COMBINATION OF ADVANCED PLATELET-RICH FIBRIN (A-PRF) AND AUTOLOGOUS BONE GRAFT IN THE MANAGEMENT OF MANDIBULAR CYST: A CASE REPORT Текст научной статьи по специальности «Клиническая медицина»

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Молчанова // Довшлля та здоров'я. - 2002. - № 4 (23). - С. 57-61.

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Vares Y.E.,

MD, PhD, DDS

Professor & Head of Chair of the Department of Surgical Dentistry

& Maxillofacial Surgery Danylo Halytsky Lviv National Medical University,

Lviv, Ukraine. Slipyi V.Z., MD

Postgraduate Student at the Department of Surgical Dentistry

& Maxillofacial Surgery Danylo Halytsky Lviv National Medical University,

Lviv, Ukraine.

COMBINATION OF ADVANCED PLATELET-RICH FIBRIN (A-PRF) AND AUTOLOGOUS BONE GRAFT IN THE MANAGEMENT OF MANDIBULAR CYST: A CASE REPORT.

Abstract. Large bone defects usually occur after enucleation of jaw cysts. To prevent incomplete regeneration of the tissue, deformation of the alveolar processes and postoperative complications intrabony defects need to be grafted with significant amounts of substitute materials.

The purpose of the presented case report is to demonstrate the effectiveness of combined use of advanced platelet-rich fibrin (A-PRF™) and autologous bone graft in the management of bone defect after cyst enucleation.

Keywords: advanced platelet-rich fibrin (A-PRF), autologous bone graft, radicular cyst, bone defect, regeneration.

Introduction. Surgical treatment of periapical lesions and odontogenic cysts requires necessity of tissue regeneration to achieve sustainable positive effect. Replacement of cavity defects in the jaws by autocellular blood platelet concentrates, including platelet-rich fibrin (PRF) is the most promising method for optimizing the healing process. Inserting this product into the area of bone wound causes prolonged release of platelet growth factors (platelet-derived growth factor (PDGF), transforming growth factor (TGF)-pi, epidermal growth factor (EGF) and insulin-like growth factor (IGF)) [1; 4]. Growth factors induce migration and proliferation of mesenchymal progenitor cells, stimulate vascularization and tissue regeneration. Cystic cavity filled with PRF clots is completely replaced by early bone tissue up to 3 months, instead of 6-12 months under physiological time healing [6]. Due to excessive

plasticity and malleability in many clinical cases it is impossible using PRF alone without mixing it with a bone substitute materials. Theoretically, and clinically proven that PRF is more effective in combination with bone particulate.

Case report. An 18-year-old female patient who reported on 05.10.2016 to the Department of Surgical Dentistry and Maxillofacial Surgery of Danylo Halyt-skyj Lviv National Medical University with recurrent pain and swelling in mandibular left region. After clinical, radiological and laboratory examination next diagnosis was made: radicular cyst of mandible in the region of 35th and 36th teeth; retention and dystopia of 38 tooth (Fig. 1; Fig. 2) Patient has been scheduled for the surgical cystectomy of the 35th, 36th teeth and 38 tooth extraction under local anesthesia. 35th, 36th teeth were treated with endodontic therapy.

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Fig. 1. Preoperative Orthopantomography (OPG).

Fig. 2. Computed Tomography (CT) Scan of the patient before the treatment.

06. 10. 2016 after sedation (Sol. Atropini sulfatis 0,1%-1,0ml., Sol. Analgini 50%-1,0ml., Sol. Dimedroli 2%-1,0ml.) antiseptic treatment of operating field was held. Local anesthesia was performed with Ubistesin forte ("3M ESPE" AG, Germany) 4% 3,4 ml solution. By using longitudinal intrasulcular incision in the area of 34th - 38th tooth and vertical incision in the area of 34th tooth, mucoperiosteal flap was created and peeled off. 38th tooth was extracted and in parallel autologous bone graft was harvested from the retromolar area. Postextraction defect was filled with blood clot. The A-

PRF+ was prepared directly during operation following the method of Choukroun J. (Nice, France) [1]. After the venipuncture 8 vacuum test-tubes were taken of v. cubity with a 10ml vacuum test-tube (A-PRF™). The tubes were centrifuged at 1300 for 8 minutes in Choukroun PRF DUO Centrifuge™ (Process for PRF®, Nice, France). The resulting PRF clots were taken out of the test-tubes, separated from red blood cells layer using surgical scissors in sterile box and were mixed with bone graft (Fig.3; Fig.4).

Fig. 3. Autologous A-PRF clots.

Fig. 4. Autologous bone graft mixed with A-PRF.

Trepanation of outer cortical plate was performed in the projection of roots of 35-36 teeth, cyst membrane

was removed and carried out for pathomorphological examination. Sharp bony edges were smoothed (Fig. 5).

Fig. 5. View of the bone wound after cyst removal.

The area of inferior alveolar nerve canal location and roots of 3 5th and medial root of the 36th tooth were covered by membranes obtained by mechanical compression of fibrin clot. The bony defect was filled with a combination of platelet rich fibrin and autologous

bone grafts. The defect was covered by PRF membrane (Fig. 6; Fig. 7). Mucoperiosteal flap stabilization was done followed by suturing using suture material (Su-pramid 4.0, Resorba®, Germany).

Fig. 6. Bone graft and A-PRF mixture placed over defect.

Fig. 7. The defect covered by A-PRF membrane.

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Postoperatively patient was kept under the antibiotic amoxicillin and clavulanic acid (0, 375g) (Augmentin™, "SmithKline Beecham Pharmaceuticals" to "GlaxoSmithKline Export Ltd", UK) three times a day for a period of 5 days, a non-steroidal antiinflammatory drug nimesulide (100 mg) (Nimesil®, "Laboratorios Menarini S.A." to "Laboratori Guidotti S.p.A." (MENARINI GROUP), Spain / Italy) three times a day after meal for a period of 4 days and 0.2% chlorhexidine gluconate solution as mouth rinse for a

period of 5 days. Suture removal was done 10 days later after surgery.

Results and Discussion. Following the patho morphological examination the provisional diagnosis was radicular cyst. Check-up examination was done three months later. Defect replacement by young bony tissue with satisfactory density was observed, in return, incomplete osteogenesis in the region of 38th tooth was identified (Fig. 8).

PB

Fig. 8. 3 months Postoperative Orthopantomography (OPG).

Expected results indicate effectiveness using platelet-rich fibrin (PRF) due to its promising results in the induction of bone healing [3]. When the cystic cavity is filled with A-PRF, this phenomenon of physiological healing is accelerated, the healing period decreasing to three months [6].

Replacement of defects in the jaws after enucleation of odontogenic cysts by composition of PRF and different bone materials was more effective rather than using those materials separately. Rapid wound healing without any signs of postoperative complications and satisfactory bone density was received during treatment, deformation of the alveolar process in the defect area was prevented [2; 9]. In the healing process growth factors were released from the fibrin clot for an extended period of time that had a positive impact on the bone regeneration [4]. Fibrin clot supported and stabilized the graft, provided protection of the operating field, accelerated integration and remodeling of the biomaterial [10; 11].

The use of PRF and bone autotransplant in surgical treatment of radicular cysts accelerated regeneration process in the affected area and accelerated regeneration process in the affected area and increased the quality of newly formed bone [12]. Autogenous bone graft is the most preferred to use in the replacement of bone defects. It does not cause any immunological reactions, demonstrates osteogenic potential and possess osteoin-ductive and osteoinductive properties [8]. Using PRF membrane for covering palatal bone block after augmentation of maxillary alveolar process decreased the block's surface resorption [7].

Kuz'minykh I.A, 2009, substantiated the feasibility of conducting with cystectomy without apical root resection covering it with membrane of autologous fibrin which significantly reduced surgery traumatism, shortened bone healing time and reduced number of postoperative complications [5]. Closing luminal defects by

PRF-membrane provided protection of the postoperative field and created optimal conditions for tissue regeneration.

Conclusion. Review of scientific literature and presented results of clinical studies demonstrate that the PRF is a unique regenerative technology which improves early wound healing, facilitates adaptation of bone implantology and promotes tissue regeneration. The use of PRF and bone graft combination allows to obtain satisfactory bone density up to 3 months after surgery, prevent deformation of the alveolar process in the defect area and avoid postoperative complications. Autogenous composition, biological compatibility, its cost and technological simplicity of preparation enable systematic use in surgical dentistry, including the replacement of jaw defects after cystectomy surgery. Prospects for further research are seen in the improvement of technology, the development of new composite materials based on advanced platelet-rich fibrin (A-PRF™) and expanding indications for its use.

References:

1. El Bagdadi K., Kubesch A., Yu X. et. al. Reduction of relative centrifugal forces increases growth factor release within solid platelet-rich-fibrin (PRF)-based matrices: a proof of concept of LSCC (low speed centrifugation concept). Eur J Trauma Emerg Surg. 2017; doi:10.1007/s00068-017-0785-7.

2. Eldibany R.M., Shokry M.M. The effect of Nanobone® in combination with platelet rich fibrin on bone regeneration following enucleation of large mandibular cysts. Tanta Dent J. 2014; 11(2): 100-108.

3. Filipskyi A.V., Horytska K.V., Hot M.M. Distant Results of Using of Platelet-Rich Fibrin in Substitution of Large Bone Cavities after Cystectomy on the Mandible. Clinical Case Report. Novyny Stomatologiyi. 2014; 81(4): 8-13.

4. Fujioka-Kobayashi M., Miron R.J., Hernandez M. et al. Optimized Platelet-Rich

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Fibrin With the Low-Speed Concept: Growth Factor Release, Biocompatibility, and Cellular Response. Journal of Periodontology. 2017; 88 (1): 112-121.

5. Kuz'minykh I.A. Clinical experience in osteoplastic material Allomatrix-implant and fibrin rich platelets use in surgical treatment of jaw radicular cysts. Stomatologiia. 2009; 88: 51-53.

6. Mitrea M., Rusu A., Cälin D.L. The management of periapical maxillary cyst by using the A-PRF (platelet rich advanced fibrin): a case report. Roman J Oral Rehabilit. 2015; 7(2): 12-19.

7. Moussa M., El-Dahab O.A., El Nahass H. Anterior Maxilla Augmentation Using Palatal Bone Block with Platelet-Rich Fibrin: A Controlled Trial. Int J Oral Maxillofac Implants. 2016; 31(3): 708-715.

8. Pape H.C., Evans A., Kobbe P. Autologous Bone Graft: Properties and Techniques. J Orthop Trauma. 2010; 24: S36-S40.

9. Shivashankar V.Y., Johns D.A., Vidyanath S., Sam G. Combination of platelet rich fibrin, hydroxyapatite and PRF membrane in the management of large inflammatory periapical lesion. J Conserv Dent. 2013; 16: 261-264.

10. Simonpieri A., Del Corso M., Sammartino G., Dohan D.M. The Relevance of Choukroun's Platelet-Rich Fibrin and Metronidazole during Complex Maxillary Rehabilitations Using Bone Allograft. Part I: A New Grafting Protocol. Implant Dent. 2009; 18: 102-111.

11. Toffler M., Toscano N., Holtzclaw D. et al. Introducing Choukroun's platelet rich fibrin (PRF) to the reconstructive surgery milieu. J Implant Adv Clin Dent. 2009; 1: 21-30.

12. Vidhale G., Jain D., Jain S. et al. Management of Radicular Cyst Using Platelet-Rich Fibrin & Iliac Bone Graft-A Case Report. J Clin Diagn Res. 2015; 9(6): ZD34-ZD36.

Kolyadko S.P.

Doctor of Medical Science, Leading Researcher of the Department of Neuroses and Borderline Conditions, State Institutions "Institute of Neurology, Psychiatry andNarcology of NAMS of Ukraine", Kharkov

Kalenska G.Y.

PhD in Psychological science, Senior Researcher of the Department of Neuroses and Borderline Conditions, State Institutions "Institute of Neurology, Psychiatry and Narcology of NAMS of Ukraine", Kharkov

Malyuta L. V.

Junior Researcher of the Department of Neuroses and Borderline Conditions, State Institutions "Institute of

Neurology, Psychiatry and Narcology of NAMS of Ukraine", Kharkov

Колядко Свтлана nempieHa

Доктор медичних наук, провiдний науковий cniepo6imHUK eiddrny Heeposie та пограничних статв, ДУ

«1нститут неврологи, психiатpii та наркологи НАМН Укра'ши», Харюв

Каленська Галина Юривна

Кандидат психoлoгiчних наук, старший науковий спiвpoбiтник вiддiлy нeвpoзiв та пограничних статв, ДУ «1нститут неврологи, психiатpii та наркологи НАМН Укра'ши», Харюв

Малюта Лiaнa Володимирiвнa молодший науковий спiвpoбiтник вiддiлy нeвpoзiв та пограничних статв, ДУ «1нститут неврологИ, психiатpii та наркологи НАМН Укра'ши», Харюв

COMPARATIVE ANALYSIS OF DEPRESSIVE SYMPTOMS DEPENDING ON THE DURATION

OF SCHIZOPHRENIA

ПОР1ВНЯЛЬНИЙ АНАЛ1З ДЕПРЕСИВНИХ ПРОЯВ1В В ЗАЛЕЖНОСТ1 В1Д ТРИВАЛОСТ1

ШИЗОФРЕНП

Анотащя: Обстежено 120 хворих на шизофренш з симптомами депресп. Вс пащенти були роздшеш на 3 групи: 38 пащенпв з тривалютю захворювання менше 5-ти рошв, 39 пащенпв з тривалютю захворю-вання 5-10 рошв i 43 патента з тривалютю захворювання бшьше 10-ти рошв. Групу порiвняння склали 42 пащента з шизофрешею без ознак депресп в клшчнш картинг В ходi дослщження вивчено: особливосл афективних, когнггавних проявiв депресп, особливосп позитивно! i негативно! симптоматики, сущидаль-ного ризику i якосп життя у хворих на шизофренш. Показана клшжо-психопатолопчна специфжа проявiв депресп у хворих на шизофренш в залежносп ввд тривалосп захворювання.

Ключовi слова: шизофрешя, депресивш порушення, клшчш особливосп.

Summary: 120 patients with schizophrenia with depressive symptoms were examined. All patients were divided into 3 groups: 38 patients with schizophrenia duration less than 5 years, 39 patients with schizophrenia duration of 5-10 years, and 43 patients with schizophrenia duration of more than 10 years. The comparison group consisted of 42 patients with schizophrenia without signs of depression in the clinical picture. The affective, cognitive disorders of depression, especially the positive and negative symptoms, suicide risk and quality of life in patients with schizophrenia were investigated in the study. The specificity of clinical and psychopathological symptoms of depression in patients with schizophrenia, depending on the duration of the disease were proven.

Keywords: schizophrenia, depressive disorder, clinical features.