Recurrent pterygium resection associated to fibrin membrane graft: report of two cases / Resseção do pterígio recorrente associada ao enxerto de membrana fibrina: relato de dois casos

ABSTRACT We propose a novel surgical technique in cases of aggressive recurrent pterygium non-subsidiary of treatment with conjunctival autografts or antimetabolites. Two presented cases were treated with surgical excision and a sutured plasma rich in growth factors membrane (mPRGF) followed by rich in growth factors (PRGF) eye drops treatment. After surgery, dexamethasone, tobramycin and PRGF eye drops were prescribed for 6 weeks. After a 12-month and 3-year post-surgical follow-up respectively, treated eyes with mPRGF did not present relapse, and visual acuity improved in both cases. No ocular complications, pain, eye discomfort nor other symptoms were observed. The combined use of PRGF eye drops and mPRGF seems an effective and safe therapy for recurrent pterygium.

RESUMO Nós propomos uma nova técnica cirúrgica em casos de pterígio agressivo recorrente não subsidiário de tratamento com autoenxertos conjuntivais ou antimetabólitos. Dois casos foram tratados com excisão cirúrgica e um plasma suturado rico em membrana de fatores de crescimento (mPRGF), seguido de tratamento com colírios ricos em fatores de crescimento (PRGF). Após a cirurgia, foram prescritos colírios de dexametasona, tobramicina e PRGF por 6 semanas. Após 12 meses e 3 anos de acompanhamento pós-cirúrgico respectivamente, os olhos tratados com mPRGF não apresentaram recidiva e a acuidade visual melhorou nos dois casos. Não foram observadas complicações oculares, dor, desconforto ocular ou outros sintomas. O uso combinado de colírios de PRGF e mPRGF parece uma terapia eficaz e segura para o pterígio recorrente.

Clinical effect of platelet rich fibrin in the treatment of periodontal intrabony defects. systematic review and meta-analysis

Background: There is currently no gold standard biomaterial for the treatment of periodontal intrabony defects (PIDs). One of the current options is the use of platelet-rich fibrin (PRF). Objective: To determine the clinical effect of PRF in the treatment of PID through a systematic review and meta-analysis. Materials and Methods: A literature search was conducted up to February 2017 in the following biomedical databases: Pubmed, Embase, Scielo, Science Direct, SIGLE, LILACS and in the Cochrane Central Register of Clinical Trials. The selection criteria included: randomized clinical trials published in the last 5 years, reporting clinical effects (probing depth, clinical insertion level or gingival recession), with a follow-up time equal to or greater than 6 months, and sample size larger than or equal to 10 patients reporting the use of PRF as a treatment for PID. The methodological quality of the studies was analyzed using the Cochrane Handbook of Systematic Reviews of Interventions as a reference. Results: The search strategy yielded 20 articles. A reduction in probing depth and an increase in clinical insertion level or a reduction in gingival recession is reported, when using PRF alone or in combination with another biomaterial or substance that stimulates tissue regeneration. Conclusion: The literature suggests that the use of PRF in the treatment of PIDs has a beneficial clinical effect when compared to control treatments.

Membrana de fibrina versus injerto conectivo como tratamiento de recesión gingival / Fibrin membrane versus connective tissue graft as gingival recession treatment

RESUMEN: Este caso clínico de boca dividida a 6 meses tiene como objetivo comparar los resultados obtenidos con una membrana de fibrina rica en plaquetas y leucocitos (L-PRF) y un injerto de tejido conectivo (ITC) en el tratamiento de recesiones gingivales clase1 de Miller en un paciente con biotipo gingival grueso. El resultado muestra que el uso de una membrana de L-PRF provee un parcial cubrimiento de la recesión y un menor malestar subjetivo del paciente cuando se compara con el ITC. Sin embargo, el ITC proporciona un mayor porcentaje de cubrimiento radicular y un mejor resultado estético que la membrana de L-PRF al cabo de 6 meses.

ABSTRACT: The aim of this split-mouth clinical study, covering a 6 month period, is to compare the results obtained from Leucocyte and Platelet Rich Fibrin Membrane (L-PRF) and Connective Tissue Grafting (CTG) in the treatment of class 1 Miller gingival recessions in a patient with thick gingival biotype. The results show that the use of L-PRF membrane provides partial coverage of the recession, as well as lower subjective patient discomfort when compared with CTG. However, CTG provides a higher percentage of root coverage and better aesthetic results than the L-PRF membrane after a period of 6 months.

Uso da fibrina rica em plaquetas na implantodontia / The use of the platelet-rich fibrin in Implantology ­ a literature review

Objetivo: realizar uma revisão da literatura acerca do uso do PRF na Implantodontia nos últimos anos, abordando artigos científicos recentes. Material e métodos: foi realizada uma busca na base de dados PubMed, ente os meses de setembro e outubro de 2016, utilizando a associação das palavras-chave na língua inglesa "PRF" e "dental implants". Posteriormente, foi feita uma complementação nas bases de dados Scielo e Google Acadêmico com os mesmos termos na língua portuguesa. Resultados: dez artigos foram selecionados, uma vez que os mesmos respeitavam os critérios de inclusão, incluindo metodologia detalhada, número significativo de pacientes e realização de procedimentos relacionados à instalação de implantes dentais. Todos os estudos avaliados reportaram alguma vantagem no uso do PRF, principalmente em relação ao ganho ósseo. No entanto, todos os estudos apresentaram limitações e apontaram a necessidade de estudos subsequentes com adequada padronização. Conclusão: após a revisão destes estudos, foi possível concluir que o PRF pode ser indicado como adjuvante nos procedimentos de enxertia e na instalação de implantes, e também pode ser utilizado como barreira mecânica em procedimentos em que esta manobra seja necessária para o sucesso final do procedimento de enxertia.

Objective: the aim of the study was to review the literature concerning the use of the PRF in Implantology in the past few years, taking into account the recent articles published in relation to this subject. Material and methods: a search was made on the PubMed (Medline) database, between September and October of 2016, with the terms "PRF" and "dental implants" and also a complementary search in Scielo and Google Academic databases, with the correspondent terms in Portuguese. Results: ten articles were included in the study, once they fulfill the inclusion criteria revealing a detailed methodology, a significant number of patients and with procedures related to the installation of dental implants. All studies evaluated reported some advantage concerning the use of the PRF, mostly in relation to the gain in the bone level. However, all studies also declared limitations of their methodologies and pointed to the necessity in the development of further studies with standard protocols. Conclusion: after revision of the mentioned articles, it was possible to conclude that the PRF can be used as an adjuvant in the grafting procedures and in the dental implant installation, also, can be used as a mechanical barrier in procedures that this kind of barrier is necessary to ensure success in the grafting procedure.

Tratamento da osteonecrose mandibular medicamentosa usando a fibrina leucoplaquetária autóloga ­ Dez meses de acompanhamento sem recidiva / Treatment of medicamentous mandibular osteonecrosis through autologous leukocyte platelet-rich fibrin ­ a 10 months follow-up without signs of recurrence

Uma paciente do sexo feminino, com 72 anos de idade e exposição óssea intraoral, portadora de osteoporose, fazia uso de bifosfonatos há mais de cinco anos. Na região posterior mandibular direita havia osso exposto, hiperemia dos tecidos moles e exsudato purulento. A região mandibular anterior mostrava drenagem de secreção purulenta. Como havia necessidade de cirurgia de fêmur por recomendação médica, a paciente foi submetida à medicação específica (amoxicilina 500 mg, metronidazol 400 mg) e irrigação local com clorexidina 0,12%. Seis meses depois, e mediante os exames de TCFC e CTx sérico, foi realizada a terapia com fibrina leucoplaquetária autóloga. Estas biomembranas foram colocadas nas áreas de osso necrótico. Depois de 15 dias, observou-se uma grande exposição da área operada. Porém, clinicamente, já se notava neovascularização. Após 30 dias, havia grande epitelização da área que se encontrava exposta anteriormente. O caso foi controlado por mais 30 dias, totalizando 60 dias, podendo ser observada uma grande cobertura de tecido mole bem vascularizada e queratinizada na região. As terapias propostas para tratamento não apresentam eficácia suficiente para serem consideradas como protocolos. Dentro dos limites deste relato, a utilização da fibrina leucoplaquetária autóloga apresentou-se favorável como alternativa após dez meses e sem recidivas, abrindo perspectivas para tratar as necroses induzidas por estes medicamentos.

A 72 years-old female patient presented with intraoral bone exposure, osteoporosis, and bisphosphonate use (> 5 years). Also, at the posterior mandible, there was soft tissue hyperemia and pus. On the other hand, the anterior mandible presented with purulent drainage. Due to the need of a hip replacement by medical recommendation, the patient was submitted to specific pharmacological regimen (Amoxicillin 500 mg, Metronidazole 400 mg), and 0.12% chlorhexidine rinses. Six months later, and after CBCT and seric CTx exams, the autologous leukocyte platelet-rich fibrin therapy was applied. These biomembranes covered areas of necrotic bone. After 15 days, there was great exposition at the surgical area. However, neovascularization was clinically observed followed 30 days later by epithelization of previously exposed areas. The case was controlled for more 30 days, where well-vascularized and keratinized soft tissue coverage was identified. The proposed therapy does not provide efficacy to be considered as protocols. However, within the limits of this presentation, the autologous leukocyte platelet-rich fibrin seems to be favorable as an alternative and after 10 months no complications were observed. This opens new perspectives to treat bisphosphonate induced bone necrosis.

Evidências científicas do uso da fibrina rica em plaquetas em odontologia: Uma revisão integrativa / Scientific evidence on the use of platelet-rich fibrin: an integrative review

Objetivo: realizar uma revisão da literatura em bases de dados eletrônicos sobre as evidências da eficácia da fibrina rica em plaquetas. Material e métodos: a partir dos bancos de dados Medline, PubMed e ClinicalKey, de março a junho de 2016, foi realizada um revisão integrativa de trabalhos sistemáticos e longitudinais. Dois revisores independentes avaliaram os critérios de inclusão e exclusão dos artigos, sendo incluídos artigos publicados de 2011 a maio de 2016. Resultados: a busca eletrônica resultou em um total de 16 referências. Conclusão: os estudos, em sua maioria, relataram aceleração do processo de cicatrização do tecido mole e diminuição da severidade das sequelas pós-operatórias imediatas em Odontologia.

Objective: to review the literature in electronic databases about the evidence of platelet rich fibrin efficiency. Material and methods: Medline, PubMed and ClinicalKey databases were searched from March to June 2016 using a combination of specific search terms. Two independent reviewers assessed the criteria for inclusion and exclusion of articles. with selected articles from 2011 to May 2016. Results: the electronic search resulted in a total of 16 references. Conclusion: most of the studies reported an acceleration of soft tissue healing process and severity decrease of the immediate postoperative sequelae in Dentistry.

Effects of platelet-rich fibrin on healing of intra-bony defects treated with anorganic bovine bone mineral

Abstract Anorganic bovine bone mineral (ABBM) is extensively used in the treatment of intra-bony defects. Platelet-rich fibrin (PRF) is a new-generation platelet concentrate with a simplified technique. Although certain studies have reported the use of PRF in the treatment of intra-bony defects, to date, none of them have evaluated its additive effects with ABBM. Therefore, a randomised, split-mouth clinical trial was conducted to compare healing of intra-bony defects treated with an ABBM-PRF combination with healing of those treated with ABBM alone. By using a split-mouth design, 15 paired intra-bony defects were randomly treated with either ABBM alone (control group) or ABBM-PRF combination (test group). Following clinical parameters and radiographical measurements were recorded at baseline and 6 months after treatment: plaque index (PI), gingival index (GI), probing depth (PD), gingival recession (GR), clinical attachment level (CAL), vertical bone loss, depth of defect and defect angle. Preoperative clinical and radiographical measurements were similar for the test and control groups. Statistically significant reductions in GI, PD, CAL, vertical bone loss, depth of intra-bony defect and widening of defect angle were detected after treatment in both groups. With respect to inter-group analysis, gain in CAL was significantly greater in the test group than in the control group, whereas no inter-group differences were observed in any other parameter. The results of this study indicate that both therapies are effective in the treatment of intra-bony defects.

Utilização de fibrina leucoplaquetária autóloga na recuperação de perfuração crítica da membrana sinusal / The use of autologous leukocyte and platelet-rich fibrin to repair critically-sized sinus membrane perforations ­ a case report

Esse trabalho teve por objetivo apresentar a fibrina leucoplaquetária autóloga como alternativa de tratamento para perfuração significativa da mucosa sinusal, durante cirurgia de elevação do assoalho do seio maxilar. O presente caso clínico relatou a obtenção da fibrina leucoplaquetária autóloga, o procedimento cirúrgico para levantamento de assoalho do seio maxilar pela técnica da janela lateral, a reparação da perfuração crítica da mucosa sinusal utilizando membranas de fibrina leucoplaquetária autóloga e os resultados alcançados. No caso exposto, a fibrina

This work aims to present the autologous leukocyte and platelet-rich fibrin as a treatment alternative for the sinus mucosa perforation during sinus floor elevation surgery. This case reports on how to obtain the autologous concentrate, the surgical procedure with the lateral window technique, the critical-size perforation repair with leukocyte platelet-rich membranes, as well as the results. In this situation, the autologous leukocyte platelet-rich fibrin demonstrated to be an efficient method to treat a large sinus mucosa perforation.

Arcabouço de PRP-gel associado a células tronco mesenquimais: uso em lesões condrais em modelo experimental equino / PRP-gel scaffold associated with mesenchymal stem cells: use in experimental chondral defect of equine models

O plasma rico em plaquetas (PRP) é conhecido por apresentar propriedades anabólicas, anti-inflamatórias e capacidade de gelificação. Atualmente o PRP é considerado eficaz na reparação da cartilagem, sendo sua capacidade de formação de gel indicada para o preenchimento de defeitos condrais. O objetivo desse estudo foi analisar o uso do PRP ativado, no formato de arcabouço, como suporte para o implante de células tronco mesenquimais (CTM), no preenchimento e tratamento de lesões condrais induzidas em equinos. Doze equinos foram submetidos a uma cirurgia artroscópica no tempo zero do experimento (T0), onde foi induzida uma lesão condral de 15 mm de diâmetro na tróclea medial femoral dos membros pélvicos direito. As 12 articulações foram divididas em dois grupos distintos com seis articulações cada (GA e GB). As articulações do GA foram submetidas ao tratamento com o implante de CTM em gel de PRP. As articulações de GB foram o grupo controle do experimento. As CTMs foram extraídas do tecido adiposo e o PRP em gel foi obtido por protocolo de dupla centrifugação seguido da adição de trombina liofilizada. Após cinco meses (T150) foi realizada nova artroscopia para avaliação macroscópica do local, coleta de amostras do tecido de reparação para análises de microscopia eletrônica, sendo realizadas imagens ressonância magnética e tomografia computadorizada no local do implante no GA. Observamos que o gel de PRP associado às CTM demonstrou ser adequado no tratamento de defeitos condrais experimentais dos equinos. GA evidenciou um melhor aspecto macroscópico e microscópico do tecido de reparação, sendo que GB mostrou maior desorganização das fibras colágenas. Nas imagens de ressonância magnética e tomografia computadorizada apenas foi relevante o local da lesão condral. O arcabouço de gel de PRP demonstrou ser apropriado no suporte do tratamento com as CTMs, sendo de fácil aplicação e efetivo, demonstrando resultados promissores na reparação de lesões condrais induzidas.(AU)

The platelet-rich plasma (PRP) is characterized by its anabolic, anti-inflammatory and gelling capability. Nowadays, the PRP is considered effective in the repair of cartilage defects, and its gelling capability is proper to filling chondral defects. So, the aim of this study was to investigate the use of activated PRP as a fibrin gel scaffold, such as support for the use with mesenchymal stem cells (MSC), on the treatment of experimentally chondral articular defects. Twelve horses were subjected to an arthroscopic surgery at time zero of the experiment (T0). A chondral defect of 15 mm diameter was created on the medial femoral trochlea and these 12 joints were divided into two groups each with six joints in each group (GA and GB). The joints of the GA were treated with implantation of MSC and PRP-gel. GB joints were the control group. MSCs were cultivated from adipose tissue and PRP-gel was obtained by double centrifugation protocol followed by addition of lyophilized thrombin. After five months (T150) was performed new arthroscopy for macroscopic evaluation of the defect local, collect samples of tissue repair for electron microscopy assessment and also was implemented a magnetic resonance images and computed tomography on GA. It was observed that the PRP-gel associated with CTMs showed a suitable treatment of experimental chondral defects in horses. GA showed a better macroscopic and microscopic appearance of the tissue repair. GB showed smaller number of chondrocytes and increased collagen fibers disorganization. At the magnetic resonance and computed tomography imaging only the local of chondral defect was viewed. The PRP-gel scaffold was satisfactory to use and support MSCs implantation. It showed an easy handling and it was effective, showing a promising results in the repair of induced chondral defects.(AU)

Fibrina rica em plaquetas e a reconstrução tecidual periodontal / Platelet-rich fibrin and periodontal tissue regeneration ­ a literature review

As evidências na literatura dos efeitos benéficos dos concentrados de plaqueta, obtidos do sangue autólogo em procedimentos cirúrgicos periodontais, têm aumentado muito nos últimos anos. O uso da fibrina rica em plaquetas ainda se encontra na fase inicial, porém, o potencial clínico de suas aplicações é muito promissor. O objetivo desta revisão foi conceituar o uso da fibrina rica em plaquetas como um procedimento que visa à regeneração das estruturas periodontais perdidas. Pôde-se concluir que a fibrina rica em plaquetas tem grande potencial de aplicação nas cirurgias periodontais e peri-implantares, demonstrando ser eficaz no tratamento de defeitos infraósseos de três paredes e de furca II mandibulares, sendo um procedimento de baixa complexidade e morbidade, de fácil aplicação clínica e com baixo custo.

The evidence in the literature of the beneficial effects of platelet concentrates obtained from autologous blood in periodontal surgical procedures has increased significantly in recent years. The use of platelet-rich fibrin is still in its early days; however, their clinical application is very promising. The objective of this review was to conceptualize the use of platelet-rich fibrin as a procedure which aims to the regeneration of lost periodontal structures. It could be concluded that platelet-rich fibrin have great potential for application in periodontal and peri-implant surgeries and have shown to be effective in treating intra-bony 3 walls and mandibular furcation II defects, being a low complexity and morbidity procedure, easy for clinical applicability and of a low cost.

Flap and abdominal wall washing and debridement using dressings to prevent seromas and hematomas in abdominoplasty / Lavagem e desbridamento do retalho e da parede abdominal com compressas como prevenção de seromas e hematomas em abdominoplastia

Seroma formation remains a common complication of abdominoplasty. The use of drain, flap fixation points, and fibrin glue has been described to reduce the incidence of seroma formation. The authors present herein an easyto- reproduce technique to decrease the risk of bleeding and eliminate the devitalized tissue caused by the detachment. The proposed strategy consists of washing and debridement, which was conducted with mechanical friction using moist flap and abdominal wall dressings.

A formação de seroma após uma abdominoplastia continua sendo uma complicação frequente. O uso de dreno, os pontos de fixação do retalho e o uso da cola de fibrina foram descritos com a finalidade de diminuir a sua incidência. Os autores apresentam uma técnica de fácil reprodução para reduzir o risco de sangramento, bem como para eliminar o tecido desvitalizado decorrente do descolamento. A tática proposta constitui-se de lavagem e desbridamento por meio da fricção mecânica com compressas umedecidas do retalho e da parede abdominal.

Platelet-Rich Fibrin a Second Generation Autologous Platelet Concentrate for the Treatment of Inadequate Width of Attached Gingiva.

Along with the better understanding of the pathogenesis of periodontal diseases, the treatment modalities for various periodontal diseases have also gone a step ahead. One of the most important and currently unsolved problems in clinical periodontics is the predictable successful treatment of inadequate width of attached gingiva. Recently, importance has been given to the use of platelet-rich fibrin (PRF) for predictably treating periodontal diseases. PRF is an intimate assembly of glycan chains, glycoproteins, and cytokines. These are enmeshed in a slowly polymerized fibrin network which has the potential to accelerate soft and hard tissue healing. This article presents the clinical results of treatment of inadequate width of attached gingiva with PRF.

Bone neoformation in defects treated with plateletrich fibrin membrane versus collagen membrane: a histomorphometric study in rabbit femurs / Neoformación ósea de defectos tratados con membrana de fibrina rica en plaquetas versus membrana de colágeno: un estudio histomorfométrico en fémur de conejos

The aim of the present research was to compare bone neoformation in bone defects treated with platelet-rich fibrin (PRF) and collagen membrane (CM) at 3 and 5 weeks. For this purpose, two bone defects with a width of 4 mm and depth of 6 mm were created in the left distal femur diaphysis of New Zealand rabbits (n=12). The subjects were randomly allocated into two groups. One of the defects was covered with a platelet-rich fibrin membrane (Centrifuged resorbable autologous blood biopolymer without biochemical modification) or a collagen membrane (gold standard - Neo Mem). The second defect was left uncovered (NC). The rabbits were sacrificed after 3 and 5 weeks (3 rabbits per period). The femur was completely removed and processed histomophometrically. The bone neformation analysis was performed using a differential point-counting method. Data was statistically analyzed (ANOVA, Tukey). The histomorphometric results showed that bone neformation in the defects treated with PRF at 3 weeks was equivalent to the CM (p<0.05). After 5 weeks, bone neformation obtained with PRF was higher than the control group and lower compared with the CM (p<0.05). The conclusion of the present study is that bone neformation in defects treated with PRF showed lower histomorphometric results compared with the one obtained with the collagen membrane and higher when compared with the control defects...

El objetivo de la investigación fue comparar la neoformación ósea de defectos óseos tratados con membrana de fibrina rica en plaquetas (PRF) y membrana de colágeno (CM), a las 3 y 5 semanas para lo cual se crearon dos defectos óseos de 4 mm de diámetro y 6 mm de profundidad en la diáfisis femoral distal izquierda de conejos Nueva Zelanda (n=12). Los animales fueron divididos aleatoriamente en 2 grupos. Uno de los defectos fue cubierto con membrana de fibrina rica en plaquetas (Biopolímero Reabsorbible Autólogo de sangre Centrifugada sin modificación bioquímica) o membrana de colágeno (Gold estándar-Neo Mem,) mientras que el segundo defecto se dejó sin cubrir (NC). Los conejos fueron sacrificados después de 3 y 5 semanas (3 conejos/periodo), se les extrae el fémur por desarticulación, se procesa y evalúa histomorfométricamente. El análisis de la neoformación ósea histológica fue realizado mediante el conteo diferencial de puntos. Los datos fueron analizados estadísticamente (ANOVA, Tukey). Los resultados histomorfométricos mostraron que la neoformación ósea de los defectos tratados con PRF a las 3 semanas fue equivalente a la neoformación obtenida en el grupo control y menor comparado con la neoformación del CM (p<0,05). A las 5 semanas la neoformación ósea obtenida con PRF fue mayor a la neoformación del grupo control y menor a la CM (p<0,05). Concluyendo que la neoformación ósea obtenida en los defectos tratados con PRF mostraron resultados histomorfométricos menores a la neoformación obtenida con colágeno y mayores en comparación a la neoformación de los defectos controles...

Analysis of the rate of maturogenesis of a traumatized Cvek’s stage 3 anterior tooth treated with platelet‑rich fibrinas a regenerative tool using three‑dimensional cone‑beam computed tomography: An original case report.

Regenerative endodontic procedures are biologically based procedures which deal with the regeneration of pulp‑like tissue, more idealistically the pulp‑dentin complex. The regeneration of this pulp‑dentin complex in an infected necrotic tooth with an open apex is possible only when the canal is effectively disinfected. Though there are various procedures for treating open apex ranging from Ca(OH) 2 apexification, mineral trioxide aggregate apexification and surgical approach, regeneration of tissues has always taken superior hand over the repair of tissues. The mechanics behind the regenerative endodontic procedures is that despite the tooth being necrotic, some pulp tissue can survive apically which under favorable conditions proliferate to aid in the process of regeneration. In the past 2 decades, an increased understanding of the physiological roles of platelets in wound healing and after tissue injury has led to the idea of using platelets as therapeutic tools in the field regenerative endodontics. In the present case report with an open apex, high sterilization protocol is followed using triple antibiotic paste as intra‑canal medicament, followed which platelet rich fibrin is used as the regenerative material of choice. Over an 18‑month follow‑up period, clinically patient is asymptomatic and radiographically there is complete regression of the periapical lesion and initiation of the root end closure.

Use of second-generation platelet concentrate (platelet-rich fibrin) and hydroxyapatite in the management of large periapical inflammatory lesion: A computed tomography scan analysis.

Periapical surgery is required when periradicular pathosis associated with endodontically treated teeth cannot be resolved by nonsurgical root canal therapy (retreatment), or when retreatment was unsuccessful, not feasible or contraindicated. Endodontic failures can occur when irritants remain within the confines of the root canal, or when an extraradicular infection cannot be eradicated by orthograde root canal treatment. Foreign‑body responses toward filling materials, toward cholesterol crystals or radicular cysts, might prevent complete periapical healing. We present here a case report wherein, combination of platelet‑rich fibrin (PRF) and the hydroxyapatite graft was used to achieve faster healing of the large periapical lesion. Healing was observed within 8 months, which were confirmed by computed tomography, following improved bone density. PRF has many advantages over platelet‑rich plasma. It provides a physiologic architecture that is very favorable to the healing process, which is obtained due to the slow polymerization process.

Uso de fibrina rica em plaquetas (PRF) no tratamento de perfurações da membrana sinusal / Use of platelet-rich fibrin (PRF) to treat sinus membrane perforations

A reabilitação de áreas edântulas sempre foi um desafio para os profissionais, em especial a posterior de maxila, pela pneumatização dos seios maxilares. Uma das complicações durante os procedimentos de levantamento sinusal são as perfurações da membrana. A fibrina rica em plaquetas (PRF), um concentrado de fatores de crescimento obtido a partir da centrifugação do sangue do paciente, tem a propriedade de acelerar o processo cicatricial, reparar as perfurações na membrana schneideriana e funcionar como material de preenchimento. O objetivo do presente estudo foi revisar a literatura e relatar um caso de selamento de perfuração de membrana sinusal utilizando membrana de fibrina (PRF) associada … hidroxiapatita bovina

Rehabilitation of edentulous areas has always been a challenge for dentists, especially on the posterior maxilla due to the pneumatization of the maxillary sinus. One of the complications during sinus lifting procedures is perforation of the membrane. The platelet-rich fibrin (PRF) is a complex of growth factors obtained from centrifuging the patient’s blood. It has the ability to accelerate the healing process and repair damages in the Schneiderian membrane, therefore, functioning as a filling material. The aim of this study was to perform a literature review and report a clinical case of sealing membrane perforation using PRF associated with bovine hydroxyapatite

Análisis comparativo de la regeneración ósea obtenida con quitosano y plasma rico en fibrina / Comparative analysis of the obtained bone regeneration with chitosan and plasma rich in fibrin

La regeneración ósea guiada (ROG) es un procedimiento que consiste en el incremento de la cantidad del hueso empleando materiales poliméricos biocompatibles como por ejemplo, el quitosano y el plasma rico en fibrina (PRF); los cuales se han valorado de manera individual con excelentes resultados. En este estudio, se propone analizar radiográficamente la regeneración ósea de ambos polímeros sobre alvéolos dentales postextracción. Se seleccionaron 5 pacientes con indicación de extracción de cordales inferiores bilaterales y a un alvéolo se aplicó quitosano y al otro PRF; se realizaron radiografías periapicales a los 15, 30, 60 y 120 días. Posteriormente, se analizaron las radiografías para observar el nivel de regeneración ósea y los resultados mostraron que ambos biomateriales regeneraron los tejidos, pero con la siguiente diferencia: la ROG con PRF ocurrió en menor tiempo mientras que la ROG con quitosano tuvo una mejor organización estructural. Se concluye que ambos biomateriales se pueden tomar como opciones de tratamientos en la regeneración ósea guiada de tejidos.

The bone regeneration it a procedure that consists in the formation of new bony tissues using biocompatible polymeric materials, among them the chitosan (natural biopolymer) and the rich fibrin plasma (PRF) this biomaterials have been studied and used to achieve the bony regeneration obtaining excellent results. The aim of this research was to design an experiment that allowing us to compare the regenerator effect of both polymers, after the extraction of dental pieces in human beings, using periapical radiography's. Five patients, with indication of extraction of the lower bilateral wisdom dental pieces were selected. Chitosan and PRF were applied on different dental sockets after surgery. To register the information, periapical Rx were taken and analyzed, the procedure were done monthly, for 120 days. The results for Rx showed that both biomaterials regenerated bony tissue. The PRF generated major quantity of tissue in minor time whereas the chitosan did it with better structural organization, so, it was possible to conclude that chitosan and PRF represents interesting options for the treatments where guided bony regeneration is required.

Treatment of Periapical Lesion with Platelet Rich Fibrin.

Periapical surgery aims to remove periapical pathology to achieve complete wound healing and regeneration of bone and periodontal tissue. Platelet rich fibrin (PRF) is a wonderful tissue engineering product and has gained much popularity due its promising results in wound healing bone induction. The features of this product are an attribute of platelet cells, which, after cellular interactions, release growth factors. This case report illustrates the use of PRF in bony regeneration after enucleation of cyst in anterior maxilla.

Levantamiento de seno maxilar con PRF: reporte de un caso clínico / Maxillary sinus lifting with PRF: report of a clinical case

La meta del tratamiento consistió en ganar hueso en las zonas posteriores del maxilar superior para lograr en una segunda cirugía la instalación de implantes dentales. La alternativa de usar aloinjerto más plaquetas rica en fibrina (PRF) constituyó una alternativa terapéutica teniendo en cuenta el acortamiento del tiempo de cicatrización y regeneración; y las virtudes del uso de PRF combinado con esta técnica. El objetivo de este trabajo fue emplear esta técnica como alternativa del tratamiento de zonas maxilares posteriores atróficas. Para realizar dicha técnica se seleccionó un paciente con reborde maxilar atrófico en las zonas de los senos maxilares. De esta manera emplear un aloinjerto, combinado con PRF obtenido del mismo paciente. Hoy en día, gracias a la aparición de las técnicas de Regeneración ósea Guiada, y dentro de éstas la utilización de plaquetas rica en fibrina (PRF), se van a poder colocar implantes en lugares donde años atrás no se hubiese pensado. A pesar de las controversias del uso de PRF, esta técnica sirve como una gran alternativa para los especialistas debido a la aparición de técnicas simplificadas que permiten una aplicación a nivel ambulatorio.