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1.
Artículo en Inglés | MEDLINE | ID: mdl-32231082

RESUMEN

Peri-implant soft tissues play a role of paramount importance, not only on the esthetic appearance, but also on the maintenance and long-term stability of implants. The present report presents the conclusions from the Consensus Conference of the South European North African Middle Eastern Implantology & Modern Dentistry Association (SENAME) (4-6 November 2016, Cairo, Egypt). The conference focused on the topic of the soft tissue around dental implants, and in particular, on the influence of implant configurations on the marginal soft tissues, soft tissue alterations after immediate, early or delayed implant placement and immediate loading, the long-term outcomes of soft tissue stability around dental implants, and soft tissue augmentation around dental implants. Thirty world experts in this field were invited to take part in this two-day event; however, only 29 experts were in the final consensus voting process.


Asunto(s)
Implantes Dentales , Mucosa Bucal , Consenso , Egipto , Humanos
2.
Clin Oral Investig ; 21(6): 1913-1927, 2017 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-28551729

RESUMEN

OBJECTIVES: Research across many fields of medicine now points towards the clinical advantages of combining regenerative procedures with platelet-rich fibrin (PRF). This systematic review aimed to gather the extensive number of articles published to date on PRF in the dental field to better understand the clinical procedures where PRF may be utilized to enhance tissue/bone formation. MATERIALS AND METHODS: Manuscripts were searched systematically until May 2016 and separated into the following categories: intrabony and furcation defect regeneration, extraction socket management, sinus lifting procedures, gingival recession treatment, and guided bone regeneration (GBR) including horizontal/vertical bone augmentation procedures. Only human randomized clinical trials were included for assessment. RESULTS: In total, 35 articles were selected and divided accordingly (kappa = 0.94). Overall, the use of PRF has been most investigated in periodontology for the treatment of periodontal intrabony defects and gingival recessions where the majority of studies have demonstrated favorable results in soft tissue management and repair. Little to no randomized clinical trials were found for extraction socket management although PRF has been shown to significantly decrease by tenfold dry sockets of third molars. Very little to no data was available directly investigating the effects of PRF on new bone formation in GBR, horizontal/vertical bone augmentation procedures, treatment of peri-implantitis, and sinus lifting procedures. CONCLUSIONS: Much investigation now supports the use of PRF for periodontal and soft tissue repair. Despite this, there remains a lack of well-conducted studies demonstrating convincingly the role of PRF during hard tissue bone regeneration. Future human randomized clinical studies evaluating the use of PRF on bone formation thus remain necessary. CLINICAL RELEVANCE: PRF was shown to improve soft tissue generation and limit dimensional changes post-extraction, with little available data to date supporting its use in GBR.


Asunto(s)
Regeneración Ósea , Regeneración Tisular Guiada Periodontal , Fibrina Rica en Plaquetas , Humanos
3.
Quintessence Int ; 48(4): 315-324, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28294200

RESUMEN

OBJECTIVES: The aim of this study was to evaluate implant survival rate and to measure peri-implant bone changes in full-arch rehabilitations with immediate placement and immediate loading implants with platform switching and Morse taper connection, in addition to platelet-rich fibrin (PRF) and buccal bone augmentation, after 4 years of follow-up. METHOD AND MATERIALS: In this retrospective controlled study, patients who had been fully rehabilitated with immediate placement and immediate loading implants were evaluated 4 years post-loading. Implants with platform switching and Morse taper connections were used (In-Kone Universal System, Global D) and PRF and buccal bone augmentation were applied. The radiographic bone loss was calculated by subtracting the bone level at baseline (BLT0) from that at the 4-year follow-up (BLT4) in immediate and delayed implants. Measurements were made at the distal, mesial, vestibular, and oral sites of the implants and the deepest value was recorded. Implants placed in extraction sites and implants placed in healed sites were considered. A comparison between the groups was performed using the Mann-Whitney test. The implant survival rate was calculated using the Kaplan-Meier analysis. RESULTS: In total, 42 patients (28 females and 14 males; average age 55.8 years old, age range 45 to 77) were recruited to this study. A total of 334 implants were put in place (226 in the maxilla, 108 in the mandible). The implant survival rate was 97.8% for the maxilla and 98.1% for the mandible, 98.3% for immediate implants and 96.9% for delayed implants. No statistically significant differences (P > .05) in the mean radiographic bone loss (mBL) were observed when comparing the immediate and delayed implants and the anterior and posterior implants. Statistically significant differences were found in the mBL between the mandibular and maxilla implants in the vestibular (P = .01) and mesial (P = .001) sites. CONCLUSION: Within their limits, the present results suggest that rehabilitation with platform switching and taper connection implants, in addition to buccal bone augmentation and the use of PRF, can lead to predictable results.


Asunto(s)
Implantes Dentales , Carga Inmediata del Implante Dental/métodos , Arcada Edéntula/rehabilitación , Anciano , Pérdida de Hueso Alveolar/diagnóstico por imagen , Pérdida de Hueso Alveolar/cirugía , Diseño de Implante Dental-Pilar , Fracaso de la Restauración Dental , Femenino , Humanos , Masculino , Persona de Mediana Edad , Fibrina Rica en Plaquetas , Estudios Retrospectivos , Resultado del Tratamiento
4.
Curr Pharm Biotechnol ; 13(7): 1231-56, 2012 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-21740370

RESUMEN

Platelet concentrates for surgical use are innovative tools of regenerative medicine, and were widely tested in oral and maxillofacial surgery. Unfortunately, the literature on the topic is contradictory and the published data are difficult to sort and interpret. In bone graft, implant and reconstructive surgery, the literature is particularly dense about the use of the various forms of Platelet-Rich Plasma (PRP) - Pure Platelet-Rich Plasma (P-PRP) or Leukocyte- and Platelet-Rich Plasma (L-PRP) - but still limited about Platelet-Rich Fibrin (PRF) subfamilies. In this second article, we describe and discuss the current published knowledge about the use of PRP and PRF during implant placement (particularly as surface treatment for the stimulation of osseointegration), the treatment of peri-implant bone defects (after peri-implantitis, during implantation in an insufficient bone volume or during immediate post-extraction or post-avulsion implantation), the sinuslift procedures and various complex implant-supported treatments. Other potential applications of the platelet concentrates are also highlighted in maxillofacial reconstructive surgery, for the treatment of patients using bisphosphonates, anticoagulants or with post-tumoral irradiated maxilla. Finally, we particularly insist on the perspectives in this field, through the description and illustration of the use of L-PRF (Leukocyte- and Platelet-Rich Fibrin) clots and membranes during the regeneration of peri-implant bone defects, during the sinus-lift procedure and during complex implant-supported rehabilitations. The use of L-PRF allowed to define a new therapeutic concept called the Natural Bone Regeneration (NBR) for the reconstruction of the alveolar ridges at the gingival and bone levels. As it is illustrated in this article, the NBR principles allow to push away some technical limits of global implant-supported rehabilitations, particularly when combined with other powerful biotechnological tools: metronidazole solution, adequate bone substitutes and improved implant designs and surfaces (for example here AstraTech Osseospeed or Intra-Lock Ossean implants). As a general conclusion, we are currently living a transition period in the use of PRP and PRF in oral and maxillofacial surgery. PRPs failed to prove strong strategic advantages that could justify their use in daily practice, and the use of most PRP techniques will probably be limited to some very specific applications where satisfactory results have been reached. Only a few simple, inexpensive and efficient techniques such as the L-PRF will continue to develop in oral and maxillofacial surgery in the next years. This natural evolution illustrates that clinical sciences need concrete and practical solutions, and not hypothetical benefits. The history of platelet concentrates in oral and maxillofacial surgery finally demonstrates also how the techniques evolve and sometimes promote the definition of new therapeutical concepts and clinical protocols in the today's era of regenerative medicine.


Asunto(s)
Regeneración Ósea/fisiología , Trasplante Óseo/métodos , Fibrina/metabolismo , Regeneración Tisular Guiada Periodontal/métodos , Plasma Rico en Plaquetas/fisiología , Cirugía Bucal/métodos , Animales , Fibrina/administración & dosificación , Humanos , Leucocitos/fisiología
5.
Curr Pharm Biotechnol ; 13(7): 1207-30, 2012 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-21740371

RESUMEN

Platelet concentrates for surgical use are innovative tools of regenerative medicine, and were widely tested in oral and maxillofacial surgery. Unfortunately, the literature on the topic is contradictory and the published data are difficult to sort and interpret. In periodontology and dentoalveolar surgery, the literature is particularly dense about the use of the various forms of Platelet-Rich Plasma (PRP) - Pure Platelet-Rich Plasma (P-PRP) or Leukocyte- and Platelet-Rich Plasma (L-PRP) - but still limited about Platelet-Rich Fibrin (PRF) subfamilies. In this first article, we describe and discuss the current published knowledge about the use of PRP and PRF during tooth avulsion or extraction, mucogingival surgery, Guided Tissue Regeneration (GTR) or bone filling of periodontal intrabony defects, and regeneration of alveolar ridges using Guided Bone Regeneration (GBR), in a comprehensive way and in order to avoid the traps of a confusing literature and to highlight the underlying universal mechanisms of these products. Finally, we particularly insist on the perspectives in this field, through the description and illustration of the systematic use of L-PRF (Leukocyte- and Platelet- Rich Fibrin) clots and membranes during tooth avulsion, cyst exeresis or the treatment of gingival recessions by root coverage. The use of L-PRF also allowed to define new therapeutic principles: NTR (Natural Tissue Regeneration) for the treatment of periodontal intrabony lesions and Natural Bone Regeneration (NBR) for the reconstruction of the alveolar ridges. In periodontology, this field of research will soon find his golden age by the development of user-friendly platelet concentrate procedures, and the definition of new efficient concepts and clinical protocols.


Asunto(s)
Regeneración Ósea/fisiología , Fibrina/metabolismo , Regeneración Tisular Guiada Periodontal/métodos , Plasma Rico en Plaquetas/fisiología , Cirugía Bucal/métodos , Animales , Fibrina/administración & dosificación , Humanos , Leucocitos/fisiología
6.
Implant Dent ; 20(1): 2-12, 2011 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-21278521

RESUMEN

PURPOSE: To assess the relevance of simultaneous sinus-lift and implantation with leukocyte- and platelet-rich fibrin (L-PRF, Choukroun's technique) as sole subsinus filling material. MATERIALS: Twenty-three lateral sinus elevations (SA4 sinus) were performed on 20 patients with simultaneous implant placement. Seven patients were treated with 19 Astra implants (AstraTech, Mölndal, Sweden) and 13 patients with 33 Intra-Lock implants (Intra-Lock Ossean, Boca Raton, FL). L-PRF membranes were used to cover the Schneiderian membrane, the implant tips served as "tent pegs" for the L-PRF-patched sinus membranes, and the subsinus cavity was finally filled with L-PRF clots. Clinical and radiographic follow-up was performed just after implant placement, after 6 months, 1 year and each following year. RESULTS: Six months after surgery, all implants were clinically stable during abutment tightening. The maximum follow-up was 6 years, and all patients were followed up for a minimum of 2 years. No implant was lost during this 6-year experience, and the vertical bone gain was always substantial, between 8.5 and 12 mm bone gain (10.4 ± 1.2). The final level of the new sinus floor was always in continuation with the implant apical end, and the periimplant crestal bone height was stable. CONCLUSION: The use of L-PRF as sole filling material during simultaneous sinus-lift and implantation seems to be a reliable surgical option promoting natural bone regeneration.


Asunto(s)
Aumento de la Cresta Alveolar/métodos , Plaquetas/fisiología , Implantes Dentales , Fibrina/uso terapéutico , Leucocitos/fisiología , Maxilar/cirugía , Seno Maxilar/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Proceso Alveolar/diagnóstico por imagen , Proceso Alveolar/patología , Regeneración Ósea/fisiología , Pilares Dentales , Implantación Dental Endoósea , Diseño de Prótesis Dental , Retención de Prótesis Dentales , Femenino , Estudios de Seguimiento , Hemostáticos/uso terapéutico , Humanos , Masculino , Membranas Artificiales , Persona de Mediana Edad , Membrana Mucosa/patología , Oseointegración/fisiología , Radiografía , Resultado del Tratamiento
7.
Implant Dent ; 18(3): 220-9, 2009 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-19509532

RESUMEN

Extensive bone grafting remains a delicate procedure, due to the slow and difficult integration of the grafted material into the physiological architecture. The recent use of platelet concentrates aims to improve this process of integration by accelerating bone and mucosal healing. Choukroun's platelet-rich fibrin (PRF) is a healing biomaterial that concentrates in a single autologous fibrin membrane, most platelets, leukocytes, and cytokines from a 10-mL blood harvest, without artificial biochemical modification (no anticoagulant, no bovine thrombin). In this second part, we describe the implant and prosthetic phases of a complex maxillary rehabilitation, after preimplant bone grafting using allograft, Choukroun's PRF membranes, and metronidazole. Twenty patients were treated using this new technique and followed up during 2.1 years (1-5 years). Finally, 184 dental implants were placed, including 54 classical screw implants (3I, Palm Beach Gardens, FL) and 130 implants with microthreaded collar (46 from AstraTech, Mölndal, Sweden; 84 from Intra-Lock, Boca Raton, FL). No implant or graft was lost in this case series, confirming the validity of this reconstructive protocol. However, the number of implants used per maxillary rehabilitation was always higher with simple screw implants than with microthreaded implants, the latter presenting a stronger initial implant stability. Finally, during complex implant rehabilitations, PRF membranes are particularly helpful for periosteum healing and maturation. The thick peri-implant gingiva is related to several healing phases on a PRF membrane layer and could explain the low marginal bone loss observed in this series. Microthreaded collar and platform-switching concept even improved this result. Multiple healing on PRF membranes seems a new opportunity to improve the final esthetic result.


Asunto(s)
Plaquetas/fisiología , Implantación Dental Endoósea , Implantes Dentales , Fibrina/fisiología , Maxilar/cirugía , Pérdida de Hueso Alveolar/prevención & control , Aumento de la Cresta Alveolar/métodos , Antiinfecciosos Locales/farmacología , Regeneración Ósea/efectos de los fármacos , Regeneración Ósea/fisiología , Trasplante Óseo/métodos , Trasplante Óseo/fisiología , Diseño de Prótesis Dental , Prótesis Dental de Soporte Implantado , Femenino , Encía/fisiología , Humanos , Leucocitos/fisiología , Masculino , Membranas Artificiales , Metronidazol/farmacología , Persona de Mediana Edad
8.
Implant Dent ; 18(2): 102-11, 2009 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-19359860

RESUMEN

Extensive bone grafting remains a delicate procedure, because of the slow and difficult integration of the grafted material into the physiological architecture. The recent use of platelet concentrates aims to improve this process of integration by accelerating bone and mucosal healing. Choukroun's platelet-rich fibrin (PRF) is a healing biomaterial that concentrates in a single autologous fibrin membrane, most platelets, leukocytes, and cytokines from a 10 mL blood harvest, without artificial biochemical modification (no anticoagulant, no bovine thrombin). Whether used as a membrane or as fragments, PRF allows a significant postoperative protection of the surgical site and seems to accelerate the integration and remodeling of the grafted biomaterial. These properties are particularly helpful for vestibular bone grafting on the alveolar ridges. Moreover, it provides a very high quality of gingival maturation.A small quantity of a 0.5% metronidazole solution (10 mg) can also be used to provide an efficient protection of the bone graft against unavoidable anaerobic bacterial contamination. This article describes a new technique of total maxillary preimplant bone grafting using allograft, Choukroun's PRF membranes and metronidazole. This first part focused on the preimplant reconstructive treatment using allogeneic bone granules. PRF membranes are particularly helpful to protect the surgical site and foster soft tissue healing. This fibrin biomaterial represents a new opportunity to improve both the maturation of bone grafts and the final esthetic result of the peri-implant soft tissue.


Asunto(s)
Aumento de la Cresta Alveolar/métodos , Plaquetas , Trasplante Óseo/métodos , Fibrina/uso terapéutico , Maxilar/cirugía , Antiinfecciosos Locales/farmacología , Regeneración Ósea/efectos de los fármacos , Femenino , Liofilización , Humanos , Membranas Artificiales , Metronidazol/farmacología , Persona de Mediana Edad
9.
Implant Dent ; 17(3): 257-70, 2008 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-18784526

RESUMEN

BACKGROUND AND OBJECTIVES: Analysis of tomodensitometric controls following sinus grafts clearly demonstrates a quite systematic lack of homogeneity. Sinus contamination by anaerobic bacteria seems almost unavoidable during bone graft surgery, and this problem may jeopardize the healing process. The aim of this study was to characterize in a systematic way the nonhomogeneities observed at 1, 2, or 3 months postsurgery within allogenous sinus grafts, and to assess the possible influence of a 0.5% sterile solution of metronidazole incorporated in the sinus bone graft. MATERIALS: This clinical study was conducted on 72 patients treated with single or bilateral sinus-lifts: 94 sinus elevations performed with freeze-dried bone allograft (Phoenix, TBF, Mions, France), with (test group) or without (control group) metronidazole. In the test group, each bone graft was hydrated with 2 mL of a 0.5% metronidazole solution, i.e., only 10 mg of metronidazole. All the patients went through a first presurgical computerized tomography (CT)-scan followed by a second scan performed at 1, 2, or 3 months postsurgery (which was used as the preimplant reference scan). For 11 patients, 2 postsurgical CT-scans were performed respectively at 10 days and 2 months. Using an arbitrary gray scale (Arbitrary Densitometric Unit) which functions according to the Hounsfield unit principle, the degree of radiographic homogeneity of the grafts was established. Density scattering provides some information on the homogeneity or nonhomogeneity of the bone graft. RESULTS: The 12 grafts performed without metronidazole show significant nonhomogeneities at 1, 2, or 3 months. Moreover, when a CT-scan is performed during the first postoperative days (at 10 days), the presence of air bubbles in the graft is confirmed. The tomodensitometric aspects of all grafts treated with metronidazole in this series are absolutely identical: they show a high degree of homogeneity. Sixty-three cases (76.8%) are homogeneous, and 19 cases (23.2%) are significantly homogeneous. The time at which the control scan is performed (10 days, 1, 2, or 3 months) does not seem to influence significantly the degree of homogeneity assessed. In the control group, some inflammatory events associated with facial oedema were observed in 25% of the cases. In the test group, no such event was recorded for the 82 sinus-lifts treated with metronidazole. CONCLUSION: A possible correlation may exist between the occurrence of non homogeneities within the bone grafts and the anaerobic bacterial contamination. The local use of a very small quantity of metronidazole (equivalent to only 1/20 of a common 200 mg oral tablet) could provide more security when performing sinus-lift procedures and an improved quality of the graft. This protocol should not be considered as an antibiotherapy, but only as way to limit the initial contamination of bone graft.


Asunto(s)
Antiinfecciosos Locales/administración & dosificación , Bacterias Anaerobias , Infecciones Bacterianas/prevención & control , Trasplante Óseo/patología , Seno Maxilar/cirugía , Metronidazol/administración & dosificación , Procedimientos Quirúrgicos Preprotésicos Orales , Matriz Ósea/trasplante , Trasplante Óseo/diagnóstico por imagen , Humanos , Tomografía Computarizada por Rayos X
10.
Artículo en Inglés | MEDLINE | ID: mdl-16504852

RESUMEN

Platelet-rich fibrin (PRF) belongs to a new generation of platelet concentrates, with simplified processing and without biochemical blood handling. In this fourth article, investigation is made into the previously evaluated biology of PRF with the first established clinical results, to determine the potential fields of application for this biomaterial. The reasoning is structured around 4 fundamental events of cicatrization, namely, angiogenesis, immune control, circulating stem cells trapping, and wound-covering epithelialization. All of the known clinical applications of PRF highlight an accelerated tissue cicatrization due to the development of effective neovascularization, accelerated wound closing with fast cicatricial tissue remodelling, and nearly total absence of infectious events. This initial research therefore makes it possible to plan several future PRF applications, including plastic and bone surgery, provided that the real effects are evaluated both impartially and rigorously.


Asunto(s)
Plaquetas , Adhesivo de Tejido de Fibrina/farmacología , Fibrina/farmacología , Hemostáticos/farmacología , Alveolo Dental/efectos de los fármacos , Cicatrización de Heridas/efectos de los fármacos , Plaquetas/fisiología , Regeneración Ósea/efectos de los fármacos , Movimiento Celular/efectos de los fármacos , Cicatriz/fisiopatología , Epitelio/fisiología , Fibroblastos/fisiología , Geles , Humanos , Leucocitos/inmunología , Células Madre Mesenquimatosas/fisiología , Neovascularización Fisiológica/fisiología , Agregación Plaquetaria/fisiología , Cicatrización de Heridas/fisiología
11.
Artículo en Inglés | MEDLINE | ID: mdl-16504861

RESUMEN

OBJECTIVE: Platelet-rich fibrin (PRF) belongs to a new generation of platelet concentrates, with simplified processing and without biochemical blood handling. The use of platelet gel to improve bone regeneration is a recent technique in implantology. However, the biologic properties and real effects of such products remain controversial. In this article, we therefore attempt to evaluate the potential of PRF in combination with freeze-dried bone allograft (FDBA) (Phoenix; TBF, France) to enhance bone regeneration in sinus floor elevation. STUDY DESIGN: Nine sinus floor augmentations were performed. In 6 sites, PRF was added to FDBA particles (test group), and in 3 sites FDBA without PRF was used (control group). Four months later for the test group and 8 months later for the control group, bone specimens were harvested from the augmented region during the implant insertion procedure. These specimens were treated for histologic analysis. RESULTS: Histologic evaluations reveal the presence of residual bone surrounded by newly formed bone and connective tissue. After 4 months of healing time, histologic maturation of the test group appears to be identical to that of the control group after a period of 8 months. Moreover, the quantities of newly formed bone were equivalent between the 2 protocols. CONCLUSIONS: Sinus floor augmentation with FDBA and PRF leads to a reduction of healing time prior to implant placement. From a histologic point of view, this healing time could be reduced to 4 months, but large-scale studies are still necessary to validate these first results.


Asunto(s)
Plaquetas , Regeneración Ósea/efectos de los fármacos , Adhesivo de Tejido de Fibrina/uso terapéutico , Fibrina/uso terapéutico , Hemostáticos/uso terapéutico , Seno Maxilar/cirugía , Procedimientos Quirúrgicos Preprotésicos Orales/métodos , Matriz Ósea/trasplante , Trasplante Óseo/métodos , Trasplante Óseo/fisiología , Implantación Dental Endoósea , Fibrina/farmacología , Adhesivo de Tejido de Fibrina/farmacología , Geles , Hemostáticos/farmacología , Humanos , Agregación Plaquetaria
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