environment after vascular remodeling, especially in the presence of mixing streams. Therefore, although the novel local vasculature might induce an improved hemodynamic environment, it is also plausible to expect that adverse hemodynamic conditions might occur. This could pose a particularly delicate condition since the aneurysm surface remains completely exposed to the novel hemodynamic environment during the stent healing period. Finally, our study emphasizes that vascular remodeling should be considered when assessing the hemodynamics in aneurysms treated with stents, especially when evaluating the earlier stages of the treatment process.

Surgical Management of Necrotizing Sialometaplasia of Hard Palate: A Case Report

Necrotizing Sialometaplasia is rare and in the oral cavity it accounts <1% of all biopsied lesion. For decades Necrotizing Sialometaplasia were treated by conservative management as it is a self healing lesion. The progressive healing period was reported from 2 weeks to 3 months in the literature. Is necrotizing sialometaplasia a self-limiting disease? Here we report a case of non-healing necrotizing sialometaplasia which was treated by surgical management. Complete regression of the lesion was evident after the surgical management and no recurrence until two years of follow-up.