ContentslistsavailableatScienceDirect
International
Journal
of
Surgery
Case
Reports
jo u r n al ho me p a g e :w w w . c a s e r e p o r t s . c o m
Platelet-rich
fibrin
(PRF)
in
implant
dentistry
in
combination
with
new
bone
regenerative
technique
in
elderly
patients
Antonio
Cortese
(MD,
DDS)
(Professor
of
Maxillofacial
Surgery
at
University
of
Salerno)
a,∗,
Giuseppe
Pantaleo
(DDS)
(Specialist
in
Oral
Surgery
at
University
of
Naples)
b,
Antonio
Borri
(MD
University
of
Salerno,
Salerno)
c,
Mario
Caggiano
(DDS)
d,
Massimo
Amato
(MD)
(Professor
of
Dentistry
at
University
of
Salerno)
eaDepartmentofMedicineandSurgery,UnitofMaxillofacialSurgery,UniversityofSalerno,Salerno,Italy
bDepartmentofNeurosciences,ReproductiveandOdontostomatologicalSciences,UniversityofNaplesFedericoII,Naples,Italy cUniversityofsalerno,Salerno,Italy
dDepartmentofMedicineandSurgery,UniversityofSalerno,Salerno,Italy eDepartmentofMedicineandSurgery,UniversityofSalerno,Salerno,Italy
a
r
t
i
c
l
e
i
n
f
o
Articlehistory:Received9July2016 Accepted10September2016 Availableonline22September2016 Keywords: PRF Splitcrest Elderlypatients Boneregeneration
a
b
s
t
r
a
c
t
INTRODUCTION:Somestudieshavedemonstratedthatplateletrichfibrin(PRF)isahealingbiomaterial withagreatpotentialforboneandsofttissueregeneration,withoutanyinflammatoryreactionsand maybeusedaloneorincombinationwithbonegrafts,promotinghemostasis,bonegrowth,and matu-ration.PRFappearsasanaturalandsatisfactoryaidinboneregenerativesurgeryinelderlypatientswith favorableresultsandlowrisks.
AIM:ThisstudywantstodemonstratehowPRFinassociationwithanewsplitcrestaugmentation techniquecanbeagreataidinimplantrehabilitation,especiallyintheelderlypatients,whenbone regenerationisrequired.
MATERIALSANDMETHODS:Tenpatientsweretreatedinthisstudy,fivefollowingtheflaplesssplitcrest newprocedureandotherfivepatientsfollowingtraditionalprocedurewithoutsplitcrestascontrol.Five patientswithanaverageagebetween50and60yearswereselectedtobeoperatedwithasplitcrest flaplessmodifiedtechniqueinordertooptimizetheregenerativeconditionswithaboneaugmentation andimplantinsertioninonesinglestageprocedure.ForallthepatientsautologousPRFhasbeenused tofillthesplitcrestgaporsimplyasregenerativematerial.Orthopantomography,intraoralradiography andCTDentaScan/CTConebeamwereperformedforeverypatientbeforethetreatmentandatfollow-up timeexeptionmadeforCT.
RESULTS:Allcasesweresuccessful,therewerenoproblemsatsurgerytime,atpost-operativeandat osteointegrationperiods.Allimplantsachievedosteointegration.Theseresultswereobtainedby accu-ratelymanagingimmediateandlatepostoperativeperiodinalloftheoperatedcases.Meandifference forheightbonelossbetweenthetwogroupsofpatientswas2.4mmatT1and2.2mmatT3.
DISCUSSION:Therationaleofthissplitcrestflaplessmodifiedtechniqueistoobtainaproperbuccal cortexexpansionpreservingitsvascularsupplyavoidingperiostealelevationforbettercorticalbone nourishing.Moreover,advantagesarereportedrelatedtotheuseofPRF.TheeffectivenessofPRFisshown inpromotingthehealingofsurgicalwounds,ithas,infact,plateletgrowthfactorsthatcanimprovethe vascularisationofthesurgicalsite,promotingneoangiogenesis.Furthermore,bysimplychangingthe settingsofthecentrifuge,itispossibletoobtainanormalgellingifithastobeusedasregenerativeand stimulatingmaterial,ormoreconsistentsubstancetobeusedasafillerinthesplitcrestgap.
CONCLUSIONS:Themainadvantagesinusingtheplatelet-richfibrinarehealingandboneregenerative propertiesincombinationwithitscompleteresorptionaftersurgery,thusavoidingasecondsurgery time,importantfactorintheelderlypatients.Currently,itisaminimallyinvasivetechniquewithlow risksandsatisfactoryclinicalresultssuchpreventingcomplicationsorimplantfailureparticularlyin elderlypatientsforagerelatedconditions.
©2016TheAuthors.PublishedbyElsevierLtdonbehalfofIJSPublishingGroupLtd.Thisisanopen accessarticleundertheCCBY-NC-NDlicense(http://creativecommons.org/licenses/by-nc-nd/4.0/).
∗Correspondingauthor.
E-mailaddresses:ancortese@unisa.it(A.Cortese),giuseppepantaleo88@gmail.com(G.Pantaleo),antonio-borri@alice.it(A.Borri),dr.mariocaggiano@gmail.com(M. Caggiano),mamato@unisa.it(M.Amato).
http://dx.doi.org/10.1016/j.ijscr.2016.09.022
2210-2612/©2016TheAuthors.PublishedbyElsevierLtdonbehalfofIJSPublishingGroupLtd.ThisisanopenaccessarticleundertheCCBY-NC-NDlicense(http:// creativecommons.org/licenses/by-nc-nd/4.0/).
1. Introduction
Platelets’regenerative potentialwasreportedinthe70’s[1], whenitwasobservedthattheycontaingrowthfactorsthatare responsiblefor increasecollagenproduction, cellmitosis,blood vesselsgrowth,recruitmentofothercellsthatmigratetothesite ofinjury,andcelldifferentiationinduction,amongothers[2].
Nowadaysinoralsurgerytherearetwokindofplatelet con-centratesforinvivotissueengineeringapplications:platelet-rich plasma(PRP)andplatelet-richfibrin(PRF).Plateletconcentrates areaconcentratedsuspensionofgrowthfactorsfoundinplatelets, whichactasbioactivesurgicaladditivesthatareappliedlocallyto inducewoundhealing[3].
PRFwasfirstusedspecificallyinoralsurgerybyDohanetal.[4]
andiscurrentlyconsideredasanewgenerationofplatelet concen-trate.Itconsistsofamatrixofautologousfibrin[5]andhasseveral advantagesoverPRP,includingeasierpreparationandnot requir-ingchemicalmanipulationoftheblood,whichmakesitstrictlyan autologouspreparation[6].Fortheseconsiderations,inourstudy wepreferredtousePRFprocedureinsteadofPRP.
PRF consists of an autologous leukocyte-platelet-rich fib-rin matrix [7] composed of a tetra molecular structure, with cytokines, platelets, and stem cells within it [5,8], which acts as a biodegradable scaffold [9] that favors thedevelopment of microvascularizationandisabletoguideepithelialcellmigration toitssurface[5,10].
Somestudies[11,12]havedemonstratedthatPRFisahealing biomaterialwithagreatpotentialforboneandsofttissue regener-ation,withoutinflammatoryreactionsandmaybeusedaloneorin combinationwithbonegrafts,promotinghemostasis,bonegrowth, andmaturation.
Thisautologousmatrixdemonstratedintheinvitrostudiesa greatpotentialtoincreasecellattachment[13]andastimulation toproliferateanddifferentiateosteoblasts[14].
Insurgicalprocedures,PRFcouldserveasaresorbable mem-branefor guided bone regeneration (GBR) [15], preventingthe migrationofnon-desirablecellsintobonedefectandprovidinga spacethatallowstheimmigrationofosteogenicandangiogenic cells permitting the underlying blood clot to mineralize [16]; moreover,anormalPRFmembranehasarapiddegradability(1–2 weeks)[17].
Fig.1.OrtopantomographyandCTDentascanofoneofpatientsselectedforsplit crestflapless,amoderateresorbededentulousridgeisshown.
Fig.2. Ortopantomographyofotherpatientselectedforsplitcrestflapless,there wasthefractureoftoothinregion1.1.
Fig.3. Ortopantomographyafterimplantinsertion.Attimeofinsertion,aresorbed edentulousridgewasshowninregion1.1.
PRFmembranehelpsinwoundhealing,protectingthesurgical site[18,19]promotingsofttissuerepair;whenmixedwithbone graft,itmayactasa“biologicalconnector”,whichattractsstem cell,favorsthemigrationofosteoprogenitorcellstothecenterof thegraft,andprovidesaneo-angiogenesis[19].
Inaddition,PRFmayactasabiologicadhesivetoholdthe parti-clestogether,facilitatingthemanipulationofthebonegrafts[20]. Inthisstudy,allofthefivepatientsofthefirstgroup(test)has beensubmittedtoanewsplitcrestflaplessmodifiedtechnique withtheuseofPRF.Plateletrichfibrincanbeusedbothasa regen-erativeandstimulatormaterial,bothasafillerinbonedefects;it dependsontype ofprotocolpreparationused.Inthistechnique boneregenerationissimilartoosteodistractioncreatinga regen-erativechamber withbone wallscovered bynativeperiosteum notcutorelevatedduringosteotomiespreservingfullabilityof feedingoftheunderlyingboneandcomparabletoreconstructive proceduresfortreatingperiodontalintraosseousdefects.
Inthisstudy,wewanttodemonstratehowPRFcanbeagreataid inimplantrehabilitation,especiallyintheelderlypatients,when boneregenerationisrequired.
2. Materialsandmethods
Tenpatientswithanagebetween50and60yearswerereferred totheMedicalDepartmentoftheUniversityofSalernofor eval-uation of a moderately reabsorbed edentulous ridgesecondary topreviousextraction. Fivepatientsweretreatedwiththesplit crestflaplessnewtechniqueforimplantinsertion,whilefiveother patients were treated with traditional technique with smaller implantstoovercomealveolarcrestthinness.Thetreatmentplan included rehabilitation with an implant-supported restoration (Figs.1–3).Thepatient’spastmedicalandsocialhistorywere non-contributory,andtheyhadgoodoralhygiene.Allthepatientshad nocontroindicationstoimplantplacement.
Thesurgerieswerenotperformedinpatientswithsystemicor psychologicaldisordersthatcontraindicateoralsurgery.
Table1
Selectedelderlypatients(splitcrestflaplesstechnique)withimplantsdistribution,typeofPRFused,boneheightlossatT0(pre-operativetime),T1(immediatepost-operative
time),T2(3monthsaftersurgery),T3(6monthsaftersurgery).
Age Implantsplaced Implantlength,mm Torque,N.cm PRFtype Boneheightloss(T0,T1,T2,T3),mm
Patient1 53 1 11 35 Moreconsistent T0:0;T1:0;T2:0;T3:1
Patient2 59 4 ≥8; ≤13 40 Normalgel T0:0;T1:0;T2:0;T3:1
Patient3 60 2 11 35 Moreconsistent T0:0;T1:0;T2:1;T3:2
Patient4 57 1 8.5 35 Moreconsistent T0:0;T1:0;T2:0;T3:1
Patient5 55 2 ≥8; ≤11 40 Normalgel T0:0;T1:0;T2:0;T3:1
Table2
Controlpatientswithtraditionaltechniquewithimplantsdistribution,boneheightlossatT0(pre-operativetime),T1(immediatepost-operativetime),T2(3monthsafter
surgery),T3(6monthsaftersurgery).
Age Implantsplaced Implantlength,mm Torque,N.cm Boneheightloss(T0,T1,T2,T3),mm
Patient1 57 2 11 40 T0:0;T1:2;T2:3;T3:3 Patient2 60 1 8 35 T0:0;T1:3;T2:4;T3:4 Patient3 52 4 ≥11; ≤13 35 T0:0;T1:2;T2:2;T3:3 Patient4 55 2 11 40 T0:0;T1:3;T2:3;T3:4 Patient5 57 2 ≥8; ≤11 35 T0:0;T1:2;T2:3;T3:3 2.1. Surgicalprocedure
Afteradministrationofalocalanesthesia,apalatally(maxilla)or lingually(mandibular)shiftedincisionwasmadetogainaccessto underlyingboneridge:periosteumelevationwasperformedonly onthealveolarridgeuptothevestibularcorticalwall.Splitcrest wasperformedmakingathinmilling,andthencombiningsharping osteotomyandthansmoothosteotomesinsertionforexpansion.It continueswithrotatingdrillsoftheimplantkitsinthebasalbone preservinganadequatebonethicknessforbuccalandmedialbone wallsbysplittedwallsdivarication duringdrillingupto2.8mm burs.Topreservecorticalwallsintegrityfurtherimplantsite prepa-rationupto3.5mm.diameterwascarriedoutbyroundosteotomes (Sommers)orballburs.Withthismethodthereisapreservation ofthe vascular supply of thevestibular corticalwallliving the periostiumattachedonthevestibularside,withoutany vestibu-lar,mesialanddistalosteotomiesalsoachievingprimaryimplant stability.
Particularlytoobtainanoptimalimplantinsertion,atwolevels ofimplantsitepreparationwasperformed:1)splitcrestflapless techniqueforthealveolarandsmallamountofbasalboneand2) additionalandtraditionaldrillingpreparationbyimplantkitatthe basalbonelevel(usuallyshowingsufficientthickness).
In this way simultaneously were obtained optimal implant stability,adequatealveolarexpansion,boneheight-stabilityover timeforadequatecorticalwallsthicknessandoptimal nourish-mentofthesplittedvestibularwallsbynativeperiosteumwith attachedgingivacovering.Expansionwithsmoothchisel contin-ueduntilappropriatesitepreparationfortheselectedimplantwas obtained,beforeperformingthesteptwopreparationwith tradi-tionalimplantkitdrilling.Finalexpansionwasmaintainedbythe implantsitself.Theimplantswerepositionedatthesametimeof surgery,bonelevelimplantswerepreferredfortheprocedure.
TheVicrylpolyglactin(91,3/0)absorbablesuturewasusedto closetheflap.
Toobtainaprimaryclosureoftheflap,essentialforaproper healingoftheosteotomysite,partialreleasingincisionstechnique byscalpelatthemid-crestfibromucosawasperformedforflap elongation.Thisaspectis particularlyimportantbecause ofthe impossibilitytoapplya traditionalmembraneonthesplitcrest osteotomybecauseoftheflaplesstechnique.Inthis wayallthe bonelackattheosteotomysitewillbecoveredbyfibromucosa afterPRFapplyatosteotomyrimforbesthealing.
Forallofthefivepatientsofthefirstgroupautologousplatelet
rich fibrin (PRF) has been used to fill the osteotomy gap or
Fig.4.Splitcrestflaplesstechnique.Afterimplantinsertion,membranesofPRF
wereusedtoassureabettersofttissuehealing,makingthewoundhealingfaster.
ThePRFwasusedinaregenerativechamberofnativebonefedbyperiosteumto
testtheosteoinductiveandosteoconductivepower.
simplyasregenerative material.It dependsontype ofprotocol preparation used. PRF protocolrequires only centrifuged blood withoutanyadditionofanticoagulantandbovinethrombin.Then, abloodsampleistakenwithoutanticoagulantin10-mLtubesin aglassorglass-coatedplastictube,thenimmediatelycentrifuged at2700rpmfor12min.Thisprotocolwasusedin2of5cases,in theother3cases,theprotocolwaschanged(3000rpmfor13min) toobtainamoreconsistentsubstancetouseasafillerinthesplit crestgap(Fig.4).
Thefiveotherpatientstreatedwiththetraditionaltechniqueas controlgroupwereselectedwithathinalveolarcrestinorderto allowsmallerimplantinsertionwithoutboneaugmentationata deeperboneposition.
Orthopantomography, intraoral radiographs and CT DentaS-can/CTConebeamwereperformedbeforesurgeryforeachpatient inorder tohavea preliminaryradiologicalinvestigationandto giveageneraloverviewofthejawboneand relevantanatomic landmarksin abidimensionaland tridimensional reconstructed planes.Intraoralandfacephotographsweretakenforaestheticand functionalevaluationofthepatientsstatus.Forallthepatientsa
beta-lactamantibiotic(Amoxicillin)wasgivenorally2gr.onehour beforethesurgery.Thepost-operativetherapyrequiredgoodoral hygiene,rinsingwithmouthwashcontaining0.2%chlorhexidine solutiontwiceadayandaneveningapplicationofthesame prod-uctingelform,aswellastheadministrationofanon-steroidal anti-inflammatoryaid(Ketoprofen80mg)for threeconsecutive days.
Followupwascarriedoutpostoperativelyat30days(clinical), 3monthsand6months(ortopantomographyandintraoralX-ray). Thisstudywasperformedfollowingtheprinciplesofthe Dec-larationofHelsinkiregardingresearchonhumans;signatureofa writteninformedconsentformfromallpatientswasrequested. Writteninformedconsentwasobtainedfromthepatientsfor pub-licationofthiscasereportandaccompanyingimages.Acopyofthe writtenconsentisavailableforreviewbytheEditor-in-Chiefofthis journalonrequest
3. Results
Allcasesendedwell,therewerenoproblemsatsurgerytime, post-operativeandintheperiodofosteointegration.Allimplants achievedosteointegration.Inallimplantsagooddegreeofprimary stabilitywasachievedatthesurgerytime.
All patients underwent an uneventful implant surgery. All implantswereplacedaccordingtothemanufacturer’sinstructions andachievingprimarystability(≥35Ncm).Nointraoperative sur-gicalcomplicationswererecorded.
Althoughpostoperativecomplicationsweregenerallymodest. Theclinicalhealingwasoptimalintheshortterm,nodehiscence wasreported.
Theseresultswereobtainedbyaccuratelymanagingimmediate andlatepostoperativeperiodinalloftheoperatedcases.
Particularattentionwaspaidtooralhygiene,andto inappro-priateearlyclinicalloadingatimmediateandlatepostoperative time.
Themaincharacteristicsandresultsachievedofthe10patients belongingtothestudyarepresentedinTables1and2.
ComparingresultsshowninTables1and2forheightdecrease atT0,T1,T2andT3betweenthenewandtraditionaltechnique itisevidentlessboneheightlossforthenewsplitcrestflapless technique.Boneheightwasmeasuredfromlowerborderofthe mandibleandfromthenoseorsinusfloorofthemaxillaeupto thealveolarbridgeatthepre-operativetimeanduptothemost coronallevelofbonetoimplantcontactatthepost-operativetime. AtT1meanheightlosswasof0mmandof1.2mmatT3forgroup 1(newflaplesstechnique)whileforgroup2patients(traditional implantinsertiontechnique)meanheightbonelosswas2.4mmat T1andof3.4atT3.
Meandifferenceforheightbonelossbetweenthetwogroupsof patientswas2.4mmatT1and2.2mmatT3.Inthiswayboneheight losswascalculatedalsoreferring topre-operativetime:heavier boneheightloss incontrolgroup canbeexplainedconsidering deeperimplantinsertionnecessityinthinalveolarcrestwithout expansionbysmallerimplantselectionwithrelatedworseningof thefinalaestheticresult.
4. Discussion
UseofPRFinoralandmaxillofacialsurgeryhasbeenimplicated indifferentproceduressuchassocketpreservation,sinusliftand boneaugmentation,rootcoverageprocedures,andhealingindonor sitewithgoodresults[6,7].
Someadvantagesarereportedintheliteraturerelatedtothe useofPRF,suchasthefollowing:
its preparation is a simplified and efficient technique, with centrifugationinasinglestep,freeand openlyaccessibleforall
clinicians[21,22];itisobtainedbyautologousbloodsample[10]; minimizedbloodmanipulation[23];itdoesnotrequirethe addi-tionofexternalthrombinbecausepolymerizationisacompletely naturalprocess,withoutanyriskofsufferingfroman immunolog-icalreaction[4,23].
Ithasanaturalfibrinframeworkwithgrowthfactorswithinthat maykeeptheiractivityforarelativelylongerperiodandstimulate tissueregenerationeffectively[13].
Itcanbeusedsolelyorincombinationwithbonegrafts, depend-ingonthepurpose[8,21];increasesthehealingrateofthegrafted bone[8,23];itisaneconomicalandquickoptioncomparedwith recombinantgrowthfactorswhenusedinconjunctionwithbone grafts[24]
Whenusedasamembrane,itavoidsadonorsitesurgical pro-cedureandresultsinareductioninpatientdiscomfortduringthe earlywound-healingperiod[25].
PRFmaypresentsomedisadvantagesasfollows:
thefinalamountavailableislowbecauseitisautologousblood
[8];thesuccessofthePRFprotocoldependsdirectlyonthe han-dling,mainly,relatedtobloodcollectiontimeanditstransference forthecentrifuge[4];needofusingaglass-coatedtubetoachieve clotpolymerization[22];possiblerefusaloftreatmentbythe punc-turerequiredforbloodcollectionatsurgerytime[21].
Thisprocedureonlyneedsaminimalexperienceofclinicianfor PRFmanipulation[7,21].
Withthisflaplesstechniquewithlingualorpalatalmucosa inci-sion, buccalalveolar cortex are preserved shiftingincision and periostealelevationonpalatalorlingualsideswherecorticalwall arethickerandmoreresistanttoreabsorption.Furthermore,this typeoftechniquereducesthepossibilityofvestibularbone fen-estration,avoidingperiimplantitisandmedicolegalconsequences, especiallyinelderlypatientswheresurgicalproblemscould hap-penmoreoftenfortheconsiderableanatomicaldifficulties[26]. Comparingthetwogroupsofpatientsoperatedforthisstudy,we canstatethatwiththisnewtechniqueitispossibletopreserve alve-olarboneheightatimplantinsertionwhileachievingtransversal alveolarexpansionbyproperboneregenerativeconditions.
In literature, in addition tothe split crest, other innovative andminimallyinvasivetechniquesfortheexpansionofthejaws aredescribed,thatareabletoimprovetheaestheticsoftheface
[27–30].
Recent literaturesuggests it isessential to leaveunchanged thevascularityofthesite,asevidencedbySchwartz-Arad[31].To allowproperosseointegration withgood healingofthesurgical sites and toassure primary closure of thesurgicalsite, releas-ing incisions byscalpel at themid crestcollapsedfibromucosa wereperformedobtainingsufficient flapelongationforprimary closureandosteotomysitecoveragewithadherent(firm) fibro-mucosa.
TopromotebonehealingattheosteotomysitesPRF(Platelet RichFibrin)canbeused.PRFseemedtoassureabettersofttissue healing,makingthewoundhealingfaster[8].EvenincaseofPRF membraneexposure,thereisnoriskofmembraneinfectionorbone loss,asPRFcanassurealsoasecondintentionhealingofthesoft tissues.Moreover,severalclinicalworkshave demonstratedthe effectivenessofPRFinpromotingthehealingofsurgicalwounds; thePRFhas,infact,plateletgrowthfactorsthatcanimprovethe vascularisation of the surgical site, promoting neoangiogenesis
[4].
The PRF if used in a regenerative chamber of native bone fedbyperiosteum,itmayobtainregeneration,whilenothaving osteoinductiveproperties.The osteoconductivepower,over the accelerationhealingprocessalreadydemonstratedintheliterature, hasrecentlybeenprovedinthearticleofSchwarz-Arad[31].
5. Conclusions
Thebiggestadvantageinusingtheplatelet-richfibrinisforits completeresorption,thusavoidingasecondsurgicaltime, abso-lutelyacrucialfactorintheelderlypatients.
Moreover,bysimplychangingthesettingsofthecentrifuge,itis possibletoobtainanormalgellingifitistobeusedasregenerative andstimulatingmaterial,oramoreconsistentsubstancetouseas afillerinthesplitcrestbonegap.
Currently,itseemstobeaminimallyinvasivetechniquewith lowrisksandsatisfactoryclinicalresultssuchpreventing compli-cationsorimplantfailureparticularlyinelderlypatientsforage relatedconditions.
Writteninformedconsentwasobtainedfromthepatientsfor publicationofthiscasereportandaccompanyingimages.Acopyof thewrittenconsentsisavailableforreviewbytheEditor-in-Chief ofthisjournalonrequest.
Authorcontributions
Allauthorscontributedsignificantlytothepresentresearchand reviewedtheentiremanuscript.
AC:Partecipatedsubstantiallyinconceptionandexecutionof thestudyandintheanalysisandinterpretationofdata;also parte-cipatedsubstantiallyinthedraftingandeditingofthemanuscript. GP:Partecipatedsubstantiallyinexecutionofthestudyandin theanalysisandinterpretationofdata;alsopartecipated substan-tiallyinthedraftingandeditingofthemanuscript.
AB:Partecipatedsubstantiallyintheanalysisandinterpretation ofdata;alsopartecipatedsubstantiallyinthedraftingandediting ofthemanuscript.
MG:Partecipatedsubstantiallyintheanalysisand interpreta-tionof data;alsopartecipated substantially inthedrafting and editingofthemanuscript.
MA:Partecipatedsubstantiallyintheanalysisand interpreta-tionof data;alsopartecipated substantially inthedrafting and editingofthemanuscript.
References
[1]R.Ross,J.Glomset,B.Kariya,L.Harker,Aplatelet-dependentserumfactor thatstimulatestheproliferationofarterialsmoothmusclecellsinvitro,Proc. Natl.Acad.Sci.U.S.A.71(1974)1207–1210.
[2]N.K.Kiran,K.S.Mukunda,T.N.TilakRaj,Plateletconcentrates:apromising innovationindentistry,J.Dent.Sci.Res.2(2011)50–61.
[3]E.Borie,D.G.Olivì,I.A.Orsi,K.Garlet,B.Weber,V.Beltrán,R.Fuentes, Platelet-richfibrinapplicationindentistry:aliteraturereview,Int.J.Clin.Exp. Med.15(2015)7922–7929.
[4]D.M.Dohan,J.Choukroun,A.Diss,S.L.Dohan,A.J.Dohan,J.Mouhyi,B.Gogly, Platelet-richfibrin(PRF):asecond-generationplateletconcentrate.PartI: technologicalconceptsandevolution,Oral.Surg.Oral.Med.Oral.Pathol.Oral. Radiol.Endod.101(2006)e37–44.
[5]D.M.Dohan,J.Choukroun,A.Diss,S.L.Dohan,A.J.Dohan,J.Mouhyi,B.Gogly, Platelet-richfibrin(PRF):asecond-generationplateletconcentrate.PartII: platelet-relatedbiologicfeatures,OralSurg.OralMed.OralPathol.Oral Radiol.Endod.101(2006)e45–50.
[6]F.Passaretti,M.Tia,V.D’Esposito,M.DePascale,M.DelCorso,R.Sepulveres, D.Liguoro,R.Valentino,F.Beguinot,P.Formisano,G.Sammartino, Growth-promotingactionandgrowthfactorreleasebydifferentplatelet derivatives,Platelets25(2014)252–256.
[7]V.Gupta,B.K.Bains,G.P.Singh,A.Mathur,R.Bains,Regenerativepotentialof plateletrichfibrinindentistry:literaturereview,Asian.J.Oral.Health.Allied. Sci.1(2011)22–28.
[8]J.Choukroun,A.Diss,A.Simonpieri,M.O.Girard,C.Schoeffler,S.L.Dohan,A.J. Dohan,J.Mouhyi,D.M.Dohan,Platelet-richfibrin(PRF):asecond-generation plateletconcentrate.PartIV:clinicaleffectsontissuehealing,OralSurg.Oral Med.OralPathol.OralRadiol.Endod.101(2006)56–60.
[9]Q.Li,S.Pan,S.J.Dangaria,G.Gopinathan,A.Kolokythas,S.Chu,Y.Geng,Y. Zhou,X.Luan,Platelet-richfibrinpromotesperiodontalregenerationand enhancesalveolarboneaugmentation,Biomed.Res.Int.2013(2013)638043.
[10]D.M.Dohan,J.Choukroun,A.Diss,S.L.Dohan,A.J.Dohan,J.Mouhyi,B.Gogly, Platelet-richfibrin(PRF):asecond-generationplateletconcentrate.PartIII: leucocyteactivation:anewfeatureforplateletconcentrates?OralSurg.Oral Med.OralPathol.OralRadiol.Endod.101(2006)e51–e55.
[11]H.Saluja,V.Dehane,U.Mahindra,Platelet-Richfibrin:asecondgeneration plateletconcentrateandanewfriendoforalandmaxillofacialsurgeons,Ann. Maxillofac.Surg.1(2011)53–57.
[12]T.H.Kim,S.H.Kim,G.K.Sándor,Y.D.Kim,Comparisonofplatelet-richplasma (PRP),platelet-richfibrin(PRF),andconcentratedgrowthfactor(CGF)in rabbit-skulldefecthealing,Arch.OralBiol.59(2014)550–558.
[13]C.L.Wu,S.S.Lee,C.H.Tsai,K.H.Lu,J.H.Zhao,Y.C.Chang,Platelet-richfibrin increasescellattachment:proliferationandcollagen-relatedprotein expressionofhumanosteoblasts,Aust.Dent.J.57(2012)207–212.
[14]D.M.DohanEhrenfest,A.Diss,G.Odin,P.Doglioli,M.P.Hippolyte,J.B. Charrier,InvitroeffectsofChoukroun’sPRF(platelet-richfibrin)onhuman gingivalfibroblasts,dermalprekeratinocytes,preadipocytes,and
maxillofacialosteoblastsinprimarycultures,OralSurg.OralMed.OralPathol. OralRadiol.Endod.108(2009)341–352.
[15]Y.C.Chang,J.H.Zhao,Effectsofplatelet-richfibrinonhumanperiodontal ligamentfibroblastsandapplicationforperiodontalinfrabonydefects,Aust. Dent.J.56(2011)365–371.
[16]G.LoGiudice,G.Iannello,A.Terranova,R.LoGiudice,G.Pantaleo,M.Cicciù, Transcrestalsinusliftprocedureapproachingatrophicmaxillaryridge.A60 monthsclinicalandradiologicalfollow-upevaluation,Int.J.Dent.(2015) 261652.
[17]T.Kawase,M.Kamiya,M.Kobayashi,T.Tanaka,K.Okuda,L.F.Wolff,H.Yoshie, Theheat-compressiontechniquefortheconversionofplatelet-richfibrin preparationtoabarriermembranewithareducedrateofbiodegradation,J. Biomed.MaterRes.BAppl.Biomater103(2015)825–831.
[18]M.DelCorso,M.Toffler,D.M.DohanEhrenfest,Useofanautologous leukocyteandplatelet-richfibrin(L-PRF)membraneinpost-avulsionsites:an overviewofChoukroun’sPRF,J.Implant.Adv.Clin.Dent.1(2010)27–35.
[19]M.Toffler,N.Toscano,D.Holtzclaw,M.D.Corso,M.D.DohanEhrenfest, IntroducingChoukroun’splateletrichfibrin(PRF)tothereconstructive surgerymilieu,J.ImplantClin.Adv.Dent.1(2009)21–30.
[20]A.Cortese,G.Pantaleo,M.Amato,P.P.Claudio,ChinWingosteotomyfor bilateralgoldenharsyndrometreatedbychinwingmentoplasty:aesthetic, functional,andhistologicalconsiderations,J.Craniofac.Surg.26(2015) 1628–1630.
[21]A.Simonpieri,M.DelCorso,A.Vervelle,R.Jimbo,F.Inchingolo,G. Sammartino,D.M.DohanEhrenfes,Currentknowledgeandperspectivesfor theuseofplatelet-richplasma(PRP)andplatelet-richfibrin(PRF)inoraland maxillofacialsurgerypart2:Bonegraft,implantandreconstructivesurgery, Curr.Pharm.Biotechnol.13(2012)1231–1256.
[22]D.M.Dohan,M.DelCorso,J.B.Charrier,CytotoxicityanalysesofChoukroun’s platelet-richfibrin(PRF)onawiderangeofhumancells:theanswertoa commercialcontroversy,OralSurg.OralMed.OralPathol.OralRadiol.Endod. 103(2007)587–593.
[23]Y.H.Kang,S.H.Jeon,J.Y.Park,J.H.Chung,Y.H.Choung,H.W.Choung,E.S.Kim, P.H.Choung,Platelet-richfibrinisaBioscaffoldandreservoirofgrowth factorsfortissueregeneration,TissueEng.PartA17(2011)349–359.
[24]A.Cortese,G.Pantaleo,I.Ferrara,A.Vatrella,I.Cozzolino,V.DiCrescenzo,M. Amato,Boneandsofttissuenon-hodgkinlymphomaofthemaxillofacialarea: reportoftwocases,literaturereviewandnewtherapeuticstrategies,Int.J. Surg.12(2014)S23–8.
[25]S.Jankovic,Z.Aleksic,P.Klokkevold,V.Lekovic,B.Dimitrijevic,E.B.Kenney,P. Camargo,Useofplatelet-richfibrinmembranefollowingtreatmentof gingivalrecession:arandomizedclinicaltrial,Int.J.PeriodonticsRestor.Dent. 32(2012)e41–50.
[26]P.DiLorenzo,M.Niola,C.Buccelli,D.Re,A.Cortese,G.Pantaleo,M.Amato, Professionalresponsibilityindentistry:analysisofinter-departmentalcase study,Dent.Cadmos83(2015)324–340.
[27]A.Cortese,G.Savastano,M.Amato,A.Cantone,C.Boschetti,P.P.Claudio,New palataldistractiondevicebybothbone-borneandtooth-borneforce applicationinaparamedianboneanchoragesite:surgicalandocclusal considerationsonclinicalcases,J.Craniofac.Surg25(2014)589–595.
[28]A.Cortese,M.Savastano,G.Savastano,P.P.Claudio,One-steptransversal palataldistractionandmaxillaryrepositioning:technicalconsiderations, advantages,andlong-termstability,J.Craniofac.Surg22(2011)1714–1719.
[29]A.Cortese,M.Savastano,A.Cantone,P.P.Claudio,Anewpalataldistractor deviceforbodilymovementofmaxillarybonesbyrigidself-locking miniplatesandscrewssystem,J.Craniofac.Surg24(2013)1341–1346.
[30]A.Cortese,G.Pantaleo,M.Amato,P.P.Claudio,Ridgeexpansionbyflapless splitcrestandimmediateimplantplacement:evolutionofthetechnique,J. Craniofac.Surg27(March(6))(2016)e123–8.
[31]D.Schwartz-Arad,L.Levin,L.Sigal,Surgicalsuccessofintraoralautogenous
blockonlaybonegraftingforalveolarridgeaugmentation14(2005)131–138.
OpenAccess
ThisarticleispublishedOpenAccessatsciencedirect.com.ItisdistributedundertheIJSCRSupplementaltermsandconditions,which permitsunrestrictednoncommercialuse,distribution,andreproductioninanymedium,providedtheoriginalauthorsandsourceare credited.