Kemik İçi Defektlerin Tedavisinde Açık Flep Debridmanı ile Trombositten Zengin Fibrin Kullanımının Etkinliği: Bir Olgu Serisi

Year 2022, Volume: 3 Issue: 2, 42 - 48, 31.12.2022

Anas Alsafadı Basem Alshujaa Dicle Altındal

Abstract

Periodontitis diş kaybının önemli bir nedenidir ve bu durum bakteri iltihabı ve periodontal yıkımla karakterizedir. Periodontal tedavinin nihai amacı sadece periodontal hastalığın gelişimini yavaşlatmak değil, aynı zamanda yeni sement oluşumu ile birlikte yeni oluşan kemik ve sement arasında yeni bir bağ dokusu ataşmanı içeren periodontal kompleksin mimari ve fonksiyonel bütünlüğünü yeniden oluşturmaktır. Diş taşı ve granülasyon dokusunun tamamen çıkarılması, periodontitis tedavisinde açık flep debridman prosedürü ile elde edilen biyolojik olarak kabul edilebilir bir diş yüzeyi elde etmenin birincil parçasıdır. Cerrahi erişimin diş taşı temizliği ve kök yüzey düzleştirilmesi etkinliğini iyileştirdiği gösterilmiştir. Son zamanlarda büyüme faktörlerinden zengin ikinci nesil bir trombosit konsantresi olan trombositten zengin fibrin, periodontal rejenerasyon prosedüründe kullanılmaktadır. Bu vaka serisinin amacı, derin kemik içi defekt hastalarının tedavisinde trombositten zengin fibrin'in etkinliğini tanımlamaktır. Debridmanın ardından kemik defekti içine taze hazırlanmış bir otolog trombositten zengin fibrin pıhtısı yerleştirilmiştir. Klinik ve radyografik takipler, ağrı yokluğu, klinik ataşman seviyesinde artış, sondalama derinliğinde azalma ve başarılı sonucu gösteren kemik rejenerasyonu ortaya çıkaran düzenli aralıklarla gerçekleştirilmiştir.

Keywords

Cerrahi flepler, kemik rejenerasyonu, trombositten zengin fibrin

The Effectiveness of Using Platelet Rich Fibrin with Open Flap Debridement in Treatment of Intra-Bony Defects: A Case Series

Abstract

Periodontitis, which is characterized by bacterial inflammation and periodontal damage, is a primary cause of tooth loss. The main objective of periodontal treatment is not only to slow down the progression of periodontal problem, but also to regenerate the architectural and functional integrity of the periodontal tissue, which includes the formation of new cementum together with a new connective tissue and newly formed bone. Thorough removal of calculus and granulation tissues is a critical part of obtaining a biologically appropriate tooth surface in the management of periodontitis, which is can achieved surgically by open flap debridement procedure. Surgical access has proved to improve the effectiveness of scaling and root planning procedure. Platelet-rich fibrin is a second-generation platelet concentrate which contains abundant amount of growth factors and can be used effectively in periodontal regeneration procedures. The goal of this case series is to show the efficiency of platelet-rich fibrin in the management of patients who have a deep intra-bony pocket by placing a freshly prepared platelet-rich fibrin clot inside intra-bony defect following open flap debridement. Clinical and radiographic follow-up were performed after a 2-year, and revealed a clinical attachment level gain, probing depth reduction, and bone fill indicating successful outcomes.

Keywords

Bone regeneration, platelet-rich fibrin, surgical flaps

References

• 1. Froum SJ, Gomez C, Breault MR. Current concepts of periodontal regeneration. A review of the literature. N Y State Dent J. 2002;68(9):14-22.
• 2. Kornman KS, Robertson PB. Fundamental principles affecting the outcomes of therapy for osseous lesions. Periodontol 2000. 2000;22:22-43.
• 3. Lang NP. Focus on intrabony defects - Conservative therapy. Periodontol 2000. 2000;22:51-58.
• 4. Reynolds MA, Kao RT, Camargo PM, Caton JG, Clem DS, Fiorellini JP, et al. Periodontal Regeneration – Intrabony Defects: A Consensus Report From the AAP Regeneration Workshop. J Periodontol. 2015;86(2 Suppl), S105–S107.
• 5. Cortellini P. Reconstructive periodontal surgery: A challenge for modern periodontology. Int Dent J. 2006;56(4 Suppl 1):250-255.
• 6. Graziani F, Gennai S, Cei S, Cairo F, Baggiani A, Miccoli M, et al. Clinical performance of access flap surgery in the treatment of the intrabony defect. A systematic review and meta-analysis of randomized clinical trials. J Clin Periodontol. 2012;39(2):145-156.
• 7. Sander L, Karring T. Healing of periodontal lesions in monkeys following the guided tissue regeneration procedure A histological study. J Clin Periodontol. 1995;22(4):332-337.
• 8. Patel GK, Gaekwad SS, Gujjari SK, S.C. VK. Platelet-Rich Fibrin in Regeneration of Intrabony Defects: A Randomized Controlled Trial. J Periodontol. 2017;88(11):1192-1199.
• 9. Stoecklin-Wasmer C, Rutjes AWS, Da Costa BR, Salvi GE, Jüni P, Sculean A. Absorbable collagen membranes for periodontal regeneration: A systematic review. J Dent Res. 2013;92(9):773-781.
• 10. Ajwani H, Shetty S, Gopalakrishnan D, Kathariya R, Kulloli A, Dolas RS, et al. Comparative evaluation of platelet-rich fibrin biomaterial and open flap debridement in the treatment of two and three wall intrabony defects. J Int Oral Heal. 2015;7(4):32-37.
• 11. Siciliano VI, Andreuccetti G, Siciliano AI, Blasi A, Sculean A, Salvi GE. Clinical Outcomes After Treatment of Non-Contained Intrabony Defects With Enamel Matrix Derivative or Guided Tissue Regeneration: A 12-Month Randomized Controlled Clinical Trial. J Periodontol. 2011;82(1):62–71.
• 12. Crea A, Dassatti L, Hoffmann O, Zafiropoulos G-G, Deli G. Treatment of Intrabony Defects Using Guided Tissue Regeneration or Enamel Matrix Derivative: A 3-Year Prospective Randomized Clinical Study. J Periodontol. 2008;79(12):2281-2289.
• 13. Froum SJ, Weinberg MA, Rosenberg E, Tarnow D. A Comparative Study Utilizing Open Flap Debridement With and Without Enamel Matrix Derivative in the Treatment of Periodontal Intrabony Defects: A
• 12-Month Re-Entry Study. J Periodontol. 2001;72(1):25-34.
• 14. Silvestri M, Ricci G, Rasperini G, Sartori S, Cattaneo V. Comparison of treatments of infrabony defects with enamel matrix derivative, guided tissue regeneration with a nonresorbable membrane and Widman modified flap. A pilot study. J Clin Periodontol. 2000;27(8):603-610.
• 15. Miteva MD. Emdogain (EMD) and platelet-rich plasma (PRP) in periodontal regeneration. Scr Sci Med Dent. 2019;5(1):27-32
• 16. Dohan Ehrenfest DM, Rasmusson L, Albrektsson T. Classification of platelet concentrates: from pure platelet-rich plasma (P-PRP) to leucocyte- and platelet-rich fibrin (L-PRF). Trends Biotechnol. 2009;27(3):158-167.
• 17. Masuki H, Okudera T, Watanebe T, Suzuki M, Nishiyama K, Okudera H, et al. Growth factor and pro-inflammatory cytokine contents in platelet-rich plasma (PRP), plasma rich in growth factors (PRGF), advanced platelet-rich fibrin (A-PRF), and concentrated growth factors (CGF). Int J Implant Dent. 2016;2(1):19.
• 18. Kökdere NN, Baykul T, Findik Y. The use of platelet-rich fibrin (PRF) and PRF-mixed particulated autogenous bone graft in the treatment of bone defects: An experimentaland histomorphometrical study. Dent Res J (Isfahan). 2015;12(5):418-424.
• 19. Pham tav. Intrabony defect treatment with platelet-rich fibrin, guided tissue regeneration and open-flap debridement: a randomized controlled trial. J Evid Based Dent Pract. 2021;21(3):101545.
• 20. Pradeep AR, Rao NS, Agarwal E, Bajaj P, Kumari M, Naik SB. Comparative Evaluation of Autologous Platelet-Rich Fibrin and Platelet-Rich Plasma in the Treatment of 3-Wall Intrabony Defects in Chronic Periodontitis: A Randomized Controlled Clinical Trial. J Periodontol. 2012;83(12):1499–507.