Platelet Rich Fibrin Matrix (PRFM) and Peripheral Blood Mesenchymal Stem Cells (PBMSCs) in the management of intraosseous defects: a randomized clinical trial

Authors

  • R Sreeparvathy K.L.E Society’s Institute of Dental Sciences, Department of Periodontics, Bengaluru
  • Sphoorthi Anup Belludi K.L.E Society’s Institute of Dental Sciences, Department of Periodontics, Bengaluru https://orcid.org/0000-0003-1148-7873
  • Ashwin Prabhu K.L.E Society’s Institute of Dental Sciences, Department of Periodontics, Bengaluru

DOI:

https://doi.org/10.1590/1678-7757-2023-0442

Keywords:

Intrabony defect, Osseous regeneration, Peripheral blood mesenchymal stem cells, Platelet-rich fibrin matrix

Abstract

A combination of peripheral blood mesenchymal stem cells (PBMSCs) and platelet rich fibrin matrix (PRFM) could be a probable periodontal regenerative material with the synergy of the added benefits of each material. Objective: This randomized controlled clinical trial aimed to evaluate the regenerative capacity of supercell (PRFM and PBMSCs) compared with that of PRFM alone in human periodontal mandibular intraosseous defects (IOD). Methodology: This study included 17 patients of both sexes (12 men, 5 women) aged 30-55 years (mean age = 37.7±4.4 years) who fulfilled the inclusion criteria (radiographic and clinical evaluation for bilateral IOD with probing pocket depth (PPD ≥ 6 mm). A split-mouth design was used in each patient. A total of 34 sites in the mandibular arch randomly received PRFM alone + open flap debridement (OFD) [Control sites] or supercell (PRFM+PBMSCs) + OFD [Test sites]. The clinical parameters plaque index (PI), gingival index (GI), PPD, clinical attachment level (CAL), and in the radiographic parameters; defect depth (DD) and defect fill percentage (DFP) were recorded at baseline, 3 and 6 months postoperatively. Early wound healing index (EHI) was used at 1 week to assess wound healing ability. Results: At 6 months, radiographic parameters revealed significant reduction in DD (P<0.001) and significant DFP values in the test group compared with the control group. The supercell showed significant improvement in PPD and CAL at the end of 6 months (P<0.001). EHI scores at 1 week showed no statistically significant difference between the test and control groups. Conclusion: Supercell can be considered a regenerative material in the treatment of periodontal IODs.

Downloads

Download data is not yet available.

References

Malathi K, Muthukumaraswamy A, Beri S. Periodontal regeneration of an intrabony osseous defect with combination of platelet rich fibrin and bovine derived demineralized bone matrix: a case report. IOSR-JDMS. 2013;4:20-6.

Miron R J, Zucchelli G, Pikos M A, Salama M, Lee S, Guillemette V, et al. Use of platelet-rich fibrin in regenerative dentistry: a systematic review. Clin Oral Investig 2017;21(6):1913-27. doi: 10.1007/s00784-017-2133-z

Dohan Ehrenfest DM, Rasmusson L, Albrektsson T. Classification of platelet concentrates: from pure platelet-rich plasma (P-PRP) to leucocyte- and platelet-rich fibrin(L-PRF). Trends Biotechnol 2009;27(3):158-67. doi: 10.1016/j.tibtech.2008.11.009

Carroll RJ, Arnoczky SP, Graham S, O’Connell SM. Characterization of autologous growth factors in Cascade platelet-rich fibrin matrix (PRFM). New Jersey: Musculoskeletal Transplant Foundation; 2006.

O'Connell SM, Hessler K, Dardik H. Cascade® autologous system platelet-rich fibrin matrix in the treatment of chronic leg ulcers. Adv Wound Care (New Rochelle) 2012;1(1):52-5. doi: 10.1089/wound.2011.0290

Sclafani AP. Safety, efficacy, and utility of platelet-rich fibrin matrix in facial plastic surgery. Arch Facial Plast Surg 2011;13(4):247-51. doi: 10.1001/archfacial.2011.3

Mohammed SA, Alhijazi AY. Evaluation the effect of platelet rich fibrin matrix on bone healing. J Baghdad Coll Dent 2011;23(4):65-70.

Lucarelli E, Beretta R, Dozza B, Tazzari PL, O'Connel SM, Ricci F, et al. A recently developed bifacial platelet-rich fibrin matrix. Eur Cell Mater 2010;20:13-23. doi: 10.22203/ecm.v020a02

Zipursky A, Bow E, Seshadri RS, Brown EJ. Leukocyte density and volume in normal subjects and in patients with acute lymphoblastic leukemia. Blood. 1976;48(3):361-71.

Yang YK, Ogando CR, Wang See C, Chang TY, Barabino GA. Changes in phenotype and differentiation potential of human mesenchymal stem cells aging in vitro. Stem Cell Res Ther. 2018;9(1):131. doi: 10.1186/s13287-018-0876-3

Chen YR, Yan X, Yuan FZ, Ye J, Xu BB, Zhou ZX, et al. The use of peripheral blood-derived stem cells for cartilage repair and regeneration in vivo: a review. Front Pharmacol 2020;11:404. doi: 10.3389/fphar.2020.00404

Zheng RC, Park YK, Kim SK, Cho J, Heo SJ, Koak JY, et al. Bone regeneration of blood-derived stem cells within dental implants. J Dent Res 2015;94:1318-25. doi: 10.1177/0022034515590368

Yamada Y, Ueda M, Naiki T, Takahashi M, Hata K, Nagasaka T. Autogenous injectable bone for regeneration with mesenchymal stem cells and platelet rich plasma: tissue-engineered bone regeneration. Tissue Eng. 2004;10:955-64. doi: 10.1089/1076327041348284

Xu L, Li G. Circulating mesenchymal stem cells and their clinical implications. J orthopaed trans 2014;2:1-7. doi: 10.1016/j.jot.2013.11.002

Elfenbein GJ, Sackstein R. Primed marrow for autologous and allogenic transplantation: a review comparing primed marrow to mobilized blood and steady-state marrow. Exp Hematol. 2004;32:327-39. doi: 10.1016/j.exphem.2004.01.010

Loe H. The gingival index, the plaque index and the retention index systems. J Periodontol 1967;38:610. 10.1902/jop.1967.38.6.610

Vandana KL, Gupta I. The location of cemento enamel junction for CAL measurement: A clinical crisis. J Indian Soc Periodontol. 2009;13(1):12-5. doi: 10.4103/0972-124X.51888

Rams TE, Slots J. Comparison of two pressure sensitive periodontal probes and a manual periodontal probe in shallow and deep pockets. Int J Periodontics Restorative Dent 1993;13:521-9.

Meadows CL, Gher ME, Quintero G, Lafferty TA. A comparison of Polylactic acid granules and decalcified Freeze-dried bone allograft in human periodontal osseous defects. J Periodontol 1993; 64:103-9. doi: 10.1902/jop.1993.64.2.103

Eichkholz P, Lenhard M, Benn DK, Staehle HJ. Periodontal surgery of vertical defects with or without synthetic bio-absorbable barriers.12-month results. J Periodontol 1998;69:1210-7.

Singhal L, Belludi SA, Pradhan N, Manvi S. A comparative evaluation of the effect of platelet rich fibrin matrix with and without peripheral blood mesenchymal stem cells on dental implant stability: A randomized controlled clinical trial. J Tissue Eng Regen Med. 2022;16:422-30. doi: 10.1002/term.3290

Drug prescribing for Dentistry, Dental Clinical Guidance [internet]. 3rd ed. Dundee: Scottish Dental Clinical Effectiveness programme; 2016 (cited 2024 May 29). Available from: https://www.sdcep.org.uk/media/2wleqlnr/sdcep-drug-prescribing-for-dentistry-3rd-edition.pdf

Walia KD, Belludi SA, Pradhan N, Jain V, Shaik S. Evaluation of platelet-rich fibrin matrix as a regenerative material in the surgical management of human periodontal intraosseous defects – a randomized controlled trial. Contemp Clin Dent. 2022;13:9-17. doi: 10.4103/ccd.ccd_832_20

Chong PP, Selvaratnam L, Abbas AA, Kamarul T. Human peripheral blood derived mesenchymal stem cells demonstrate similar characteristics and chondrogenic differentiation potential to bone marrow derived mesenchymal stem cells. J Orthop Res 2012;30:634-42.

Belludi SA, Singhal L, Gubbala M. Peripheral blood mesenchymal stem cells and platelet rich fibrin matrix in the management of class II gingival recession: a case report. J Dent (Shiraz) 2021;22:67-70. doi: 10.30476/DENTJODS.2020.81784.0

Hujoel PP, DeRouen TA. Validity issues in split-mouth trials. J Clin Periodontol 1992;19:625-7. doi: 10.1111/j.1600-051x.1992.tb01709.x

Antczak-Bouckoms AA, Tulloch JF, Berkey CS. Split mouth and crossover designs in dental research. J Clin Periodontol 1990;17:446-53. doi: 10.1111/j.1600-051x.1990.tb02343.x

Singh PK, Kumari A. Prevalence and distribution of different types of bone defects in chronic periodontitis in bagalkot subjects - a clinical study. Int J Sci Study. 2017;5:281-6.

Simon BI, Gupta P, Tajbaksh S. Quantitative evaluation of extraction socket healing following the use of autologous platelet rich fibrin matrix in humans. Int J Periodontics Restorative Dent. 2011;31:285-95.

Isidor F, Karring T, Attstrom R. Reproducibility of pocket depth and attachment level measurements when using a flexible splint. J Clin Periodontol 1994;11:662-8. doi: 10.1111/j.1600-051x.1984.tb01314.x

Talaiepour AR, Panjnoush M, Soleimanishayeste Y, Abesi F, Sahba S. A survey on the accuracy of radiovisiography in the assessment of interproximal intrabony defects. J Dent. 2005;2:29-32.

Fabbro MD, Bortolin M, Taschieri S, Ceci C, Weinstein RL. Antimicrobial properties of platelet-rich preparations. A systematic review of the current preclinical evidence. Platelets. 2016;27:276-85. doi: 10.3109/09537104.2015.1116686

Sung DK, Chang YS, Sung SL, Yoo HS, Ahn SY, Park WS. Antibacterial effect of mesenchymal stem cells against Escherichia coli is mediated by secretion of beta-defensin-2 via toll-like receptor 4 signalling. Cell Microbiol. 2016;18(3):424-36. doi: 10.1111/cmi.12522

Abdul Ameer LA, Raheem ZJ, Abdulrazaq SS, Ali BG, Nasser MM, Khairi AW. The anti-inflammatory effect of platelet-rich plasma in the periodontal pocket. Eur J Dent 2018;12:528-31. doi: 10.4103/ejd.ejd_49_18

Patel GK, Gaekwad SS, Gujjari SK, S C VK. platelet-rich fibrin in regeneration of intrabony defects: a randomized controlled trial. J Periodontol. 2017;88(11):1192-9. doi: 10.1902/jop.2017.130710

Lekovic V, Camargo PM, Weinlaender M, Vasilic N, Aleksic Z, Kenney EB. Effectiveness of a combination of platelet-rich plasma, bovine porous bone mineral and guided tissue regeneration in the treatment of mandibular grade II molar furcations in humans. J Clin Periodontol 2003;30:746-51. doi: 10.1034/j.1600-051x.2003.00368.x

O'Connell S, Carroll R, Beavis A, Arnoczky S. Flow cytometric characterization of Cascade platelet-rich fibrin matrix (PRFM). In: Edison, NJ, editor. The impact of exogenous thrombin on platelet concentrates (PC). New Jersey: Musculoskeletal Transplant Foundation; 2006. v.4, p. 66.

Nevins M, Kao RT, McGuire MK, McClain PK, Hinrichs JE, McAllister BS, et al. Platelet-derived growth factor promotes periodontal regeneration in localized osseous defects: 36-month extension results from a randomized, controlled, double-masked clinical trial. J Periodontol. 2013;84(4):456-64. doi: 10.1902/jop.2012.120141

Zhang L, Leeman E, Carnes DC, Graves DT. Human osteoblasts synthesize and respond to platelet-derived growth factor. Am J Physiol 1991;261(2 Pt1):C348-54. doi: 10.1152/ajpcell.1991.261.2.C348

Simon B, Zatcoff A, Kong J, O'Connell S. Clinical and histological comparison of extraction socket healing following the use of autologous platelet-rich fibrin matrix (PRFM) to ridge preservation procedures employing demineralized freeze dried bone allograft material and membrane. Open Dent J. 2009;3:92-9. doi: 10.2174/1874210600903010092

Chen FM, Gao LN, Tian BM, Zhang XY, Zhang YJ, Dong GY, et al. Treatment of periodontal intrabony defects using autologous periodontal ligament stem cells: a randomized clinical trial. Stem Cell Res Ther. 2016;7:33. doi: 10.1186/s13287-016-0288-1

Wu G, Pan M, Wang X, Wen J, Cao S, Li Z, et al. Osteogenesis of peripheral blood mesenchymal stem cells in self assembling peptide nanofiber for healing critical size calvarial bony defect. Sci Rep.

Miron RJ, Moraschini V, Fujioka-Kobayashi M, Zhang Y, Kawase T, Cosgarea R, et al. Use of platelet-rich fibrin for the treatment of periodontal intrabony defects: a systematic review and meta-analysis. Clin Oral Investig. 2021;25(5):2461-78. doi: 10.1007/s00784-021-03825-8

Downloads

Published

2024-08-12

Issue

Section

Original Articles

How to Cite

Sreeparvathy, R., Belludi, S. A., & Prabhu, A. (2024). Platelet Rich Fibrin Matrix (PRFM) and Peripheral Blood Mesenchymal Stem Cells (PBMSCs) in the management of intraosseous defects: a randomized clinical trial. Journal of Applied Oral Science, 32, e20230442. https://doi.org/10.1590/1678-7757-2023-0442