While implant therapy is highly successful with the con- ventional approach, L-PRF — when used as a biological modifier — can improve wound healing and decrease postsurgical discomfort. USE IN THREE-WALLED BONY DEFECTS Sharma and Pradeep10 conducted a study on the effects of placing L-PRF in three-walled bony defects in patients with chronic periodontitis. Dur- ing the study, 56 defects were treated by adding L-PRF while conducting open-flap debridement or performing open-flap debridement without the addition of L-PRF. Periodontal attachment levels and probing depths were documented with measurements at baseline and nine months post- treatment. Periodontal dressing and sutures were removed after two weeks. A regimen of 0.12% chlorhexidine rinse was also implemented during this time. After two weeks, self-care was performed using a soft toothbrush and gentle brushing. No subgingival instrumentation occurred during the nine months. Posttreatment values showed probing depths improved for the test group (approximately 4.55 mm versus 3.21 mm for the control group). Periodontal attachment levels also improved when L-PRF was added (value for the test group was 3.31 mm versus 2.77 mm in the control group). Additionally, test sites showed an approximate 48.26% greater bone production for filling the site ver- sus 1.8% for those sites in which L-PRF was not placed. When compar- ing the two methods of treatment, it was found that when L-PRF was used, probing depths decreased, periodontal attachment level increased, and more bone was generated than when performing con- ventional open-flap debridement.10 In another study, Sharma and Pradeep12 evaluated the effects of placing L-PRF in Class II furcation defects when conducting open-flap debridement in comparison to open-flap debridement alone. Thirty-six defects were treated with one of these approaches. Plaque index, sulcus bleeding index, probing depth, clinical attachment level, gingival marginal level, and radiographic bone analysis were compared using baseline and nine month postoperative measurements. Periodontal dressing and sutures were removed after two weeks while using 0.12% chlorhexidine rinse during this time. Self-care was also performed using a soft toothbrush and gentle brushing. No subgingival instrumentation occurred for nine months. The data indicated a greater reduction of probing depth was found for the L-PRF clinical group, with a difference of 2.17 mm as compared with the non L-PRF control group. The test group also showed a significantly greater vertical defect fill (50.8 +/- 6.24) when compared with the control sites (16.7 +/- 6.42) at the nine- month recare appointment. Upon evaluation, both clinical and 42 Decisions IN DENTISTRY • December 2017 Following treatment, each patient was prescribed 500 mg of amox- icillin for five to seven days. Oral hygiene instructions were demon- strated and a soft food diet was recommended for the next week to two weeks. The sutures were removed seven days posttreatment, and exams were scheduled every week for the following three weeks. After four to six months, the patients returned for healing cap placement, and again two weeks later for abutment delivery. The implants were reassessed every three months over a 1-year period. Implant success was evaluated based on stability, sulcular bleeding, peri-implant pocket depth and radiographic findings. Results of this study revealed a 100% success rate, with ideal osseointegration and a reduction in postopera- tive problems.16 radiographic parameters indicated drastic improvement observed at those areas treated with L-PRF and open-flap debridement when compared with only open-flap debridement.12 A study by Al-Khawlani et al8 examined the benefits of L-PRF when placed at sites of mandibular fracture. When L-PRF was placed in close proximity to bone, enhanced bone development occurred. A group of patients (ranging in age from 20 to 42) with mandibular fractures par- ticipated as subjects. The L-PRF was applied along the fracture line of the mandible, as plates were used to stabilize it. Patients were evaluated over six months postsurgery. The results indicated that L-PRF placement enhanced osteoblast and bone formation, leading to improved healing. This autologous procedure led to more stable bone regeneration.8 SINUS LIFTS Sinus lifts are most commonly done so there is enough bone available to place an implant. A study by Mazor et al1 determined the success of using L-PRF in a simultaneous sinus lift and implant placement pro- cedure. Sinus lifts are necessary when a natural tooth has been lost and the maxillary sinus, covered by the Schneiderian membrane, pneumatizes — preventing bone formation. A sinus lift is performed to lift this membrane to allow more space for bone. Additionally, bone or bone grafting material is placed to encourage bone growth in the area to stabilize the site for a future implant.1 Typically, the graft must be placed four to six months prior to implant placement; however, new methods are improving the success of completing both proce- dures at the same time. The L-PRF technique is useful during sinus lift procedures, especially when bone is needed for implant placement. Data were collected from 20 subjects via 25 sinus elevations and the placement of 14 implants.1 There was no control group, but participants had to be in good health and meet certain criteria. All implants were similar in length and width, and there was approximately 2.9 mm of bone height remaining in each edentulous area. A full tissue flap was elevated and an ultrasonic lancet used to open a bony window. The Schneiderian membrane was deli- cately lifted and the bony window left attached to support the new sinus floor. This protects the sinus membrane and promotes space maintenance. Several vials of blood (72 ml) were taken from each sub- ject and centrifuged. The PRF clots were removed and membranes compressed to be placed in each sinus. One to two PRF membranes were placed on the Schneiderian membrane in case there were any undetectable perforations created during the procedure. The implants were placed with the tips acting in a manner to hold the new sinus floor in place. One to two additional PRF membranes were placed over the window before the flap was replaced to prevent invagination of the gingival mucosa. Patients were put on a 14-day chlorhexidine glu- conate rinse regimen, six days of amoxicillin, and instructed to take ibuprofen as needed.1 As expected, eight to 10 days following the procedure, a panoramic radiograph revealed no obvious change in bone density; however, six months later, the treated sites were filled with a dense bone-like tissue. Participants described minimal discomfort and all implants presented as stable. Six months posttreatment, the procedure was deemed 100% successful by Mazor et al.1 While some studies show that the use of DecisionsInDentistry.com
