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Background Recommendations for soft tissue management associated with customized bone regeneration should be developed. The aim of this study was to evaluate a new protocol for customized bone augmentation in a digital workflow. Methods The investigators implemented a treatment of three-dimensional bone defects based on a customized titanium mesh (Yxoss CBR®, ReOSS, Filderstadt, Germany). Patients and augmentation sites were retrospectively analysed focussing on defect regions, demographic factors, healing difficulties and potential risk factors. An exposure rate was investigated concerning surgical splint application, A®- PRF and flap design. Results In total, 98 implants could be placed. Yxoss CBR® was removed after mean time of 6.53 ± 2.7 months. Flap design was performed as full flap preparation (27.9%), full flap and periosteal incision (39.7%), periosteal incision (1.5%), poncho/split flap (27.9%) and rotation flap (2.9%). In 25% of the cases, exposures of the meshes were documented. Within this exposure rate, most of them were slight and only punctual (A = 16.2%), like one tooth width (B = 1.5%) and complete (C = 7.4%). A®- PRF provided significantly less exposures of the titanium meshes (76.5% no exposure vs. 23.5% yes, p = 0.029). Other parameters like tobacco abuse (p = 0.669), diabetes (p = 0.568) or surgical parameters (mesh size, defect region, flap design) did not influence the exposure rate. Surgical splints were not evaluated to reduce the exposure rate (p = 0.239). Gender (female) was significantly associated with less exposure rate (78,4% female vs. 21.6% male, p = 0.043). Conclusions The results of this study suggest that the new digital protocol including patient-specific titanium meshes, resorbable membranes and bone grafting materials was proven to be a promising technique. To improve soft tissue healing, especially A®-PRF should be recommended.

Resumen Los concentrados de plaquetas son sustancias bioactivas autólogas, que tienen utilidad clínica en la regeneración tisular guiada. Este articulo muestra el caso de un paciente diagnosticado con periodontitis agresiva generalizada, quien fue medicado con doxiciclina e intervenido quirúrgicamente en dos tiempos, en la primera intervención se eliminó el tejido de granulación y agentes infecciosos locales a través de un raspaje y alisado radicular a campo abierto, en la segunda intervención, se realizó regeneración tisular guiada con aloinjerto y fibrina rica en plaquetas. En la reevaluación posquirúrgica, se valoró los cambios clínicos y radiográficos, observándose una disminución de la profundidad al sondaje, una mejoría en el nivel de inserción clínico y relleno óseo radiográfico cuando se compararon los datos basales y de seguimiento hasta por cuatro meses. Abstract Platelet concentrates are autologous bioactive substances that have which has an important role clinical in the periodontal tissue regeneration. This article shows the case of a patient the patient had been diagnosed with aggressive periodontitis. The patient was treated by pharmacotherapy (docycline) and he underwent double surgeries. In the first surgical intervention was scaling and root planing with additional soft- tissue curettage. And the second surgical, tissue guided regeneration was performed using allograft and platelet rich plasma. Treatment generated satisfactory clinical outcomes in terms of probing depth reduction, clinical attachment level gain and radiographic bone fill. The data were recorded at base line, reevaluation, and 4 months post-surgery. Resumo Os concentrados de plaquetas são substâncias bioativas autólogas que têm utilidade clínica na regeneração do tecido periodontal. Este artigo mostra o caso de um paciente diagnosticado com periodontite agressiva generalizada, medicado com doxiciclina e submetido a duas cirurgias. Na primeira intervenção, o tecido de granulação e os agentes infecciosos locais foram eliminados por raspagem em campo aberto e, na segunda intervenção, foi realizada regeneração tecidual guiada com aloenxerto e fibrina rica em plaquetas. Na reavaliação pós-cirúrgica, as alterações clínicas e radiográficas foram avaliadas, observando-se redução da profundidade da bolsa, melhor nível de inserção e preenchimento ósseo radiográfico quando comparados os dados basais e de acompanhamento por até quatro meses.

Platelet concentrates have been widely used in regenerative medicine, including endodontics. The aim of this manuscript was to assess critically the efficacy of PRF in the treatment of endodontic periapical lesions in adult patients on the basis of the literature. The PICO approach was used to properly develop literature search strategies. The PubMed database was analyzed with the keywords: “((PRP) OR (PRF) OR (PRGF) OR (CGF)) AND (endodontic) AND ((treatment) OR (therapy))”. After screening of 155 results, 14 articles were included in this review. Different types of platelet concentrates are able to stimulate the processes of proliferation and differentiation of mesenchymal stem cells. Platelet rich fibrin (PRF) releases growth factors for at least 7 days at the application site. Growth factors and released cytokines stimulate the activity of osteoblasts. Moreover, the release of growth factors accelerates tissue regeneration by increasing the migration of fibroblasts. It was not possible to assess the efficacy of PRF supplementation in the treatment of endodontic periapical lesions in permanent, mature teeth with closed apexes, due to the lack of well-designed scientific research. Further studies are needed to analyze the effect of PRF on the healing processes in the periapical region.

Bone defects lead to aesthetic and functional losses, causing dental rehabilitation to be more difficult. The objective of this work is to histologically assess the hard tissue healing of bone defects filled with platelet-rich fibrin (PRF) alone or as an adjuvant for mixing with and covering anorganic bovine bone (ABB), compared to ABB covered with a resorbable collagen membrane (CM). This study was designed as a crossover animal study. Four 5-mm tibia defects, 5 mm apart from each other, were surgically created on the tibias of 6 sheep. The defects were randomly filled with ABB + CM, PRF alone, ABB+PRF, or were left empty. The animals were euthanized on days 10, 20, and 40 post-operatively. No group showed any signs of bone necrosis. Inflammation was observed in 2 control and 3 test defects with no statistically significant difference between groups at each time point. The ABB + CM and ABB + PRF groups experienced the highest bone regeneration ratios. No differences between the empty-defect and PRF groups were observed in regard to bone regeneration. No statistical difference was observed between the ABB+PRF and ABB + CM groups in regard to bone regeneration and the amount of residual graft material at each time point. The use of PRF should be preferred due to its autogenous origin, low cost, and ease of use.

The dental rehabilitation of a patient following single-tooth extraction in the esthetic zone is often clinically challenging. The treatment option for this is implant-supported single crown which has the advantage that adjacent teeth do not have to be prepared, as in a fixed prosthesis. This article presents a case of immediate implant placement in relation to 22 and a guided bone regeneration approach with platelet-rich fibrin (PRF) and bone graft. After immediate implant placement, to compensate for the gap (jumping distance) between the implant surface and bone walls of the socket, we used bone grafts and PRF clot as well as PRF membrane to achieve guided bone regeneration. PRF, which is the second generation platelet concentrate, offers the surgeon an access to growth factors with a simple and available technology. These growth factors, which are autologous, nontoxic, and nonimmunogenic, enhance and accelerate the normal bone regeneration pathways. The case presented showed successful outcome with a 1 year follow-up period.

Trombositten zengin fibrin (TZF); bünyesinde bol miktarda trombosit ve büyüme faktörü bulunduran, santrifüj işlemi sırasında hiçbir kimyasal ajana ihtiyaç duymayan tamamen otolog ikinci nesil bir kan ürünüdür. TZF, hasar gören dokuya iyileşme ve artmış rejenerasyon kabiliyeti kazandırır. Üçüncü nesil olarak da T-TZF geliştirilmiştir. T-TZF, TZF'e göre daha yoğun bir fibrin ağına sahip olduğu için rezorpsiyon süresi daha uzundur. T-TZF'nin uzayan rezorpsiyon süresinin, kemik oluşumuna katkısı araştırılması hedeflenmektedir.Çalışmamızın amacı; tavşan tibialarına oluşturulan silindirik defektlerin test ve kontrol gruplarına uygulanan tedaviler sonucunda kemik dolumlarını değerlendirmektir.Çalışmamızda 28 adet sağlıklı, erkek, Yeni Zellanda tavşanı kullanıldı. Tavşanların her iki tibiasının gövde kısmına silindirik defektler açıldı (3mm çapında, 4mm derinliğinde). Defektler e-PTFE, TZF ve T-TZF membranlarla örtüldü. Bir defekt, normal kemik iyileşmesini inceleyebilmek için boş bırakıldı. Operasyonlar sonrasında tavşanlar 7, 14, 28 ve 42. günlerde sakrifiye edildi ve tibiaları çıkarıldı. Alınan örnekler mikro-bilgisayarlı tomografi (µBT) ile analiz edildikten sonra histomorfometrik olarak incelendi. µBT sonuçları istatistiksel olarak analiz edildiğinde, tüm gruplarda ve sakrifikasyon zamanları arasında istatistiksel olarak farklılıklar bulundu. Histolojik kesitlerden elde edilen sonuçlara göre de iyileşme ve yeni kemik oluşumu değerleri arasında istatistiksel olarak farklılıklar vardır. Platelet rich Fibrin (PRF) is a second generation product which is enriched with thrombocyte and growth factors. PRF is an autologous product that is produced by centrifuge and does not include any biochemical modification. PRF enhances the regeneration and healing around the injured areas. T-PRF is developed as a third generation product. Resorption time of T-PRF is longer than PRF due to its denser fibrin network. In this study, prolonged resorption time of T-PRF's contribution on bone formation is investigated.The aim of this study is to evaluate bone fill inside the cylindrical defects randomly allocated to test or control treatments within the same animal model. 28 healthy male New Zealand rabbits were used in this study. The cylindrical defects were surgically created at both tibia (3 mm in diameter and 4 mm in length). Each tibia has two identical defects at the shaft of the bone. Defects were covered up with e-PTFE, PRF and Titanium-PRF (T-PRF) membrane. One defect area was used for a control group for the control of regular bone healing observation. The rabbits were sacrificed at 7, 14, 28, 42 days after operations. The both tibias of the rabbits were excised. The samples were analyzed by micro computerized tomography (µCT). After µCT screening, all samples were examined histologically. After analyzation with µCT, there was a statistical difference between each group and the sacrification times. The histological samples showed that there was a difference between each groups according to healing and new bone regeneration. 94

Lökosit ve Trombositten Zengin Fibrinin Bariyer Membran Olarak Kullanılması ve Kemik Rejenerasyonu Üzerine Etkisinin Değerlendirilmesi Bu çalışmanın amacı, kritik boyutlu kemik defektlerinin tedavisinde Lökosit ve Trombositten Zengin Fibrin (TZF) ve düşük doz lazer uygulanmış TZF (DDL-TZF)' nin bariyer membran olarak yeni kemik oluşumuna etkisinin, kolajen membranla karşılaştırılarak değerlendirilmesidir. Bu çalışmada 5 adet, ortalama 40 kg ağırlığında, 18-24 aylık merinos tipi erişkin erkek koyun kullanıldı. Koyunlardan 4 tüp, 10 cc kan alındı ve 2700 rpm' de 12 dakika santrifüj edilerek TZF elde edildi. Genel anestezi altında, koyunların sağ iliak krestine mukoperiosteal elevasyon ile ulaşım sağlandı. Her bir koyunda toplam 8 adet kritik boyutlu defekt oluşturuldu. Defektlerin tümüne deproteinize sığır kaynaklı kemik grefti yerleştirildi. Bir gruptan iki adet defekt olacak şekilde defektler dört gruba ayrıldı. Defektler sırasıyla kolajen membranla, membran haline getirilmiş TZF ile ve membran haline getirilmiş DDL-TZF ile örtüldü. Bir gruba, kontrol grubu olarak membran yerleştirilmedi. Toplam 40 defekt elde edildi. Hayvanlar 12. haftanın sonunda sakrifiye edildi. Elde edilen kesitler histomorfometrik yöntem ile incelendi. Çalışmanın sonuçlarına göre tüm gruplarda ana parametrelerimiz olan; yeni kemik oluşumu (BV/TV), kemik hacmi (BV) ve kemik yüzeyi (BS) değerlendirmelerinde artış gözlenmiştir. Gruplar arası karşılaştırmada tüm ana parametrelerde en yüksek değerler kolajen grubunda elde edilmiştir ve bu fark istatistiksel olarak anlamlıdır (p0,05). TZF grubu, kontrol grubuna göre daha başarılı olmasına rağmen istatistiksel olarak anlamlı fark tespit edilmemiştir (p>0,05). Bu bulgulara göre TZF ve DDL-TZF' nin bariyer membran olarak etkinlik gösterdiği anlaşılmaktadır. Ancak TZF membranın etkinliğini arttırmak için daha ileri çalışmalara gerek vardır.Anahtar Kelimeler: Yönlendirilmiş Kemik Rejenerasyonu, Trombositten Zengin Fibrin, Düşük Doz Lazer Tedavisi Using of Leukocyte and Platelet Rich Fibrin as a Barrier Membrane and Evaluation Its Effect on Bone Regeneration The aim of this study was to compare the effects of Leukocyte and Platelet Rich Fibrin (PRF) and low-level-laser applied PRF (LLL-PRF) as barrier membranes with collagen membranes on new bone formation for the treatment of critical size bone defects. In this study, 5 male sheep with average weight of 40 kg and 18-24 months old were used. 4 tubes of 10 cc blood were drawn from the sheep and centrifuged at 2700 rpm for 12 minutes to obtain PRF. The right iliac crest of sheep was exposed by the mucoperiosteal elevation under general anesthesia. A total of 8 critical defects were created in each sheep. A deproteinized bovine bone graft was placed in all defects. The defects were divided into four groups with two defects from each group. The defects were covered respectively with collagen membrane or PRF in membrane form or LLL-PRF in membrane form. Membrane was not placed in one group which served as the control group. A total of 40 defects were obtained. Animals were sacrificed at the end of 12th week. The sections obtained were analyzed by histomorphometric method. According to the results of study, our main parametres which are the new bone formation (BV / TV), bone volume (BV) and bone surface (BS) rates were increased in all groups. In the comparison between the groups, the highest values in all main parameters were obtained in the collagen group and this difference was statistically significant (p0,05). Although the PRF group was more successful than the control group, no statistically significant difference was found (p>0,05). The findings of the current study suggest that PRF and LLL-PRF may act as barrier membranes. However, further studies are needed to increase the efficiency of the PRF membrane.Key Words: Guided Bone Regeneration, Platelet Rich Fibrin, Low Level Therapy. 100

Background: Alveolar bone defect regeneration has long been problematic in the field of dentistry. Gingival stromal progenitor cells (GSPCs) offer a promising solution for alveolar bone regeneration. In order to optimally differentiate and proliferate progenitor cells, growth factors (GFs) are required. Platelet rich fibrin (PRF) has many GFs and can be easily manufactured. Core-binding factor subunit-α1 (CBF-α1) constitutes a well-known osteogenic differentiation transcription factor in SPCs. Sox9, as a chondrogenic transcription factor, interacts and inhibits CBF-α1, but its precise role in direct in vitro osteogenesis remains unknown. GSPCs cultured in vitro in PRF to optimally stimulate osteogenic differentiation has been largely overlooked. The aim of this study was to analyze GSPCs cultured in PRF osteogenic differentiation predicted by CBF-α1/Sox9. Methods: This study used a true experimental with post-test only control group design and random sampling. GPSCs isolated from the lower gingiva of four healthy, 250-gram, 1-month old, male Wistar rats (Rattus Novergicus) were cultured for two weeks, passaged every 4-5 days. GSPCs in passage 3-5 were cultured in five M24 plates (N=108; n=6/group) for Day 7, Day 14, and Day 21 in three different mediums (control negative group: αModified Eagle Medium; control positive group: High Glucose-Dulbecco’s Modified Eagle Medium (DMEM-HG) + osteogenic medium; Treatment group: DMEM-HG + osteogenic medium + PRF). CBF-α1 and Sox9 were examined with ICC monoclonal antibody. A one-way ANOVA continued with Tukey HSD test (p0.05) was performed. Results: The treatment group showed the highest CBF-α1/Sox9 ratio (16.00±3.000/14.33±2.517) on Day 7, while the lowest CBF-α1/Sox9 ratio (3.33±1.528/3.67±1.155) occurred in the control negative group on Day 21, with significant difference between the groups (p Conclusion: GSPCs cultured in PRF had potential osteogenic differentiation ability predicted by the CBF-α1/sox9 ratio.

Trombosit konsantrasyon ürünleri, içerdikleri yüksek orandaki büyüme faktöründen dolayı doku iyileşmesini hızlandırmak için son yıllarda sıklıkla kullanılmaktadır. Farklı trombositten zengin fibrin yapılarının, doku iyileşmesi üzerindeki etkilerini değerlendiren birçok çalışma bulunmaktadır. Farklı santrifüj değerlerinde elde edilen trombositten zengin fibrin konsantrelerinin kemik iyileşmesi üzerindeki etkilerini karşılaştıran çalışma sayısı ise sınırlıdır. Bu çalışmanın amacı mandibulada diş çekimi sonrası çekim soketine uygulanan farklı santrifüj değerlerine sahip trombositten zengin fibrinin yeni kemik oluşumu üzerine etkisinin, histomorfometri ile değerlendirilmesidir.Bu çalışmaya, İzmir Katip Çelebi Üniversitesi (İKÇÜ) Diş Hekimliği Fakültesi Ağız, Diş ve Çene Cerrahisi Anabilim Dalı'na başvuran, alt çenede en az 3 adet dişe çekim endikasyonu koyulan ve diş çekim boşluklarına iyileşme sürecinin ardından dental implant uygulanacak 20 hasta çalışmaya dahil edilmiştir. Çekim boşluklarının korunması amacıyla diş çekimlerinin hemen ardından soketler 3,7x10mm boyutlarında drille standardize edilip ardından lökositten ve trombositten zengin fibrin (L-TZF) ve Geliştirilmiş trombositten zengin fibrin (A-TZF) uygulanmıştır. Kontrol grubu işlem yapılmadan doğal iyileşmeye bırakıldı. Çekim soketlerine trombositten zengin fibrin (TZF) uygulandıktan sonra 8 hafta beklenmiş, ilgili bölgelerden implant yerleştirilmeden önce trefan frez ile histomorfometrik inceleme amacıyla örnek alınmıştır. Her hastada implantların osseointegrasyonu için protetik tedavi öncesi 3 ay beklenmiştir. Histolojik incelemelerde trombosit konsantrasyon ürünlerinin kemik iyileşmesini istatistiksel açıdan anlamlı şekilde hızlandırdığı görülmüştür. Yapılan histomorfometrik değerlendirmeler, L-TZF'nin A-TZF'den daha uzun süre etki gösteren ve yeni kemik oluşmunu daha etkili şekilde arttıran bir ürün olduğunu göstermiştir. L-TZF'nin ve A-TZF'nin ayrı ayrı tek başlarına soketlere uygulandığ̆ı gruplarda yeni kemik oluşumunun kontrol grubundan daha yüksek oranda gerçekleştiği belirlenmiştir. Platelet concentrate products are frequently used in recent years to accelerate tissue healing due to the high growth factor they contain. There are many studies evaluating the effects of different thrombocyte rich fibrin constructs on tissue healing. The number of studies comparing the effects of thrombocyte-rich fibrin concentrates obtained at different centrifuges on bone healing is limited. The aim of this study is to evaluate the effect of thrombocyte-rich fibrin obtained at different centrifugal values on the new bone formation, histomorphometric analysis applied to the extraction socket after extraction in the lower jaw. 20 patients who applied to the Department of Oral and Maxillofacial Surgery, Faculty of Dentistry in İzmir Katip Çelebi University (İKÇU), who had indications of at least 3 teeth extractions in the lower jaw and following dental implantation after the healing process in the extraction sites were included in this study. Immediately after tooth extraction, extraction sockets were standardized with 3,7x10mm sized drills then leucocyte and platelet rich fibrin (L-PRF) and advanced platelet rich fibrin (A-PRF) were applied into the extraction sockets for preservation. But the group was allowed to recover naturally without applying anyhing . After applying PRF to the extraction socket, it was waited for 8 weeks and then samples were obtained for histomorphometric evaluation with trephine burs from the extraction site where the implants planned to be placed. 3 months waited for osseointegration prior to prosthetic rehabilitation. Histological evaluations showed that platelet concentration products significantly increased bone healing statistically. The histomorphometric evaluations showed that L-PRF is a product that has a longer duration of action than A-PRF and increases the formation of new bone at a higher rate. It was determined that in the groups where L-PRF or A-PRF were applied alone, the formation of new bone was higher than in the control group. 137

İmplant endikasyonu olan vakalarda, rezorbsiyon sonucu horizontal veya vertikal kemik kaybı olan bölgelerde implant uygulaması öncesi veya sırasında ogmentasyon işlemleri uygulanır. Büyüme faktörleri ve yara iyileşmesine etkilerine dair yapılmış yakın tarihli birçok çalışma mevcuttur. Büyüme faktörlerinin temel kaynağı olan ve periferal kandan elde edilen trombositten zengin biyomateryaller çok sayıda klinik uygulamada kullanılmaktadır.PRF tekniği temelde hastadan alınmış venöz kanın santrifuj edilmesi sonucu trombosit ve büyüme faktörlerinin fibrin matriks içerisinde toplanması işlemi olup, uygulandığı bölgede mikrovaskülarizasyon ve epitel hücre göçünün gerçekleşmesini sağlamakta, bu da açık yaralarda yara iyileşmesinin hızlanması sonucunu doğurmaktadır. Bununla birlikte, hem lökosit içermesi hem de lökosit göçünü yönlendirici yapısı PRF'nin enfekte yaralarda da kullanılmasını mümkün kılmaktadır. İyileşme sürecini hızlandırıcı etkisi soket koruma tekniğinde kullanılmasına da imkan vermekte; ağrı, kuru soket benzeri olası komplikasyonlara karşı koruyucu etkisi bulunmaktadır. İçeriğindeki büyüme faktörlerine bağlı olarak kemik greftleri ile birlikte kullanımı iyileşme süreçlerinde daha hızlı ve iyi sonuç alınmasına vesile olmaktadır. Koyun tibialarında yaptığımız çalışmada sığır kaynaklı kemik grefti ile PRF nin etkinliği karşılaştırılmıştır. Birlikte kullanıldığında greftin etkinliğini arttırdığı saptanmıştır. Tek başına kullanımında kemik içi iyileşmesini anlamlı derecede etkilemediği ortaya çıkmıştır. Bone augmentation procedures applied during and before dental implant indicated cases because of the horizontal and vertical bone deficiencies. Recent years there are many researches about growth factors and effects on wound healing. Platelet, which is obtained from peripheral blood, is the main source of growth factors. This is why platelet rich biomaterials use in many clinical applications. Platelet rich fibrin (PRF) is one of the techniques that obtain platelet rich biomaterial. PRF technique base on collecting and centrifuge peripheral blood, this causes the growth factors and platelet accumulate in fibrin matrix. PRF, increases the micro vascularization and epithelium immigration at the side it applied. By this way it speeds up the open wound healing. Moreover it contain leukocyte and it orient the leukocyte immigration. Because of this propertie of PRF, it can be used in infected wounds. It can also be used as a socket protection technique because it speeds up the wound healing. It can decrease the complication prevalence and occurrence as pain, dry socket. When PRF and bone graft combination applied on a side they speeds up and improve the wound healing because it contains growth factors. In this study, we compare the efficiency of PRF and bovine biomaterial on sheep tibia bony defects. According to findings it improves the efficiency when their combination applied. When they applied separately, they do not improve the bone healing significantly. 139

Diş kaybını mütakiben alveolar kemikte rezorpsiyon meydana gelmektedir. İmplantasyon öncesi uygun kemik miktarının elde edilebilmesi için çeşitli ogmentasyon işlemleri gerekebilmektedir. Kemik ogmentasyonlarında kullanılan biyomateryaller, yeni oluşacak kemiğin hacmini, kalitesini ve rejenerasyonun süresini etkilemektedir. Otojen greftin hala altın standart olarak kabul edilmesine rağmen gelişen teknoloji ile birlikte alternatif olarak yarı sentetik ve sentetik greft materyalleri geliştirilmiştir. Osteokondüktif özelliklerinin iyi olmasına rağmen bu greftlere osteoindüktif ve osteojenik özellikler katabilmek için son yıllarda büyüme faktörleri ve büyüme faktörleri içeren trombosit konsantrasyonları ile kombine kullanımları yaygınlaşmaya başlamıştır.Bu çalışmanın amacı, bir sentetik greft ve trombosit konsantrasyonu kombinasyonu olan mineralize plazmatik matriksin (MPM) kemik rejenerasyonuna etkisini ve otojen grefte alternatif olup olamayacağını araştırmaktır. İki guba ayrılan 6 adet koyunda 12 tibia kemiği kullanılarak 6 mm çapında kritik boyutlu defektler oluşturulmuş, bu defektlere MPM, trombositten zengin fibrin (PRF) + beta trikalsiyum fosfat (β-TCP), β-TCP ve otojen greft yerleştirilmiştir. Bir grup kontrol amacıyla boş bırakılmıştır. 3 ve 6 haftalık iyileşme sürelerinin ardından alınan örneklerde yeni oluşan kemik, rezidüel greft miktarları ile doku yanıtı parametreleri histolojik ve histomorfometrik olarak değerlendirilmiştir. Hem erken hem de geç dönem sonuçlarına göre en yüksek yeni oluşan kemik miktarı otojen greft grubunda bulunurken MPM grubu sonraki en yüksek değerleri vermiştir. En az rezidüel greft materyali miktarları da yine MPM grubunda elde edilmiş olup, doku yanıtı skorları anlamsız dercede düşük bulunmuştur. MPM' nin biyouyumluluğu yüksek ve yeni kemik oluşumuna katkı sağlayan bir biyomateryal olduğu sonucuna varılmıştır.Anahtar Kelimeler: Kemik Rejenerasyonu, Büyüme Faktörleri, Kemik Ogmentasyonu,Fibrin Ağı, Trombosit Konsantrasyonu Alveolar bone resorption occurs following loss of tooth. Various augmentation procedures may be required to obtain the appropriate amount of bone before implantation. Biomaterials which are used in bone augmentations affect the volume, quality and regeneration duration of the newly formed bone. Although autogenous graft is still the gold standard, semi-synthetic and synthetic graft materials have been developed as an alternative with thriving technology. Despite the good osteoconductive properties, combined use of platelet concentrations with growth factors and growth factors has been widespread in recent years to provide osteoinductive and osteogenic properties of these grafts. The aim of this study is to investigate the effect of mineralized plasmatic matrix (MPM) which is a combination of synthetic graft and platelet concentration, on bone regeneration and whether it could be an alternative to autogenous graft. Critical size defects in 6 mm size were created on the 12 tibia bones of 6 sheeps and diveded in two groups. The defects were filled with MPM, platelet rich fibrin (PRF) + beta tricalcium phosphate (β-TCP), β-TCP and autogenous graft. One defect was left empty as control group. After 3 and 6 weeks healing periods new bone formation, residual graft amounts and tissue response parameters were evaluated histologically and histomorphometrically.According to both early and late results the highest amount of newly formed bone was found in the autogenous graft group, while the MPM group gave the next highest values. Residual graft material amounts were also obtained least in the MPM group and tissue response scores were found insignificant. As a result, MPM is a biomaterial with high biocompatibility and contributes the new bone formation.Key Words: Bone Regeneration, Growth Factors, Bone Augmentation, Fibrin Network,Platelet Concentration 137

Sinüs ogmentasyonu dişsiz posterior maxillada en çok uygulanan cerrahi işlemlerden biridir. Sinüs membranı elevasyonundan sonra hangi greft materyalinin kullanılacağı ise hala tartışmalıdır. Büyüme faktörlerinin greft materyalleri ile karıştırılması, sert dokunun iyileşmesini güçlendirmek için tercih edilmektedir. Bu çalışma, maksiller sinüs ogmentasyonunda Mineralize Plazmatik Matriks (MPM) ile deproteinize sığır kemik minerali (Bio-Oss) arasındaki kemik rejenerasyon kapasitesini karşılaştırmayı amaçlamıştır. Yaşları 31 ile 63 arasında değişen (ort. 49) olan 7 hastada (5 kadın ve 2 erkek) toplam 14 sinüs ogmentasyonu yapıldı. Çalışma için splitmouth tasarım kullanıldı. Bu nedenle bilateral posterior maksiller sinüs ogmentasyon ihtiyacı olan hastalar çalışmaya dahil edildi. Hastalarda lateral pencere tekniği kullanılarak membran elevasyonu yapıldı. Ardından greft materyali olarak rastgele seçilen bir tarafa MPM diğer tarafa Bio-Oss uygulandı. Sinüs pencereleri rezorbe olabilen kollajen membranla kapatıldı. Dört aylık iyileşme periyodunun ardından trefan frezle biyopsi örnekleri alındı.Histolojik ve histomorfometrik değerlendirmenin ardından her iki materyalde de greftin tam rezorbe olmadığı görüldü. MPM grubunda yeni kemik oluşumu % 45, olgun kemik % 14, fibröz matriks % 29 ve rezidüel greft % 10 bulundu. Bio-Oss grubunda ise yeni kemik oluşumu % 39, olgun kemik % 15, fibröz matriks % 28 ve rezidüel greft % 15 bulundu. Gruplar arasında herhangi bir parametrede istatistiksel olarak anlamlı bir fark bulunmadı.Çalışma sonucunda yeni kemik oluşumu açısından MPM nispi olarak daha iyi olmasına rağmen aradaki fark istatistiksel olarak anlamlı değildir. Daha geniş serilerde yapılacak çalışmalar, grefte entegre trombositten zengin fibrinin iyileşmeye olan etkisinin anlaşılmasına katkı sağlayacaktır.Anahtar Kelimeler: Bio-Oss, Greft materyalleri, Mineralize plazmatik matriks, Trombositten zengin fibrin. Sinus augmentation is one of the most predictable procedure to increase the amount of bone in posterior edentulous maxilla. One key question that remains is to define the best filling material for the subsinus cavity after lifting the sinus membrane. Using growth factors mixed with bone grafting particles may be a promising procedure to improve the healing of the hard tissue. This study aims to compare the capacity of bone regeneration between the Mineralized Plasmatic Matrix (MPM) and deproteinize bovine bone mineral (Bio-Oss) in sinus lifting.A total amount of 14 sinus augmentations were performed in 7 patients, 5 women and 2 men, with an age range between 31 and 63 years and a mean age of 49 years. The (splitmouth) design was used for the study. Hence, a bilateral sinus floor augmentation (SFA) was required in all patients in order to facilitate dental implant placement in the posterior maxilla. Sinus elevation procedure was carried out following the antero-lateral approach. In one of the sinus cavities, augmentation was done by using Mineralized Plasmatic Matrix (MPM) prepared with Bio-Oss (Fig.4) and the other sinüs cavity grafted with deproteinize bovine bone mineral (Bio-Oss). After 4 months, biopsies were taken using a trephine bur. Histomorphometric analyses were performed on sections. Complete resorption of the grafting materials, i.e. Bio-Oss or MPM, did not occur within 4 months after SFA. Residual granules were partially embedded in newly formed bone, which was predominantly lamellar bone. In the MPM group, new bone formation was observed in 45%, mature bone 14%, fibrouse matrice 29% and graft 10%. In the Bio-Oss group, new bone formation was observed in 39%, mature bone 15%, fibrouse matrice 28% and graft 15%. No statistically significant difference was found in any parameters.Although the MPM is relatively better in terms of new bone formation as a result of the study, the difference is not statistically significant. New studies in larger series will contribute to know the effect of platelet rich fibrin integrated the graft to the healing.Key Words: Bio-Oss, Bone substitute materials, Mineralized plasmatic matrix, Platelet rich fibrin. 107

Bu çalışmanın amacı, trombositten zengin fibrin enjeksiyonunun midpalatal sutur içerisinde hızlı üst çene genişletmesi sonrası kemik formasyonu üzerine olan etkisini araştırmaktır.Bu çalışma her birinde 15 hızlı üst çene genişletme tedavisi hastası olan 2 gruptan oluşmaktadır. Kontrol grubu: Yalnızca hızlı üst çene genişletme tedavisi yapılan hastalar. Tedavi grubu: Hızlı üst çene genişletmesi ile birlikte 3 kez plateletten zengin fibrin (PRF) enjeksiyonu yapılan hastlar. Her iki gruptan da hızlı üst çene genişletme apareyini takiben 8. haftada konik ışınlı bilgisayarlı tomografi (CBCT) alınmıştır. Alınan CBCT katıtları üzerinden midpalatal suturdaki kemik yoğunluk değerleri kesitsel ve oransal olarak ölçülmüştür.Çalışma ve kontrol gruplarının hızlı üst çene genişletmesi sonrası midpalatal suturdaki kemik yoğunluğu değerlerinin gruplar arası karşılaştırılma sonuçlarına göre kesitsel ölçümlerde çalışma grubunda midpalatal sutur kalsifikasyonu kontrol grubuna göre istatistiksel olarak anlamlı derecede fazla bulunmuştur (p0,05).PRF'nin midpalatal suturda kemik yoğunluğunu arttırdığı fakat bu farkın istatistiksel olarak anlamlı olmadığı bulunmuştur. The aim of this study was to investigate the effect of thrombocyte-rich fibrin injection on bone formation after rapid maxillary expansion in midpalatal suture.This study consisted of 2 groups, each with 15 patients with upper jaw enlargement treatment. Control group: Only patients with rapid upper jaw dilation. Treatment group: Patients who underwent injection of platelet rich fibrin (PRF) 3 times with rapid maxillary expansion. Radiographs were obtained with conical beam computed tomography (CBCT) at 8 weeks after rapid maxillary expansion in both groups. Bone density values in the midpalatal suture were measured cross-sectionally and proportionally on the CBCT footprints.According to the results of the comparison of the bone density values of the midpalatal sutur after the rapid maxillary expansion of the study and control groups, the midpalatal suture calcification in the study group was found to be statistically significantly higher than the control group (p 0,05).PRF increased bone density in midpalatal sutur, but this difference was found not to be statistically significant. 82

Amaç: Düşük santrifüj hızı konsepti ile elde edilen i-TZF likidinin allogreft ile karıştırılmasıyla oluşan putty greftin kemik oluşumuna ve yeni oluşan kemiğin kalitesine etkilerinin çekim soketi modeli kullanılarak histomorfometri ve immünohistokimya ile değerlendirilmesi amaçlanmıştır.Materyal ve Metod: 25 çekim soketinde i-TZF & allogreft karışımı soket uygulanıp greftlenen saha, elde edilen TZF membran ile örtülenmiştir. Kontrol grubundaki 25 sokette ise herhangi bir uygulama yapılmamış, yalnızca pıhtının stabilizasyonu sağlamıştır. Tüm olgularda flep esnetilmemiş, yumuşak doku kenarlarını yaklaştırıcı çapraz matres sütur uygulanmıştır. 2 aylık iyileşme dönemi sonunda implant uygulaması planlanmış, bu aşamada histolojik inceleme amacıyla trefan frez ile kemik dokusu örneği alınmıştır. Soket driller ile şekillendirildikten sonra uygun boyutlardaki dental implant yerleştirilip Osstell Mentor cihazı ile primer stabilizasyon değerleri ölçülmüştür. Elde edilen kemik dokuları histolojik, histomorfometrik ve immünohistokimyasal olarak incelenmiştir.Sonuç: Kemik dokusu örneklerinin histomorfometrik analiz sonuçlarına göre i-TZF uygulanan grupta hem kontrol grubuna göre hem de literatürde yalnızca allogreft ile soket koruma yapılan çalışmalara göre istatistiksel olarak anlamlı düzeyde yeni kemik oluşumu gözlenmiştir. İmmünohistokimyasal incelemede, ALP, OCN ve PCNA primer antikorlarına karşı çalışma grubunda kontrol grubuna kıyasla istatistiksel olarak daha fazla hücresel immünoreaktivite gözlenmiştir. İmplantların primer stabilite değerleri karşılaştırıldığında çalışma grubunda istatistiksel olarak yüksek ISQ değerleri elde edilmiştir. Çalışmamızın sonuçlarına göre kemik oluşumunu hızlandırdığını ve yeni oluşan kemik miktarı ve kalitesini arttırdığını gözlemlediğimiz bu yöntemin uzun dönem etkisinin gözlenmesi için farklı klinik ve deneysel çalışmaların yapılmasına ihtiyaç duyulmaktadır.Anahtar Kelimeler: PRF, allogreft, histoloji, ogmentasyon Aim: The aim of this study is to evaluate the effects of new bone formation by histomorphometry and immunohistochemistry of the putty graft which is formed by mixing allograft with i-PRF liquid which is obtained with low speed centrifugation concept.Material-Method: In the 25 extraction areas, the socket preservation was applied using the i-PRF & allograft mixture and the grafting areas were covered with the PRF membranes obtained simultaneously. In the 25 sockets in the control group, no socket preservation was applied and stabilization of the clot was ensured. In all cases, the flap was not released or advanced, only cross matress sutures were performed. At the end of the 2-month recovery period, bone tissue samples were taken for histological examination using trephine bur. After the socket was prepared with drills, appropriate size dental implant was placed and the primary stabilization values were measured with Osstell Mentor device. Obtained bone tissues were examined histologically, histomorphometric and immunohistochemically.Results: According to the results of histomorphometric analysis of bone tissue samples, there were significantly more new bone formation in the socket preservation group using i-PRF compared to the control group and socket preservation studies were used only allograft in the literature. In immunohistochemical examination, more cellular immunoreactivity was observed in the study group against ALP, OCN and PCNA primary antibodies compared to the control group. When the primary stability values of the implants were compared, statistically high ISQ values were obtained in the study group. Different clinical and experimental animal studies are needed to observe the long-term effect of this method which we observed to accelerate bone formation and increase the amount and quality of the newly formed bone according to the results of our study.Keyword: PRF, allograft, histology, augmentation 145

Context: The platelet rich fibrin (PRF) is second generation platelet concentrate that has been widely used and researched for stimulation and acceleration of soft tissue and osseous healing. Its continuous delivery of growth factors and proteins mimic the need of physiological wound healing and regenerative tissue processes. Aims and Objectives: The aim of this study was to evaluate the efficacy of PRF in osseous regeneration after enucleation of cystic lesions. The objectives of this study were: (1) To evaluate osseous regeneration radiographically with the use of PRF in intrabony defects after cystic enucleation. (2) To evaluate the degree of bone density in intrabony defects with the use of PRF postoperatively after 1 st , 3 rd , and 6 th months. Subjects and Methods: 10 cases of cystic lesions were treated using PRF after cystic enucleation. Follow-up radiographs (orthopantomogram) were taken 1 st , 3 rd , and 6 th months postoperatively. Bone density was measured with grayscale histogram using Adobe Photoshop 7.0 software. Results: The subsequent follow-up examinations revealed progressive, predictable, and significant radiographic osseous regeneration. Conclusion: The use of PRF in management of cystic lesions seems to be a novel therapeutic approach promoting faster osseous regeneration within 6 months postoperatively however further study is required with larger sample size and with a control group.

В процессе разработки способов лечения переломов тел позвонков, в частности в случае травматического повреждения, необходимо понимать биологию процессов образования и реорганизации регенерата для возможности оптимизации репаративного остеогенеза.Цель: оценить влияние обогащенного тромбоцитами фибрина на заживление дефекта тела позвонка в эксперименте на кроликах.Методы: проведено моделирование на 18 беспородных кроликах-самцах в возрасте 4–5 мес. со средней массой тела (4 ± 0,5) кг. Животным выполняли дырчатый дефект (диаметр и глубина по3 мм) в каудальном апофизе тел позвонков LIII, LIV. Дефекты у 9 кроликов опытной группы заполняли обогащенным тромбоцитами фибрином, контрольной (9 животных) — оставляли незаполненными и закрывали в обоих случаях гемостатической пленкой «Fibrilar». Обогащенный тромбоцитами фибрин изготавливали по методике D. M. Dohan Ehrenfest непосредственно перед операцией. Через 14 сут, 1 и 3 мес. после моделирования выполняли гистологическое исследование с морфометрией площадей тканей регенерата в области травматического повреждения.Результаты: через 14 сут в зоне дефекта тел позвонков кроликов контрольной группы преобладали грануляционная и фиброретикулярная ткани. Относительная площадь новообразованной костной ткани в дефектах кроликов опытной группы была больше в 2,16 раза (p < 0,01) по сравнению с контролем. Через 1 мес. она заполняла всю территорию дефекта и превышала показатели контроля в 1,2 раза (p < 0,05), а в дефектах тел позвонков кроликов контрольной группы сохранялись участки фиброретикулярной ткани. Через 3 мес. у кроликов обеих групп зона дефекта была заполнена пластинчатой костной тканью.Выводы: введение в дырчатый дефект тела позвонка кроликов обогащенного тромбоцитами фибрина способствует ускорению костеобразования через 14 дней и 1 мес. после травмы., У процесі розроблення способів лікування переломів тіл хребців, зокрема в разі травматичного ушкодження, необхідно розуміти біологію процесів утворення та реорганізації регенерату для можливості оптимізації репаративного остеогенезу.Мета: оцінити вплив збагаченого тромбоцитами фібрину на загоєння дефекту тіла хребця в експерименті на кролях.Методи: проведено моделювання на 18 безпородних кролях-самцях віком 4–5 міс. із середньою масою тіла (4 ± 0,5) кг. Тваринам виконували дірчастий дефект (діаметр і глубина по 3 мм) у каудальному апофізі тіл хребців LIII, LIV. Дефекти у 9 кролів дослідної групи заповнювали збагаченим тромбоцитами фібрином, контрольної (9 тварин) — залишали незаповненими і закривали в обох випадках гемостатичною плівкою «Fibrilar». Збагачений тромбоцитами фібрин виготовляли за методикою D. M. Dohan Ehrenfest безпосередньо перед операцією. Через 14 діб, 1 і 3 міс. після моделювання виконували гістологічне дослідження з морфометрією площ тканин регенерату в зоні травматичного ушкодження.Результати: через 14 діб у зоні дефекту тіл хребців кролів контрольної групи переважали грануляційна і фіброретикулярна тканини. Відносна площа новоутвореної кісткової тканини в дефектах кролів дослідної групи була більшою у 2,16 разу (p < 0,01) порівняно з контролем. Через 1 міс. вона заповнювала всю територію дефекту і перевищувала показники контролю в 1,2 разу (p < 0,05), а в дефектах тіл хребців кролів контрольної групи зберігалися ділянки фіброретикулярної тканини. Через 3 міс. у тварин обох груп зона дефекту була заповнена пластинчастою кістковою тканиною.Висновки: введення в дірчастий дефект тіла хребця кролів збагаченого тромбоцитами фібрину сприяє прискоренню кісткоутвореня через 14 днів і 1 міс. після травми., In the process of developing methods for treating fractures of vertebral bodies, in particular in case of traumatic injury, it is necessary to understand the biology of the processes of formation and reorganization of the regenerate for the possibility of optimizing reparative osteogenesis.Objective: to assess the effect of platelet rich fibrin on the healing of a defect in the vertebral body in experimental rabbits.Methods: simulations were performed in 18 male rabbits aged 4–5 months with an average body weight (4 ± 0.5) kg. A hole defect (diameter and depth of3 mm) in the caudal apophysis of vertebral bodies L3, L4 was created. Defects in 9 rabbits of the experimental group were filled with platelet-rich fibrin, in control (9 animals) defect left unfilled and closed in both cases with a haemostatic «Fibrilar» film. Platelet rich fibrin was prepared by the method of D. M. Dohan Ehrenfest immediately before the operation. After 14 days, 1 and 3 months a histological study was carried out with morphometry of areas of regenerate tissues in the area of traumatic injury.Results: after 14 days in the zone of defect in the vertebral bodies of the rabbits of the control group, granulation and connective tissues predominated. The relative area of the newly formed bone tissue in the defects of the rabbits of the test group was 2.16 times greater (p < 0.01) than in the control group. After 1 month it filled the entire territory of the defect and exceeded the control indicators by 1.2 times (p < 0.05), and in the defects of the vertebral bodies of the rabbits of the control group, the areas of the connective tissue were preserved. After 3 months in rabbits of both groups, the defect zone was filled with lamellar bone tissue.Conclusions: the introduction of platelet rich fibrin into the perforated defect of the vertebral body of the rabbits promotes acceleration of bone formation 14 days and 1 month after injury.

The purpose of the present study is to provide the efficacy of autologous platelet rich fibrin in bone augmentation and bone regeneration procedures in regard of soft and hard tissue healing in oral surgery treatment.

Bone regeneration is often needed prior to dental implant treatment due to the lack of adequate quantity and quality after infectious diseases. The greatest regenerative power was obtained with autologous tissue, primarily the bone alive, taken from the same site or adjacent sites, up to the use centrifugation of blood with the selection of the parts with the greatest potential regenerative. In fact, various techniques and technologies were chronologically successive to cope with an ever better preparation of these concentrates of blood. Our aim is to review these advances and discuss the ways in which platelet concentrates may provide such unexpected beneficial therapeutic effects.The research has been carried out in the MEDLINE and Cochrane Central Register of Controlled Trials database by choosing keywords as "platelet rich plasma", "platelet rich fibrin", "platelet growth factors", and "bone regeneration" and "dentistry".Autologous platelet rich plasma is a safe and low cost procedure to deliver growth factors for bone and soft tissue healing.The great heterogeneity of clinical outcomes can be explained by the different PRP products with qualitative and quantitative difference among substance.