Citation Information :
Ibraheem W. Effect of Platelet-rich Fibrin and Free Gingival Graft in the Treatment of Soft Tissue Defect preceding Implant Placement. J Contemp Dent Pract 2018; 19 (7):895-899.
Introduction: Free gingival graft is a procedure that is used to increase keratinized tissue around teeth and edentulous sites for future dental implants. Keratinized tissue is critical for maintainability of surgical site and flap management. Platelet-rich fibrin consists of bioactive and biological components, mainly composed of growth factors. Growth factors attract stem cells to the site of release and stimulate cell proliferation. Moreover, growth factors promote angiogenesis, which accelerates wound healing. Site preparation is critical in implant dentistry, including soft tissue and hard tissue augmentation.
Aim: To improve free gingival graft (FGG) healing by using platelet-rich fibrin (PRF) at the soft tissue defect area of extracted upper right first molar in order to restore keratinized tissue and prepare the site for bone grafting followed by dental implant placement.
Case report: A healthy female patient, 59 years old, presented to the dental clinic at the University at Buffalo, School of Dental Medicine, seeking dental implants to restore missing teeth. The patient had an extraction for upper right first molar 4 months ago. The surgical extraction left severe soft and hard tissue defects at the site. Free gingival graft was placed at the site to increase keratinized tissue band followed by PRF to improve healing. Cyanoacrylate adhesive was used to stabilize PRF. Two months later, a full-thickness flap was reflected, and tenting screws placed with bone grafting at the site. Titanium-reenforced membrane was placed over the bone graft. Three months later, tenting screws were removed and two dental implants were placed at the site.
Conclusion: The use of PRF accelerates the healing of FGG. More tissue handling could be achieved by increasing the keratinized tissue during surgical procedures.
Clinical significance: The combination of PRF and FGG could help in the healing process during soft tissue procedures.
Camargo PM, Melnick PR, Kenney EB. The use of free gingival grafts for aesthetic purposes. Periodontol 2000 2001 Oct;27:72-96.
Langer B. The regeneration of soft tissue and bone around implants with and without membranes. Compend Contin Educ Dent 1996 Mar;17(3):268-270, 272.
Lang NP, Löe H. The relationship between the width of keratinized gingiva and gingival health. J Periodontol 1992 Oct;43(10):623-627.
Miyasato M, Crigger M, Egelberg J. Gingival condition in areas of minimal and appreciable width of keratinized gingiva. J Clin Periodontol 1977 Aug;4(3):200-209.
Kiran NK, Mukunda KS, Tilak Raj TN. Platelet concentrates: a promising innovation in dentistry. J Dent Sci Res 2011 Feb;2(1):50-61.
Gupta V, Bains BK, Singh GP, Mathur A, Bains R. Regenerative potential of platelet rich fibrin in dentistry: literature review. Asian J Oral Health Allied Sci 2011 Jan-Mar;1(1):22-28.
Dohan DM, Choukroun J, Diss A, Dohan SL, Dohan AJ, Mouhyi J, Gogly B. Platelet-rich fibrin (PRF): a secondgeneration platelet concentrate. Part I: technological concepts and evolution. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006 Mar;101(3):e37-e44.
Dohan DM, Choukroun J, Diss A, Dohan SL, Dohan AJ, Mouhyi J, Gogly B. Platelet-rich fibrin (PRF): a second-generation platelet concentrate. Part II: platelet-related biologic features. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006 Mar;101(3):e45-e50.
Laurens N, Koolwijk P, de Maat MP. Fibrin structure and wound healing. J Thromb Haemost 2006 May;4(5):932-939.
Dohan DM, Choukroun J, Diss A, Dohan SL, Dohan AJ, Mouhyi J, Gogly B. Platelet-rich fibrin (PRF): a secondgeneration platelet concentrate. Part III: leucocyte activation: a new feature for platelet concentrates? Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006 Mar;101(3):e51-e55.
Buser D, Sennerby L, De Bruyn H. Modern implant dentistry based on osseointegration: 50 years of progress, current trends and open questions. Periodontol 2000 2017 Feb;73(1):7-21.
Kawase T, Kamiya M, Kobayashi M, Tanaka T, Okuda K, Wolff LF, Yoshie H. The heat-compression technique for the conversion of plate- let-rich fibrin preparation to a barrier membrane with a reduced rate of biodegradation. J Biomed Mater Res B Appl Biomater 2015 May;103(4):825-831.
Li Q, Pan S, Dangaria SJ, Gopinathan G, Kolokythas A, Chu S, Geng Y, Zhou Y, Luan X. Platelet-rich fibrin promotes periodontal regeneration and enhances alveolar bone augmentation. Biomed Res Int 2013 Mar;2013:638043.
Molly L, Quirynen M, Michiels K, van Steenberghe D. Comparison between jaw bone augmentation by means of a stiff occlusive titanium membrane or an autologous hip graft: a retrospective clinical assessment. Clin Oral Implants Res 2006 Oct;17(5):481-487.
Ozcan M, Ucak O, Alkaya B, Keceli S, Seydaoglu G, Haytac MC. Effects of platelet-rich fibrin on palatal wound healing after free gingival graft harvesting: a comparative randomized controlled clinical trial. Int J Periodontics Restorative Dent 2017 Sep-Oct;37(5):e270-e278.
Saluja H, Dehane V, Mahindra U. Platelet-rich fibrin: a second generation platelet concentrate and a new friend of oral and maxillofacial surgeons. Ann Maxillofac Surg 2011 Jan;1(1):53-57.
Joseph VR, Sam G, Amol NV. Clinical evaluation of autologous platelet rich fibrin in horizontal alveolar bony defects. J Clin Diagn Res 2014 Nov;8(11):ZC43-ZC47.
Yu P, Zhai Z, Jin X, Yang X, Qi Z. Clinical application of platelet-rich fibrin in plastic and reconstructive surgery: a systematic review. Aesthetic Plast Surg 2018 Apr;42(2): 511-519.
Annunziata M, Oliva A, Buonaiuto C, Di Feo A, Di Pasquale R, Passaro I, Guida L. In vitro cell type specific biologic response of human periodontally related cells to platelet rich plasma. J Periodontal Res 2005 Dec;40(6):489-495.
Hurzeler MB, Weng D. A single incision technique to harvest subepithelial connective tissue graft from the palate. Int J Periodontics Restorative Dent 1999 Jun;19(3):279-287.
Simonpieri A, Del Corso M, Vervelle A, Jimbo R, Inchingolo F, Sammartino G, Dohan Ehrenfest DM. Current knowledge and perspectives for the use of platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) in oral and maxillofacial surgery part 2: bone graft, implant and reconstructive surgery. Curr Pharm Biotechnol 2012 Jun;13(7):1231-1256.