감염된 미성숙 영구치에서 platelet-rich fibrin과 double antibiotic paste를 이용한 치수 재혈관화 : 증례 보고

전상윤,이난영,이상호 大韓小兒齒科學會 2013 大韓小兒齒科學會誌 Vol.40 No.3

Paradigm shift in management of infected immature permanent teeth has occurred. The new concept of the treatment includes minimal or no intracanal instrumentation, disinfection with triple antibiotic paste and sealing with mineral trioxide aggregate. This regenerative endodontic treatment promotes differentiation of periradicular stem cells that induce regeneration of vital tissue and continuation of root formation. Thorough disinfection and three-dimensional scaffold are important in this new concept of the treatment. Platelet-rich fibrin has been reported as 'new scaffold' instead of blood clot, which had been used in the past. Triple antibiotics can be used to disinfect the tooth but may lead to complications including discoloration. Three cases of infected immature permanent tooth caused by dens evaginatus fracture are presented. After removal of necrotic pulp and thorough intracanal irrigation, only platelet-rich fibrin was applied to the root canal in the first case. In the other cases, topical antibiotics was used for disinfection and platelet-rich fibrin for scaffold. In all the cases, the opening was sealed with mineral trioxide aggregate. All the cases showed proper healing of inrabony lesion and some lengthening of root. According to these cases, regenerating vital tissue of the infected immature permanent tooth can be achieved with disinfection and application of platelet-rich fibrin. 감염된 미성숙 영구치의 치수치료에 있어 줄기세포의 분화를 유도하는 생활조직의 재생과 지속적인 치근형성을 도모하는방향으로 패러다임이 전환되고 있는데, 여기에서는 소독, 스캐폴드(scaffold), 그리고 폐쇄가 중요하다. 소독을 위해 triple antibiotics가 널리 사용되고 있으며, 스캐폴드로써 기존의 혈병대신 platelet-rich fibrin의 사용이 보고되었다. 본 증례보고에서는 치외치 파절에 의해 치수가 감염된 미성숙 영구치에서 platelet-rich fibrin을 스캐폴드로써 이용한 치수 재혈관화를시행하였다. 발수와 근관세척 후 첫 증례에서 국소적 항생제의 적용 없이 platelet-rich fibrin을 단독 사용하였고 두 번째와세 번째 증례에서는 국소적 항생제 적용 후 platelet-rich fibrin을 적용하였는데 모두 양호한 치유 결과를 얻었다.

Evaluation of blood clot, platelet-rich plasma, and platelet-rich fibrin–mediated regenerative endodontic procedures in teeth with periapical pathology: a CBCT study

Markandey Swati,Das Adhikari Haridas 대한치과보존학회 2022 Restorative Dentistry & Endodontics Vol.47 No.4

Objectives This study compared the clinical and radiological outcomes of regenerative endodontic procedures (REPs) using blood clots (BCs), platelet-rich plasma (PRP), and platelet-rich fibrin (PRF) through intraoral periapical radiography (IOPAR) and cone-beam computed tomography (CBCT). Materials and Methods Forty-five single-rooted necrotic teeth with periapical pathology were randomly allocated to receive BC, PRP, or PRF as an individual scaffold. Outcomes were evaluated in 35 teeth in 23 patients with a follow-up period of 12–24 months through qualitative IOPAR scoring and quantitative CBCT measurements. Healing of periapical lesions and in immature teeth, changes in the apical foramen diameter (AFD), root wall thickness (RWT), and root length (RL) were assessed. A p value less than 0.05 was considered to indicate statistical significance. Results All teeth were asymptomatic except 1 in the PRP group. Periapical lesion healing was seen in all except 2 teeth in the BC group and 3 in the PRP group. Both IOPAR and CBCT revealed no significant differences in bone healing or changes in AFD, RWT, and RL among the 3 groups. A positive pulp sensibility response to the cold test was seen in 2 teeth in the BC group, but none to the electric pulp test. Intracanal calcification (ICC) was evident in more teeth in the BC group than in the PRP and PRF groups, and was also significantly higher in immature teeth. Conclusions Our results revealed that BC, PRP, and PRF have similar potential as scaffolds in REPs, and ICC may be a concern for long-term outcomes. Objectives This study compared the clinical and radiological outcomes of regenerative endodontic procedures (REPs) using blood clots (BCs), platelet-rich plasma (PRP), and platelet-rich fibrin (PRF) through intraoral periapical radiography (IOPAR) and cone-beam computed tomography (CBCT). Materials and Methods Forty-five single-rooted necrotic teeth with periapical pathology were randomly allocated to receive BC, PRP, or PRF as an individual scaffold. Outcomes were evaluated in 35 teeth in 23 patients with a follow-up period of 12–24 months through qualitative IOPAR scoring and quantitative CBCT measurements. Healing of periapical lesions and in immature teeth, changes in the apical foramen diameter (AFD), root wall thickness (RWT), and root length (RL) were assessed. A p value less than 0.05 was considered to indicate statistical significance. Results All teeth were asymptomatic except 1 in the PRP group. Periapical lesion healing was seen in all except 2 teeth in the BC group and 3 in the PRP group. Both IOPAR and CBCT revealed no significant differences in bone healing or changes in AFD, RWT, and RL among the 3 groups. A positive pulp sensibility response to the cold test was seen in 2 teeth in the BC group, but none to the electric pulp test. Intracanal calcification (ICC) was evident in more teeth in the BC group than in the PRP and PRF groups, and was also significantly higher in immature teeth. Conclusions Our results revealed that BC, PRP, and PRF have similar potential as scaffolds in REPs, and ICC may be a concern for long-term outcomes.

Effect of Platelet-Rich Fibrin on Repair of Defect in the Articular Disc in Rabbit Temporomandibular Joint by Platelet-Rich Fibrin

( Hyun Su Baek ),( Hye Sung Lee ),( Bok Joo Kim ),( In Kyo Chung ),( Chul Hoon Kim ),( Sun Mi Jin ),( Hie Sung Hwang ),( Sang Hun Shin2 ) 한국조직공학·재생의학회 2011 조직공학과 재생의학 Vol.8 No.6

The objective of this study was to evaluate platelet-rich fibrin (PRF)’s effectiveness in repairing articular disc defect in the temporomandibular joint (TMJ) of rabbits. Eight rabbits were divided into four groups of two rabbits each, corresponding to groups A, B, C, and D. Both TMJs of all of the rabbits were used in the experiments: the right joints comprised the experimental groups, and the left ones, the control groups. The disc defect was circular and 2 mm in diameter. In the experimental groups, the PRF was compressed into the defect, whereas the control group defects were left untreated. A, B, C, and D groups were sacrificed at the 1st, 2nd, 4th and 6th weeks, respectively. The defects of each control group exhibited no specific changes. Contrastingly, in each experimental group, there was an increased number of chondroblasts at the margins of the defects, along with accelerated cell differentiation and a columnar cell arrangement observable at the time of cell differentiation. The experimental groups showed inflammatory cell infiltrations and fibrosis by the 1st week, maturation of chondrocytes by the 2nd week, and proliferation by the 4th week, after which the defects began to be filled with chondrocytes, a process that was complete after the 6th week. In the histological evaluation (H-E), the experimental groups showed significant increases of chondroblasts after the 2nd and 4th weeks, as well as regular columns of chondrocyte arrays observable during cell division. After 6 weeks, the defects were filled with chondrocytes.

임플란트 주위 골 결손 부위에 Choukroun's Platelet-rich-fibrin와 실크 분말 복합 이식재 사용

장은식,이형석,이희성,이희종,박기유,박영욱,윤연진,홍순민,박준우,Jang, Eun-Sik,Lee, Hyung-Seok,Lee, Hee-Sung,Lee, Hee-Jong,Park, Ki-Yu,Park, Young-Wook,Yoon, Youn-Jin,Hong, Soon-Min,Park, Jun-Woo 대한악안면성형재건외과학회 2011 Maxillofacial Plastic Reconstructive Surgery Vol.33 No.2

Purpose: Choukroun's platelet-rich-fibrin (PRF) is composed of platelets, white blood cells and fibrin matrix. It does not induce enough bone formation by itself but it can improve bone formation with calcium. Silk fibroin does not cause inflammatory reactions because it is bio-compatible and degradable. The purpose of this study was to exam the bone formation when a combination of Choukroun's PRF and silk fibroin was used. Methods: In this study, cell reactions to silk powder with differing molecular weights was first tested to select the appropriate silk powder. Then we applied these bone graft materials on defects of skull and in a peri-implant bony defect model in New Zealand rabbits. The results between the experimental and control s (non-grafted) group were analyzed. Results: The small sized silk fibroin powder showed increased cellular proliferation for bone-regeneration. There was no statistically significant difference between the experimental group and the control group at 6 weeks, but more new bone formation was observed in the combination graft group at 12 weeks (P<0.05). And in the dental implant model, the combination bone graft group showed much improved torque test results, which was statistically significant. Histomorphometric analysis showed more regenerated cortical bone and a higher mean bone to implant in the experimental group. Both were statistically significant. Conclusion: The combination graft of Choukroun's platelet-rich-fibrin (PRF) and silk fibroin powder can successfully restore the bony defects in a skull defected model and a peri-implant bony defects model.

상악 전치부 3D-티타늄 차폐막과혈소판농축섬유소를 적용한 골유도재생술의임상적 평가

이나연,윤정호,고미선,정양훈,이정진,서재민 대한구강악안면임플란트학회 2018 대한구강악안면임프란트학회지 Vol.22 No.4

The aim of the current study was to evaluate the results of horizontal guided bone regeneration (GBR) with xenograf t (deproteinized bovine bone mineral, DBBM), allograf t (irradiated allogenic cancellous bone and marrow), titanium membrane, resorbable collagen membrane, and advanced platelet-rich fibrin (A-PRF) in the anterior maxilla. The titanium membrane was used in this study has a three-dimensional (3D) shape that can cover ridge defects. Case 1. A 32-yearold female patient presented with discomfort due to mobility and pus discharge on tooth #11. Three months af ter extracting tooth #11, diagnostic sof tware (R2 GATE diagnostic sof tware, Megagen, Daegu, Korea) was used to establish the treatment plan for implant placement. At the first stage of implant surgery, GBR for horizontal augmentation was performed with DBBM (Bio-Oss®, Geistlich, Wolhusen, Switzerland), irradiated allogenic cancellous bone and marrow (ICB cancellous®, Rocky Mountain Tissue Bank, Denver, USA), 3D-titanium membrane (i-Gen®, Megagen, Daegu, Korea), resorbable collagen membrane (Collagen membrane®, Genoss, Suwon, Korea), and A-PRF because there was approximately 4 mm labial dehiscence after implant placement. Five months after placing the implant, the second stage of implant surgery was performed, and healing abutment was connected after removal of the 3D-titanium membrane. Five months after the second stage of implant surgery was done, the final prosthesis was then delivered. Case 2. A 35-year-old female patient presented with discomfort due to pain and mobility of implant #21. Removal of implant #21 fixture was planned simultaneously with placement of the new implant fixture. At the first stage of implant surgery, GBR for horizontal augmentation was performed with DBBM (Bio-Oss®), irradiated allogenic cancellous bone and marrow (ICB cancellous®), 3D-titanium membrane (i-Gen®), resorbable collagen membrane (Ossix plus®, Datum, Telrad, Israel), and A-PRF because there was approximately 7 mm labial dehiscence after implant placement. At the second stage of implant surgery six months after implant placement, healing abutment was connected after removing the 3D-titanium membrane. Nine months after the second stage of implant surgery was done, the final prosthesis was then delivered. In these two clinical cases, wound healing of the operation sites was uneventful. All implants were clinically stable without inflammation or additional bone loss, and there was no discomfort to the patient. With the non-resorbable titanium membrane, the ability of bone formation in the space was stably maintained in three dimensions, and A-PRF might influence soft tissue healing. This limited study suggests that aesthetic results can be achieved with GBR using 3D-titanium membrane and A-PRF in the anterior maxilla. However, long-term followup evaluation should be performed. Ⅰ. 서론 : 상악 전치부의 경우 임플란트 식립은 환자의 심미적 요구와 기존의 해부학적 형태로 인해 임상가들에게 도전적인 영역일 수 있다. 상악 전치부는 크게 해부학적, 병리학적 2가지의 원인으로 인한 조직 결함을 가지게 된다. 해부학적 요인으로는 좁은 치조골 너비와 치조돌기의 순면 경사, 병리학적 요인으로치아 외상, 급성 또는 만성 감염 및 결손치의 부적절한 시기의 수복으로 인한 치조골 결손부의 증가를예로 들 수 있다1, 2. 그러나 위와 같은 어려움에도 불구하고, 상악 전치부에서 임플란트 식립은 구치부와비교 시 성공률과 생존율 면에서 유사하다고 보고된다3, 4. 치아는 발치 후 잔존 치조골 폭경과 수직적 골 높이의 소실이 일어나고, 이로 인해 연조직의 변화 또한 수반된다5. 따라서, 이상적인 위치에 임플란트를 식립하기 위해서는 결손 된 경조직과 연조직의 변화를 고려해야 한다. 골 결손 부위를 재건하기 위한 골유도재생술(guided bone regeneration, GBR)은 예지성 있는 치료로 여겨지며, 일차 치유 봉합(primary wound closure), 혈관 신생(angiogenesis), 공간 형성/ 유지(space creation/maintenance), 그리고 초기 혈병과 임플란트의 안정성(stability of both the initial blood clot implant fixture)의 4가지 생물학적 원리에 기초하여 임상적인 성공을 이룰 수 있다6. 경조직 재건을 위한 차폐막의 사용은 필수적인데 현재 임상에서 환자와 술자의 편의를 위해 차폐막의 제거를 위한 2차 수술이 필요 없는 흡수성 차폐막의 사용이 많이 이루어지고 있다. 그러나 비흡수성차폐막의 경우 흡수성보다 공간 유지에 유리하고, 차폐막이 기능하는 시간을 조절할 수 있으며, 흡수되면서 방출되는 물질에 의한 골 이식 부위의 영향이 없다는 장점이 있어 골 이식 부위에 따라 비흡수성차폐막의 사용은 계속 이루어지고 있다7. 특히 이번 증례에서 사용한 티타늄 차폐막은 골 결손부 크기에 따라 선택할 수 있도록 3차원적(3 dimension, 3D)으로 디자인된 제품(i-Gen®, Megagen, Daegu, Korea)으로 이러한 3D-티타늄 차폐막(i-Gen®)은 차폐막이 제거된 이후에 발생 가능한 골 소실의 양을 고려하여 임플란트 주위에 충분한 골두께가 확보되도록 만들어졌다. 이렇게 3D-티타늄 차폐막을 사용하여 골유도재생술을 하면 만들어지는 치조골의 형태를 예측 할 수 있다. 한편, 최근 의료계에서는 결손부 치료 시, 재생 및 상처 치유 과정을 효과적으로 증진시키기 위한 재료 및 방법에 관해 활발히 연구 중이다. 그중 platelet-rich plasma (PRP)는 인간 혈액 샘플에서 유래한1세대 지지체(scaffold)로 광범위한 연구가 이루어졌다. 그러나 PRP를 만들기 위해서는 항응고제와bovine thrombin이 필요하고 제작 과정이 번거로운 단점이 있어 임상 적용에 제한이 있었다. 그래서 이런 단점을 개선하고 간소화한 platelet-rich fibrin (PRF)가 개발되었다8. PRF는 제작과정에 따라 여러 종류가 있는데 이번 증례에는 advanced platelet-rich fibrin (A-PRF)를적용하였다. A-PRF는 기존의 PRF보다 느린 속도의 원심 분리 과정을 통해 제작되며, 더 많고 다양한 혈액 세포와 성장 인자를 포함하여 세포 활성과 치유를 증진시킨다는 연구보고가 있다9. 이번 연구에서A-PRF의 구성을 확인 하기 위해 환자의 A-PRF membrane에 대해서 scanning electron microscope (SEM) 분석을 시행하였다. A-PRF membrane은 탈수 과정을 거친 후 영하 70도로 동결 건조되었다. SEM 촬영을 위해 동결 건조시킨 검체를 platinum으로 coating (LEICA EM ACE200, sputter...

가토의 두개 결손부에서의 실크 단백질과 platelet-rich fibrin (PRF)의 골형성 효과

송지영,권해용,권광준,박영욱,김성곤,Song, Ji-Young,Kweon, Hae-Yong,Kwon, Kwang-Jun,Park, Young-Wook,Kim, Seong-Gon 대한구강악안면외과학회 2010 대한구강악안면외과학회지 Vol.36 No.4

Introduction: This study evaluated the bone regenerative effect of silk fibroin mixed with platelet-rich fibrin (PRF) of a bone defect in rabbits. Materials and Methods: Ten New Zealand white rabbits were used for this study and bilateral round shaped defects were formed in the parietal bone (diameter: 8.0 mm). The silk fibroin mixed with PRF was grafted into the right parietal bone (experimental group). The left side (control group) was grafted only PRF. The animals were sacrificed at 4 weeks and 8 weeks. A micro-computerized tomography (${\mu}$CT) of each specimen was taken. Subsequently, the specimens were decalcified and stained for histological analysis. Results: The average value of plane film analysis was higher in the experimental group than in the control group at 4 weeks and 8weeks after surgery. However, the difference was not statistically significant.(P>0.05) The tissue mineral density (TMD) in the experimental group at 4 weeks after surgery was significantly higher than the control group.(P<0.05) Conclusion: Silk fibroin can be used as a scaffold of PRF for rabbit calvarial defect repair.

Regenerating the Pulp–Dentine Complex Using Autologous Platelet Concentrates: A Critical Appraisal of the Current Histological Evidence

Riaz Amna,Shah Furqan A. 한국조직공학과 재생의학회 2021 조직공학과 재생의학 Vol.18 No.1

Autologous platelet concentrates such as platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) have gained overwhelming popularity in regenerative endodontics. Clinical evidence reveals the lack of a particular advantage of using PRP or PRF over an evoked blood clot in promoting canal wall thickening and/or continued root development in immature necrotic teeth. Moreover, despite stimulating tissue repair and repopulating the root canals of immature and mature permanent teeth, the new vital tissue may not possess the functional activity of the native pulp tissue.To better understand the origin, nature, and long-term fate of the tissue types found within the pulp space, we critically examine all available histo-/morphological evidence for pulp–dentine complex regeneration using PRP and/or PRF, alone or together with an evoked blood clot, specialised or unspecialised primary cells, and other biomaterials.Histological data from clinical studies is scant. Reportedly, the inner dentinal surface supports cementum-like tissue formation, but this interface likely deviates in structure and function from the native cementodentinal junction. Presence of bone-like tissue within the pulp space is intriguing since de novo osteogenesis requires closely coordinated recruitment and differentiation of osteoprogenitor cells. Compared to untreated necrotic teeth, an evoked blood clot (with/without PRF) improves fracture resistance. Tooth regeneration using PRF and dental bud cells is unreliable and the constituent neoformed tissues are poorly organised.PRP/PRF fail to demonstrate a significant advantage over an induced blood clot, alone. The true nature of neoformed tissues remains poorly characterised while their response to subsequent insult/injury is unexplored.

Leukocyte platelet-rich fibrin in endodontic microsurgery: a report of 2 cases

Pires Mariana Domingos,Martins Jorge N. R.,Baruwa Abayomi Omokeji,Pereira Beatriz,Ginjeira António 대한치과보존학회 2022 Restorative Dentistry & Endodontics Vol.47 No.2

Endodontic microsurgery is a predictable treatment option when orthograde treatment or retreatment is unsuccessful or unfeasible. However, when there is a gross compromise of periapical bone, achievement of bone regeneration after the surgical procedure may be hampered. In such cases, the application of guided tissue regeneration principles, with adjunctive use of leukocyte platelet-rich fibrin to fill the bone defect as a bone substitute and as a membrane to cover the site, provides a cost-effective solution with the benefits of accelerated physiological healing and reduced post-surgical pain and discomfort. This case report presents 2 cases of endodontic microsurgery of the upper lateral incisors with loss of buccal cortical plate, where platelet-rich fibrin was successfully applied.

혈소판 농축재제를 이용한 창상치유의 촉진

한형민,전여름,나동균,유대현 대한성형외과학회 2011 Archives of Plastic Surgery Vol.38 No.4

Purpose: Although platelet-rich plasma (PRP) potentiate the wound healing activity of adipose-derived stem cells (ADSCs), its effect cannot be sustained for a prolonged period of time due to short duration of action. This led us to design and produce platelet-rich fibrin (PRF), in an effort to develop a tool which lasts longer, and apply it on wound healing. Methods: Two symmetrical skin defects were made on the back of seven nude mice. ADSCs were applied to each wound, combined with either PRP or PRF. The wound area was measured over 14 days. By day 16, the wound was harvested and histologic analysis was performed including counting of the blood vessel. Results: The healing rate was more accelerated in PRP group in the first 5 days (p<0.05). However, PRF group surpassed PRP group after 6 days (p<0.05). The average number of blood vessels observed in the PRF group was 6.53 ± 0.51, compared with 5.68 ± 0.71 for the PRP group. Conclusion: PRF exerts a slow yet pervasive influence over the two-week course of the wound healing process. Thus, PRF is probably more beneficial for promoting the activity of ADSCs for a sustained period of time.

Effect of Leukocyte-Platelet Rich Fibrin (L-PRF) on Tissue Regeneration and Proliferation of Human Gingival Fibroblast Cells Cultured Using a Modified Method

Mudalal Mahmoud,Wang Zhanqi,Mustafa Shockry,Liu Yiping,Wang Yao,Yu Jize,Wang Shengnan,Sun Xiaolin,Zhou Yanmin 한국조직공학과 재생의학회 2021 조직공학과 재생의학 Vol.18 No.5

Background: An in vitro study on rapid culturing method of human gingival fibroblast cells (HGFCs) was established to investigate the potential use of the leukocyte-platelet rich fibrin (L-PRF) in tissue engineering technology, different medical fields, including periodontology and implantology. Methods: Eight biopsies were obtained from eight different donors and a modified culturing technique was developed to obtain HGFCs. The modified 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide MTT assay was used to compare the cell viability when the modified culturing method was used in comparison to the standard method. Blood samples were collected from the same patients and L-PRF was isolated using a standard protocol. The releases of platelet-derived growth factor-AA and transforming growth factor-beta1 at various time intervals were observed using enzyme-linked immunosorbent assay (ELISA) kit. The proliferative effect of L-PRF on HGFCs was assessed by the cell counting kit—8 assay. Results: A simple and rapid modified method for in vitro HGFC culture yielded a cellular monolayer within three to nine days after cell culture. L-PRF with three-dimensional polymer fibers released growth factors that peaked during the first three hours and continued to produce up to 10 days. The L-PRF presented a dose-dependent effect on HGFCs proliferation where HGFCs proliferation increased with an increase in L-PRF concentration. Conclusion: The modified technique for the culture of HGFCs might be useful for the development of future experimental and clinical studies, besides L-PRF has great therapeutic potential in oral surgery fields. Background: An in vitro study on rapid culturing method of human gingival fibroblast cells (HGFCs) was established to investigate the potential use of the leukocyte-platelet rich fibrin (L-PRF) in tissue engineering technology, different medical fields, including periodontology and implantology. Methods: Eight biopsies were obtained from eight different donors and a modified culturing technique was developed to obtain HGFCs. The modified 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide MTT assay was used to compare the cell viability when the modified culturing method was used in comparison to the standard method. Blood samples were collected from the same patients and L-PRF was isolated using a standard protocol. The releases of platelet-derived growth factor-AA and transforming growth factor-beta1 at various time intervals were observed using enzyme-linked immunosorbent assay (ELISA) kit. The proliferative effect of L-PRF on HGFCs was assessed by the cell counting kit—8 assay. Results: A simple and rapid modified method for in vitro HGFC culture yielded a cellular monolayer within three to nine days after cell culture. L-PRF with three-dimensional polymer fibers released growth factors that peaked during the first three hours and continued to produce up to 10 days. The L-PRF presented a dose-dependent effect on HGFCs proliferation where HGFCs proliferation increased with an increase in L-PRF concentration. Conclusion: The modified technique for the culture of HGFCs might be useful for the development of future experimental and clinical studies, besides L-PRF has great therapeutic potential in oral surgery fields.