Surgical removal of mandibular third molars is a routine procedure in oral and maxillofacial surgery, often followed by pain, swelling, trismus, and alveolar osteitis (AO), affecting patient comfort and daily function. Platelet-rich fibrin (PRF) is an autologous biomaterial that promotes healing through the gradual release of cytokines and growth factors. This prospective, randomized, controlled, and patient-blinded study investigated whether PRF applied to the extraction socket reduces postoperative symptoms and complications. Ninety patients scheduled for mandibular third molar removal were randomized to receive PRF or no adjunct treatment prior to wound closure. Seventy-five patients completed follow-up and were included in the analysis. Postoperative outcomes including AO, infection, pain, trismus, analgesic use, and sick leave were recorded over 10 days. The incidence of AO was lower in the PRF group (3.0%) compared to the control group (11.9%), although the difference was not statistically significant. PRF treatment significantly reduced postoperative pain during the first six days. These findings suggest that while PRF may not significantly reduce AO incidence, it can contribute to improved patient comfort and recovery by decreasing early postoperative pain.

Oral and maxillofacial (OMF) tissue engineering has always been the subject of longstanding professional and academic debates. Despite rapidly evolving therapeutic approaches including reconstructive surgeries, tissue grafts, platelet-rich therapies, and mesenchymal stem cell-based treatments, there are remaining concerns regarding the therapeutic efficacy, safety profile, immunological compatibility, target-specificity, and ethical issues of such therapies. In addition to the multifactorial nature of OMF diseases, complex maxillofacial anatomy and neurovasculature further pinpoint the urgent need for breakthroughs in the era of OMF treatments. In recent years, exosomes have garnered immense popularity as the frontiers of regenerative medicine. Exosomes, natural nanovesicles secreted by a wide range of cells, act as nano messengers that harbor the rich molecular cargo received by their original cells and demonstrate important roles for diverse physiological and pathological intercellular communications. Among the different sources of exosomes, the oral cavity hosts a wide variety of mesenchymal stem cell-derived and salivary exosomes. Owing to the neural crest origin and multipotent differentiation, oral stem cell-derived exosomes hold great promise for OMF tissue engineering. Moreover, exosomes derived from pathological oral cavity cells and saliva samples provide diagnostic and prognostic signatures for different OMF diseases. This review highlights the cutting-edge diagnostic and therapeutic applications of oral cavity-derived exosomes in the field of OMF regeneration. Furthermore, we emphasize the existing challenges and constraints in exosome-based diagnostics and therapy, thus offering important perspectives for the future clinical application of exosomes derived from the oral cavity.

Injectable platelet-rich fibrin (I-PRF) is an autologous fibrin matrix rich in leucocytes, platelets and growth factors, and could serve as a sustained-release vehicle for a variety of active biomolecules. The aim of the current randomized controlled trial was to compare the effect of vitamin C (VitC) with I-PRF as a locally delivered adjunct to professional mechanical plaque removal (PMPR) versus PMPR with local delivery of I-PRF or PMPR alone on non-surgical periodontal treatment (NSPT) outcomes of stage-II periodontitis.

Forty-five patients (n = 45) diagnosed with stage-II grade A periodontitis were randomly assigned into test (PMPR + I-PRF/VitC; n = 15) or control groups (PMPR + I-PRF; n = 15 and PMPR; n = 15). Bleeding on probing (BOP; primary outcome), probing depth (PD), clinical attachment level (CAL), gingival margin (GM), plaque index (PI) and radiographic bone gain/loss (horizontal, vertical and total) were assessed at baseline, three- and six-months post-treatment. Post-operative pain was further assessed at second- and third-day post-treatment.

Although BOP scores were lower in the PMPR + I-PRF/VitC group, the regression analysis revealed that gender was the only significant predictor for BOP, with females showing a reduced propensity (p < 0.05). Clinical and radiographic parameters significantly improved in all groups independently (p < 0.05). PD-reduction was 1.73 ± 0.59 mm, 1.67 ± 0.49 mm and 1.73 ± 0.59 mm, CAL-change was 1.33 ± 0.49 mm, 1.20 ± 0.56 mm and 0.93 ± 0.59 mm and GM-change was 0.40 ± 0.51 mm, 0.33 ± 0.49 mm and 0.73 ± 0.70 mm in the PMPR + I-PRF/VitC, PMPR + I-PRF and PMPR groups respectively. No intergroup differences were notable regarding BOP or changes in PD, CAL, GM, PI and radiographic bone measurements at three or six months relative to baseline (p > 0.05). Significantly lower pain scores at two and three days were notable in the PMPR + I-PRF/VitC and PMPR + I-PRF groups compared to the PMPR group (p < 0.05).

Apart from a positive effect on the patients' post operative pain perception, I-PRF with or without the addition of vitamin C does not additionally improve the clinical outcomes of PMPR alone in the NSPT of stage-II grade A periodontitis patients.

Trial registration. The study was retrospectively registered in the US National Institutes of Health Clinical Trials Registry (NCT05129267) on 2021-11-10.

Insufficient bone volume is a major problem in implant dentistry, which can be counteracted by using guided bone regeneration technique. Among the materials recently tested, synthetic polymers have been recommended as showing excellent biocompatibility and biodegradability.

The aim of this pilot study was to analyze and compare through means of histology the healing of the bone tissue in critical size osseous defects in New-Zealand rabbit tibiae after application of beta-tricalcium phosphate (β-TCP) alone, β-TCP combined with leucocyte platelet-rich fibrin (L-PRF) and an injectable experimental bone cement (EBC) represented by a dual-curable degradable synthetic polymer.

Two New-Zealand rabbits were used. Three standardized osseous defects of 5 mm diameter were created in each tibia. Each defect was filled with either β-TCP alone (control), β-TCP combined with L-PRF (test) or with EBC (test). The animals were sacrificed at 25 and 70 days; the tibia samples were removed, fixed in 10 % formaldehyde and stained with AZAN.

While at 25 days β-TCP produced sparse bone formation, at 70 days mature bone formation was visible in all areas of the defect with minimum remaining graft particles; at 25 days, β-TCP combined with L-PRF produced broad areas of bone lamellae, while at 70 days bone tissue formation was limited; at both 25 and 70 days, the EBC was stable and not penetrated by bone cells, while a narrow band of connective tissue could be seen superjacent and inferior to it.

Among the tested biomaterials, β-TCP was capable of generating bone formation at both healing time-points, while the addition of L-PRF seemed to provide a synergistic effect only in the early phase of bone healing.

Sticky bone, created from concentrated growth factor (CGF) or advanced platelet-rich fibrin (A-PRF), contains various growth factors. This study analyzed the release patterns of growth factors from CGF sticky bone (CGF-SB) and A-PRF sticky bone (A-PRF-SB) to inform their application in bone grafting.

CGF, A-PRF, CGF-SB, and A-PRF-SB were incubated for 28 days, with supernatant collected on days 1, 7, 14, 21, and 28. Growth factors-platelet-derived growth factor-BB (PDGF-BB), vascular endothelial growth factor (VEGF), and basic fibroblast growth factor (bFGF)-were quantified using multiplex assays. Transforming growth factor-β1 (TGF-β1) and insulin-like growth factor-1 (IGF-1) were measured by ELISA.

CGF and A-PRF released more than half of their PDGF-BB, VEGF, and bFGF within day 1, followed by rapid declines. Differently, sticky bone released these growth factors more gradually, surpassing 50% cumulative release by day 7 and sustaining over time. IGF-1 and TGF-β1 in all groups reached 50% release by days 7 and 14, respectively. A-PRF-SB released significantly more PDGF-BB, bFGF, and TGF-β1 than CGF-SB (p < 0.05).

Both CGF-SB and A-PRF-SB exhibit slower and sustained growth factor release compared to CGF and A-PRF alone, with A-PRF-SB offering superior release profiles, highlighting its enhanced potential for bone grafting applications.

Concentrated growth factors (CGF) is a biomaterial with regenerative potential, enriched with platelets, leukocytes, growth factors, and fibrin, but it degrades within 2-3 weeks. Albumin extends CGF stability, while silver nanoparticles (SNP) improve its mechanical and antibacterial properties. This in vitro and ex vivo study investigates the impact of albumin (Alb-CGF) and albumin with SNP (Alb-CGF-SNP) on CGF's mechanical properties, degradation rate, and cellular bioactivity.

Blood samples were collected from 15 healthy volunteers who met specific inclusion criteria, with the sample size determined using G*Power software for power calculation. Three groups were prepared: control CGF, experimental Alb-CGF, and Alb-CGF-SNP. Membranes were produced using a Medifuge MF200 centrifuge and activated plasma albumin gel (APAG) device following standard settings. In experimental groups, the superficial 2.5 ml of plasma layer was heated at 75 °C for 10 min before combining with the buffy coat layer of CGF. Mechanical properties were tested using a texture analyzer, degradation rates were measured by weight loss percentage, and cellular bioactivity was evaluated with a Sysmex hematology analyzer. Data analysis was conducted using GraphPad Prism 8.0. Group differences were assessed via one-way ANOVA and Welch ANOVA, with Tukey's HSD test for post hoc paired group comparisons.

The control (CGF) showed the highest mechanical properties, with Ultimate Tensile Strength (UTS) (95.6 kPa), Modulus of Toughness (55.55 kJ/m3), and Young's Modulus (75.73 kPa; (P < 0.01). No significant differences were observed in the strain at break across groups (P > 0.90). Alb-CGF-SNP displayed superior degradation resistance, with 45.2% weight loss at day 60 versus 84.2% in CGF (P < 0.01). CGF had the highest WBC and platelet levels, with amounts of 2.25 and 3.11-fold, respectively (P < 0.01).

The modification of CGF with albumin and silver nanoparticles enhanced degradation resistance, although it did not reach the tensile strength and cellular content of unmodified CGF. Clinically, Alb-CGF and Alb-CGF-SNP serve as effective barrier membranes due to their prolonged stability, while CGF remains advantageous where high mechanical strength is required. Despite lower elasticity limiting suturing, their plasticity supports use as fillers or for tissue phenotype modification in regenerative applications.

Enterocutaneous fistulas (ECF) are challenging to treat contributing to high morbidity and high mortality rates, significantly impacting the quality of life of the patients. Its susceptibility to antibiotic-resistant infections often leads to chronic inflammation, complicating treatment with conventional methods. Here, 18NC75-10P-1IL is reported, which is a multi-functional shear-thinning hydrogel comprised of gelatin and nanosilicates for injectability, an ionic liquid for bactericidal effects, and platelet rich fibrin fraction for pro-healing properties; this biomaterial is engineered for the treatment of ECFs. Through rigorous testing, the mechanical properties of 18NC75-10P-1IL were tailored for catheter injection to achieve durable occlusion of fistulous tracts under external pressures simulating clinical scenarios. 18NC75-10P-1IL demonstrated pro-healing effects and anti-microbial activity against highly resistant patient-derived bacteria known to be associated with ECF. Subcutaneous implantation and anorectal fistula models confirmed its biocompatibility, pro-healing, anti-inflammatory, and anti-microbial properties compared to control materials, suggesting promising potential for clinical translation in the treatment of human ECFs.

Hydroxyapatite used as a coating for titanium dental implants reduces the time required for osseointegration. Platelet-rich fibrin (L-PRF) releases growth factors and cytokines, enhancing tissue healing and bone regeneration. This study aimed to evaluate histologically, histomorphometrically, and by microcomputed tomography an implant surface coated with nanostructured hydroxyapatite (HAnano), in comparison with a double acid-etched (DAA) surface, both with and without peri-implant grafting with L-PRF, installed in over-instrumented sites in a low-density bone. Five adult sheep (2-4 years old) received twenty 3.5 × 10 mm implants in the iliac crest. Bone-to-implant contact (BIC) and bone-occupied area fraction (BAFo) were evaluated histomorphometrically after an 8-week experimental period. Brown-Forsyth analysis of variance (ANOVA) and Welch's ANOVA test did not identify significant differences between the experimental groups. On average, BIC ranged from 44% (HAnano + L-PRF) to 63% (DAA + L-PRF). µCT analysis revealed that bone volume density in the peri-implant region ranged from 26% (HAnano + L-PRF) to 39% (DAA). No statistically significant differences were observed between the groups. Both implant surfaces studied allowed osseointegration in low bone density sites, independently of peri-implant grafting with L-PRF, after 8 weeks of implantation. While this model provided controlled conditions for evaluating early-stage osseointegration, the absence of functional loading and the relatively short follow-up period should be considered when extrapolating the findings to clinical applications. Future studies should assess these variables under load-bearing conditions with extended observation periods. All the sheep in this study remained alive.

Improving soft tissue quality and quantity around dental implants is crucial for successful outcomes. Platelet-Rich Fibrin (PRF) is showing promise in enhancing wound healing and implant stability. This systematic review aims to evaluate the clinical benefits of PRF in soft tissue regeneration around dental implants compared to standard methods.

This systematic review adhered to the PRISMA guidelines and utilizing the PICO methodology, investigated the use of Platelet-Rich Fibrin (PRF) in soft tissue augmentation during implant therapy. The primary outcomes assessed include the width of keratinized mucosa and soft tissue thickness, comparing PRF interventions to standard techniques.The study included randomized controlled trials (RCTs) and comparative studies, focusing on human patients needing implant therapy with or without PRF. An extensive search of databases and manual references was conducted; data extraction involved assessing study quality and risk of bias, but due to high heterogeneity among studies, a meta-analysis was not feasible, leading to a systematic review of the available literature.

A total of 766 references were initially identified, with 29 being eligible after screening. Nine studies were included for detailed review. The findings revealed that PRF is effective in increasing the width of keratinized mucosa (KT) and soft tissue thickness (STT) around implants. Even if free gingival grafts (FGG) sometimes performed better. However, the differences between PRF and FGG were not clinically significant, and PRF offers lower cost, ease of use, and reduced morbidity. There was limited information on the esthetic outcomes of PRF, with only two studies addressing this aspect, showing mixed results.

Overall, PRF demonstrated positive effects on KT width and STT, but further research with rigorous methodology and larger sample sizes is needed to better understand its impact on implants health and esthetics.

This review aims to provide an overview of the types of membranes, bone substitutes, and mucosal substitutes used for GTR and GBR and briefly explores recent innovations for tissue regeneration and their future perspectives. Since this is a narrative review, no systematic search, meta-analysis, or statistical analysis was conducted. Using biomaterials for GTR and GBR provides a reduction in postoperative morbidity, as it contributes to less invasive clinical procedures, serving as an alternative to autogenous grafts. Moreover, randomized clinical trials (RCTs) and systematic reviews are essential for the evaluation of new biomaterials. These studies provide more robust evidence and help guide clinical practice in the selection of safer and more effective biomaterials, allowing for the personalization of treatment protocols for each patient.

Advanced platelet-rich fibrin + (A-PRF+) represents a third generation of autologous platelet derivatives. Appropriate centrifugation conditions cause the formation of a clot containing platelets, which slowly release growth factors that influence healing. The objective of this article was to undertake a review of the available literature on the effectiveness of A-PRF+ use in hard tissue procedures.

In order to ensure the most accurate and relevant results, only randomized clinical trials regarding bone regeneration techniques/bone healing that compared the effect of the A-PRF+ addition in dentistry were included in this study. Articles taken into consideration for the review were published between the beginning of 2014 and 31 December 2024. The search of manuscripts for the review was conducted using the PubMed, Scopus, Google Scholar, and Cochrane databases. For this study, 10 articles focusing on A-PRF+ were qualified.

A-PRF+ was found to increase the post-surgical vertical and horizontal alveolar ridge dimensions. The bone formed in the surgical site presented a higher volume of vital and non-vital bone and a more optimal bone composition, at the same time providing a lower percentage of connective tissue inclusions. When combined with other grafting biomaterials, A-PRF+ enhanced their performance and integration. A-PRF+ did not have any significant effect on the mineral bone density compared with other grafting materials. Compared with PRF and other blood derived plasmas rich in growth factors, the performance of A-PRF+ was generally better, but often with no statistical significance. The treatment of periodontal defects measured by the reduction in pocket depth and clinical attachment level also fared better with the A-PRF+ addition, although there was no differences noted between A-PRF+ and biphasic calcium phosphate and xenograft. Finally, the A-PRF+ addition improved the primary implant stability in the evaluated studies.

The A-PRF+ addition to the surgical protocols significantly enhanced the healing of the bone and when combined with biomaterials improved their integration and increased the implant insertion torque, improving the primary and secondary stability. It may be a viable alternative for patients that express their concern towards human- and animal-derived biomaterials.

With the extensive application of flap surgery in clinical practice, it has been a matter of great concern to improve the survival rate of flap surgery for a long time. This study compared and explored the effect of the three generations of platelet concentrates (PCs), including platelet-rich plasma (PRP), platelet-rich fibrin (PRF), and concentrated growth factor (CGF), on flap survival.

After PRP, PRF, and CGF gels were observed by scanning electron microscope (SEM), their vascularizing effect were assessed by infrared thermal imager, flap survival experiment, arterial perfusion angiography, and immunohistochemical staining in a rat dorsal cross-region perforator flap model.

The fibrin of PRP gel showed irregular clumps and loose structure, while that of PRF and CGF gels formed 3D network structure with orderly arrangement and compact structure. In animal models, the use of all the three PCs can increase the number of vessels and the amount of blood perfusion in choke zones (all P < 0.05), thus improving the flap survival rate. Moreover, the effects of CGF and PRF were obviously better than those of PRP (all P < 0.05), but there was no significant difference between CGF and PRF (P > 0.05).

PRP, PRF, and CGF all have a good effect on promoting vascularization, and can significantly improve the survival rate of dorsal cross-region perforator flap in rat model. Besides, PRF and CGF have greater potential in promoting vascularization than PRP.

This study aimed to comparatively assess the clinical success and radiographic regenerative dentin formation of Platelet Rich Fibrin (PRF) and mineral trioxide aggregate (MTA) when used as direct pulp capping agents. This double-blinded two parallel armed randomized controlled clinical trial comprised the allocation of 108 patients with traumatically exposed dental pulp during the management of deep carious lesions by undergraduate students after fulfilling inclusion and exclusion criteria. Patients were randomized into two groups (n = 54 in each group) using computer-generated simple randomization, wherein one group Platelet Rich Fibrin (PRF) was prepared from patients' blood samples and applied directly over exposed pulp followed by MTA application and in the other group MTA was applied directly over pulp exposure. In both groups, cavities were restored with resin-modified glass ionomer liner and resin composite restoration. The overall success of treatment was calculated at 6 and 12 months after assessing pulp sensibility, history of pain, tenderness on percussion and the existence of any periapical pathosis using in periapical radiographs. Moreover CBCT was used at 12 months to determine the presence or absence of dentin bridge as a secondary outcome. After 12 months follow-up, there was no statistically significant difference in overall success of pulp capping in both groups. As the both groups showed 92.59% success rate. CBCT evaluation of dentin bridge formation by Platelet Rich Fibrin (PRF) demonstrated a significantly higher percentage than that formed in cases treated with MTA alone (p < 0.001). Direct pulp capping with Platelet Rich Fibrin (PRF) exhibited a clinical and radiographic success rate comparable to that of MTA. Platelet Rich Fibrin (PRF) can be implemented as a direct pulp capping agent in forthcoming clinical applications.

Arthrogenic temporomandibular disorders (TMDs) that do not respond to conservative treatment necessitate the use of semi-conservative methods, such as arthrocentesis. However, the ranking of intraarticular devices used in arthrocentesis remains controversial. Therefore, a network meta-analysis and systematic review were conducted to compare the different materials used for arthrocentesis.

Databases of Cochrane Library, EMBASE, PubMed, and Web of Science were searched systematically to retrieve randomized controlled trials (RCTs) published in English comparing the efficacy of different intraarticular materials used for arthrocentesis. The mean differences (MD) and 95% confidence interval (CI) were calculated for maximum mouth opening (MMO) and pain perception using Bayesian network meta-analysis.

Among the 7674 studies retrieved, 13 RCTs were included in the quantitative synthesis. Evaluation of the short-term follow-up (1-3 months) outcomes revealed that saline-platelet-rich plasma (saline-PRP) and saline-steroid yielded the greatest improvement in MMO, with MDs of 3.49 (CI: -4.23, 10.81) and 3.36 (CI: -4.70, 10.46), respectively. Saline-PRP exhibited improvement in terms of pain reduction (MD=-2.72 (CI: -5.80, 0.35). Evaluation of the long-term follow-up outcomes revealed that saline-PRP yielded promising results for both outcomes: MD of 1.58 (CI: -6.84, 9.92) and -2.79 (CI: -9.44, 3.60) for MMO and pain reduction, respectively.

Saline-PRP injection led to a clinically noticeable shift in MMO and pain perception in the short term; in contrast, the results of saline-PRP, saline-hyaluronic acid (HA), and saline steroids were statistically insignificant. Saline-HA and saline-steroid effectively increased MMO in the long term, whereas saline-PRP yielded the most distinct reduction in pain.

To assess the radiographic outcomes, complications, and implant survival rates of advanced platelet-rich fibrin versus xenografts in hydraulic sinus floor elevation.

In this randomized trial, 40 patients with 46 implants were divided into two groups: a test group (advanced platelet-rich fibrin alone) and a control group (xenograft alone). The key outcome measures included bone regeneration, implant survival, and complications.

Both groups achieved 100% implant survival. One case of maxillary sinus infection occurred in the control group after surgery. There was no significant difference in bone regeneration between the two groups at 6 months post-surgery and 12 months post-load (P > 0.05). The residual bone height and sinus width at the apex of the implant were significant negative predictors of bone regeneration (P < 0.05), whereas the presence of adjacent teeth was a significant positive predictor (P < 0.05).

Both advanced platelet-rich fibrin and xenografts effectively enhanced bone growth at sinus floor elevation, achieving high implant survival rates over one year. Advanced platelet-rich fibrin alone may be a viable xenograft alternative, necessitating further long-term studies to confirm its efficacy. The study was registered in the Chinese Clinical Trial Registry (http://www.chictr.org.cn/) with the registration number ChiCTR2100042060. This clinical trial was not registered before participant recruitment or randomization.

This study compared the success rate following single-visit versus two-visit regenerative endodontic procedures of non-vital mature anterior teeth with periapical lesion. Thirty-two patients were randomly assigned into two groups: group A: single visit and group B: two visit. All assigned teeth were chemo-mechanically prepared. For group A, platelet rich fibrin was placed into the root canal followed by the placement of Biodentine and final restoration. For group B, calcium hydroxide was placed for 3 weeks, followed by the same regenerative procedures in the second visit. Follow-up visits were at 3, 6, 9 and 12 months, and periapical lesion was assessed by CBCT at the beginning and 12 months after treatment. There was no statistical difference between the success rate of group A (28.6%) and group B (64.3%). Regenerative endodontic procedure can be a promising treatment for mature non-vital teeth with further investigations needed for the single-visit protocol. Trial Registration: Registered at www.clinicaltrials.com NCT03717337.

Although uncommon, adverse local and systemic reactions to local anesthetic administration can occurred. The postanesthetic necrosis is a rare complication which usually involved the palatal region. The wound healing is a complex process regulated by a range of growth factors. Concentrated growth factor (CGF) is the latest generation of autologous platelet concentrate which has been widely used in the repair and regeneration of oral soft and hard tissue. The study aims to analyses the clinical benefit of CGF in the treatment of postanesthetic necrosis of the hard palate.

The study included all patients referred to the Department of Maxillo-Facial Surgery, Marche University General Hospital, between 2020 and 2022, for aseptic ulcer of the hard palate due to local anesthetic administration. For each patient, the surgical debridement of the necrotic tissue and a peripheral blood sample were performed. The CGF was obtained by a centrifuge device and sutured in the affected site. The greasy gauze, placed to prevent the matrix detachment, was removed seven days post-operative.

Seven patients (M:F=4:3, mean age 48.6±5.1 years) were enrolled in the study. After 7 days post-operative, no infection, discomfort, or dysphagia were reported. Moreover, 4 patients (57%) showed a total re-epithelialization, while 3 patients (43%) with larger defects, displayed a partial re-epithelialization. A complete recovery occurred in all cases 15 days after surgery.

CFG represents a promising potential preparation for the oral mucosa wound healing able to promote the granular tissue formation and the mucosa re-epithelialization.

This study investigates the postoperative benefits of low-level laser therapy (LLLT) and platelet-rich fibrin (PRF) in enhancing patient comfort and reducing complications after mandibular third molar extractions.

Sixty patients with vertically impacted mandibular third molars were randomly assigned to one control and three test groups (n = 15 each). In Group 1, PRF was applied to the socket post-extraction. In Group 2, PRF was combined with LLLT (B-Cure Dental Laser, 808 nm wavelength, 4 J/cm² energy density, continuous wave) applied extra-orally for three days post-surgery. Group 3 received LLLT alone. Group 4 (control group) underwent traditional osteotomy without additional treatments. All patients were prescribed 875/125 mg amoxicillin/clavulanic acid twice daily for five days.

Postoperative parameters such as pain, swelling, analgesic use, and trismus were assessed on days 1, 2, 3, and 7. Significant improvements in pain, swelling, and trismus were observed in Groups 2 and 3 compared to the control (p < 0.001). Swelling was also significantly reduced in Group 1 compared to the control.

The study demonstrated favorable clinical outcomes in the LLLT and PRF groups, suggesting that both treatments could be promising strategies for improving postoperative recovery in terms of comfort and reduced complications.

Clinicaltrials.gov ID: NCT06262945. The trial was first registered on 16/02/2024. Retrospectively registered.

This systematic review aimed to evaluate all available evidence across all fields of medicine regarding the comparative effectiveness of platelet-rich plasma (PRP) versus injectable platelet-rich fibrin (i-PRF). A comprehensive search was conducted in PubMed, Scopus, and Web of Science up to September 30, 2024. Following a thorough screening process, studies were divided into in vitro, in vivo, and clinical studies based on their tissue/clinical indications. The initial search generated 2192 articles, of which 23 met the inclusion criteria. The findings demonstrated that i-PRF yielded higher platelet concentrations and offered a more sustained, long-term release of growth factors over time when compared to PRP. Overall, it was determined from in vitro studies that i-PRF significantly improved the activity of many cell types, including for skin, cartilage, periodontal, bone, soft tissue around dental implants, and pulp cells. In vivo outcomes also generally indicated that i-PRF outperformed PRP in cartilage and testicular regeneration. However, in orthodontic tooth movement, PRP was found to lead to superior short-term effects, while i-PRF showed more beneficial long-term effects. Clinical studies also found superior outcomes of i-PRF in skin regeneration, cartilage, and pulp regeneration. Outcomes regarding orthodontic tooth movement utilizing i-PRF or PRP remain controversial. In 72% of studies, i-PRF was found to lead to better outcomes across the various fields of medicine when compared to PRP, whereas 24% found no differences between the groups. Reasons and inconsistencies across the studies may be attributed to protocol differences and tissue types. Overall, additional clinical studies are needed with well-designed research and centrifugation protocols to better understand the regenerative potential of platelet concentrates in medicine. i-PRF offers a more sustained and prolonged release of growth factors and was favored in the majority of studies over PRP and should, therefore, be favored for the majority of medical and dental applications.

Acute kidney injury (AKI) is a major and unmet medical need, characterized by a sudden onset of kidney dysfunction that often occurs within 7 days. Adipose-derived stem cells (ADSCs) are known for their regenerative, differentiative, and repair abilities, making them a promising therapeutic option for kidney injury. Platelet-rich fibrin releasate (PRFr), derived from platelet-rich fibrin after static incubation, contains numerous growth factors that may promote the differentiation and proliferation of stem cells. Additionally, acupoints such as Shenshu (BL23) have been used in clinical practice and experimental settings, particularly in renal failure treatments.

This study aimed to evaluate the synergistic effects of ADSCs and PRFr, administered separately or in combination, at the Shenshu acupoint (BL23) in New Zealand white rabbits with acute kidney injury. The treatment groups were injected with ADSCs, PRFr, or a combination of both. Serum creatinine (CRE) and blood urea nitrogen (BUN) levels were measured to assess kidney function. Additionally, histological examination of kidney tissue was performed to observe morphological changes and tissue repair.

The PRFr + ADSCs treatment group exhibited a significant reduction in CRE and BUN levels during the second week following transplantation. After 7 weeks of treatment, the PRFr + ADSCs group showed the most favorable kidney repair outcomes, with intact glomeruli, no edema or vacuole-like changes in the renal tubular epithelial cells, and no significant infiltration of inflammatory cells in the surrounding tissues.

The administration of PRFr, ADSCs, and their combination at the Shenshu acupoint (BL23) demonstrated a potential therapeutic effect in repairing damaged renal cells, improving kidney function, and reducing serum CRE and BUN levels. These findings suggest that injection of PRFr, ADSCs, and their combination at the Shenshu acupoint (BL23) can effectively repair damaged renal cells and improve kidney function in AKI. The observed synergistic effect indicates that this approach holds potential as a novel therapeutic strategy for kidney injury. Further research is needed to optimize treatment protocols and elucidate the underlying mechanisms.

Platelet-rich fibrin (PRF) membranes are a biomaterial derived from the patient's own blood, used in different medical and dental areas for their ability to promote healing, tissue regeneration, and reduce inflammation. They are obtained by centrifuging the blood, which separates the components and concentrates the platelets and growth factors in a fibrin matrix. This material is then moulded into a membrane that can be applied directly to tissues. The use of these PRF membranes is often associated with the use of different biomimetic materials such as deproteinized bovine bone mineral (DBBM), β-tricalcium phosphate (β-TCP), enamel matrix derivative (EMD), and hydroxyapatite (HA). Different indications of PRF membranes have been proposed, like alveolar ridge preservation, alveolar ridge augmentation, guided tissue regeneration (GTR), and sinus floor augmentation. The aim of this narrative review is to check the state-of-the-art and to analyze the existing gaps in the use of PRF membranes in combination with biomimetic materials in alveolar ridge preservation, alveolar ridge augmentation, guided tissue regeneration (GTR), and sinus floor augmentation.

Skin wounds are common injuries that affect quality of life and incur high costs. A considerable portion of healthcare resources in Western countries is allocated to wound treatment, mainly using mechanical, biological, or artificial dressings. Biological and artificial dressings, such as hydrogels, are preferred for their biocompatibility. Platelet concentrates, such as platelet-rich plasma (PRP) and platelet-rich fibrin (PRF), stand out for accelerating tissue repair and minimizing risks of allergies and rejection. This study developed PRF and PRP-based dressings to treat skin wounds in an animal model, evaluating their functionality and efficiency in accelerating the tissue repair process.

To develop wound dressings based on platelet concentrates and evaluating their efficiency in treating skin wounds in Wistar rats.

Wistar rats, both male and female, were subjected to the creation of a skin wound, distributed into groups (n = 64/group), and treated with Carbopol (negative control); PRP + Carbopol; PRF + Carbopol; or PRF + CaCl2 + Carbopol, on days zero (D0), D3, D7, D14, and D21. PRP and PRF were obtained only from male rats. On D3, D7, D14, and D21, the wounds were analyzed for area, contraction rate, and histopathology of the tissue repair process.

The PRF-based dressing was more effective in accelerating wound closure early in the tissue repair process (up to D7), while PRF + CaCl2 seemed to delay the process, as wound closure was not complete by D21. Regarding macroscopic parameters, animals treated with PRF + CaCl2 showed significantly more crusting (necrosis) early in the repair process (D3). In terms of histopathological parameters, the PRF group exhibited significant collagenization at the later stages of the repair process (D14 and D21). By D21, fibroblast proliferation and inflammatory infiltration were higher in the PRP group. Animals treated with PRF + CaCl2 experienced a more pronounced inflammatory response up to D7, which diminished from D14 onwards.

The PRF-based dressing was effective in accelerating the closure of cutaneous wounds in Wistar rats early in the process and in aiding tissue repair at the later stages.

Maxillary sinus augmentation (MSA) is a standard and predictable procedure to increase bone height in the atrophic posterior maxilla. Many biomaterials are employed in this technique; however, autologous platelet concentrates have been found to reduce clinical recovery time and improve bone gain in MSA.

This study aimed to compare the radiographic, histomorphometric, and implant stability outcomes of titanium-prepared platelet-rich fibrin (T-PRF) and deproteinized bovine bone mineral (DBBM) in a two-stage MSA technique.

This randomized controlled split-mouth study included patients requiring bilateral two-stage MSA at the Periodontology Department of Kutahya Health Sciences University between March 2022 and April 2023. Patients with systemic comorbidities and residual bone height >5 mm in the bilateral posterior maxilla were excluded.

The predictor variable was the two-stage MSA technique. Each surgical site was randomly assigned to the T-PRF or DBBM group for two-stage MSA.

The primary outcome was the histomorphometric evaluation of the percentage of new bone between the 2 groups. Secondary outcomes included radiographic evaluation of total bone height (ToBH), bone gain, bone density (BD), and graft volume (GV) on cone-beam computed tomography 6 months post-MSA, clinical assessment of primary implant stability at implant placement and secondary stability 3 months postplacement, and histomorphometric evaluation of the percentage of residual particles, percentage of connective tissue, and percentage of blood vessels from bone biopsy samples collected 6 months after MSA.

Age, sex, periodontitis susceptibility, and smoking status were treated as covariates.

The Wilcoxon signed-rank test was used for bivariate comparisons between 2 groups, and the Pearson or Spearman test was used to analyze correlations of variables within groups. A P value ≤ .05 was considered statistically significant.

The sample was composed of 10 patients with bilateral maxillary sinuses, 20 MSA regions, 8 (80%) males and 2 (20%) females with a mean age of 51.30 (9.06) year. The percentage of new bone was 19.48 ± 14.60 μm2 in the T-PRF group and 8.31 ± 5.47 μm2 in the DBBM group, and there was no statistically significant difference between the groups (P = .074). Radiographic measurements showed ToBH, GV, and BD values of 10.64 ± 3.96 mm, 989.89 ± 523.07 mm3, and 192.09 ± 127.90 hounsfield unit in the T-PRF group and 14.25 ± 1.65 mm, 1,519.39 ± 432.61 mm3, and 492.77 ± 117.35 hounsfield unit in the DBBM group, respectively. ToBH, GV, and BD values were statistically significant between the groups (P = .01 and P = .00). Primary and secondary implant stability in the T-PRF group were 71.11 ± 12.48 implant stability quotient (ISQ) and 68.03 ± 6.81 ISQ, respectively, compared with 67.94 ± 19.84 ISQ and 72.46 ± 11.21 ISQ in the DBBM group. The difference was not statistically significant between the groups (P = .41 and P = .33).

Although T-PRF demonstrated inferior radiographic outcomes compared with DBBM during the initial6-month healing phase, both techniques yielded comparable results regarding new bone formation and implant stability. Further research is warranted to explore the efficacy of different T-PRF applications in MSA. This trial is registered at ClinicalTrials.gov (NCT05596084).

Auto-concentrated growth factor (CGF) constitutes the latest generation of plasma extract, and has high concentrations of growth factors and white blood cells. Due to the continuous variable speed centrifugation used during preparation, the tensile strength of the fibrin is also higher. CGF preparation does not involve the use of animal serum, minimizing the risk of infection and immune rejection. Therefore, it has wide potential applications in various fields of regenerative medicine. This paper summarizes the history behind CGF development, reviews the clinical applications and research progress concerning single CGF therapy and CGF used in combination with other treatments in multiple wound repair, and summarizes its potential value as therapeutic agent. Finally, some constructive suggestions and research perspectives for the application of CGF in wound healing are put forward. The available evidence indicates that CGF can promote the healing of chronic refractory wounds and acute wound, promote the growth of granulation, accelerate the speed and improve the quality of wound healing, reduce scar formation, minimize the need for repeated wound dressing, and ameliorate the pain experienced by patients.

Diabetic foot ulcers (DFUs) are severe complications of diabetes, often leading to chronic wounds, amputations, and increased mortality risk. Platelet concentrates (PCs)-natural biomaterials utilized in regenerative medicine-have garnered attention for their capacity to enhance tissue repair and wound healing. This study reviews the preparation methods, biological mechanisms, and clinical efficacy of three generations of PCs: platelet-rich plasma (PRP), platelet-rich fibrin (PRF), and concentrated growth factors (CGF). Comparative analysis reveals that PRP, the first generation, provides abundant growth factors but relies on anticoagulants, which may hinder fibrin formation and tissue adhesion. PRF, as the second generation, eliminates anticoagulants, forming a fibrin matrix that sustains growth factor release and enhances cell migration. CGF, the latest advancement, employs refined centrifugation to achieve higher growth factor concentrations and a denser fibrin matrix, accelerating tissue regeneration. Case series results demonstrated superior wound healing outcomes with CGF, including faster epithelialization and reduced healing time compared to PRP and PRF. These findings underscore CGF's potential as the most effective PC for managing DFUs, supporting its broader clinical adoption in advanced wound care.

Mucosal fenestration, a condition that poses risks to dental integrity, requires effective management to prevent complications such as unwanted tooth loss. The integration of guided tissue regeneration (GTR), Platelet-rich fibrin (PRF), and bone grafts is an effective strategy for managing mucosal fenestration, ensuring optimal tissue regeneration and long-term success.

The purpose of this case series was to describe the effect of autologous PRF membrane for corneal reconstruction surgery in dogs. PRF membranes made from two healthy dogs unrelated to the current case series were used for PRF histologic analyses.

Seven dogs with complicated corneal ulcerations.

A complete ophthalmic examination, hematology, and fibrinogen analysis were performed pre-surgery. A PRF clot was made from autologous blood in a serum tube after centrifugation in a horizontal Bio-PRF® Centrifuge at 700 × g for 8 min. The PRF clot was processed in a PRF-Box® into a PRF membrane. The PRF membrane was sutured to the corneal ulcer bed. Each dog had a follow-up at days 5-7, 12-14, and 30-40 post-surgery. A final long-term follow-up was performed as well.

A positive outcome with healing and a "good" quality PRF membrane was seen in six out of seven dogs. One dog had a fibrinogen level below normal range and the PRF membrane was of "poor" quality. This dog developed a descemetocele 13 days post-surgery and needed rescue surgery. Mean healing time for all dogs was 9 ± 5.5 days. Minimal scarring, corneal pigmentation, and vascularization were observed at the final long-term follow-up 288 ± 44 days post-surgery.

PRF membrane was successful as graft material for corneal ulceration reconstruction surgery. Low fibrinogen appeared to have negative effect on the quality of the PRF membrane, showing the importance for the surgeon to evaluate the quality of the PRF membrane prior to surgery.

Aim: Noncontained (1- or combined 1- to 2-wall) periodontal intraosseous defects represent challenging clinical situations with unpredictable surgical therapeutic outcomes. This randomized clinical trial assessed demineralized freeze-dried bone allograft (DFDBA) with low speed-platelet-rich fibrin (PRF) membrane compared to DFDBA with collagen membrane (CM) in the surgical periodontal therapy of noncontained intraosseous defects of stage III periodontitis patients. Methodology: Twenty-two stage III periodontitis patients with noncontained intraosseous defects measuring ≥3 mm and clinical attachment loss ≥5 mm were randomly allocated into two groups: test group (low-speed PRF membrane + DFDBA) and control group (CM + DFDBA), with 11 participants per group. Clinical and radiographic assessments were conducted at baseline, 3, 6, 9, and 12 months for clinical attachment level (CAL; primary outcome), gingival recession depth (GRD), probing depth (PD), full mouth bleeding score (FMBS) and full mouth plaque score (FMPS), radiographic bone fill and radiographic linear defect depth (RLDD; all secondary outcomes). Results: The mean (±SD) CAL-gain for the test group was 2.45 (±1.51), 2.91 (±1.70), 2.91 (±1.87), and 2.82 (±1.83) mm, while for the control group 2.82 (±1.25), 3.27 (±1.27), 3.00 (±1.41), and 2.64 (±1.50) mm at 3, 6, 9, and 12 months, respectively, with no significant intergroup differences (p > 0.05). Despite the absence of significant intergroup differences, both groups demonstrated significant intragroup improvement in CAL- and PD-gain, and RLDD-reduction at 3, 6, 9, and 12 months as well as RLDD improvement at 12 months (p < 0.05). Conclusion: PRF membranes, in conjunction with DFDBA, show significant improvement of periodontal clinical and radiographic parameters, comparable to CMs with DFDBA. Trial Registration: ClinicalTrials.gov identifier: NCT03922503.

Background: Apical surgery can address periapical pathologies when conventional endodontic treatments fail. Advanced platelet-rich fibrin (A-PRF) has emerged as a regenerative material with the potential to enhance healing in periapical surgery. In this study, we evaluated the effect of A-PRF on periapical lesion healing using cone beam computed tomography (CBCT). Methods: A randomized controlled trial at Rīga Stradiņš University Institute of Stomatology included 43 participants (15 males, 28 females; mean age: 44 years) with periradicular lesions. Participants were divided into experimental and control groups. Baseline and follow-up CBCT imaging assessed lesion volumes at 6 and 12 months post-surgery. Results: Mean lesion volumes significantly decreased from 431.4 mm3 at baseline to 102.8 mm3 at 6 months and 49.2 mm3 at 12 months (p < 0.001). A-PRF did not significantly reduce the lesion sizes compared to the controls (p = 0.043), but was associated with reduced inflammation and enhanced soft tissue healing. Key confounders included gender and baseline lesion volume, with males exhibiting smaller lesion sizes postoperatively. Conclusions: The results suggest that A-PRF may not offer a significant advantage in terms of reducing defect size or improving radiographic resolution.

The management of an endodontic failure in a traumatized tooth with an open apex presents a major dilemma. The arrest of root growth after traumatic injury is a substantial consequence of pulpal necrosis. Conventional endodontic treatment procedures will be challenging by the resulting thin, fragile dentinal walls, which will impede the appropriate debridement and optimal apical sealing. Apexification is a well-established procedure that is designed to treat or preserve a tooth with an incomplete root apex and necrotic pulpal tissue by promoting the formation of a calcified apical barrier through the application of a bioactive substance at the root apex. The present case report demonstrates a successful apexification procedure for an endodontically failed permanent central incisor with an open apex with a two-year follow-up time. The clinical and radiographical results revealed the absence of signs and symptoms and the formation of hard tissue at the root apex. The tooth was extracted for prosthodontic reasons and processed for histologic examination. The histologic evaluation revealed dentin-like and cementum-like tissues formed at the apical barrier.

Background/Objectives: Autogenous palatal free gingival graft (FGG) harvesting presents challenges for patients due to the increased risk of postoperative morbidity related to a second intraoral surgical wound that heals with secondary intention. This parallel-group, randomized, controlled, open-label trial aimed to evaluate the efficacy of the application of leukocyte- and platelet-rich fibrin (L-PRF) membrane to the palatal donor site on wound healing, hemostasis, and pain control after FGG harvesting. Methods: Twenty-eight adult patients with insufficient attached gingiva underwent soft tissue augmentation using FGG harvested from the palate at the Department of Oral and Maxillofacial Surgery, Baskent University, Turkey. Patients were randomized to either an L-PRF group or a control group. In the L-PRF group, the L-PRF membrane was sutured to the donor sites, whereas in the control group, donor sites healed by secondary intention. Postoperative evaluations were conducted on days 1, 3, 5, and 7 and at weeks 2, 3, 4, 5, and 6. Donor sites were evaluated clinically for pain, burning sensation, bleeding, wound healing, and color match to adjacent tissues. Donor site wound areas were analyzed using digital images. Results: Two patients were excluded from the analysis due to loss of contact, leaving 26 (n = 13, n = 13) patients for analysis. Donor site pain and burning sensation were significantly lower in the L-PRF group compared to the control group during the first two postoperative weeks (p < 0.001). Bleeding was significantly lower in the L-PRF group on postoperative days 1 and 3 (p < 0.001). Clinical healing index scores were significantly higher in the L-PRF group at weeks 3 and 4 (p < 0.001). Additionally, palatal wound area reductions from baseline were significantly greater in the L-PRF group at all follow-up intervals (p < 0.001). Conclusions: The application of an L-PRF membrane to palatal donor wounds after FGG harvesting significantly reduces postoperative pain, decreases bleeding, and accelerates healing, providing a valuable autologous biomaterial for enhanced wound healing and improved patient comfort.

Epidural scar fibrosis commonly leads to functional disability and pain following spinal surgery and is a prevalent manifestation of Failed Back Surgery Syndrome (FBSS). This study aimed to evaluate the use of silver nano-articles (AgNPs) loaded on chitosan (Chi/Ag-NPs) with platelets-rich fibrin (PRF) gel for the reduction of post-laminectomy epidural scar adhesions.

A total of 90 male Sprague Dawley rats (255 ± 55gm) were randomized in-to six groups, each group with 15 rats: control group, laminectomy group, PRF group, Chi/Ag-NPs group, combined treatment group (PRF + Chi/Ag-NPs), and a group to prepare PRF. Lumbar laminectomy procedures were performed between L3-L5 in all rats except the control group. After a 30-days follow-up, macroscopic examination, histological studies, and mRNA evaluation for TGFβ-1and IL-6, were conducted.

Data revealed that epidural scar adhesion, scaring, arachnoid involvement, dural thickness, as well as inflammation and TGFβ-1and IL-6 coding genes expression were significantly reduced in PRF group, Chi/Ag-NPs group, and combined group compared to the laminectomy group. Combined treatment showed more significant better outcomes.

The use of PRF with Chi/Ag-NPs as nano biomaterials could be considered a combination therapy for the reduction of EF post-laminectomy in a rat model.

Currently, autologous platelet concentrates (APCs) are frequently used for soft- and hard-tissue regeneration, not only within the oral cavity, but also extra-orally including chronic wounds, burns, joints, dermatological conditions, among others. The benefits of APCs are largely influenced by the treatment strategy but also their preparation. This paper therefore discusses in detail: the physical properties of blood cells, the basic principles of blood centrifugation, the impact of the centrifugation protocol (rotations/revolutions per minute, g-force, variation between centrifuges), the importance of timing during the preparation of APCs, the impact of the inner surface of the blood tubes, the use/nonuse of anticoagulants within APC tubes, the impact of the patient's hematocrit, age, and gender, as well as the important requirements for an optimal centrifugation protocol. All these variables indeed have a significant impact on the clinical outcome of APCs.

Platelet-rich plasma (PRP) has been employed for orthopedic applications for decades due to the abundance of bioactive cues/growth factors that ameliorate the proliferation and migration of relevant cells involved in tissue repair/regeneration. In this work, PRP was incorporated into injectable compositions of alginate-based hydrogel and evaluated in vitro and in vivo. In vitro tests revealed that PRP addition promoted cell adhesion, cell proliferation, and distribution of seeded fibrochondrocytes on the hydrogel. Further, the DNA quantification and sGAG estimation confirmed the production of fibrocartilage-specific extracellular matrix, predominantly type 1 collagen and sGAG. For in vivo evaluation, tears were created surgically in the rabbit menisci and were filled with injectable hydrogel. Sham and hydrogel without PRP were used as controls. Histopathological evaluation after 3 months of implantation revealed that the healing was partial for sham control, but complete for hydrogel without PRP. The hydrogel served as the scaffold for fibrocartilage tissue regeneration. On the other hand, PRP-incorporated hydrogel showed good healing with low signs of inflammation as evidenced by histology and biochemical content. The healing was complete, and the nature of the regenerated tissues was very close to native tissue indicating that alginate-based hydrogel is a promising candidate for meniscal tissue repair.

The sagittal split ramus osteotomy (SSRO) carries potential risks and complications. A double-blind, split-mouth, randomized clinical trial was performed, involving 30 patients undergoing mandibular setback. Advanced platelet-rich fibrin (A-PRF) was applied to one side, and the other side served as a control. The volume of postoperative drainage over 24 h was recorded. At 1, 2, and 5 days, and 3 months postsurgery, nerve recovery was assessed using the two-point discrimination test (TPD), while pain was evaluated using a visual analogue scale (VAS pain). Facial swelling was evaluated by taking linear measurements from facial reference points at the same time intervals. In the treatment group, the 24-hour drainage volume was lower (P = 0.011), pain was better on day 5 (P = 0.011), and TPD was better on day 2 (P = 0.011), day 5 (P = 0.007), and 3 months postoperatively (P = 0.020) than in the control group. There was also less facial swelling in the treatment group when compared to the baseline of 3 months postoperative (day 1, P = 0.012; day 2, P = 0.001; day 5, P = 0.011). The difference in bone mineral density (HU) at 3 months between the treatment group (469.7 ± 134.2) and the control group (348.3 ± 127.2) was statistically significant (P = 0.011), in favour of the treatment group. A-PRF may reduce postoperative complications such as neurosensory disturbance of the inferior alveolar nerve, pain, swelling, and drainage while enhancing bone healing in the osteotomy gap following SSRO. TRIAL REGISTRATION: The study was registered with the Chinese Clinical Trial Register (ChiCTR2200064534).

Surgical endodontics is the last resort to manage persistent periapical lesions, which do not respond to conventional endodontic treatment. The rationale of periapical surgery is to remove all infected tissues and provide a sealed environment that promotes the healing of periradicular tissues. In order to enhance healing, several biomaterials have been utilized, such as bone grafts, collagen membranes, and platelet concentrates. This case report presents two cases of surgical management of a periapical lesion in failed primary endodontic treatment in the maxillary first premolar and first molar by apicoectomy and the use of platelet-rich fibrin (PRF) for bone regeneration and tissue healing. Both cases were diagnosed as periapical granuloma and showed considerable radiographic bone fill at six and 12 months of follow-up, demonstrating the benefits of PRF in surgical endodontics.

The survival of an organism relies on its ability to repair the damage caused by trauma, toxic agents, and inflammation. This process involving cell proliferation and differentiation is driven by several growth factors and is critically dependent on the organization of the extracellular matrix. Since autologous platelet concentrates (APCs) are fibrin matrices in which cells, growth factors, and cytokines are trapped and delivered over time, they are able to influence that response at different levels. The present review thoroughly describes the molecular components present in one of these APCs, leukocyte- and platelet-rich fibrin (L-PRF), and summarizes the level of evidence regarding the influence of L-PRF on anti-inflammatory reactions, analgesia, hemostasis, antimicrobial capacity, and its biological mechanisms on bone/soft tissue regeneration.

Regenerative endodontic treatment is a promising approach for healing periapical lesions and continuous root maturation. Although previous studies have reported its outcomes, the dynamics of morphological changes over time remain unclear. Therefore, this study aimed to evaluate changes in the periapical status and root dimensions over a 60-month follow-up period.

The follow-up duration, periapical status changes, calcific barrier formation, degree of apical closure and radiographic root area changes were compared with those of the last follow-up in this retrospective study. Radiographic root area changes were calculated as the difference between the total root and total canal areas.

Fifty-eight patients (81 teeth) underwent regenerative endodontic treatment during the study period, of whom 32 patients (36 teeth, 62%) were included. The survival and success rates of the treated teeth were 100% and 94.4%, respectively. All teeth developed a calcific bridge in the cervical third of the root canal, indicating the presence of vital tissue. Apical narrowing (partial or total) was observed in 75% of the cases. The root maturation stage affected the percentage increase in the radiographic root area. Teeth in Cvek stages II-III showed a higher radiographic root area increase than more mature teeth. All tooth radiographic root areas increased significantly in the initial 20 months of the treatment and moderately thereafter.

Regenerative endodontic treatment is a safe approach for traumatised immature teeth. The presence of a radiographic calcified bridge may be an early indication of treatment success. The main complete tooth morphological changes occur after approximately 20 months posttreatment. These findings may help clinicians better understand the time-dependent changes in the root morphology after treatment, improve the follow-up schedule and predict the progress of healing during follow-up visits.

Autologous platelet concentrates (APCs) applied alone or combined with other biomaterials are popular bioactive factors employed in regenerative medicine. The main biological rationale of using such products is to concentrate blood-derived growth factors and cells into the wound microenvironment to enhance the body's natural healing capacity. First-generation APC is represented by platelet-rich plasma (PRP). While different protocols have been documented for PRP preparation, they overall consist of two cycles of centrifugation and have important limitations related to the use of an anticoagulant first and an activator afterward, which may interfere with the natural healing process and the release of bioactive molecules. The second generation of platelet concentrates is represented by leukocyte and platelet-rich fibrin (L-PRF). L-PRF protocols involve a single centrifugation cycle and do not require the use of anticoagulants and activators, which makes the preparation more straight forward, less expensive, and eliminates potential risks associated with the use of activators. However, since no anticoagulant is employed, blood undergoes rapid clotting within the blood collection tube; hence, a timely management of L-PRF is crucial. This review provides an overview on the most documented protocols for APC preparations and critically discusses the main differences between first- and second-generation APCs in terms of cell content, protein release, and the formation of a 3D fibrin network. It appears evident that the inconsistency in reporting protocol parameters by most studies has contributed to conflicting conclusions regarding the efficacy of different APC formulations and has significantly limited the ability to interpret the results of individual clinical studies. In the future, the use of a standardized classification system, together with a detailed reporting on APC protocol parameters is warranted to make study outcomes comparable. This will also allow to clarify important aspects on the mechanism of action of APCs (like the role of leukocytes and centrifugation parameters) and to optimize the use of APCs in regenerative medicine.

The current literature about the effect of advanced platelet rich fibrin(A-PRF) with vestibular incision subperiosteal tunnel access (VISTA) technique in treating gingival recession is scarce. Therefore, the aim of the current randomized clinical trial is to evaluate the effect of A-PRF with VISTA technique in the treatment of Cairo class 1 gingival recession (RT1).

Twenty-four patients who met the eligibility criteria were randomly allocated into two groups. VISTA + A-PRF was the treatment of the study group, while VISTA + collagen matrix was performed for the control group. The clinical outcomes were assessed by a single-blind assessor at baseline, three months, and six months. They were divided into primary and secondary outcomes. The primary outcomes included recession depth (RD), recession width (RW), gingival thickness (GT), mean of root coverage % (MRC%), and width of attached gingiva (WAG) while the secondary outcome included clinical attachment level (CAL).

The primary outcomes analysis demonstrated statistically significant improvements in RD, RW, MRC%, GT, and WAG after 3 and 6 months in both groups (p < 0.001). However, the study group demonstrated a significantly greater improvement than the control group in RD, RW, and MRC%. No significant differences were observed between the two groups regarding GT and WAG.

Both treatment approaches were effective in the treating of RT1 adjacent gingival recessions. A-PRF showed promising results compared to collagen matrix.

The current randomized clinical trial was registered at ClinicalTrials.gov (Registration number: NCT06357351) and it was released on 10/04/2024.

This randomized prospective controlled trial investigated the effectiveness of different strategies of regenerative endodontic therapy on necrotic mature anterior teeth with chronic periapical periodontitis with 18 months follow up.

A total analyzed 51 adult participant with mature single rooted teeth having necrotic pulp with chronic periapical periodontitis (PAI ≥ 3) were selected. Patients had been randomly categorized into three distinct groups (n = 17 each group). All groups received the same treatment on the first visit. After 2 weeks, regenerative treatment was performed using either blood clot technique, Standard-PRF and Advanced-PRF approach. A standardized radiograph was taken, and the patients instructed for 6, 12 and 18 months follow up periods. Fisher's exact test was applied to compare the frequency of PAI scores at different follow-up intervals between the three groups.

The results showed radiographic success at 18 months (58.8% in blood group, 94.1% in S-PRF group and 76.5% in A-PRF group). There was no statistically significant difference between the three groups according to incidence of healing at 6, 12 and 18 months. Clinical success was 82.4% in blood group and 88.2% in both S-PRF and A-PRF groups. There was no significant difference between the three groups (p = 1). The overall success (clinical and radigraphic) was 76.5%. Incidence of the gaining sensitivity after 12 and 18 months was 29.4% with A-PRF group and 41.2% within the S-PRF group, 17.6% with BC group.

PRF based regenerative technique may outperform the blood clot technique in treatment of non-vital mature teeth with chronic periapical periodontitis. There is a need for future randomized clinical studies to consolidate procedures in this field with more prolonged evaluation periods.

The study was retrospectively registered with ClinicalTrials.gov (ID: NCT04606719 ) in 28/10/2020.

Evaluation of platelet-rich fibrin as an adjuvant in surface healing of contracted orbital sockets.

Prospective, interventional, and comparative study of 25 patients with moderate to severe contracted sockets conducted over 2 years (February 2020-February 2022). Group 1 underwent a dermis-fat graft with fornix forming sutures supplemented by a platelet-rich fibrin membrane, while group 2 received a dermis-fat graft with fornix forming sutures only. Patients over 18 years were evaluated as per prefixed inclusion and exclusion criteria. Assessments were conducted at 1, 3, and 12 months postsurgery, focusing on wound evaluation, socket epithelialization, postoperative pain, prosthesis rehabilitation, and complications, if any. Wound evaluation and pain intensity were assessed utilizing the wound evaluation score and visual analog scale, respectively. Socket epithelization was documented clinically at every visit.

The study showed a mean age of 38.8 ± 8.8 years, with a 2:1 male-to-female ratio. Group 1 consistently scored higher on wound evaluation score than group 2 at all follow-up points. In group 1, 81.8% achieved a maximum wound evaluation score at 4 weeks and 100% at 3 and 12 months, compared to group 2's 42.8%, 50%, and 57.1%, respectively ( p < 0.05). Postoperative contracture occurred in 3 group 2 patients at the final follow-up, with 6 showing unsatisfactory appearance. Group 1 demonstrated significantly lower pain intensity on postoperative day 1 ( p = 0.03), and greater epithelization at 4 weeks.

platelet-rich fibrin appears to be an effective solution for enhancing wound healing during socket reconstruction, attributed to its sustained release of growth factors and mesenchymal stem cells.

The most frequent complication following hypospadias correction is fistula formation. Recently, fibrin glue has been employed as a 2nd layer covering the urethroplasty resulting in a reduction in the incidence of fistulas. Platelet-rich fibrin (PRF) is an autologous growth factor-rich source. Although the authors recommend the use of additional layers in hypospadias correction, there remains a controversy. In a trial to address this issue, our research was conducted to compare the accessibility of urethroplasty coverage using PRF to traditional local flaps, aiming to prevent fistula formation in hypospadias repair.

This is a prospective single-blinded randomized controlled study that involved 60 hypospadias cases admitted to Mansoura University Children Hospital's Pediatric Surgery department between March 2021 and March 2023. These 60 cases were randomly divided into 2 equal groups: (group A platelet-rich fibrin coverage membrane & group B local dartos flap as an additional layer). Both groups were compared regarding the rate of complications. All cases were evaluated regarding age at repair, type of hypospadias, urethral plate width, length of urethroplasty, and size of the 2nd layer. The blood loss and operative time were documented and post-operatively; the cases were assessed for the repair intactness, shape, and size of the neo-meatus, existence of any post-operative problems such as urethral fistula, urethral stricture, meatal stenosis, failure of the repair, or diverticulum. Statistical analysis was carried out following data collection.

The median length of the 2nd layer in group A was 20 mm (range 15-23 mm) and in group B was 22.5 mm (range 19.5-25 mm) and the difference between the two groups was statistically significant (p = 0.012∗), while its median width in group A was 10 mm (range 10-11 mm) and in group B was 15 mm (range 10-18 mm) and also there was statistically significant difference (p = 0.001∗). The mean operative time in group A was 95.73 ± 11.9 min and in group B was 102.33 ± 10.32 min and there was a statistically significant difference (P < 0.001). The length of hospital stay in group A was 5.47 ± 1.11 days and in group B was 5.47 ± 0.89 days. The urethral fistula was detected in 4 cases of group A (13.3%) and 3 cases of group B (10%). The failure of repair was similar, one case of each group (3.3%). The meatal stenosis was reported in only one case of group A (3.4%) and 7 cases of group B (24.1%) (P = 0.02∗) and the difference was statistically significant. There were no reports of urethral strictures among the cases in either group over the follow-up period (mean 9 months, range 5-17 months).

PRF patch may be employed as a coverage layer over the urethroplasty in repair of the distal hypospadias, especially in cases without accessible vascular flap with comparable outcome to traditional local flaps.

A prospective single blinded randomized controlled trial (computer-generated numbers method).

Level 2.

Multiple methods have been used to treat hypertrophic scarring; however, an optimal treatment method remains to be established. We aimed to research and compare the effects of cell-free fat extract (CEFFE) and platelet-rich fibrin (PRF) on hypertrophic scar formation based on histomorphological analysis in this study.

Twelve rabbits were divided into four groups randomly. (CEFFE+PRF group, n=3; CEFFE group, n=3, PRF group, n=3 and Control group, n=3). After the ear hypertrophic scar model were established, the two ears of each rabbit in the four groups were injected with CEFFE 0.05 mL/cm2 + PRF 0.05 mL/cm2, CEFFE 0.1 mL/cm2, PRF 0.1 mL/cm2, and saline 0.1 mL/cm2, respectively. The scar elevation index and histological analysis using hematoxylin-eosin and Masson staining were evaluated after injection on day 40.

The CEFFE+PRF group was significantly more effective in the prevention of pathological scar formation than the CEFFE-only, PRF-only, and control groups in terms of capillary count, collagen organization, fibroblast count, and scar elevation index (p<0.05).

CEFFE combined with PRF was the most effective treatment for the prevention of hypertrophic scar formation in our study.