Oral and Maxillofacial Surgery
Platelet-rich fibrin (PRF): A second-generation platelet concentrate. Part V: Histologic evaluations of PRF effects on bone allograft maturation in sinus lift

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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) (Phœnix; 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.

Section snippets

Patient selection

This study is a case of 9 sinus elevations performed between January 2001 and June 2003 with FDBA (Phoenix; TBF, France) with or without PRF (Table I). The study was conducted in accordance with the standards of the Declaration of Helsinki of 1983. The patients were informed about the aim and design of the study and written consent was obtained.

Patients with immunologic diseases, unstable diabetes mellitus, ongoing chemo- or radiotherapy, or a history of drug abuse were excluded. The inclusion

Results

Preliminary analyses highlight mineralized trabecular bone rich in osteocytes with important oteoïd borders in contact with dense cellular osteoblast fronts (Fig. 1). Nevertheless, trabecular bone areas are less massive, more spaced and surrounded by adipose tissue. These observations especially concern apical parts of the samples. This phenomenon is explainable by the difficulty of correctly packing the bone graft particles in the entire sinus cavity during surgery. Even if such areas are less

Discussion

The aim of this histologic study was to evaluate the potential of PRF in combination with freeze-dried bone allograft to enhance bone regeneration in sinus floor elevation. Histomorphometric analysis shows that bone structures between control group (FDBA alone) and test group (FDBA+PRF) seem to be similar. But the healing period of the 2 groups was not identical (8 months and 4 months, respectively). Therefore, use of PRF with FDBA to perform sinus floor augmentation seems to accelerate bone

Conclusions

In this study, the histologic similarities observed between these 2 groups (FDBA alone and FDBA+PRF) make it possible to consider sinus floor augmentation surgery with a shorter healing period before implant placement (4 months instead of 8 months). Furthermore, the quantity of bone material used to fill the sinus cavity can be safely reduced without injuring the final bone density. Finally, the PRF membranes appear to be able to treat sinus membrane perforation and permit the surgery to be

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    This article is an English translation of: Choukroun J, Simonpieri A, Girard MO, Schoeffler C, Dohan S, Dohan D. Les concentrés plaquettaires. 4ème partie: Analyses histologiques. Implantodontie 2004;13:167-72. Published in the French journal Implantodontie, Elsevier SAS. All rights reserved.

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