Impressive tissue regeneration of severe oral mucositis post stem cell transplantation using cord blood platelet gel.

BACKGROUND: Platelet gel from cord blood (CBPG) is a recently developed blood component for topical use. We report a case of life-threatening mucositis after high-dose chemotherapy with fotemustine and cytarabine that was successfully treated with CBPG. CASE REPORT: A patient with non-Hodgkin lymphoma who was undergoing autologous hematopoietic stem cell transplantation developed severe oral and esophageal mucositis with severe bacterial sepsis and cytomegalovirus infection, causing prolonged neutropenia. CBPG was topically administered daily to the oral cavity. The CBPG was partially reabsorbed and partially swallowed. RESULTS: After 8 consecutive days of administration, the patient's oral mucosa markedly improved, showing restitutio ad integrum, and the patient's clinical status progressively improved. No side effects were seen after CBPG application. CONCLUSION: This case supports the need to conduct controlled studies comparing the efficacy of autologous and allogeneic platelet gel from adult and umbilical cord blood for the topical treatment of severe oral mucositis occurring after high-dose chemotherapy.

Bone modifications around porous trabecular implants inserted with or without primary stability 2 months after tooth extraction: A 3-year controlled trial.

PURPOSE: Implant primary stability has long been considered a prerequisite for successful osseointegration. However, achieving stability may be difficult when placing implants in wide postextractive bone defects. The purpose of this study was to conduct a clinical and radiographic investigation of bone modifications at porous-structured implants inserted with or without primary stability. MATERIALS AND METHODS: Fifty porous-structured implants were inserted in the posterior sockets of 50 consecutive patients 2 months after tooth extraction, combined with allogeneic bone and a resorbable membrane. The implants were divided into two groups according to insertion torque: spinner (spinning at 35 Ncm, n = 23) and stable (stable at 35 Ncm, n = 27). Implant stability was assessed by resonance frequency analysis from baseline to 6-month function. Follow-up took place 3 years after implant placement. RESULTS: At baseline, the implant stability quotient was undetectable in the spinner group and averaged 75.07 ± 5.84 in the stable group. At uncovering, the implant stability quotient increased to 71.33 ± 4.42 and 77.97 ± 3.30 in the spinner and stable group, respectively (P < 0.001). After 6 months of loading, no between-group difference in implant stability quotient was found (P = 0.13). Marginal bone level changes were similar between groups at all follow-ups, averaging -0.41 ± 0.77 mm and -0.15 ± 0.53 mm at 36-month follow-up in the spinner and stable group, respectively (P = 0.35). No implant failed throughout the observation period. Neither biological nor mechanical complications occurred. CONCLUSION: Implants with a moderately rough surface and a porous-structured body may osseointegrate even without primary stability.

Graft-versus-host disease (GvHD) of the tongue and of the oral cavity: a large retrospective study.

Graft-versus-host disease (GvHD) causes severe mucositis, impairs feeding and favors infection. The objective of this study was to identify the impact of GvHD in the oral cavity. We reviewed all consecutive patients who developed oral GvHD after HSCT. The study period was over 14 years. 53 patients were identified. M/F = 1.4; median age was 48.6 years; the median follow-up was for up to 3 years and 6 months. Conditioning regimens included several drugs (e.g., busulfan, cyclophosphamide and fludarabine). In 11 cases, radiotherapy (RT) was also used. Patients treated with RT were more likely to have tooth decay requiring fillings (p = 0.029), to need canal root interventions (p = 0.005) and to have tartar requiring oral hygiene interventions (p = 0.011). Patients with a lymphoma diagnosis were more likely to develop perioral scleroderma and chronic oral GvHD (cGvHD) (p = 0.045). Oral acute GvHD (aGvHD) was seen in 26 patients (49.1%). 21 (39.6%) patients developed cGvHD. GvHD of the tongue was seen in 21 (40%) patients. Oral mucositis was seen in only 5 patients (9.4%). Conditioning regimens with RT are more likely to induce oral aGvHD. The tongue is often affected by GvHD.

Platelet gel: a new therapeutic tool with great potential.

Chronic wounds, such as diabetic foot ulcers, represent a serious clinical problem for patients and clinicians. Management of these wounds has a strong economic impact worldwide. Complications resulting from injuries are a frequent cause of morbidity and mortality. Chronic wounds lead to infections, painful dressings and prolonged hospitalisation. This results in poor patient Quality of Life and in high healthcare costs. Platelet concentrates (PC) are defined as autologous or allogeneic platelet derivatives with a platelet concentration higher than baseline. PC are widely used in different areas of Regenerative Medicine in order to enhance wound healing processes; they include platelet-rich plasma (PRP), platelet gel (PG), platelet-rich fibrin (PRF), serum eye drops (E-S), and PRP eye drops (E-PRP). This review highlights the use of platelet-rich plasma (PRP) and platelet gel (PG) preparation for clinical use.

Healing of a soft tissue wound of the neck and jaw osteoradionecrosis using platelet gel.

AIM: Bone osteoradionecrosis is a serious complication of radiation treatment. Current treatment approaches are not curative and treatment response is often poor leading to high social and healthcare costs. CASE REPORT: We report on the first case of osteoradionecrosis with successful restitutio ab integro by repeated administration of platelet gel (PLT-gel) and surgery in a critically ill patient. The administration of PLT-gel during a severe septic episode helped regeneration of bone and soft tissues, shortening the hospital stay of the patient. It was also noted that following applications of PLT-gel, both the use of morphine and the numbers of infective episodes were reduced. CONCLUSION: Additional studies are needed to confirm the promising effect of PLT-gel for the treatment of osteoradionecrosis.