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  Most popular articles (Since January 18, 2018)

 
 
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CASE REPORTS
Application of liquid platelet-rich fibrin for treating hyaluronic acid-related complications: A case report with 2 years of follow-up
Shahram Ghanaati, Sarah Al-Maawi, Yvonne Schaffner, Robert Sader, Joseph Choukroun, Cleopatra Nacopoulos
May-August 2018, 1(2):74-77
DOI:10.4103/GFSC.GFSC_11_18  
Platelet-rich fibrin (PRF) is a blood concentrate system derived from the peripheral blood by means of centrifugation. In esthetic medicine, hyaluronic acid (HA) is safe and most frequently used for esthetic treatment and skin augmentation. However, some complications such as inflammation were reported in the literature after the injection of HA as a xenogeneic material. The present case report presents a case of the treatment of complication after HA injection. The subject received the injection of HA in combination with filler material and developed a purulent and granulomatous dermal and subdermal skin infection that was eliminated by incision. To prevent scar formation, the subject was treated with dermal and subdermal liquid PRF injections for 1 year, and the case was documented for 2 years. The PRF injections promoted wound healing and minimized the scar formation. After two sessions, the patient swelling and redness were significantly decreased compared to baseline. After 4 sessions, complete wound healing was achieved without obvious scar formation. This case report shows that the use of liquid PRF as a bioactive system promotes wound healing and skin regeneration as well as minimizes scar formation. However, controlled clinical studies are needed to further elucidate the benefit of PRF as an autologous and bioactive material for esthetic skin treatment.
  11,357 735 5
REVIEW ARTICLE
One hundred years after Vitamin D discovery: Is there clinical evidence for supplementation doses?
Shahram Ghanaati, Joseph Choukroun, Ulrich Volz, Rebekka Hueber, Carlos Fernando de Almeida Barros Mourão, Robert Sader, Yoko Kawase-Koga, Ramesh Mazhari, Karin Amrein, Patrick Meybohm, Sarah Al-Maawi
January-April 2020, 3(1):3-11
DOI:10.4103/GFSC.GFSC_4_20  
In the last decade, an increasing awareness was directed to the role of Vitamin D in nonskeletal and preventive roles for chronic diseases in different fields. Vitamin D deficiency was reported in many countries worldwide and is considered as a pandemic. However, no consensus exists about whether and how supplementation of Vitamin D may be beneficial as a preventive or adjuvant therapy. Thereby, this review aimed to deliver an overview about the administrated doses of Vitamin D in randomized controlled clinical studies, in order to evaluate the currently available clinical evidence. In addition, focus was placed on the recent advances on Vitamin D nonskeletal actions. The results sometimes showed a great discrepancy between the recommended Vitamin D dose by different guideline authorities, which are from 400 to 4000 IU/day, and the used doses in recent randomized controlled clinical studies, which were up to 100,000 IU/day. Different studies showed the positive effect of Vitamin D in supporting the immune system and preventing different chronic and infectious diseases. These findings reflect the need to rethink existing reference ranges and intake recommendations. Based on the analyzed range of clinically applied doses, we recommend a Vitamin D supplementation based on three different ranges, which include <40 ng/ml, >40 <80 ng/ml, and >80 ng/ml with oral Vitamin D intake of 10,000 IU/day, 5000 IU/day, and 1000 IU/day, respectively. A 25-hydroxyvitamin D blood serum monitoring is furthermore recommenced every 3 months to re-adjust the Vitamin D dose based on the above-mentioned concept. Ongoing clinical studies will have to further prove this concept for different patient groups.
  10,077 647 3
ORIGINAL ARTICLES
Controversies related to scientific report describing g-forces from studies on platelet-rich fibrin: Necessity for standardization of relative centrifugal force values
Richard Miron, Joseph Choukroun, Shahram Ghanaati
September-December 2018, 1(3):80-89
DOI:10.4103/GFSC.GFSC_23_18  
Leukocyte and platelet-rich fibrin (PRF), a second-generation platelet concentrate has been the focus of intensive research endeavors over the last 2 decades. Over the years, numerous reports have however failed to accurately report g-force values which have caused considerable confusion in the field. These values have since been re-transcribed incorrectly in many studies moving forward, and this article aims to address this topic to avoid further confusion in the field. We address several reports in which PRF centrifugal g-forces have been calculated at the PRF clot (referred to as relative centrifugal force [RCF]-clot) as opposed to the international standard method described at the bottom of centrifugation tubes (RCF-max). We further highlight how RCF-clot is not only a deviation from the standard international method used to report g-force values, but one subject to significant error owing to centrifugation time, patient hematocrit levels, initial volume of blood collected, and other factors. For these reasons and those further reported throughout this article, we address this controversy in detail to avoid further confusion regarding the report of g-force values in future studies. Furthermore, we propose a standardization regarding the accurate report of g-force values in future studies investigating PRF at the RCF-max.
  9,131 1,158 28
Characterization of a new membrane from concentrated growth factors associated with denaturized Albumin (Alb-CGF) for clinical applications: A preliminary study
Carlos Fernando de Almeida Barros Mourão, Ezio Gheno, Emanuelle Stellet Lourenço, Renata de Lima Barbosa, Gregori M Kurtzman, Kayvon Javid, Elena Mavropoulos, Stefano Benedicenti, Mônica Diuana Calasans-Maia, Rafael Coutinho de Mello Machado, Gutemberg Gomes Alves
May-August 2018, 1(2):64-69
DOI:10.4103/GFSC.GFSC_21_18  
Background: One of the main issues pertaining to the use of fibrin membranes today, is their clinical efficacy for guided bone regeneration. This requires the need for membrane stability and a controlled resorption that enables the barrier to remain functionally during a relevant clinical time span. Human serum albumin is known to have an impact in the formation and stability of the fibrin networks density and permeability. Therefore, its interaction with fibrin aggregates may provide interesting features to autologous blood-derived biomaterials. Aim: In this context, the present study sought to characterize membranes produced through a modified protocol for concentrated growth factors (CGF) associated with activated plasma albumin gel (APAG). Method: Mixing denaturized albumin with CGF from the same blood samples into glass containers resulted in solid malleable membranes, with a modified denser ultrastructure as revealed by scanning electron microscopy (SEM). Results: The membranes presented a high density of nucleated cells, uniformly distributed along its length, and were able to release growth factors such as PDGF, VEGF, and FGF2 for 7 days. Conclusion: This preliminary study indicates that the protocol may provide autologous moldable and stable biomaterials for use as a soft tissue barrier, offering the basis for further research on its effectiveness for guided tissue regeneration.
  8,184 920 8
TECHNICAL NOTES
Platelet-rich fibrin minimally invasive root recession soft-tissue grafting
Delia Tuttle, Gregori M Kurtzman, Scott H Froum
January-April 2018, 1(1):32-37
DOI:10.4103/GFSC.GFSC_1_17  
A common problem encountered in every dental practice, root recession presents as an esthetic issue as well as creating exposed root surfaces that may illicit sensitivity and have greater caries potential than covered roots. Frequently, patients avoid treatment due to fear related to the traditional flap surgery approach. Technology, via biologics from the patient being treated has shifted surgical techniques to become minimally invasive, allowing lower morbidity and post-operative discomfort. The Gum Drop Technique (GDT) a papilla preservation technique, with a less invasive surgical approach utilizing PRF as the graft material with improved healing compared to packaged materials will be discussed as an alternative to traditional flap surgical approaches for root recession treatment.
  6,482 898 -
Platelet-rich fibrin in the Alveolar Bone graft in cleft lip and palate patient
Bruno Santos de Barros Dias, Thiago Schneider, Henrique Pessoa Ladvocat Cintra
January-April 2018, 1(1):27-31
DOI:10.4103/GFSC.GFSC_4_18  
Reconstruction of the alveolar ridge in patients with cleft lip and palate can be a challenging procedure. This stage of the treatment allows stabilization of the dental arch, adequate dental eruption, and orthodontic movement in the area of the cleft. Hence, it should be performed before the eruption of the permanent canine. Failure mainly occurs by dehiscence, exposure, and contamination of the bone graft. Adequate dissection, the definition of anatomical planes, and precise suture are paramount for a good result. However, this is often not enough. Sometimes, there is an anatomical limitation to make a suitable soft-tissue scaffold to be filled with bone graft. The lack of a hermetic closure of the anatomical planes can lead to contamination of the graft or even prevent its accomplishment in the same surgical time. Growth factors have been widely used in dentistry, with striking results in bone and tissue regeneration. Among these, platelet-rich fibrin is distinguished by allowing it to be made an autogenous membrane. This membrane supports exposure to the oral cavity without contamination and can stimulate the healing of soft and bony tissue, acting as a physical barrier. Its use as a growth factor and protective barrier of the alveolar bone graft in patients with cleft lip and palate is a promising tool for obtaining better results.
  5,666 684 -
CASE REPORTS
Tomographic and clinical findings, pre-, trans-, and post-operative, of osseodensification in immediate loading
Rafael Coutinho Mello Machado, Cristiane Santos da Gama, Sandro Henrique Batista, Denise Rizzo, Helder Valiense, Ruda F Moreira
September-December 2018, 1(3):101-105
DOI:10.4103/GFSC.GFSC_22_18  
The advance of surgical techniques and modifications with respect to the surface and macrogeometry of dental implants, such as immediate and early loading, can help reduce the time of rehabilitation for the patient when excellent primary stability is the primary prerequisite. Starting from this principle, studies using a novel technique to replace bone-subtractive drilling have been developed to optimize the implant site. This new technique, called osseodensification, was developed by Dr. Salah Huwais and patented in 2012. The name of the procedure suggests the induction of a compression wave at the tip of specially designed drills at the point of contact. This case report suggests that the clinical and radiographic results obtained could support the hypothesis that a true gain in primary stability as well as a compaction grafting can be achieved by the use of this technique.
  5,276 721 5
ORIGINAL ARTICLES
Concentrated growth factors in maxillary sinus floor augmentation: A preliminary clinical comparative evaluation
Andrea Forabosco, Ezio Gheno, Sergio Spinato, Giovanna Garuti, Eleonora Forabosco, Ugo Consolo
January-April 2018, 1(1):2-7
DOI:10.4103/GFSC.GFSC_6_18  
Aims: The primary aim of this clinical study was to examine the effect of concentrated growth factors matrix (CGFm) on implant survival rate in augmented sinuses; the secondary aim was to evaluate the effect of CGFm on sinus augmentation postoperative morbidity. Materials and Methods: Fifty patients were selected from a pool of participants requiring maxillary sinus augmentation. Of these, 25 patients (control-group) received a corticocancellous xenograft. The other 25 patients (test group) received a mixture of 70% CGF matrix and 30% corticocancellous xenograft. Venous blood samples were drawn from each patient and immediately centrifuged. Four components were identified vertically from top to bottom: (1) An upper liquid phase constituted by serum; (2) a phase constituted by polymerized fibrin buffy coat; (3) a middle phase constituted by aggregated platelets with CGFs; and (4) a lower phase constituted by red blood cells. The middle (second and third) phases represented the CGFm and were mixed with the graft material. The survival rate was calculated and comparison was made between the 2 different groups using Kaplan–Meier analysis. Statistical significance was set at P < 0.05. Results: A 96.4% survival rate was described in the test group (with CGFm) and a 96.1% survival rate in the control group (without CGFm). No statistically significant differences were observed between the survival rates of the two groups after 1 year. Conclusions: The mixture of CGFm (70%) with xenograft (30%) is an alternative to xenograft material alone and is a predictable procedure resulting in less postoperative morbidity in sinus augmentation.
  5,128 822 -
REVIEW ARTICLE
Platelet concentrates as an adjunctive therapy for medication-related osteonecrosis of the Jaw: A systematic review and meta-analysis
Massimo Del Fabbro, Silvio Taschieri, Funda Goker
May-August 2018, 1(2):48-57
DOI:10.4103/GFSC.GFSC_19_18  
Medication-related osteonecrosis of the jaw (MRONJ) is a drug-related adverse event consisting of progressive bone destruction in the maxillofacial region of patients under current or previous treatment with antiresorptive or antiangiogenic medications. Autologous platelet concentrates (APC) demonstrated to enhance bone and soft-tissue healing in many oral surgery procedures. This systematic review aimed to evaluate APC effect for treatment and prevention of MRONJ in patients under antiresorptive therapy. An electronic search was performed on MEDLINE, Scopus, Web of Science, and Cochrane databases using specific search terms, combined with AND, OR. Both prospective and retrospective studies with at least three patients and 3 months' follow-up were included, and they underwent data extraction and risk of bias assessment. When possible, a meta-analysis was undertaken. Eighteen studies reporting on 946 patients were included in this study. Postsurgery follow-up ranged from 3 to 94 months. The adjunct of APC in MRONJ treatment significantly reduced osteonecrosis recurrence with respect to control (P = 0.001). APC was also beneficial for MRONJ prevention, being associated with a lower MRONJ incidence after tooth extraction (P = 0.03). Heterogeneity was found regarding medication type, clinical indication, triggering factors, study design, follow-up duration, type of APC, and outcomes adopted to evaluate treatment success. Although the results of this review must be cautiously interpreted, due to the low-evidence level and limited sample size of the studies included, they are suggestive for possible benefits of APC when associated with surgical procedures for treatment of MRONJ. To confirm such indication, further prospective comparative studies with large sample size are urgently needed.
  5,207 594 3
CASE REPORTS
Socket preservation using demineralized tooth graft: A case series report with histological analysis
Alzaga-Vega Marco Tulio, Chang-Dong Kang, Ocampo-Acosta Fabian, Grace Eun Ah Kim, Hyung-Gyun Kim, Dong-Seok Sohn
January-April 2020, 3(1):27-34
DOI:10.4103/GFSC.GFSC_16_19  
Purpose: The aim of the study is to histologically evaluate new bone formation in extraction sockets augmented with autologous demineralized dentin bone (ADDB). Materials and Methods: Teeth were extracted from 19 patients and prepared as ADDB and then grafted in 27 extraction socket sites. The graft was covered with membrane made of concentrated growth factors (membrane) and the wounds were closed without periosteal releasing incision (open-membrane technique). Bone biopsy was performed at each implant site after 4 months of healing. Results: Wound healing was uneventful. Histologically, bone reformation was observed in all the augmented sockets, and ADDB showed favorable integration with newly formed bone. Conclusion: Immediate graft after extraction using ADDB is recommended for socket preservation.
  4,883 474 -
SPECIAL SECTION CASE REPORT
Incorporating the socket-shield technique in the esthetic treatment of a patient's smile: A case report with 2-year follow-up
Dárcio Luis Fonseca
January-April 2018, 1(1):38-41
DOI:10.4103/GFSC.GFSC_1_18  
The socket-shield technique has demonstrated promising histological and clinical results. Osseointegration has been reported to occur successfully with this technique, with added benefit of preserving the tissues buccofacial to an immediate implant. The present case report describes a modification of the socket-shield technique. Clinical and radiological examination at 25-month follow-up confirmed positive midterm esthetic results with high pink and white esthetic scores. Based on the clinical experience with this technique, it is the author's opinion that the socket-shield technique may well be the future accepted norm that best fulfills the goals of immediate implant treatment to offset buccofacial tissue recession and ridge collapse.
  4,627 628 -
CRITICAL REVIEW
The use of platelet-rich fibrin concentrate in tissue healing and regeneration in dentistry
Lídia Souza De Andrade, Lenira Pelloso Leite, Fernanda Britto De Melo Silva, Rodrigo Figueiredo De Brito Resende, Marcelo José Pinheiro Guedes De Uzeda
January-April 2018, 1(1):23-26
DOI:10.4103/GFSC.GFSC_5_18  
Platelet-rich fibrin (PRF) concentrate was developed in France in 2001 by Choukroun et al. Initially known in its platelet gel form, it can also be used as a membrane, being widely used to accelerate the healing of soft and hard tissues. The aims of this study are to report the applicability of platelet-rich fibrin in dental practice, seeking evidences of benefits in the regeneration and healing process of both soft and hard tissue. For this, a bibliographic survey of articles published between 2007 and 2017 was carried out using the descriptors: “Platelet-rich fibrin,” “oral surgery,” “fibrin” and “growth factors,” during the month of December 2017 resulting in nine selected articles according to the preestablished inclusion criteria. The results of the studies either showed that PRF presents effective and safe use when used in combination with biomaterials or isolated, in addition to presenting low risk associated with satisfactory clinical results.
  4,412 756 -
ORIGINAL ARTICLES
Homogeneous pressure influences the growth factor release profiles in solid platelet-rich fibrin matrices and enhances vascular endothelial growth factor release in the solid platelet-rich fibrin plugs
Sarah Al-Maawi, Carlos Herrera-Vizcaino, Eva Dohle, Tomislav A Zrnc, Puria Parvini, Frank Schwarz, Robert Sader, Joseph Choukroun, Shahram Ghanaati
January-April 2018, 1(1):8-16
DOI:10.4103/GFSC.GFSC_9_18  
Aims: Platelet-rich fibrin (PRF) exists in both solid and fluid forms. The present study was the first to evaluate the influence of homogeneous pressure on the growth factor (GF) release in pressed PRF-matrices and plugs. Methods and Material: A solid PRF-matrix (208 g; 8 min) was pressed to obtain a plug, and a pressed PRF-matrix that are used in clinical application. The released exudates were evaluated compared to liquid PRF (60 g and 3 min). The VEGF, TGF-ß1 and EGF release was quantified using ELISA. The fibrin structure and cellular components in solid PRF groups were evaluated histologically. Results: The pressed PRF-matrix and PRF-plug exhibited denser fibrin structure compared to the non-pressed PRF-matrix. On day 7, the PRF-plug and non-pressed PRF-matrix showed significantly higher release of VEGF, TGF-ß1 and EGF compared to that of the pressed PRF-matrix. The accumulated VEGF concentration was significantly higher in the PRF-plug compared to that in the PRF-matrix and non-pressed PRF-matrix. The accumulated EGF and TGF-ß1 concentrations over 10 days showed no statistically significant differences between the evaluated solid PRF groups. The exudates released TGF-ß1 and EGF passively, that was only detectable in after 1 and 7 hours. Liquid PRF released significantly higher GFs than the exudates at all investigated time points. The early VEGF and EGF release in liquid PRF (1 hour to 1 day) was significantly higher than that in the solid PRF-matrices. On day 10, significantly higher accumulated GFs were detected in the solid PRF groups compared to those in the liquid PRF. Thus, the combination of both solid and liquid PRF is a potential tool to generate a clinically relevant system with sustained bioactivity. Conclusions: These results highlight the potential to influence the GFs release profile of solid PRF matrices by pressure and obtain a clinically applicable plug with significantly higher VEGF release, providing further understanding of the release profile of PRF matrices as a drug delivery system.
  4,492 577 -
CASE REPORTS
Utilization of concentrated growth factor as a sole sinus augmentation material
Kayvon Javi, Gregori M Kurtzman, Mariam Nadi, Hossein Javi
September-December 2018, 1(3):95-100
DOI:10.4103/GFSC.GFSC_12_18  
Posterior maxillary tooth loss frequently coincides with loss of available bone volume for implant placement due to both atrophy of the residual crestal bone and enlargement of the maxillary sinus. The longer the teeth have been missing, the greater the loss of osseous structure that may house implants. This necessitates augmentation of the maxillary sinus to provide adequate bone to place implants. Maxillary sinus augmentation with various bone graft material have become routine treatment over the past 38 years. Various materials have been utilized including allografts, xenografts and synthetics with varying levels of success as measured by the amount of graft maturation and its density to support implants following healing. As the use of autogenous blood products has increased in dental surgery for both soft and hard tissue applications, those materials have expanded into use when augmenting the sinus. As blood biology has grown in use with regard to grafting using the patients own blood to supply growth factors and other patient derived products, grafting has improved the clinical results we are able to achieve. These blood derived products have been mixed with packed osseous graft materials to help improve the quality and quantity of the resulting graft following healing. The case presented in this article demonstrates graft maturation as evidenced by density can be achieved using CGF alone with no added osseous graft materials. The benefit of this approach is no issues with the potential of a patient reaction to the packaged osseous graft material that are typically used and cost of treatment is reduced as packaged products are not utilized in the sinus augmentation procedure.
  4,440 510 -
SHORT COMMUNICATION
Proposal for point-of-care testing of platelet-rich plasma quality
Tomoyuki Kawase, Akira Takahashi, Taisuke Watanabe, Tetsuhiro Tsujino
January-April 2019, 2(1):13-17
DOI:10.4103/GFSC.GFSC_26_18  
Platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) regenerative therapy lacks evidence to make clinical decisions. This weakness cannot be addressed only by standardization of preparation protocols and devices. In this article, we have emphasized on the necessity for quality testing to obtain strong evidence supporting PRP/PRF therapy.
  4,257 438 9
ORIGINAL ARTICLES
Peri-implant mucosae inflammation during osseointegration is correlated with low levels of epidermal growth factor/epidermal growth factor receptor in the peri-implant mucosae
Marcos Alexandre Fonseca, Lucas Carneiro Costa, Aristides Da Rosa Pinheiro, Telma Regina Da Silva Aguiar, Valquiria Quinelato, Leticia Ladeira Bonato, Fernando Luiz Duarte Almeida, José Mauro Granjeiro, Priscila Ladeira Casado
January-April 2018, 1(1):17-22
DOI:10.4103/GFSC.GFSC_7_18  
Peri-implant mucosae inflammation during osseointegration period can promote host response imbalance and bone resorption by bacteria infiltration. Aim: To evaluate the association between EGF and EGFR gene expressions in the peri-implant tissue with mucosae inflammation during osseointegration period. Material and Methods: Forty-nine participants, with 59 endosseos implants, were recruited for this study. All participants included were rehabilitated with implants in two stages surgical protocol, presenting favorable bone quality and quantity. Osseointegration was evaluated one month after exposure surgery, wich was performed three months (mandible) and 6 months (maxillary) after implant placement. The criteria to consider the proper osseointegration were: Implant immobility; absence of peri-implant radiolucency; and no clinical signs of inflammation. Based on clinical and radiographic characteristics of peri-implant sites, participants were characterized as (i) having healing without complications (with proper osseointegration without mobility of the implant, and without clinical signs of mucosal inflammation) (control group) or (ii) failure peri-implant healing (with inadequate osseointegration characterized by signs of mucosae inflammation and/or implant mobility) (test group). Gingival biopsies were collected from 49 participants after osseointegration period, during the exposure procedure. Total RNA from gingival samples was isolated using the Trizol® reagent. The reaction of reverse transcription of PCR was performed for the synthesis of complementary DNA from 300ng RNA using Improm-II Reverse Transcription System™. Specific primers for EGF (NM_001963.4) and EGFR (NM_005228.3) were based on the BLAST data. The Livak method (2-ΔΔCT) was used to determine the relative quantification of the expression of EGF and EGFR. The values were normalized by relative expression of β-actin. Results: There was no difference between control and test groups to race, sex, age, alcohol consumption, general medical conditions, current medications, edentulism and periodontal phenotype. All RNA samples revealed proportions A260 nm/A280 nm more than 1.9. EGF and EGFR showed significant lower expression in gingival tissues removed from regions with failure healing (test group). EGF showed mRNA expression with an average of 44.53 ± 79.16 and 01.02 ± 1:33 in the control groups and test, respectively (P = 0.008). Similarly EGFR expression was significantly higher in the control group (102.03 ± 329.57) compared to the test group (7.85 ± 4.16) (P = 0:04). Conclusion: Low levels of EGF and EGFR are associated with inadequate healing of mucosal peri-implant during the osseointegration period.
  3,882 466 -
ORIGINAL ARTICLE
The effects of human amniotic fluid on periodontal ligament fibroblast cell viability, proliferation, and cytokine/growth factor expression
Ahmed Gamil Ibraheem, Steven B Blanchard, Saleh Mohammed Al-Hijji, Khaled Al-Nasr-Allah, L Jack Windsor
May-August 2019, 2(2):23-29
DOI:10.4103/GFSC.GFSC_10_19  
Background: The importance of the amniotic fluid (AF) to the fetus is clear. However, very few studies have been published to examine the potential uses of this fluid in various areas such as tissue regeneration. AF contains epidermal growth factor, transforming growth factor-alpha, transforming growth factor beta-1, insulin-like growth factor-I, erythropoietin and granulocyte colony-stimulating factor, as well as hyaluronic acid and hyaluronic acid-stimulating factor. Previous studies suggest that AF can increase fibroblast proliferation and chemotaxis, and decrease apoptosis as well as promote wound healing. Furthermore, evidence showed that human AF inhibits hyaluronidase, elastase, and cathepsin. The current study examined the effects of human AF on periodontal ligament fibroblasts (PDLF) in terms of cell toxicity, cell proliferation, and cytokine/growth factor expression. Materials and Methods: Cytotoxicity of AF on PDLF was determined using lactate dehydrogenase assays. PDLF proliferation was determined using water-soluble tetrazolium-1 assays. Cytokine/growth factor expression was determined on AF-treated PDLF, AF alone, and PDLF alone utilizing protein arrays. Results: Human AF at 10% and below did not affect cell growth and was not toxic. AF-treated PDLF cells showed a decrease in cytokine/growth factor levels compared to the sum of cytokine/growth factor levels in AF only and cells only for 39 of the 80 proteins examined (48.8%). Of the 39 examined cytokines, 20 inflammatory cytokines, 11 cell cycle cytokines, 1 anti-inflammatory cytokine, and 7 other cytokines were decreased. Conclusion: Human AF at the examined concentrations was not toxic to PDLF cells and did not influence their proliferation. In addition, AF (10%) caused a decrease in the total protein levels of cytokines/growth factors expressed in 39 of the 80 proteins examined (48.8%). Of the 39 examined cytokines, 20 inflammatory cytokines, 11 cell cycle cytokines, 1 anti-inflammatory cytokine, and 7 other cytokines were decreased.
  3,984 335 -
EDITORIAL
New and improved platelet-rich fibrin membranes
Carlos Fernando de Almeida Barros Mourao, Kayvon Javid
January-April 2020, 3(1):1-2
DOI:10.4103/GFSC.GFSC_5_20  
  3,817 467 1
REVIEW ARTICLE
The role of centrifugation process in the preparation of therapeutic blood concentrates: Standardization of the protocols to improve reproducibility
Shahram Ghanaati, Carlos Fernando Mourão, Elisabeth H Adam, Robert Sader, Homayoun H Zadeh, Sarah Al-Maawi
September-December 2019, 2(3):41-44
DOI:10.4103/GFSC.GFSC_15_19  
Investigations of endogenous blood-derived growth factors have increased in the past two decades. The initial protocols for blood concentrates, such as platelet-rich-plasma, utilized anticoagulants followed by bovine thrombin to catalyze fibrin polymerization. Subsequently, platelet-rich-fibrin (PRF) protocol was developed to eliminate anticoagulants and thrombin. The PRF production was described in a vertical rotor centrifuge with an angle of ~33°. Many commercial enterprises have attempted to replicate this protocol with a multitude of different centrifuges. These attempts have utilized revolutions per minute (RPM) to develop their protocol to generate PRF. However, RPM is a variable parameter, as it depends on the design and radius of the centrifuge. The separation of blood components is highly dependent on the relative centrifugal force (RCF) generated, which is based on the applied centrifugal force, expressed as multiples of earth's gravitation (g) field. RCF is a function of the acceleration due to the gravity of the earth, g = 9.81 m/s2 RCF, not RPM, is the key factor for the sedimentation of the cells and proteins within blood concentrates. RCF is determined using the maximum centrifuge radius for calculation. The initial PRF was generated by applying an RCF of 700 ×g. Accordingly, so far, a large number of studies existing about PRF are not comparable, as they were technically prepared with different RCFs. In addition, due to the nonstandardized measurement methods, in some published studies, incorrect RCF values are published as the authors did not know how to calculate the RCF correctly. This is the case for a widespread blood concentrate called leukocyte-PRF, which is commercially available. Recently, we introduced the low-speed centrifugation concept (LSCC) for the production for solid and liquid PRF matrices. This concept is based on the above-mentioned initial PRF protocols, which represents a relatively high RCF. It shows that a systematic reduction of 700 ×g to 44 ×g can significantly increase the cells and growth factors within the same blood concentrates. The LSCC concept was established initially for a fixed rotor centrifuge with a radius of ~110 mm. The present narrative review highlights the necessity of standardization in the generation of blood concentrates, which utilizes RCF, rather than commercial protocols.
  3,651 440 7
CASE REPORTS
Using extracted teeth as a novel graft material in atrophic ridge augmentation: A report of two cases with histology and cone-beam computed tomography
Julio César Capella Cobos
January-April 2020, 3(1):18-26
DOI:10.4103/GFSC.GFSC_14_19  
After a dental extraction procedure, the extracted teeth are discarded disregarding their properties as an excellent graft material. The use of extracted teeth as a graft material was first performed by Dr. Marshall Urist in 1967, where he discovered and verified that the decalcified dentin matrix can induce bone formation, but his decalcification method took at least 5 days to accomplish before being able to use it as a graft material. Currently, an ultrasonic technology with temperature and vacuum control, named VacuaSonic® System reduces the decalcification time dramatically (≤80 min) converting the tooth into graft material at chairside immediately after the dental extraction with the result being an autogenous tooth graft material (ATG). The aim of this article is to introduce two clinical cases: one case of alveolar ridge augmentation, and the other, socket preservation using ATG mixed with liquid-phase concentrated growth factors (LP-CGF) prepared at chairside on the same day of the dental extraction procedure. LP-CGF is obtained from the same patient, which was collected in blood collection tubes and processed by a special centrifuge device. The result obtained by mixing ATG with LP-CGF is a graft matrix named “Gummy Tooth Graft.”
  3,683 356 -
Xeno-synthetic bone block includes cellular remnants: Acceptable components or lack of purification?
Anna Orlowska, Sarah Al-Maawi, Juraj Brozovic, Robert Sader, Shahram Ghanaati
May-August 2018, 1(2):70-73
DOI:10.4103/GFSC.GFSC_10_18  
Naturally derived bone substitute materials have to undergo controlled purification processes to be suitable for clinical application. The aim of the present article is to analyze the structure and composition of a new commercially available bovine-derived bone substitute material, SmartBone®, for the presence and localization of organic and inorganic constituents. Standardized conventional methods were performed for the histological analysis using hematoxylin and eosin, Azan, Masson-Goldner trichrome, as well as specific tartrate-resistant acid phosphatase staining, and were evaluated by light microscopy. The results showed a calcified trabecular structure with preserved lamellar substructure. In addition, organic structures were found within the osteocyte lacunae, the haversian canals, and the inter-trabecular region. The presence of organic remnants within the bone block raises the question on what extent including organic material could affect the regeneration process and application safety in clinical settings and whether including specific organic material such as collagen could be beneficial for bone regeneration. Thereby, further preclinical and clinical studies are necessary to evaluate the bone block examined here and to determine whether a clinician should accept the organic remnants within bone blocks.
  3,547 435 -
ORIGINAL ARTICLE
Effect of Vitamin D3on nonmelanoma skin cancer cells: A comparative in vitro study
Eva Dohle, Pasinee Vorakulpipat, Sarah Al-Maawi, Rita Schröder, Patrick Booms, Robert Sader, Charles James Kirkpatrick, Shahram Ghanaati
January-April 2020, 3(1):12-17
DOI:10.4103/GFSC.GFSC_2_20  
Background: The use of Vitamin D3, as an alternative drug, combined with common therapeutic strategies to treat nonmelanoma skin cancers, has recently attracted attention. However, in vitro data on Vitamin D3action on different tumor cell lines compared to healthy cells are lacking. Aims and Objectives: In this context, the present study aimed to investigate the potential role of Vitamin D3's ability as an antitumor treatment. Materials and Methods: Cell growth, cell viability, and apoptosis as well as cell cycle distribution were comparatively assessed in a squamous cell carcinoma (SCC) cell line, a basal cell carcinoma (BCC) cell line, and healthy primary normal human epidermal keratinocytes (NHEK) in response to various Vitamin D3concentrations. Results: Tumor and healthy cells clearly responded differently to Vitamin D3application with regard to metabolic activity and apoptosis. The application of Vitamin D3reduced the metabolic activity of the BCC and SCC cancer cell lines (and not NHEK) and induced cell cycle arrest. Furthermore, Vitamin D3-mediated increased apoptosis was observed in tumor cells but not in healthy primary keratinocytes. Conclusions: Our findings indicate an antiproliferative and proapoptotic Vitamin D3-dependent effect on skin cancer cells in vitro, highlighting Vitamin D3as a potential and beneficial alternative drug for further studies with respect to possible clinical strategies to treat nonmelanoma skin cancers.
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CASE SERIES
The use of implants with conometric connection and monophasic implants to optimize the maintenance of soft tissues in esthetic areas
Andrea Palermo, Franco Ferrante, Dario Spitaleri
January-April 2018, 1(1):42-46
DOI:10.4103/GFSC.GFSC_2_17  
Background: The purpose of this study is to analyze the advantages of the conometric connection and of the monophasic implants in the esthetic area. This work, according to the authors, helps the clinician to achieve excellent results on soft tissue by knowing and avoiding the pumping effect. Methods: In this study, ten titanium implants of Immediateload SA-CH have been introduced instead of teeth in the upper and lower frontal area, (extracted because of infection or agenesis) with 1 year of follow-up with perfect healing of the interincisive papilla. Results: Thanks to the results achieved, that is osteointegration, minimal crestal bone resorption, good interincisive papilla maintained in the esthetic zone, it is clear how the conometric connection and the monophasic implant are an excellent prosthetic solution minimizing the effects of flat-to-flat connections. Conclusion: From the observed results, it has been highlighted that Immediateload Company appears to have two perfect solutions (conometric connection and monophasic fixture) to be used in esthetic area like lateral upper incisors.
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CASE REPORT
Using concentrated growth factors as an alternative to bone graft material in sinus augmentation to rehabilitate atrophic posterior maxilla
Julio César Capella Cobos, Adolfo Enriquez Granados
May-August 2019, 2(2):30-36
DOI:10.4103/GFSC.GFSC_12_19  
A larger number of senior patients want to eliminate the use of conventional overdenture such as Conventional Complete Denture or Removable Partial Denture and replace it by an Implant-supported fixed prosthesis or at least implant-supported overdenture with the purpose of restoring and improving the masticatory function, aesthetics besides helping them gain confidence to talk and smile. Most of those patients have lost their teeth and been posteriorly edentulous for extended periods of time, causing severe bone resorption and Pneumatized Maxillary Sinus that makes it impossible for conventional dental implant placement. This report reviews two successful cases of rehabilitation of the atrophic posterior maxilla with previous bilateral ridge augmentation in Pneumatized Maxillary Sinuses using solely Concentrated Growth Factors (CGF) without bone graft augmentation with simultaneous implant placement. Where CGF is obtained from the patient's which was collected in blood collection tubes and processed by a special centrifuge device.
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ORIGINAL ARTICLES
Does cationic incorporation into carbonated hydroxyapatite improve bone repair?
Giovanna Pesce, Jhonathan Raphaell Nascimento Barros, Rodrigo Resende, Madelaine Torres da Silva, Marcelo José Uzeda, Adriana Terezinha Novellino Alves, José Albuquerque Calasans-Maia, Monica Diuana Calasans-Maia
May-August 2018, 1(2):58-63
DOI:10.4103/GFSC.GFSC_18_18  
Background: Calcium phosphate ceramics are a group of materials that have been widely used in bone regeneration, especially hydroxyapatite (HA), because of its biocompatibility and similarity to the main mineral phase component of bone tissue. However, the biological apatite has nanometric dimensions and cationic and anionic substitutions and presents low crystallinity, which differs from stoichiometric HA. Aims: The ionic substitutions in the composition of HA have been done to mimic biological apatite and improve its physicochemical characteristics. Previous studies have demonstrated that strontium-, magnesium-, zinc-, and iron-isolated substitution stimulate osteoblastic activity, as well as reduce osteoclastic activity. Materials and Methods: This study evaluated the osteogenic potential of nanostructured carbonated hydroxyapatite microspheres (cHAMs) containing 5% strontium, 5% zinc, 5% magnesium, 1% iron, and 5% manganese, after implantation in a critical size defect in the rat's calvaria. Two experimental groups were studied: cHA 37°C (nanostructured cHA, control) and cHAM 37°C (metals doped nanostructured cHA). The animals were euthanized after 1, 3, and 6 months, and the samples were histologically processed for histomorphometric analysis regarding the presence of residual biomaterial, neoformed bone, and connective tissue. Statistical Analysis: The averages found were analyzed statistically by the D'Agostino and Pearson analysis and by Kruskal–Wallis test; significant differences were observed for P < 0.05. Results: The test group presented less neoformed bone (P < 0.05) and was less bioabsorbed at 1 and 3 months (P < 0.05). Conclusion: The biomaterials studied were compatible osteoconductors, but the doping with multiple metals did not improve bone repair.
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