Search Results (412)

Platelet-rich fibrin (PRF) has been widely used in regenerative dentistry because of its potential to support tissue regeneration. Recently, modifications in PRF preparation protocols and tube surface characteristics have attracted attention because of their possible influence on fibrin organization and biologic activity. The present in vitro study aimed to evaluate the effects of nano-hydroxyapatite platelet-rich fibrin (HA-PRF) on gingiva-derived mesenchymal stem cells (GMSCs) by comparing it with leukocyte platelet-rich fibrin (L-PRF) and titanium platelet-rich fibrin (T-PRF). Gingival tissue and venous blood samples were obtained from a systemically healthy male volunteer. PRF membranes were prepared using conventional glass tubes, nano-hydroxyapatite-coated tubes, and titanium tubes. GMSCs were isolated, characterized, and cultured with PRF membranes. Cell viability and metabolic activity were evaluated using MTT analysis. Apoptosis and necrosis rates were assessed by Annexin V/PI flow cytometry. VEGF and TGF-β1 release levels were determined by ELISA, whereas IL-1β, IL-6, and TNF-α gene expression levels were analyzed using qRT-PCR. The HA-PRF and L-PRF groups demonstrated higher cell viability values compared with the T-PRF group on day 7. Annexin V/PI analysis revealed no statistically significant differences between the groups in terms of apoptosis and necrosis. Growth factor release and cytokine gene expression profiles demonstrated time-dependent biologic responses in all PRF membranes. Within the limitations of this study, HA-PRF showed no evidence of cytotoxicity and demonstrated biologic responses comparable to those observed with conventional L-PRF. Both HA-PRF and L-PRF generally exhibited more favorable cellular responses than T-PRF under the present experimental conditions. Full article

Background/Objectives: Peri-implant diseases, encompassing peri-implant mucositis and peri-implantitis, affect 43% and 18.8–23% of implant-bearing patients, respectively, representing significant clinical challenges in implant dentistry. While mechanical debridement remains foundational, biologically active materials offer promising adjunctive regenerative strategies. This narrative review synthesises current evidence regarding five biologically active materials: enamel matrix derivative (EMD), platelet-rich fibrin (PRF), fibroblast growth factor-2 (FGF-2), recombinant human platelet-derived growth factor-BB (rhPDGF-BB/GEM 21S^®), and polynucleotide–hyaluronic acid combinations (Regenfast^®). Methods: The relevant literature was identified using electronic databases, including MEDLINE, PubMed, Scopus, and Google Scholar. This review focused on clinical studies and randomised controlled trials with a minimum follow-up of six months investigating biologically active materials in peri-implant disease management. Material mechanisms, clinical efficacy, therapeutic limitations, and evidence quality were systematically evaluated. Attention was directed toward identifying genuine biological distinctions between peri-implant and periodontal disease contexts. Results: EMD demonstrates efficacy exclusively within multimodal surgical protocols, with isolated application yielding limited benefits. rhPDGF-BB shows superior periodontal regenerative capacity; however, dedicated peri-implantitis trials remain absent. FGF-2 exhibits paradoxical osteogenic suppression despite bone fill achievement, limiting peri-implant applicability. PRF and Regenfast^® demonstrate a mechanistically sound rationale yet lack substantive peri-implant disease validation. The critical findings revealed that peri-implant regeneration fundamentally differs from periodontal regeneration: implants lack periodontal ligament anatomy, rendering ligamentogenic differentiation-promoting agents biologically inappropriate. Conclusions: Contemporary biologically active materials demonstrate compelling periodontal efficacy yet remain inadequately validated for peri-implantitis management. This disparity reflects authentic biological distinctions rather than insufficient investigation. Until multicentre randomised controlled trials stratify efficacy across distinct peri-implant disease presentations, practitioners must prioritise evidence-based surgical fundamentals—meticulous decontamination, strategic grafting, and optimised wound healing—integrating biologically active materials judiciously within comprehensive, anatomy-respecting treatment protocols. Full article

Impacted mandibular third molars present a common challenge in oral surgery, often associated with postoperative complications such as delayed healing and periodontal defects; therefore, optimizing adjunctive therapies is clinically important. In this study, we aimed to evaluate the efficacy of platelet-rich fibrin (PRF) and preoperative azithromycin in modulating inflammation and enhancing wound healing following surgical extraction of impacted mandibular third molars. In this prospective clinical study, healthy subjects aged 18–50 years were randomly assigned to three groups: a control group receiving standard postoperative amoxicillin therapy, a PRF group receiving PRF with standard therapy, and a PRF-plus-azithromycin group receiving PRF, standard therapy, and a single preoperative dose of azithromycin. Clinical parameters were assessed and cytomorphometric analysis was performed preoperatively and postoperatively. Clinical parameters generally improved over time in all groups (p < 0.001). Differences between groups were observed for interincisal distance, Landry Index, and pain scores, with a trend toward more favorable outcomes in the combined-therapy group. Cytomorphometric analysis revealed cellular alterations in the control group, relative stability in the PRF group, and intermediate changes in the combined-therapy group. Within the limitations of this study, the combination of PRF and preoperative azithromycin showed potential benefits in several postoperative outcomes. However, given the study design and sample characteristics, these findings should be considered preliminary and require confirmation in larger prospective studies before definitive clinical recommendations can be made. Full article

Methods of ridge preservation following tooth extraction, aiming to maintain alveolar bone volume and support tissue regeneration, have been extensively researched. Continuously, new approaches and materials are being explored in this context. To scientifically evaluate outcomes, the pre-implant situation is usually assessed radiologically, histologically, and/or clinically. However, the influence of ridge preservation on implant placement itself is rarely examined in depth, and if at all, the focus has been on implant stability or survival rates. Based on the assumption that preoperative radiological assessment, including cone beam computed tomography, provides only an indirect and inherently limited approximation of actual intraoperative bone condition, undetected factors such as insufficient bone density, mechanically unfavorable trabecular structure, or incompletely resorbed residual biomaterial may necessitate a shift of the implant from the preferred position originally occupied by the tooth root. We therefore established a method that evaluates and categorizes implant position in three dimensions based on radiological data post-implantation. Our data, derived from a multicenter randomized clinical trial (RCT), demonstrate that the greatest positional deviations are observed without preservation, whereas the combination of biomaterial and PRF most frequently allowed for central implant placement. The proposed method proves well suited for evaluating the outcome of ridge preservation procedures. The findings demonstrate that both the absence and presence, and further the type, of preservation have a measurable influence on the final implant positioning. Full article

Background: Regenerative endodontic procedures (REPs) aim to restore pulp vitality and promote root development in immature necrotic permanent teeth. Scaffold materials provide a 3D framework to support cellular migration, proliferation, and differentiation and play a critical role in regenerative interventions. Commonly used scaffolds include PRP, PRF, and collagen; however, hyaluronic acid has also demonstrated promising treatment outcomes. Objective: To evaluate whether hyaluronic acid (HA) provides superior regenerative outcomes compared to PRP, PRF, and collagen scaffolds. Methods: A systematic electronic search was conducted across PubMed, Scopus, and EBSCOhost. A total of 952 articles were identified in the initial search, of which 19 articles were included in the final review. Due to heterogeneity, a narrative synthesis was performed. Results: PRF demonstrated the most consistent improvement in root development and dentinal wall thickening. Apical closure and periapical healing were achieved across all scaffold types. Evidence for HA was limited, with no clear superiority identified. Conclusions: Current evidence does not support the superiority of HA over established scaffolds. Further standardised clinical trials are required to make definitive comparisons on scaffold effectiveness. Full article

Temporomandibular joint osteoarthritis (TMJ-OA) is a multifactorial degenerative disorder characterized by progressive cartilage degradation, subchondral bone remodeling, and chronic inflammation, leading to pain and functional impairment in affected individuals. Despite its clinical impact, effective disease-modifying treatments remain limited, highlighting the need for innovative therapeutic approaches for treating this condition in the future. This manuscript examines the biological rationale, clinical applications, and therapeutic potential of platelet-rich plasma (PRP) and injectable platelet-rich fibrin (i-PRF) in the management of TMJ-OA. As autologous platelet-derived biomaterials, PRP and i-PRF contain high concentrations of growth factors and bioactive molecules that can modulate inflammatory responses and support tissue repair. PRP is associated with a relatively rapid release of these mediators, whereas i-PRF forms a fibrin matrix that may enable a more sustained release profile. Current clinical evidence suggests that both therapies show potential to contribute to pain reduction and may facilitate improvements in mandibular function. However, substantial heterogeneity in preparation protocols, study designs, and outcome measures limits the comparability and generalizability of these findings to the general population. Overall, PRP and i-PRF represent promising, minimally invasive regenerative strategies for managing TMJ-OA. Full article

Introduction: platelet-rich fibrin (PRF) is a second-generation platelet concentrate which is known for promoting cell migration, tissue repair, angiogenesis and bone formation. In contrast, the specific effects of trauma-activated PRF on mesenchymal stromal cells (MSC) are not yet fully understood. The present study investigates systemic effects of surgical trauma-activated PRF on MSCs in vitro, analyzing their metabolic activity, inflammatory responses, and regenerative capacity to optimize advanced treatment concepts for severe fractures and injuries. Material & Methods: PRF membranes (T-PRF from trauma patients, C-PRF from healthy controls) were generated. After co-incubation with MSC cells for 24, 72, and 120 h, further investigations of metabolic activity (MTT assay) and gene expression analyses were performed. Results: for MTT assay, results especially showed a significantly higher metabolic activity of T-PRF after 120 h. ELISA-results measuring cytokine levels (CXCL10, IL-6, VEGF, and IDO) exposed a frequent peak in T-PRF group at 72 h, declining slightly at 120 h. In the gene expression analyses, T-PRF exerted a comparatively stronger stimulating effect on MAPK14 and VEGFA after 24 h, while a decrease in gene expression for MAPK8, MAPK14, and RUNX2 was observed over time. Conclusion: surgical trauma-activated PRF seems to be a powerful inducer of early inflammatory and stress responses in MSCs with preserved angiogenic but limited osteogenic signaling. Therefore, a targeted balance between inflammatory activation and sustainable regeneration, as well as optimized preparation and possible combination with immunomodulatory approaches, appear to be crucial for the therapeutic success of PRF-based strategies. Full article

Poor bone quality in osteoporotic patients remains a major challenge for achieving predictable osseointegration. This study serves as a mechanistic complement to previously reported structural data, aiming to investigate the molecular pathways underlying the synergy between nanostructured surfaces and autologous blood concentrates in compromised bone. Ninety-six Wistar rats were divided into healthy (SHAM) and osteoporotic (OVX) groups. Implants with nanostructured hydroxyapatite (NanoHA) or dual acid-etched (DAE) surfaces were installed in the tibiae, associated or not with leukocyte- and platelet-rich fibrin (L-PRF). Gene expression (RT-qPCR) for Runx2, Alpl, Bglap, Spp1, Tnfrsf11, and Tnfrsf11b was assessed at 7 and 30 days. In compromised systemic conditions (OVX), the NanoHA + L-PRF association promoted a robust “molecular rescue” of bone metabolism. At 30 days, this synergistic group exhibited a significant upregulation of Alpl (mean: 11.69 ± 1.65) and Runx2 (mean: 4.49 ± 0.82) compared to DAE controls (p < 0.05). Crucially, the therapy orchestrated a protective remodeling environment by significantly inducing Tnfrsf11b expression (5.50 ± 0.88), effectively balancing the Tnfrsf11/Tnfrsf11b ratio. Late-stage maturation markers (Bglap and Spp1) were also significantly elevated, effectively mimicking healthy physiological levels observed in the SHAM group. NanoHA biofunctionalization, synergistically with L-PRF, triggers a transcriptional reprogramming of the peri-implant microenvironment, mitigating the catabolic effects of estrogen deficiency. These findings provide a biological foundation for enhanced clinical predictability in high-risk patients, suggesting that local interfacial modifications can overcome systemic bone compromise. Full article

Introduction: Orthobiologics such as Platelet-Rich Plasma (PRP) and Injectable Platelet-Rich Fibrin (i-PRF) have emerged as promising tools in regenerative medicine. However, the lack of methodological standardization and the still limited comparative characterization between these products represent significant barriers to their optimized clinical application. This comparative laboratory study aimed to characterize and differentiate PRP and i-PRF, focusing on their cellular composition, obtained volume, and total Platelet-Derived Growth Factor (PDGF-BB) content. Materials and Methods: This study was conducted with 34 individuals meeting standard blood donation criteria. Peripheral blood samples were collected from all participants. PRP was obtained using a modified double-spin centrifugation protocol, whereas i-PRF was prepared using a modified low-speed centrifugation technique. Cellularity (platelet and leukocyte counts), final produced volume, and total PDGF-BB content were assessed using complete blood count analysis and an enzyme-linked immunosorbent assay (ELISA), respectively. Statistical analysis was performed using Linear Mixed Models (LMMs). Results: Both protocols resulted in significant increases in platelet and leukocyte concentrations compared to baseline values. PRP showed significantly higher platelet and leukocyte concentrations compared with i-PRF, as well as markedly higher PDGF-BB levels. In contrast, i-PRF yielded a substantially greater final volume and enabled a higher absolute delivery of total leukocytes, whereas PRP delivered a greater absolute number of platelets. In exploratory analyses, female sex, the presence of comorbidities, and increased abdominal circumference were associated with variations in product volume and cellular composition. Discussion: These findings indicate that PRP and i-PRF exhibit distinct biological profiles in terms of cellularity, volume, and total PDGF-BB content. Whether these laboratory differences translate into distinct clinical outcomes remains unknown. The results should therefore be viewed as hypothesis-generating: they suggest that PRP and i-PRF may not be interchangeable, and that future randomized clinical trials are needed to define product-specific indications based on the target tissue and desired biological mechanism. Full article

Background/Objectives: Platelet-rich fibrin (PRF) is widely used in regenerative medicine and dentistry because of its ability to deliver growth factors and cellular components that support tissue healing. However, accurate quantification of platelets and leukocytes within PRF matrices remains challenging, as indirect subtraction-based methods may not reliably reflect the true cellular composition. This study aimed to apply a direct fibrinolytic digestion–flow cytometry approach for precise cellular quantification and to systematically evaluate the effects of different centrifugation protocols on PRF cellular composition and fibrin architecture. Methods: PRF clots were generated using high-speed protocols (leukocyte- and platelet-rich fibrin [L-PRF] and concentrated growth factors [CGF]) and low-speed protocols (advanced PRF [A-PRF] and A-PRF+). Cellular content was quantified using a fibrinolytic digestion-based approach with tissue plasminogen activator, followed by flow cytometry analysis. Histological evaluation was performed to assess fibrin architecture and cellular distribution. Results: L-PRF and CGF exhibited significantly greater platelet enrichment than A-PRF. T-lymphocyte counts were elevated across all PRF groups, with significantly higher levels observed in L-PRF and CGF than in A-PRF. Monocyte and neutrophil levels were reduced following PRF preparation; however, A-PRF retained significantly higher neutrophil levels than CGF, whereas B-lymphocyte levels showed a moderate increase without significant intergroup differences. Histologically, high-speed protocols produced pronounced cellular stratification and denser fibrin networks, whereas low-speed protocols demonstrated a more homogeneous leukocyte distribution within a porous fibrin matrix. Conclusions: Centrifugation protocols significantly influence PRF cellular composition and fibrin architecture. The direct fibrinolytic digestion–flow cytometry approach provides a reliable method for accurate cellular quantification and may facilitate the standardization and optimization of PRF preparation protocols for regenerative applications. Full article

Background: Platelet concentrates (PCs), including platelet-rich fibrin (PRF) and its derivatives, have been increasingly investigated as autologous adjuncts in alveolar and periodontal regenerative procedures. This systematic review aimed to evaluate whether PCs improve clinical, radiographic, and histological outcomes compared with conventional regenerative approaches. Methods: A comprehensive search of PubMed, Scopus, and Web of Science identified randomized clinical trials on intrabony and furcation defects, alveolar ridge preservation, alveolar cleft reconstruction, and periodontally accelerated osteogenic orthodontics (PAOO). Sixteen studies met the inclusion criteria. Results: Overall, PCs, used alone as membranes or in combination with allograft materials, have been associated with significant clinical and radiographic improvements, with three main patterns of effect emerging across studies: (i) adjunctive benefit in selected outcomes (e.g., ridge width preservation and new bone formation when PRF was combined with graft materials); (ii) non-inferiority or equivalence compared with conventional regenerative approaches, particularly in periodontal intrabony defects; and (iii) lack of consistent superiority, as several studies reported comparable outcomes to standard techniques rather than clear advantages. In cleft reconstruction, PRF used in combination with allografts has shown comparable or non-inferior results to standard graft approaches, potentially reducing morbidity. Despite these favorable trends, evidence has been mixed in terms of platelet preparation protocols, defect types, additional biomaterials, and length of follow-up. The heterogeneity of the included studies and the absence of quantitative synthesis limit the strength of the conclusions. Conclusions: Within these limitations, PCs appear to represent a valid complement or alternative to conventional regenerative strategies, primarily as an adjunct rather than a clearly superior approach, and further well-designed randomized clinical trials with standardized protocols and longer follow-up are needed to strengthen clinical recommendations. Full article

Background/Objectives: Intra-articular injectable platelet-rich fibrin (I-PRF) is increasingly used in the management of joint-origin temporomandibular joint (TMJ) disorders, but variability in follow-up TMJ disease severity remains substantial. This study assessed whether baseline oral behaviors were associated with follow-up TMJ disease severity after intra-articular I-PRF therapy, using baseline-adjusted analyses of follow-up HI. Methods: This secondary exploratory cohort analysis was conducted within the framework of a registered clinical trial (NCT05883982). Fifty-one consecutive adult patients treated with intra-articular I-PRF were included. Baseline oral behaviors were assessed using the Oral Behaviors Checklist (OBC-21), and TMJ disease severity was quantified using the Helkimo Index (HI) at baseline and final follow-up. Associations between baseline predictors and follow-up HI were evaluated using baseline-adjusted linear regression models including baseline HI as a covariate. Results: Mean (SD) HI decreased descriptively from 7.0 (6.2) at baseline to 2.5 (3.0) at final follow-up (p < 0.001). Baseline HI was strongly associated with follow-up HI (β = 0.32, 95% CI 0.22 to 0.41, p < 0.001), whereas symptom duration (β = 0.02, 95% CI −0.10 to 0.15, p = 0.70) and injection laterality (β = −0.42, 95% CI −1.73 to 0.89, p = 0.52) were not. No OBC-21 item showed a clear baseline-adjusted association with follow-up HI after correction for multiple comparisons. The largest absolute baseline-adjusted regression coefficients were observed for awake bruxism (β = 0.80, 95% CI 0.08 to 1.52, FDR-adjusted p = 0.60) and singing (β = −0.58, 95% CI −1.41 to 0.25, FDR-adjusted p = 0.83). Conclusions: Baseline oral behaviors did not emerge as strong standalone baseline-adjusted factors associated with follow-up HI after intra-articular I-PRF therapy. However, the observed associations may still have been influenced by baseline disease severity dimensions not fully captured by total baseline HI, such as structural disease stage, pain intensity, psychosocial burden, or other unmeasured clinical severity features. The observed nominal and directional item-level patterns should be interpreted only as hypothesis-generating and require confirmation in larger, better-characterized cohorts. Full article

Although internal fixation and surgical approaches promote fracture healing, some outcomes remain unsatisfactory. Advanced platelet-rich fibrin (A-PRF) has been shown to provide more growth factors, and in vitro cell proliferation has not been evaluated for treating bone fractures in veterinary medicine. The purpose of this study was to evaluate the bone-healing activity of A-PRF in traumatic canine fractures. Twelve dogs with single radius–ulna or tibia–fibula fractures were randomly assigned to two groups: a control group and an A-PRF group. Both groups were treated with a locking compression plate and screws and received pain control. Post-operatively, dogs were evaluated for serum C-reactive protein (CRP) levels and post-operative pain scores on days 1, 3, and 7. Lameness and weight-bearing scores were evaluated on days 1, 3, 7, 14, 30, and 60. Bone healing was assessed at 2 weeks, 1 month, and 2 months using calculated relative bone density (%). Compared with the control, the A-PRF group showed higher bone density at 2 months and lower lameness at 14 days post-operatively. Although the CRP level, an inflammation response marker, was higher in the A-PRF group within one day. No significant difference in pain score was observed. In conclusion, A-PRF serves as an effective adjunctive therapy for promoting bone healing when treating canine appendicular fractures with surgical internal fixation. Full article

Platelet-rich plasma (PRP) is widely used as a second-line treatment for chronic tendinopathy that persists despite structured conservative care, yet outcomes and imaging correlates remain heterogeneous. This review outlines PRP biology and preparation, summarises quantitative imaging techniques for monitoring tendon response, and presents the experience of a single centre integrating these methods into routine supraspinatus and lateral elbow PRP workflows. PRP is described as an autologous platelet concentrate with variable leukocyte and fibrin content, with leukocyte-rich formulations commonly selected for chronic tendinopathy. Quantitative approaches—including ultrasound shear-wave elastography and radiomics, MRI T2/T2* mapping, CT-based bone metrics, PET/CT, and optical techniques—offer numerical biomarkers of tendon structure, mechanics, and inflammation but are rarely implemented in PRP trials. At the authors’ centre, leukocyte-rich PRP is injected under ultrasound guidance after failed physiotherapy, and follow-up combines validated questionnaires with grey-level run-length matrix texture analysis of ultrasound and 3.0 T MRI T2 distribution profiling. A pilot ultrasound study in supraspinatus and common extensor tendinosis showed uniform short-term clinical improvement and significant changes in most texture features, with selected parameters correlating with symptom relief. A prospective supraspinatus cohort demonstrated significant six-month clinical gains in both tendinosis and small partial-thickness tears, whereas only the tendinosis group exhibited T2 profile convergence toward asymptomatic patterns. These data indicate that quantitative ultrasound radiomics and whole-length T2 profiling are feasible imaging biomarkers that capture PRP-induced tendon remodelling beyond qualitative imaging and may help tailor PRP protocols to specific tendon phenotypes. Full article

Medication-related osteonecrosis of the jaw (MRONJ) represents a major clinical challenge for oral and maxillofacial surgery departments as well as dental practices. With increasing life expectancy and the more frequent use of medications associated with osteonecrosis, the incidence of MRONJ continues to rise. To date, there are no uniform treatment standards with scientifically proven effectiveness for this condition. To evaluate the impact of platelet-rich fibrin (PRF) on the outcomes of MRONJ treatment and to identify factors that may influence the effectiveness of PRF therapy, we conducted a comparative prospective study including 22 patients divided into two groups: patients treated with PRF and patients treated without PRF. PRF was prepared according to the PRF Duo Quattro Process protocol for PRF (Nice, France). The study was registered at ClinicalTrials.gov (NCT07464678). The following parameters were assessed: age, smoking status, gender, lesion location, body mass index (BMI), C-reactive protein (CRP) concentration, pain intensity, presence or absence of fistulas, soft tissue healing and radiological findings. Patients were evaluated preoperatively and postoperatively at 14 days, 6 weeks, and 6 months. The study demonstrated a reduction in pain after surgery among patients treated with PRF. In addition, the use of PRF resulted in improved healing outcomes in patients with elevated CRP. Higher BMI was associated with poorer therapeutic response to PRF. Improvements in soft tissue healing and disease stage were observed in the PRF group; however, these differences did not reach statistical significance. All findings should be interpreted with caution due to the limited sample size. There is still no standardized treatment for MRONJ. The use of platelet-rich fibrin as an inexpensive and safe adjunctive therapy may provide clinical benefits for patients, particularly through a significant reduction in pain. Further large-scale, multicenter studies are required to confirm these findings. Full article