The pioneer use of a modified PRGF-Endoret® technique for wound healing in a hemodialyzed diabetic patient in a terminal stage of renal disease.

In the literature, this paper is the first to describe the use of plasma rich in growth factors (PRGF)-Endoret® in hemodialyzed diabetic patients, to promote the healing of after amputation wounds. The PRGF-Endoret® was primarily conceived to be used in maxillofacial surgery, oral implantology, etc., the innovation residing in the blood collection technique (quantity, moment of the week, rhythmicity), which was adapted to the specific conditions of the hemodialyzed patient. Moreover, in the initial phases, the two PRGF fractions were innovatively applied as single alternating layers on the wound surface. Only after the surface of the wound decreased, the two PRGF fractions were applied as overlapping layers. Nevertheless, the paper presents the optimal method to assess the clinical evolution of the wound. Histopathological examination of the biopsy performed during wound preparation for PRGF application brought additional, essential data for orienting the therapeutic approach. The exclusion of calciphylaxis, a disease with high mortality risk, encouraged the application of this method, and also demonstrated the microscopic features in hemodialyzed diabetic patients.

Successful management of spontaneous bone regeneration after jaws cystectomy using PRGF approach; case series.

In the jaws, the healing process of bone defects occurs differently compared with other anatomical sites where healing is done by the formation of scar tissue. This is due to physiological bone remodeling and continuous bone resorption and apposition. In the case of large cysts, there is an increased risk of postoperative infection due to the retraction of the blood clot on the bony walls. The use of plasma rich in growth factors (PRGF), with or without autologous bone addition, for filling the cystic cavities is beneficial not only for its antimicrobial effect, but also due to simultaneously release of growth factors from platelet alpha granules and adhesive proteins. The aim of our work was to emphasize the spontaneous bone healing of the maxilla and mandible after the enucleation of large and medium-sized cysts in asymptomatic patients of different age. The outcome of three patients who underwent surgery for removal of radicular cysts is presented. Imagistic [cone-beam computed tomography (CBCT)] and histological examination was performed aiming to evaluate the quality of new bone at the site of the bone defect, after different time intervals. By using PRGF approach, the healing of mandibular bone occurred 18 months after cystectomy in a smoker patient, 54-year-old, while the healing of maxillary bone using autologous bone mixed with PRGF occurred after six months in a 63-year-old patient. In a young patient (14 years old), the regeneration period was six months, using PRGF and a fibrin cloth for filling the defect.

The utility of histopathologic examination in appreciation of mandibular osteoporotic status.

The study was performed on 14 female patients aged between 54 and 83 years, presented for insertion of mandibular implants and diagnosed with systemic osteoporosis on DXA. Radiological examination showed no striking maxillar bone rarefactions or changes in the mandibular cortex form that allows the diagnosis of osteoporosis at the jaw. To obtain informations on the health status of mandibular bone in these patients, we considered it appropriate to do histopathological investigations on fragments of bone harvested from implant insertion area. To this end, fragments of bone harvested when performing the new alveolus were fixed in Stieve mixture, decalcified with trichloroacetic acid and included in paraffin. Five-micrometer thick sections were stained with Goldner's Trichrome method and examined microscopically. Histopathology revealed changes of different intensity in the organic and vascular components of the mandibular bone, in all patients studied, with differences from case to case. Thus, confirming that patients with systemic osteoporosis diagnosed by DXA at the femoral neck and/or the vertebrae have histological changes in the mandibular bone, but the extent of damage is different. Providing detailed information about organic component and bone vascularization, crucial components in the early stages of osseointegration, histopathology is more useful for assessing mandibular osteoporotic status, compared with methods of investigation that aim only the mineral component, mineralization being the final stage of osseointegration. Highlighting mandibular osteoporotic early lesions by histopathological examination allows a patient-specific therapeutic approach and could be an accurate method of assessment for required osseointegration period, depending on the degree of impairment.