Guided bone regeneration in staged vertical and horizontal bone augmentation using platelet-rich fibrin associated with bone grafts: a retrospective clinical study

Abstract

Background The use of guided bone regeneration (GBR) for vertical and horizontal bone gain is a predictable approach to correct the bone defects before implant installation; however, the use of different protocols is associated with different clinical results. It is suggested that platelet-rich fibrin (PRF) could improve the outcomes of regenerative procedures. Thus, this study aimed to describe the bone gain associated with GBR procedures combining membranes, bone grafts, and PRF for vertical and horizontal bone augmentation. Materials and methods Eighteen patients who needed vertical or horizontal bone regeneration before installing dental implants were included in the study. The horizontal bone defects were treated with a GBR protocol that includes the use of a mixture of particulate autogenous and xenogenous grafts in the proportion of 1:1, injectable form of PRF (i-PRF) to agglutinate the graft, an absorbable collagen membrane covering the regenerated region, and leukocyte PRF (L-PRF) membrane covering the GBR membrane. The vertical bone defects were treated with the same grafted mixture protected by a titanium-reinforced non-resorbable high-density polytetrafluoroethylene (d-PTFE-Ti) membrane and covered by L-PRF. The bone gain was measured using a cone-beam computed tomography at baseline and after a period of 7.5 (± 1.0) months. Results All patients underwent surgery to install implants after this regenerative protocol. The GBR produces an increase in bone thickness (p < 0.001) and height (p < 0.005) after treatment, with a bone gain of 5.9 ± 2.4 for horizontal defects and 5.6 ± 2.6 for vertical defects. In horizontal defects, the gain was higher in the maxilla than in mandible (p = 0.014) and in anterior than the posterior region (p = 0.033). No differences related to GBR location were observed in vertical defects (p > 0.05). Conclusion GBR associated with a mixture of particulate autogenous and xenogenous grafts and i-PRF is effective for vertical and horizontal bone augmentation in maxillary and mandibular regions, permitting sufficient bone gain to future implant placement. Trial registration REBEC, RBR-3CSG3J. Date of registration—19 July 2019, retrospectively registered. http://www.ensaiosclinicos.gov.br/rg/RBR-3csg3j/

Alveolar Bone Ridge Augmentation Using Polymeric Membranes: A Systematic Review and Meta-Analysis

“…The complications rate was 8.4%, while five studies did not report any type [ 16 , 19 , 24 , 25 , 27 ]. The 11 remaining studies demonstrate some clinical complications, including: membrane exposure, the most frequent (15 membranes exposures in seven studies [ 17 , 21 , 23 , 26 , 28 , 29 , 30 ]); nine dehiscences were reported in three studies [ 18 , 20 , 22 ]; two manuscripts referred to one infection each [ 23 , 26 ] ( Table 1 ).…”

“…Ten of the selected studies used autologous bone + xenogenic as bone substitute [ 16 , 18 , 19 , 20 , 21 , 23 , 24 , 25 , 26 , 30 ], from which, 70% used particulate autologous bone + xenograft [ 16 , 18 , 21 , 24 , 25 , 26 , 30 ], 20% used autologous bone block [ 19 , 23 ], and one study compared both techniques [ 20 ], concluding that mean horizontal bone gain and width after healing were significantly greater in the group of autologous particulate bone compared to bone block.…”

“…High bone gain results (5.9 ± 2.4 mm [ 25 ], 5.42 ± 0.76 mm [ 20 ], and 5.03 ± 2.15 mm [ 21 ]) were obtained in three studies which employed a common protocol. They used a collagen membrane with bovine-derived xenograft in combination with autogenous bone chips as bone filler.…”

“…It should be considered that the experiments’ sample size ranges from 6 to 21 patients and from 6 to 29 surgical interventions. A mean bone gain of 5.9 mm (SD: 2.4 mm) was achieved in the study with the greatest sample size [ 25 ], a case series in which a combination of demineralized bovine bone matrix particles with autogenous bone, adding leukocytes and platelet rich fibrin was used. However, it should be remarkable that a high statistical significance was obtained at the random-model effects ( p < 0.001).…”

Efficacy of i-PRF in regenerative endodontics therapy for mature permanent teeth with pulp necrosis: study protocol for a multicentre randomised controlled trial

“…This liquid blood derivative is enriched with high concentrations of platelets, leukocytes, and growth factors [ 31 – 33 ]. Recent studies have reported that i-PRF provides a three-dimensional fibrin-dynamic gel embedded with platelets, leukocytes, type-I collagen, osteocalcin, and growth factors [ 31 ] with the potential to modulate inflammatory processes [ 34 ], exert anti-bacterium and anti-biofilm activities [ 35 , 36 ], and promote osteogenesis [ 37 – 39 ]. Compared to PRF, i-PRF results in better bone regeneration [ 39 ], treatment of gingival recession defects [ 40 ], and elimination of endodontic infection [ 36 ].…”