Ultrasonographic analysis of palatal donor site healing accelerated with platelet-rich fibrin following subepithelial connective tissue harvesting

Authors

DOI:

https://doi.org/10.1590/1678-7757-2023-0448

Keywords:

Platelet-rich fibrin., Ultrasonography, Wound healing, Blood flow, Palate, Regeneration

Abstract

Objective: Platelet-rich fibrin (PRF) contains a variety of growth factors and bioactive molecules that play crucial roles in wound healing and angiogenesis. We aimed to evaluate the effects of PRF on tissue thickness and vascularization of the palatal donor site by ultrasound (USG) following subepithelial connective tissue harvesting. Methodology: Methodology: A subepithelial connective tissue graft was harvested from the palatal region with a single incision for root coverage in 20 systemically healthy patients. In the test group (n = 10), the PRF membrane was placed at the donor site, whereas no material was applied in the control group (n=10). Palatal tissue thickness (PTT) and pulsatility index (PI) were evaluated by USG at baseline and on the 3rd, 7th, 14th, 30th, and 90th days after surgery. The early healing index (EHI) was used to evaluate donor site healing for 30 days. Results: PTT was significantly higher in the PRF group on the 3rd and 14th days after surgery when compared to the controls. In the PRF-treated group, PI levels were significantly higher than in the controls, especially on the 14th day. PTT increased significantly 90 days after surgery compared to the test group baseline, but controls showed a significant decrease. The PRF group showed statistically significant improvements in EHI scores compared to controls on days 3, 7, and 14. This study found a negative correlation between PI values and EHI scores on postoperative days three and seven in the test group. Conclusion: USG is a non-invasive, objective method to radiographically evaluate the regenerative effects of PRF on palatal wound healing after soft tissue harvesting. To overcome graft inadequacy in reharvesting procedures, PRF application may enhance clinical success and reduce possible complications by increasing tissue thickness and revascularization in the donor area.

Downloads

Download data is not yet available.

References

Chambrone L, Botelho J, Machado V, Mascarenhas P, Mendes JJ, Avila-Ortiz G. Does the subepithelial connective tissue graft in conjunction with a coronally advanced flap remain as the gold standard therapy for the treatment of single gingival recession defects? A systematic review and network meta-analysis. J Periodontol. 2022;93(9):1336-52. doi: 10.1002/JPER.22-0167

Thoma DS, Buranawat B, Hammerle CH, Held U, Jung RE. Efficacy of soft tissue augmentation around dental implants and in partially edentulous areas: a systematic review. J Clin Periodontol. 2014;41 Suppl 15:S77-91. doi: 10.1111/jcpe.12220

Tavelli L, Barootchi S, Avila-Ortiz G, Urban IA, Giannobile WV, Wang HL. Peri-implant soft tissue phenotype modification and its impact on peri-implant health: a systematic review and network meta-analysis. J Periodontol. 2021;92(1):21-44. doi: 10.1002/JPER.19-0716

Zucchelli G, Felice P, Mazzotti C, Marzadori M, Mounssif I, Monaco C, et al. 5-year outcomes after coverage of soft tissue dehiscence around single implants: a prospective cohort study. Eur J Oral Implantol. 2018;11(2):215-24.

Kumar A, Sood V, Masamatti SS, Triveni MG, Mehta DS, Khatri M, et al. Modified single incision technique to harvest subepithelial connective tissue graft. J Indian Soc Periodontol. 2013;17(5):676-80. doi: 10.4103/0972-124X.119294

Hürzeler MB, Weng D. A single-incision technique to harvest subepithelial connective tissue grafts from the palate. Int J Periodontics Restorative Dent. 1999;19(3):279-87.

Fickl S, Fischer KR, Jockel-Schneider Y, Stappert CF, Schlagenhauf U, Kebschull M. Early wound healing and patient morbidity after single-incision vs. trap-door graft harvesting from the palate--a clinical study. Clin Oral Investig. 2014;18(9):2213-9. doi: 10.1007/s00784-014-1204-7

Karthikeyan BV, Khanna D, Chowdhary KY, Prabhuji ML. The versatile subepithelial connective tissue graft: a literature update. Gen Dent. 2016;64(6):e28-e33.

Del Pizzo M, Modica F, Bethaz N, Priotto P, Romagnoli R. The connective tissue graft: a comparative clinical evaluation of wound healing at the palatal donor site. a preliminary study. J Clin Periodontol. 2002;29(9):848-54. doi: 10.1034/j.1600-051x.2002.290910.x

Tavelli L, Barootchi S, Ravida A, Oh TJ, Wang HL. What Is the safety zone for palatal soft tissue graft harvesting based on the locations of the greater palatine artery and foramen? A systematic review. J Oral Maxillofac Surg. 2019;77(2):271 e1- e9. doi: 10.1016/j.joms.2018.10.002

Soileau KM, Brannon RB. A histologic evaluation of various stages of palatal healing following subepithelial connective tissue grafting procedures: a comparison of eight cases. J Periodontol. 2006;77(7):1267-73. doi: 10.1902/jop.2006.050129

Tavelli L, Barootchi S, Stefanini M, Zucchelli G, Giannobile WV, Wang HL. Wound healing dynamics, morbidity, and complications of palatal soft-tissue harvesting. Periodontol 2000. 2023;92(1):90-119. doi: 10.1111/prd.12466

Stavropoulou C, Atout RN, Brownlee M, Schroth RJ, Kelekis-Cholakis A. A randomized clinical trial of cyanoacrylate tissue adhesives in donor site of connective tissue grafts. J Periodontol. 2019;90(6):608-15. doi: 10.1002/JPER.18-0475

Dias SB, Fonseca MV, Santos NC, Mathias IF, Martinho FC, Santamaria M Jr, et al. Effect of GaAIAs low-level laser therapy on the healing of human palate mucosa after connective tissue graft harvesting: randomized clinical trial. Lasers Med Sci. 2015;30(6):1695-702. doi: 10.1007/s10103-014-1685-2

Lektemur Alpan A, Torumtay Cin G. PRF improves wound healing and postoperative discomfort after harvesting subepithelial connective tissue graft from palate: a randomized controlled trial. Clin Oral Investig. 2020;24(1):425-36. doi: 10.1007/s00784-019-02934-9

Fan Y, Perez K, Dym H. Clinical uses of platelet-rich fibrin in oral and maxillofacial surgery. Dent Clin North Am. 2020;64(2):291-303. doi: 10.1016/j.cden.2019.12.012

Marx RE. Platelet-rich plasma (PRP): what is PRP and what is not PRP? Implant Dent. 2001;10(4):225-8. doi: 10.1097/00008505-200110000-00002

Varela HA, Souza JC, Nascimento RM, Araujo RF Jr., Vasconcelos RC, Cavalcante RS, et al. Injectable platelet rich fibrin: cell content, morphological, and protein characterization. Clin Oral Investig. 2019;23(3):1309-18. doi: 10.1007/s00784-018-2555-2

Sohn DS. Lecture titled with sinus and ridge augmentation with CGF and AFG. In: Symposium on CGF and AFG. Tokyo: June 6; 2010.

Tunali M, Özdemir H, Küçükodacı Z, Akman S, Yaprak E, Toker H, et al. A novel platelet concentrate: titanium-prepared platelet-rich fibrin. Biomed Res Int. 2014;2014:209548. doi: 10.1155/2014/209548

Choukroun J. Advanced PRF, & i-PRF: platelet concentrates or blood concentrates. J Periodontal Med Clin Pract. 2014;1(1):3.

Mourão CF, Valiense H, Melo ER, Mourão NB, Maia MD. Obtention of injectable platelets rich-fibrin (i-PRF) and its polymerization with bone graft. Rev Col Bras Cir. 2015;42:421-3. doi: 10.1590/0100-69912015006013

Choukroun J, Diss A, Simonpieri A, Girard MO, Schoeffler C, Dohan SL, et al. Platelet-rich fibrin (PRF): a second-generation platelet concentrate. Part IV: clinical effects on tissue healing. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;101(3):e56-60. doi: 10.1016/j.tripleo.2005.07.011

Miron RJ, Zucchelli G, Pikos MA, 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

Tikku AP, Kumar S, Loomba K, Chandra A, Verma P, Aggarwal R. Use of ultrasound, color Doppler imaging and radiography to monitor periapical healing after endodontic surgery. J Oral Sci. 2010;52(3):411-6. doi: 10.2334/josnusd.52.411

Figueredo CA, Catunda RQ, Gibson MP, Major PW, Almeida FT. Use of ultrasound imaging for assessment of the periodontium: a systematic review. J Periodontal Res. 2023;10.1111/jre.13194

Nguyen KC, Le LH, Kaipatur NR, Major PW. Imaging the cemento-enamel junction using a 20-mhz ultrasonic transducer. Ultrasound Med Biol. 2016;42(1):333-8. doi: 10.1016/j.ultrasmedbio.2015.09.012

Nguyen KT, Le LH, Kaipatur NR, Zheng R, Lou EH, Major PW. High-Resolution ultrasonic imaging of dento-periodontal tissues using a multi-element phased array system. Ann Biomed Eng. 2016;44(10):2874-86. doi: 10.1007/s10439-016-1634-2

Moore CA, Law JK, Retout M, Pham CT, Chang KC, Chen C, et al. High-resolution ultrasonography of gingival biomarkers for periodontal diagnosis in healthy and diseased subjects. Dentomaxillofac Radiol. 2022;51(6):20220044. doi: 10.1259/dmfr.20220044

Majzoub J, Tavelli L, Barootchi S, Salami A, Inglehart MR, Kripfgans OD, et al. Agreement in measurements of ultrasonography-derived periodontal diagnostic parameters among multiple raters: a diagnostic accuracy study. Oral Surg Oral Med Oral Pathol Oral Radiol. 2022;134(3):375-85. doi: 10.1016/j.oooo.2022.03.010

Tavelli L, Barootchi S, Majzoub J, Chan HL, Giannobile WV, Wang HL, et al. Ultrasonographic tissue perfusion analysis at implant and palatal donor sites following soft tissue augmentation: A clinical pilot study. J Clin Periodontol. 2021;48(4):602-14. doi: 10.1111/jcpe.13424

Shahidi S, Shakibafard A, Zamiri B, Mokhtare MR, Houshyar M, Mahdian S. The Feasibility of ultrasonography in defining the size of jaw osseous lesions. J Dent (Shiraz). 2015;16(4):335-40.

Koca-Unsal RB, Unsal G, Kasnak G, Firatli Y, Ozcan I, Orhan K, et al. Ultrasonographic evaluation of the titanium-prepared platelet-rich fibrin effect in free gingival graft procedures. J Periodontol. 2022;93(2):187-94. doi: 10.1002/JPER.21-0076

Zucchelli G, De Sanctis M. Treatment of multiple recession-type defects in patients with esthetic demands. J Periodontol. 2000;71(9):1506-14. doi: 10.1902/jop.2000.71.9.1506

Donn BJ, Jr. The free connective tissue autograft: a clinical and histologic wound healing study in humans. J Periodontol. 1978;49(5):253-60. doi: 10.1902/jop.1978.49.5.253

Polimeni G, Xiropaidis AV, Wikesjo UM. Biology and principles of periodontal wound healing/regeneration. Periodontol 2000. 2006;41:30-47. doi: 10.1111/j.1600-0757.2006.00157.x

Sohn DS. Lecture titled with sinus and ridge augmentation with CGF and AFG. In: Symposium on CGF and AFG. Tokyo: June 6; 2010.

Tunali M, Özdemir H, Küçükodacı Z, Akman S, Yaprak E, Toker H, et al. A novel platelet concentrate: titanium-prepared platelet-rich fibrin. Biomed Res Int. 2014;2014:209548. doi: 10.1155/2014/209548

Choukroun J. Advanced PRF, & i-PRF: platelet concentrates or blood concentrates. J Periodontal Med Clin Pract. 2014;1(1):3.

Mourão CF, Valiense H, Melo ER, Mourão NB, Maia MD. Obtention of injectable platelets rich-fibrin (i-PRF) and its polymerization with bone graft. Rev Col Bras Cir. 2015;42:421-3. doi: 10.1590/0100-69912015006013

Choukroun J, Diss A, Simonpieri A, Girard MO, Schoeffler C, Dohan SL, et al. Platelet-rich fibrin (PRF): a second-generation platelet concentrate. Part IV: clinical effects on tissue healing. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;101(3):e56-60. doi: 10.1016/j.tripleo.2005.07.011

Miron RJ, Zucchelli G, Pikos MA, 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

Tikku AP, Kumar S, Loomba K, Chandra A, Verma P, Aggarwal R. Use of ultrasound, color Doppler imaging and radiography to monitor periapical healing after endodontic surgery. J Oral Sci. 2010;52(3):411-6. doi: 10.2334/josnusd.52.411

Figueredo CA, Catunda RQ, Gibson MP, Major PW, Almeida FT. Use of ultrasound imaging for assessment of the periodontium: a systematic review. J Periodontal Res. 2023;10.1111/jre.13194

Nguyen KC, Le LH, Kaipatur NR, Major PW. Imaging the cemento-enamel junction using a 20-mhz ultrasonic transducer. Ultrasound Med Biol. 2016;42(1):333-8. doi: 10.1016/j.ultrasmedbio.2015.09.012

Nguyen KT, Le LH, Kaipatur NR, Zheng R, Lou EH, Major PW. High-Resolution ultrasonic imaging of dento-periodontal tissues using a multi-element phased array system. Ann Biomed Eng. 2016;44(10):2874-86. doi: 10.1007/s10439-016-1634-2

Moore CA, Law JK, Retout M, Pham CT, Chang KC, Chen C, et al. High-resolution ultrasonography of gingival biomarkers for periodontal diagnosis in healthy and diseased subjects. Dentomaxillofac Radiol. 2022;51(6):20220044. doi: 10.1259/dmfr.20220044

Majzoub J, Tavelli L, Barootchi S, Salami A, Inglehart MR, Kripfgans OD, et al. Agreement in measurements of ultrasonography-derived periodontal diagnostic parameters among multiple raters: a diagnostic accuracy study. Oral Surg Oral Med Oral Pathol Oral Radiol. 2022;134(3):375-85. doi: 10.1016/j.oooo.2022.03.010

Tavelli L, Barootchi S, Majzoub J, Chan HL, Giannobile WV, Wang HL, et al. Ultrasonographic tissue perfusion analysis at implant and palatal donor sites following soft tissue augmentation: A clinical pilot study. J Clin Periodontol. 2021;48(4):602-14. doi: 10.1111/jcpe.13424

Shahidi S, Shakibafard A, Zamiri B, Mokhtare MR, Houshyar M, Mahdian S. The Feasibility of ultrasonography in defining the size of jaw osseous lesions. J Dent (Shiraz). 2015;16(4):335-40.

Koca-Unsal RB, Unsal G, Kasnak G, Firatli Y, Ozcan I, Orhan K, et al. Ultrasonographic evaluation of the titanium-prepared platelet-rich fibrin effect in free gingival graft procedures. J Periodontol. 2022;93(2):187-94. doi: 10.1002/JPER.21-0076

Zucchelli G, De Sanctis M. Treatment of multiple recession- type defects in patients with esthetic demands. J Periodontol. 2000;71(9):1506-14. doi: 10.1902/jop.2000.71.9.1506

Donn BJ, Jr. The free connective tissue autograft: a clinical and histologic wound healing study in humans. J Periodontol. 1978;49(5):253-60. doi: 10.1902/jop.1978.49.5.253

Polimeni G, Xiropaidis AV, Wikesjo UM. Biology and principles of periodontal wound healing/regeneration. Periodontol 2000. 2006;41:30-47. doi: 10.1111/j.1600-0757.2006.00157.x

Eren G, Kantarci A, Sculean A, Atilla G. Vascularization after treatment of gingival recession defects with platelet-rich fibrin or connective tissue graft. Clin Oral Investig. 2016;20(8):2045-53. doi: 10.1007/s00784-015-1697-8

Yousefi S, Qin J, Dziennis S, Wang RK. Assessment of microcirculation dynamics during cutaneous wound healing phases in vivo using optical microangiography. J Biomed Opt. 2014;19(7):76015. doi: 10.1117/1.JBO.19.7.076015

Barootchi S, Chan HL, Namazi SS, Wang HL, Kripfgans OD. Ultrasonographic characterization of lingual structures pertinent to oral, periodontal, and implant surgery. Clin Oral Implants Res. 2020;31(4):352-9. doi: 10.1111/clr.13573

Tavelli L, Kripfgans OD, Chan HL, Vera Rodriguez M, Sabri H, Mancini L, et al. Doppler ultrasonographic evaluation of tissue revascularization following connective tissue graft at implant sites. J Clin Periodontol. Forthcoming 2023. doi: 10.1111/jcpe.13889

Molnar B, Molnar E, Fazekas R, Ganti B, Mikecs B, Vag J. assessment of palatal mucosal wound healing following connective-tissue harvesting by laser speckle contrast imaging: an observational case series study. Int J Periodontics Restorative Dent. 2019;39(2):e64-e70. doi: 10.11607/prd.3878

Martinez CE, Smith PC, Palma Alvarado VA. The influence of platelet-derived products on angiogenesis and tissue repair: a concise update. Front Physiol. 2015;6:290. doi: 10.3389/fphys.2015.00290

Lektemur Alpan A, Torumtay Cin G, Kizildag A, Zavrak N, Ozmen O, Arslan S, et al. Evaluation of the effect of injectable platelet rich fibrin (i-PRF) in wound healing and growth factor release in rats: a split-mouth study. Growth Factors. 2024;42(1):36-48. doi: 10.1080/08977194.2023.2289375

Uslu K, Tansuker HD, Tabaru A, Egeren SE, Kulahci KK, Bulut P, et al. Investigation of the effects of thrombocyte-rich plasma, systemic ozone and hyperbaric oxygen treatment on intraoral wound healing in rats: experimental study. Eur Arch Otorhinolaryngol. 2020;277(6):1771-7. doi: 10.1007/s00405-020-05872-5

Lindeboom JA, Mathura KR, Aartman IH, Kroon FH, Milstein DM, Ince C. Influence of the application of platelet-enriched plasma in oral mucosal wound healing. Clin Oral Implants Res. 2007;18(1):133-9. doi: 10.1111/j.1600-0501.2006.01288.x

Liu YH, To M, Okudera T, Wada-Takahashi S, Takahashi SS, Su CY, et al. Advanced platelet-rich fibrin (A-PRF) has an impact on the initial healing of gingival regeneration after tooth extraction. J Oral Biosci. 2022;64(1):141-7. doi: 10.1016/j.job.2021.11.001

Downloads

Published

2024-04-19

Issue

Section

Original Articles

How to Cite

Cin, G. T. ., Alpan, A. L. ., Açkgöz, G., & Uçan, G. Özlü . (2024). Ultrasonographic analysis of palatal donor site healing accelerated with platelet-rich fibrin following subepithelial connective tissue harvesting. Journal of Applied Oral Science, 32, e20230448. https://doi.org/10.1590/1678-7757-2023-0448