Marginal Bone‐Level Alterations at Implants Installed in Block versus Particulate Onlay Bone Grafts Mixed with Platelet‐Rich Plasma in Atrophic Maxilla. A Prospective 5‐Year Follow‐Up Study of 15 Patients

Background: Extensive atrophy of the alveolar process may require a bone‐grafting procedure prior to implant treatment. Autogenous bone grafts from the iliac crest, used as onlay block and particulate bone, have been used together with sinus‐lift procedure in order to rehabilitate patients with extremely resorbed maxillae. However, there are to our knowledge no 5‐year follow‐up studies evaluating the extent of bone‐level change in patients treated with respectively block and particulate autogenous bone grafts. Purpose: The purpose of this prospective clinical study was to conduct a 5‐year follow‐up analysis with focus on bone‐level alteration in block versus particulate onlay bone grafts. Material and Methods: Fifteen out of originally 19 patients who were treated with iliac bone grafts and oral implants in the maxilla have been followed through the first 5 postoperative years. In a first study conducted on 19 patients, the role of platelet‐rich plasma in conjunction with autogenous bone was evaluated. In this 5‐year follow‐up study, the marginal bone alterations have been documented at base line, 1 year and 5 years of loading to the nearest 0,1 mm at mesial and distal surfaces of the implants. Two implants were installed on each side of the midline in either block or particulate bone grafts giving test and control sides in each patient. Additionally, two implants on each side were installed in residual bone/grafted sinus floor. Result: Marginal bone alteration in the anterior maxilla appeared larger at the side augmented by block bone at baseline, and after 1 and 5 years of loading, but the change was not statistically significant. Moreover, there was a significantly higher degree of marginal alteration during the first year of loading, compared with the examinations after 5 years. Conclusion: The present follow‐up study showed that there is no significant difference in the extension of resorption between block‐ and particulate autogenous bone grafts over a 5‐year period. Most of the resorption occurred during the first year in function.     

Additive effect of autologous platelet concentrates in treatment of intrabony defects: a systematic review and meta‐analysis

The aim of the present review is to systematically evaluate the additive effect of autologous platelet concentrates (APCs) in treatment of intrabony defects when used along with other regenerative procedures and when used alone in terms of clinical and radiological outcomes. A search was performed in electronic databases (i.e., MEDLINE and the Cochrane Central Register of Controlled Trials) in order to identify randomized clinical trials (RCTs) assessing the additive efficacy of APCs for healing and regeneration of hard and soft tissues in patients undergoing regenerative surgical procedures for the treatment of intrabony defects, having a follow‐up of at least 9 months. Included studies underwent risk of bias assessment and data extraction. The main variables evaluated for efficacy were: pocket depth (PD), clinical attachment level (CAL), radiographic bone filling, and postoperative pain. The effect of APCs adjunct was evaluated for the following procedures: open flap debridement (OFD) alone, OFD plus grafting of the defect with autogenous bone or bone substitutes, and grafting in combination with a covering membrane for guided tissue regeneration (GTR). Platelet‐rich fibrin (PRF) has a significant additive effect when used along with OFD. Platelet‐rich plasma (PRP) has a significant additive effect when used along with bone grafts. Conversely, PRP was found to be ineffective when used in combination with GTR procedures. No study evaluated the effect of APCs on postoperative pain. Platelet‐rich plasma may be used advantageously as an adjunct to grafting materials, but not in combination with GTR, for treatment of intrabony defects. Moreover, PRF can be effective as a sole regenerative material, in combination with OFD. There is still a lack of evidence regarding the effect of PRF in combination with grafting materials and GTR, the effect of other types of APCs such as plasma rich in growth factors, and the effect of APCs on postoperative pain.     

Platelet‐rich fibrin membranes as scaffolds for periosteal tissue engineering

Objectives: Platelet‐rich fibrin (PRF)‐based membranes have been used for covering alveolar ridge augmentation side in several in vivo studies. Few in vitro studies on PRF and no studies using human periosteal cells for tissue engineering have been published. The aim is a comparison of PRF with the commonly used collagen membrane Bio‐Gide^® as scaffolds for periosteal tissue engineering. Material and methods: Human periosteal cells were seeded on membrane pieces (collagen [Bio‐Gide^®] and PRF) at a density of 10⁴ cells/well. Cell vitality was assessed by fluorescein diacetate (FDA) and propidium iodide (PI) staining, biocompatibility with the lactate dehydrogenase (LDH) test and proliferation level with the MTT, WST and BrdU tests and scanning electron microscopy (SEM). Results: PRF membranes showed slightly inferior biocompatibility, as shown by the LDH test. The metabolic activity measured by the MTT and WST tests was higher for PRF than for collagen (BioGide^®). The proliferation level as measured by the BrdU test (quantitative) and SEM examinations (qualitative) revealed higher values for PRF. Conclusion: PRF appears to be superior to collagen (Bio‐Gide^®) as a scaffold for human periosteal cell proliferation. PRF membranes are suitable for in vitro cultivation of periosteal cells for bone tissue engineering. To cite this article:
Gassling V, Douglas T, Warnke, PH, Açil Y, Wiltfang J, Becker ST. Platelet‐rich fibrin membranes as scaffolds for periosteal tissue engineering.
Clin. Oral Impl. Res. 21 , 2010; 543–549.
doi: 10.1111/j.1600‐0501.2009.01900.x