Division of Periodontology and Implant Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China.
Shanghai PerioImplant Innovation Center, Department of Oral and Maxillofacial Implantology, National Clinical Research Center of Stomatology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
J Clin Periodontol. 2022 Sep;49(9):889-898. doi: 10.1111/jcpe.13688. Epub 2022 Jul 17.
Leucocyte- and platelet-rich fibrin (L-PRF) has been tested for enhancing alveolar ridge preservation (ARP), but little is known about the local release profile of growth factors (GF), and the clinical equipoise related to its efficacy remains. This study compared the patterns of GF release, early soft tissue healing, and alveolar ridge resorption following unassisted healing and L-PRF application in non-molar extraction sockets.
Atraumatic tooth extraction of two hopeless teeth per patient was followed by unassisted healing or L-PRF placement to fill the socket in 18 systemically healthy, non-smoking subjects. This intra-individual trial was powered to assess changes in horizontal alveolar ridge dimensions 1 mm below the crest of alveolar bone. GF concentrations in wound fluid were assessed with a multiplex assay at 6, 24, 72, and 168 h. Early healing was evaluated with the wound healing index and changes in soft tissue volumes on serial digital scans. Hard tissue changes were measured on superimposed CBCT images after 5 months of healing.
L-PRF resulted in higher GF concentrations in wound fluid (WF) than in the control, but no differences in release patterns or time of peak were observed. No inter-group differences in early healing parameters were observed. Alveolar bone resorption was observed in both groups. No significant inter-group differences were observed in hard tissue healing 1, 3, or 5 mm apical to the original bone crest or in the ability to digitally plan a prosthetically guided implant with or without bone augmentation.
L-PRF increased the GF concentrations in WF of extraction sockets without shifting the pattern observed in unassisted healing, while the increased delivery did not translate into clinical benefits in early wound healing or ARP. The current findings question the assumption that increased local concentrations of GF by L-PRF translate into improved clinical outcomes. Additional definitive studies are needed to establish the benefits of L-PRF in ARP (ClinicalTrials.gov NCT03985033).
富白细胞和血小板纤维蛋白（L-PRF）已被用于增强牙槽嵴保存（ARP），但人们对生长因子（GF）的局部释放模式知之甚少，其疗效的临床均衡性仍然存在。本研究比较了非磨牙拔牙窝中未辅助愈合和 L-PRF 应用后的 GF 释放模式、早期软组织愈合和牙槽嵴吸收。
对每位患者的两颗无望牙齿进行非创伤性拔牙，然后让其在 18 名系统健康、不吸烟的受试者中进行未辅助愈合或 L-PRF 放置以填充牙槽窝。这项个体内试验有足够的效力来评估牙槽骨嵴下 1 毫米处水平牙槽嵴尺寸的变化。在 6、24、72 和 168 小时时，使用多重分析评估伤口液中的 GF 浓度。使用伤口愈合指数和连续数字扫描中软组织体积的变化评估早期愈合。愈合 5 个月后，在叠加的 CBCT 图像上测量硬组织变化。
L-PRF 导致伤口液（WF）中的 GF 浓度高于对照组，但释放模式或峰值时间没有差异。两组之间的早期愈合参数无差异。两组均观察到牙槽骨吸收。在原始牙槽嵴骨顶上方 1、3 或 5 毫米处的硬组织愈合以及是否需要进行骨增量的种植体修复指导的数字化规划方面，两组之间没有显著的组间差异。
L-PRF 增加了拔牙窝 WF 中的 GF 浓度，而没有改变未辅助愈合中观察到的模式，而增加的输送并没有转化为早期伤口愈合或 ARP 的临床获益。目前的研究结果对 L-PRF 通过增加局部 GF 浓度可转化为改善临床结果的假设提出了质疑。需要进一步的确定性研究来确定 L-PRF 在 ARP 中的益处（ClinicalTrials.gov NCT03985033）。
