Platelet rich fibrin (PRF) is an autologous biological product which becomes popular day by day and available in a wide variety of fields in medicine. Platelet concentrates which are introduced at the early 90s have evolved over the years. The use such autologous materials have become trendy in recent years to encounter demanding expectations of patients, improve treatment success and maximize patient comfort. Despite its increasing use in dentistry and oral surgery, the most indications and effects are still being discussed. PRF is easily accepted by patients because of its low cost, easy to receive, low donor morbidity, low postoperative complication and infection rate. This biomaterial may be a solution for patients who have strong negative beliefs about the use of allografts and xenografts or who are afraid of complications during the grafting procedure. The objectives of these technologies are to use their synergistic effect to improve the hard and soft tissue regeneration. PRF in oral surgery are used for alveolar bone reconstruction, dental implant surgery, sinus augmentation, socket preservation, osteonecrosis, oroantral fistula closure, struggling with oral ulcers, preventing swelling and edema constitution. This chapter aims to review the clinical applications of platelets in oral surgery and the role of molecular components in tissue healing.
Background : CBL around implants is a multifactorial process with multiple etiology. Several factors like thickness of the gingiva at the implant site have been identified to affect early in time the amount of CBL. Most of the studies have been generated with implants loaded after more than 2 months following surgery. To the best of our knowledge, there is no experimental or clinical study comparing the effect of the gingiva thickness on early loaded implants. Aim/Hypothesis : To retrospectively evaluate the effect of soft tissue thickness on crestal bone loss of early loaded implants after 1 and 5 years. Materials and Methods : 44 tapered implants with platform switching (C1 ® , MIS) were crestally placed in the posterior mandible and maxilla to rehabilitate edentulous sites; healing followed a 2-stage surgical protocol. The implants were loaded after six to eight weeks. Mesial and distal crestal bone loss (CBL) and soft tissue thickness (STT) were measured on standardized panoramic radiographs. Thin gingiva sites were 21, average thickness was 2.0 ± 0.3 mm; thick gingiva sites were 23, average thickness was 3.0 ± 0.8 mm. Success rate and crestal bone loss were measured after 1 and 5 years. The t-test was used to compare the CBL differences between groups; significance was set at 0.05. Results : No early loaded implant failed at the 1-and 5-year of follow-up; the success rate was 100%. After 1 year, the CBL of the thin and thick gingival groups were 0.96 ± 0.49 and 0.55 ± 0.41 mm, respectively; the difference was statistically significant (P = 0.004). After 5 years, the CBL of the thin and thick gingiva groups increased to 1.12 ± 0.84 and 0.65 ± 0.69 mm, respectively; the difference however was not statistically significant (P = 0.052). Pairwise comparison of CBL between the 1-and 5-year follow-up for the thin and thick gingiva groups showed no statistically significant differences. Conclusions and Clinical Implications : Within the limitations of this study, early loading of C1 implants within 6 to 8 weeks is considered to be safe. After 1 year, CBL was more pronounced at sites with a thin gingiva; at 5 years the difference between the groups was levelled. Between 1 and 5 years, the CBL increased slightly but not in a statistically significant way.
Background : Maxillary sinus lift has become one of the most common treatment options for overcoming hard-tissue deficiencies in posterior maxilla. The success of the sinus lift procedure is based on several principles, such as passive flap closure, graft stability during healing, and vascularity of regenerated bone. Perforation of the Schneiderian membrane is regarded as a surgical complication which can be followed by an inflammatory response possibly compromising bone formation. Aim/Hypothesis : The aim of this study is to evaluate the prevalence, effects and treatment of the Schneiderian membrane perforation and its effects on the clinical outcome of sinus lift procedures. Materials and Methods : Sites with 5 mm of bone height or less were included in the study. After flap elevation steel and diamond burrs were used to create a lateral window on the buccal aspect of the edentulous posterior maxilla. Using sinus lift hand instruments the Schneiderian membrane was lifted until the medial wall of the sinus is free of the membrane. If a perforation was present and smaller than 5 mm, a native collagen membrane was placed on the perforation. If it was larger, a cross-linked collagen membrane was used to cover most of the sinus cavity and fixed with titanium pins on the buccal aspect of the edentulous crest and inside the sinus on the medial wall, effectively "replacing" the Schneiderian membrane to prevent graft particles from moving through the perforation. The xenogenic bone graft was placed in the sinus and another collagen membrane was placed on the window. Sutures were placed providing a passive closure. Results : In this study the clinical outcomes of sinus lift procedures performed on 462 sites in 310 patients were retrospectively evaluated. 26 procedures involved treating perforations. 15 were smaller than 5 mm and 11 larger. Perforations were treated during the same procedure. The operation time was increased when a perforation was present. Early exposure of the surgical area was experienced in one site larger than 5 mm followed by an inflammatory response requiring a second operation. In other sites significant bone loss or post surgical complications were not observed. Implant delivery was possible after the procedure for all sites. Conclusions and Clinical Implications : The presence of perforations can be treated with collagen membranes during the same operation and grafting can safely be performed as planned. Following patients is critical and necessary for detection of inflammation in surgical sites. In 2 year follow-ups no patients presented long-term complications.
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