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   2018| May-August  | Volume 1 | Issue 2  
    Online since August 3, 2018

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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
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.
  13,024 822 6
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
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.
  10,198 1,030 18
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
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.
  5,976 641 3
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
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.
  4,273 473 1
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
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.
  4,247 432 -
Current practices and research in regenerative endodontics: A brief summary
Thomas Anthony Montagnese
May-August 2018, 1(2):47-47
  3,202 434 -