富血小板纤维蛋白在骨缺损修复中引导成骨能力的动物实验研究

目的:探讨富血小板纤维蛋白(PRF)对骨缺损早期引导骨生成的能力,为PRF在口腔种植学中的应用及研究提供依据。方法:12只大白兔分Ⅰ组、Ⅱ组,每组6只12侧下颌骨骨缺损。Ⅰ组应用方法 A、B充填各6侧。Ⅱ组应用方法 C、D充填各6侧。(A:PRF覆盖骨粉,B:胶原膜覆盖骨粉,C:PRF混合骨粉,D:骨粉)。术后2周、4周、8周处死Ⅰ,Ⅱ组各2只进行大体标本观察、HE染色及CT骨密度值检测。结果:(1)各时间段大体观察骨愈合硬度A组与C组相似,较B组、D组硬度强,B组优于D组。(2)各时间段HE染色比较A组及C组新生骨组织及再血管化相似,均优于B组、D组,新生骨排列较B组、D组规则。(3)骨密度测量2周、4周A与C组无统计学差异,A、C组与B、D组之间分别具有统计学差异,8周A组与C、B组之间无统计学差异,与D组分别存在统计学差异。讨论:PRF的作用机制及效果对比研究。结论:(1)PRF联合骨粉引导骨再生早期效果优于单独使用骨粉或覆盖胶原膜。(2)PRF覆盖骨粉及PRF混合骨粉引导骨再生效果基本相同。     

富血小板血浆修复种植体周围骨缺损的实验研究

目的探讨富血小板血浆(platelet-rich plasma,PRP)修复种植体周围骨缺损的能力。方法Beagle犬4只,拔除单侧下颌1、2、4前磨牙作为实验牙位。3个月后植入种植体,其周围制备骨缺损并植入相应骨移植材料:实验组植入PRP/磷酸三钙(tricalcium phosphate,TCP);对照组植入TCP。8、16周分别处死动物2只,进行组织学、扫描电镜观察,观察新骨形成和种植体-新骨界面情况,能谱分析种植体-新骨界面Ca含量。结果8周及16周通过肉眼及组织学观察,实验组修复效果优于对照组,种植体-新骨界面Ca含量均高于对照组,差异有显著性(P<0.05)。结论PRP/TCP作为修复种植体周围骨缺损的骨移植材料具有可行性。     

富血小板血浆促进成骨作用的研究进展

<正>富血小板血浆(platelet-rich plasma,PRP)是自体全血经过梯度离心、分离得到的血小板浓缩物,血小板含量丰富。当血小板激活时,能释放多种生长因子,如血小板源性生长因子(platelet-derived growth factor,PDGF),转化生长因子-β(transforming growth factor-β,TGF-β),血管内皮生长因子(vascular     

富血小板血浆与骨修复

富血小板血浆（PRP）是全血经过离心分离而得到的血制品,含有全血中70％以上的血小板．现已知PRP是自体生长因子库．富含多种生长因子．如血小板源性生长因子（PDGF）、转化生长因子（TGF）、成纤维细胞生长因子（FGF）和胰岛素生长因子（IGF）等。这些生长因子对细胞的生长分化和组织的形成有着重要作用。近年来的研究表明,PRP能促进骨修复。在国外,PRP已逐步应用于口腔种植、颌面重建外科、牙周外科等领域。     

富血小板血浆在种植体周围骨缺损修复中的实验研究

目的:探讨富血小板血浆(platelet-richplasma,PRP)、PRP复合骨诱导活性材料(osteoinduction active material,OAM)对种植体周围骨缺损修复的作用。方法:Beagle犬4只,拔除每只犬一侧下颌第一、二前磨牙及其双侧下颌第四前磨牙作为实验牙位。3个月后拔牙处植入种植体,每只犬共植入3颗种植体,第一、二前磨牙牙位植入1颗种植体为对照组,对侧第四前磨牙牙位植入1颗种植体为实验A组,同侧第四前磨牙牙位植入1颗种植体为实验B组。种植术中同期制备种植体周围骨缺损并植入相应骨移植材料:A组植入PRP/OAM;B组植入PRP/磷酸三钙;对照组植入磷酸三钙。种植术后8、16周处死动物,进行组织学观察,测量种植体周围骨密度,采用SPSS13.0软件对数据进行单因素方差分析。结果:8周时,实验A组新骨与种植体形成区段性骨结合;实验B组种植体边缘可见新骨形成,但量较少;对照组种植体边缘为纤维性界面。8周时骨密度测量,各组间骨密度差异无统计学意义。16周时,实验A组可见哈佛系统,实验A、B组新骨与种植体形成骨整合;对照组仅为纤维性结合。16周时骨密度测量,两实验组骨密度均显著高于对照组。结论:PRP及PRP/OAM可促进种植体周围骨缺损修复。     

骨诱导活性材料复合富血小板血浆修复犬种植体周围骨缺损

目的从组织学角度评价骨诱导活性材料(osteoinduction active material,OAM)复合富血小板血浆(platelet-rich plas-ma,PRP)对种植体周围骨缺损的修复效果。方法Beagle犬4只,拔除下颌1、2、4前磨牙。每只犬左右两侧实验牙位随机分为实验侧和对照侧,实验侧第4前磨牙牙位为实验A组,第1、2前磨牙牙位为实验B组,对照侧第1、2前磨牙牙位为对照组。3个月后植入种植体,制备种植体周围骨缺损。实验A组骨缺损区植入OAM/PRP;B组植入OAM;对照组植入磷酸三钙。8、16周分别处死动物2只,进行组织学观察,能谱分析种植体-新骨界面Ca含量。结果8周时,A、B组新骨与种植体形成区段性骨结合,对照组种植体边缘为纤维性界面。各组间种植体-新骨界面Ca含量存在显著性差异。16周时,实验A、B组可见哈佛氏系统,新骨与种植体形成骨整合,对照组为纤维性结合。实验各组Ca含量均显著高于对照组。结论OAM及PRP/OAM能促进种植体周围骨缺损修复。     

富血小板血浆促进骨缺损修复的研究进展

本文介绍了富血小板血浆的特点及在骨缺损修复中的研究进展,讨论了富血小板血浆促进骨组织缺损修复的可能机制,提出了富血小板血浆修复骨组织缺损目前还存在的问题.     

富血小板血浆及其在口腔颌面骨修复中的应用

1984年,Assoion等发现了人血浆中提取的富血小板血浆（platelet—rich plasma,PRP）中含有多种生长因子,当PRP与氯化钙以及凝血酶混合后,各种生长因子即从血小板中的仪颗粒中释放出来^[1]。这些生长因子包括血小板源性生长因子（platelet—derived growth factor,PDGF）、转化生长因子β（transforming growth factor—β,TGF—β）、     

富血小板血浆与骨诱导活性材料复合物促种植体周骨缺损修复的实验研究

目的:观察富血小板血浆(platelet-rich plasma,PRP)、PRP复合骨诱导活性材料(osteoinduction active material,OAM)对种植体周围骨缺损的修复效果,探讨其作为种植体周围骨缺损修复材料的可行性.方法:Beagle犬4只,拔除双侧下颌第一、二、四前磨牙,3个月后植入种植体,制备种植体周围骨缺损并植入相应骨移植材料.A组植入PRP/ OAM,B组植入PRP,磷酸三钙,对照组植入磷酸三钙.种植术后8、16周各处死2只动物,进行组织学观察,能谱分析种植体-新骨界面Ca2+含量,采用SPSS13.0软件包对数据进行单因素方差分析.结果:8周时,实验A组新骨与种植体形成区段性骨结合;实验B组种植体边缘可见新骨形成,但量较少;对照组种植体边缘为纤维性界面.16周时,实验A组可见哈佛系统,实验A、B组新骨与种植体形成骨整合;对照组为纤维性结合.能谱分析显示,8、16周时各组间钙含量百分比均存在显著差异.实验A组最高,实验B组其次,对照组最低.结论:PRP及PRP/OAM应用于种植体周围骨缺损中,可以促进骨缺损的修复,并形成理想的种植体-骨结合界面.     

富血小板血浆对表面多孔性种植体周骨再生的作用

目的:研究钛合金颗粒熔附表面多孔性种植体在植入时应用富血小板血浆(PlateletRichPlasma,PRP),对种植体周围骨再生的影响。方法:钛合金颗粒熔附表面多孔性种植体30枚分别植入5条狗的双侧下颌骨,左侧种植体在植入时局部应用PRP,右侧为对照组。术后3天、1、3、6及12周分别将动物处死,进行组织学和组织形态学分析。结果:术后3天和1周时,两组的组织学表现及骨-种植体接触率(Bone-implantcontact,BIC)均相似。术后3周时,实验组可观察到骨单位已开始形成,两组的骨-种植体接触率具有显著性差异(PRP组为68.11±17.63%,对照组为44.26±31.79%)。术后6周及12周时两组无明显区别。结论:表面多孔性种植体局部应用PRP可更有利于种植体周围早期骨再生,但PRP加快种植体周围骨再生的机制还有待于进一步的研究。     

Platelet-rich plasma and bovine porous bone mineral combined with guided tissue regeneration in the treatment of intrabony defects in humans

BACKGROUND: A combination of platelet-rich plasma (PRP), bovine porous bone mineral (BPBM) and guided tissue regeneration (GTR) has been shown to be effective in promoting clinical signs of periodontal regeneration in intrabony defects. As an initial attempt to clarify the role played by each of the three treatment components, this study was performed to compare the clinical effectiveness of two regenerative techniques for intrabony defects in humans: a combination of PRP/BPBM/GTR vs. GTR. MATERIAL AND METHODS: Eighteen patients participated in the study. Using a split-mouth design, interproximal bony defects were surgically treated with either an absorbable membrane made of polylactic acid for GTR or a combination of PRP/BPBM/GTR. Changes in pocket depth, attachment level and defect fill as revealed by 6-month reentry surgeries were evaluated. RESULTS: Both treatment modalities resulted in significant pocket depth reduction and clinical attachment gain as compared to baseline values. Pocket depth reduction was 4.98 +/- 0.96 mm on buccal and 4.93 +/- 0.92 mm on lingual sites of the PRP/BPBM/GTR group and 3.62 +/- 0.81 mm on buccal and 3.54 +/- 0.88 mm on lingual sites of the GTR group. The gain in clinical attachment observed was 4.37 +/- 1.31 mm on buccal and 4.28 +/- 1.33 mm on lingual sites of the PRP/BPBM/GTR group and 2.62 +/- 1.23 mm on buccal and 2.44 +/- 1.21 mm on lingual sites of the GTR group. The amount of defect fill observed was 4.78 +/- 1.26 mm on buccal and 4.66 +/- 1.32 mm on lingual sites of the PRP/BPBM/GTR group and 2.31 +/- 0.76 mm on buccal and 2.26 +/- 0.81 mm on lingual sites of the GTR group. All differences between the two groups were statistically significant in favor of the PRP/BPBM/GTR group. CONCLUSIONS: The results of this study suggest that PRP and BPBM provide an added regenerative effect to GTR in promoting the clinical resolution of intrabony defects on patients with severe periodontitis.     

Effectiveness of a combination of platelet-rich plasma,bovine porous bone mineral and guided tissue regeneration in the treatment of mandibular grade II molar furcations in humans

OBJECTIVE: A combination of platelet-rich plasma (PRP), bovine porous bone mineral (BPBM) and guided tissue regeneration (GTR) has been shown to be effective as regenerative treatment for intrabony periodontal defects. The purpose of this study was to evaluate the effectiveness of PRP, BPBM and GTR used in combination as regenerative treatment for grade II molar furcation defects in humans. MATERIAL AND METHODS: Using a split-mouth design, a total of 52 grade II mandibular molar furcation defects were treated either with PRP/BPBM/GTR (experimental group, n=26) or with an open flap debridement (control group, n=26). The primary outcomes evaluated in this study included changes in pocket depth, attachment level and re-entry bone levels (horizontal and vertical) between baseline and 6 months postoperatively. RESULTS: The results showed that the experimental group presented with significantly greater pocket reduction (4.07+/-0.33 mm for experimental and 2.49+/-0.38 mm for control sites), gain in clinical attachment (3.29 +/- 0.42 mm for experimental and 1.68+/-0.31 mm for control sites), vertical defect fill (2.56+/- 0.36 mm for experimental and -0.19+/-0.02 for control sites) and horizontal defect fill (2.28+/-0.33 mm for experimental and 0.08+/-0.02 mm for control sites) than the control group. CONCLUSIONS: It was concluded that the PRP/BPBM/GTR combined technique is an effective modality of regenerative treatment for mandibular grade II furcation defects. Further studies are necessary to elucidate the role played by each component of the combined therapy in achieving these results.     

Guided tissue regeneration in intrabony periodontal defects following treatment with two bioabsorbable membranes in combination with bovine bone mineral graft. A clinical and radiographic study

AIM: Comparison of two bioabsorbable barriers (collagen and polylactic acid (PLA) membranes) combined with a bovine bone mineral (BBM) graft, with an access flap procedure (AFP) alone for treating intrabony defects. MATERIAL AND METHODS: Thirty-four subjects participated in this prospective, controlled clinical trial. Baseline clinical examination (probing depth (PD), clinical attachment level (CAL)) of selected sites was performed 2 months after completion of conservative treatment in conjunction with hard-tissue measurements to ascertain the depth of the defect (cementoenamel junction to the bottom of the defects). After randomly dividing patients into three groups (two membrane groups, one control group), full thickness flaps were elevated and exposed root surfaces planed before filling defects with bone graft and positioning a barrier membrane covering the defect. The control group was treated identically except for the barrier and bone graft placement. Clinical treatment outcomes were finally evaluated 12 months after surgery for changes of PD and CAL. Radiographs at baseline and 12 months were compared using non-standardized digital radiography. RESULTS: A mean reduction in PD value of 5.08 mm and mean CAL gain of 4.39 mm occurred in the collagen-BBM group. Corresponding values for the PLA-BBM group were 4.72 and 3.71 mm, while access flap procedure (AFP) sites produced values of 2.50 and 2.43 mm. All improvements in clinical parameters were statistically significant (p<0.001) within groups for all variables. Both membranes produced statistically greater PD reduction and CAL gain compared with AFP treatment (p<0.05). Comparison between barrier groups failed to reveal any statistically significant difference in probing pocket depth reduction (p=0.56) or in CAL gain (p=0.34). CONCLUSION: Placement of the two barrier membranes used in the present study in combination with BBM graft significantly improved clinical and radiographic parameters of deep intrabony pockets and proved superior to access flap alone.     

Platelet-rich fibrin and bovine porous bone mineral vs. platelet-rich fibrin in the treatment of intrabony periodontal defects

Lekovic V, Milinkovic I, Aleksic Z, Jankovic S, Stankovic P, Kenney EB, Camargo PM. Platelet‐rich fibrin and bovine porous bone mineral vs. platelet‐rich fibrin in the treatment of intrabony periodontal defects. J Periodont Res 2012; 47: 409–417. © 2011 John Wiley & Sons A/S Background and Objective: Bovine porous bone mineral (BPBM) is a xenograft that has been successfully utilized in periodontal regeneration. Platelet‐rich fibrin (PRF) is a leukocyte and platelet preparation that concentrates various polypeptide growth factors and therefore has the potential to be used as regenerative treatment for periodontal defects. The purpose of this study was to examine the suitability of autologous PRF as regenerative treatment for periodontal intrabony defects in humans and to examine the ability of BPBM to augment the regenerative effects exerted by PRF. Material and Methods: Using a split‐mouth design, 17 paired intrabony defects were randomly treated either with PRF or with PRF–BPBM combination. Re‐entry surgeries were performed at 6 mo. Primary study outcomes were changes in pocket depth, attachment level and defect fill. Results: Preoperative pocket depths, attachment levels and transoperative bone measurements were similar for the PRF and PRF–BPBM groups. Postsurgical measurements revealed a significantly greater reduction in pocket depth in the PRF–BPBM group (4.47 ± 0.78 mm on buccal and 4.29 ± 0.82 mm on lingual sites) when compared with the PRF group (3.35 ± 0.68 mm on buccal and 3.24 ± 0.73 mm on lingual sites). The PRF–BPBM group presented with significantly greater attachment gain (3.82 ± 0.78 mm on buccal and 3.71 ± 0.75 mm on lingual sites) than the PRF group (2.24 ± 0.73 mm on buccal and 2.12 ± 0.68 mm on lingual sites). Defect fill was also greater in the PRF–BPBM group (4.06 ± 0.87 mm on buccal and 3.94 ± 0.73 mm on lingual sites) than in the PRF group (2.21 ± 0.68 mm on buccal and 2.06 ± 0.64 mm on lingual sites). Conclusion: The results of this study indicate that PRF can improve clinical parameters associated with human intrabony periodontal defects, and BPBM has the ability to augment the effects of PRF in reducing pocket depth, improving clinical attachment levels and promoting defect fill.     

Platelet-rich plasma may not provide any additional effect when associated with guided bone regeneration around dental implants in dogs

OBJECTIVE: The aim of this study was to evaluate histometrically bone healing in surgically created dehiscence-type defects around titanium implants treated with an association of platelet-rich plasma (PRP) and guided bone regeneration (GBR). MATERIALS AND METHODS: Ten male adult mongrel dogs were used, from which the three low premolars (P2, P3, P4) and the first molar were extracted. Three months after teeth extraction, two implant sites were bilaterally drilled, buccal bone dehiscences were created and four titanium implants were placed. Dehiscences were randomly assigned to the following groups: (1) PRP, (2) GBR, (3) PRP+GBR and (4) control. After 3 months, the animals were sacrificed and the implants and adjacent hard tissues were processed for undecalcified sections. Bone-to-implant contact (BIC), bone density within the limits of implant threads (BW), bone density (BD) and new bone area (BA) in a zone lateral to the implant corresponding to bone defects were obtained and measured. RESULTS: Intergroup analysis (two-way ANOVA -alpha=5%) demonstrated that when PRP was utilized,no differences were observed for all parameters (P>0.05). However, significant differences were observed for BIC and BW toward membrane-treated groups (P<0.05). CONCLUSION: Within the limits of this study, it was concluded that PRP does not exert additional effects on bone healing in bone defects created around dental implants and treated by GBR.     

Evaluation of guided tissue regeneration in interproximal defects

Abstract This study clinically evaluates the use of expanded polytetrafluoroethylene (ePTFE) membranes with or without the addition of decalcified freeze-dried hone allograft (DFDBA) in the treatment of interproximal intraosseous defects, 25 patients (26 paired defects) diagnosed with advanced periodontitis and having at least 2 bilateral interproximal probing depths of s6 mm participated in the study. After the hygiene phase, measurements were made to determine soft tissue recession, pocket depth, and clinical attachment levels. Defects from each pair were randomly treated with either ePTFE alone (control), or ePTFE + DFDBA (experimental). Measurements were made during the surgery to determine crestal resorption, defect resolution and defect fill. Membranes were removed at 4 to 6 weeks. At 6 months, the soft and hard tissue measurements (surgical reentry) were repeated. Both groups showed statistically significant improvement when compared to baseline (p<0.001), but no difference was determined between groups. Control sites showed a 50% bone fill and experimental sites had 54% bone fill. The defect resolution changes were also similar between control and experimental groups, respectively (80%, 74%). For this short-term study, it was concluded that either technique was beneficial for the treatment of intraosseous defects. Other studies are needed to assess the long-term stability of the improvements rendered by these treatments.     

富含血小板血浆与口腔种植骨再生

富含血小板血浆因含多种高浓度生长因子而对骨再生有促进作用。本文综述了富含血小板血浆在促进口腔种植骨再生的研究进展。     

Blood-filled spaces with and without deproteinized bone grafts in guided bone regeneration. A histomorphometric study of the rabbit skull using non-resorbable membrane

This experimental study evaluated the effects of deproteinized bone grafts on guided bone regeneration (GBR). A groove was made in the bone marrow of the external cortical plate of the skull. A dome of non-resorbable membrane was placed on the groove and secured with titanium pins. The secluded graft space was filled with autogenous blood clots (control group) and deproteinized bone particles (experimental group). The rabbits were sacrificed 2, 4, 8 and 12 weeks after the operation. Decalcified and paraffin-embedded, transverse 3-mum-thick sections were made and stained with hematoxylin and eosin. The proportions of newly formed bone and newly formed bone-graft particle contact surfaces were histomorphometrically measured in the basal, central, and peripheral areas from the cortical plate to the top of the dome. In the control group, the basal area showed a significant increase at 4 weeks (P<0.01) and a significant decrease at 8 weeks (P<0.01). The central and peripheral areas showed gradual increases in the proportion of newly formed bone. The experimental group showed significant increase at 4 weeks in the basal area and at 8 weeks in central and peripheral area (P<0.01). There were significant differences between both groups in basal and central area (P<0.01). The proportion of newly formed bone-graft particle contact length showed significant increases at 4 weeks (P<0.01) and no significant decreases at 8 and 12 weeks in three areas. The present study showed that deproteinized bone grafts maintain newly formed bone in extensive areas for a prolonged period during GBR.     

富血小板血浆与脱矿冻干骨联合应用治疗牙周骨缺损的meta分析

目的: 从临床和影像学两方面系统评价富血小板血浆（platelet rich plasma,PRP )与脱矿冻干骨（demineralized freeze-dried bone allografts, DFDBA）联合应用治疗牙周骨内缺损的临床疗效。方法: 计算机检索Pubmed、The Cochrane Library、EMbase、中国知网、万方及维普数据库,检索PRP与DFDBA联合应用与PRP或DFDBA单独使用治疗牙周骨内缺损的随机对照试验（RCT),检索时限均从建库至2016年12月。由2名研究员按照纳入和排除标准独立筛选文献、提取资料,评价纳入研究的方法学质量。采用RevMan 5.2 软件进行统计学分析。结果: 最终纳入6个RCT,205个牙周骨内缺损位点。6个研究结果显示,牙周基础治疗后,PRP与DFDBA联合应用组与PRP或DFDBA组的探诊深度（probing depth, PD）改变量差异无统计学意义[MD=0.35,95%CI（-0.09,0.79),P=0.12],而临床附着丧失（clinical attachment loss,CAL）改变量2组间差异显著[MD= 0.68,95%CI（0.41,0.94）,P<0.00001]。有3个研究从影像学方面评估了治疗后骨充盈的改变量,其中釉-牙骨质界到牙槽骨缺损底部间距离(CEJ-BD)的改变量2组间差异显著[MD=0.71,95%CI（0.46,0.95）,P<0.00001];牙槽嵴缺损顶点到缺损底部间距离(AC-BD)的改变量2组间差异具有显著性[MD=0.64,95%CI（0.41,0.87),P<0.00001];而釉-牙骨质界到牙槽嵴缺损顶点的距离的改变量（CEJ-AC)2组间差异无显著性[MD=0.03,95%CI（-0.10,0.16),P=0.68]。结论: 现有研究证据表明,在牙周基础治疗后,PRP与DFDBA联合应用治疗牙周骨缺损在附着丧失和骨充盈上优于单用PRP或DFDBA组,而探诊深度无显著差异。受纳入研究数量及质量的限制,上述研究需要更多高质量、大样本的研究予以证实。