Senior Consultant, Oral Surgery Section of the Dental School of the University of Torino at the Azienda Ospedaliera Città della Salute e della Scienza of Torino, Turin, Italy.
Resident, Oral Surgery Section of the Dental School of the University of Torino at the Azienda Ospedaliera Città della Salute e della Scienza of Torino, Turin, Italy.
J Oral Maxillofac Surg. 2021 Feb;79(2):305-312. doi: 10.1016/j.joms.2020.09.033. Epub 2020 Sep 24.
Infections foster morbidity and mortality after liver transplantation (LT). Pre-LT eradication of oral infectious foci is not always possible for patients needing an urgent LT because postextraction sockets must be healed before the patient is operated, and this requires at least 3 weeks. To accelerate healing, we tested the effect of plasma-rich growth factor (PRGF), a highly concentrated form of autogenous platelets on healing.
Prospective case-control split-mouth study for more than 100 candidates for LT needing routine extractions of 2 homologous teeth: a socket was to be treated with PRGF, whereas its match (control [CTRL]) was to undergo natural healing. The outcome of interest was the socket size derived from the measurements on the transversal diameters and deepest level of penetration on the PRGF and CTRL sides after extraction and on day 7, 14, and 21 postextraction. The primary predictor was treatment status (PRGF vs CTRL); secondary predictors, the tooth extracted and patient's features. The statistical analysis used nonparametric tests and best subset regression.
All measurements evidenced a significantly (P < .0001) more advanced closure on the PRGF side than the CTRL side. One week after extraction, PRGF sockets were reduced to 12% (molars) and 6% (nonmolars) of the original wound versus 32 and 20% for CTRL, respectively. The percentage of PRGF sockets with size less than or equal to 5% was 7% for molars and 44% for nonmolars versus 0 and 12% for CTRL (P < .0001), respectively. The percentages with size less than or equal to 10% were 37% for molars and 81% for nonmolars on the PRGF side versus 2 and 26% on the CTRL side, respectively. These percentages showed a significant decrease for smoking patients.
The outcome of our trial showed that PRGF significantly accelerates closure of postextraction sockets. Its use, at least in patients who occupy top positions in the LT waiting list, is recommended.
感染会增加肝移植（LT）后的发病率和死亡率。对于需要紧急 LT 的患者，由于拔牙后必须等待拔牙窝愈合才能进行手术，而这至少需要 3 周时间，因此无法预先消除口腔感染病灶。为了加速愈合，我们测试了富含生长因子的血浆（PRGF）的效果，这是一种自体血小板的高度浓缩形式。
这是一项针对 100 多名 LT 候选者的前瞻性病例对照分口研究，这些患者需要常规拔出 2 颗同源牙齿：一侧拔牙窝接受 PRGF 治疗，而对侧（对照[CTRL]）拔牙窝进行自然愈合。主要结果是拔牙后和拔牙后第 7、14 和 21 天，从横向直径和最深穿透深度测量得出的拔牙窝大小。主要预测因子是治疗状态（PRGF 与 CTRL）；次要预测因子为所拔出的牙齿和患者特征。统计分析使用非参数检验和最佳子集回归。
所有测量结果均表明，PRGF 侧的愈合明显（P<0.0001）更快。拔牙后一周，PRGF 拔牙窝缩小至原始伤口的 12%（磨牙）和 6%（非磨牙），而 CTRL 分别为 32%和 20%。PRGF 拔牙窝的大小小于或等于 5%的比例分别为磨牙的 7%和非磨牙的 44%，而 CTRL 分别为 0%和 12%（P<0.0001）。PRGF 磨牙和非磨牙拔牙窝的大小小于或等于 10%的比例分别为 37%和 81%，而 CTRL 分别为 2%和 26%。对于吸烟患者，这些比例明显下降。
本试验结果表明，PRGF 可显著加速拔牙窝的愈合。建议至少在 LT 等候名单上排名靠前的患者中使用。
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