The Effect of Platelet Rich Fibrin (PRF) and Bone Graft (Carbonate Apatite) Applications on Platelet Derived Growth Factor-BB Post Flap Surgery in Patients with Chronic Periodontitis

Abstract:

Chronic periodontitis characterized by a periodontal pocket over 5 mm, alveolar bone resorption accompanied by tooth mobility, requires periodontal surgical treatment. Conventional surgical treatment can not achieve the regeneration of periodontal tissue and thus requires regenerative procedures, such as with the addition of PRF. PDGF-BB is a growth factor that plays an important role in wound healing. Developments in additional bioactive ingredients in surgical procedures are used to regulate inflammation and increase the speed of the healing process. The purpose of this study was to determine the effect of PRF and bone graft (carbonate apatite) on PDGF-BB levels post-surgical flap in patients with chronic periodontitis. The experimental study with open label and consecutive sampling was conducted on 10 subjects of chronic periodontitis who received surgical flap treatment with bone graft and PRF; and 10 subjects without PRF. GCF samples were collected immediately before surgery and 7 days post flap surgery for examination of PDGF-BB levels by ELISA method. The data were calculated statistically by Mann-Whitney test (p <0.05). The results showed that the mean difference of PDGF-BB level in PRF group was 9.44 pg/ml (-1.20 – 37.79 pg/ml) with p value (0.013) and Non-PRF group was 7.97 pg/ml (-6.62 - 44.42 pg/ml) with p value (0.059). The p value in the PRF group > 0.05 means a significant increase in PDGF-BB levels on the 7^th day post flap surgery. Examination of PDGF levels, especially PDGF-BB, should be done in each healing phase of the wound from the inflammatory phase to the maturation and remodeling phase, for example on the 3^rd, 7^th, 14^th and 28^th days when PDGF levels approach zero and the healing process it's almost over, referring to the results of Alzahrani's research (2018) and also Matsuoka and Grotendorst (1989) which showed higher levels of PDGF-BB and VEGF in GCF on days 1, 3, 7 and 14 after surgery with minimally invasive surgery (MIS) technique. The conclusions of this study showed that the application of Platelet Rich Fibrin (PRF) and bone graft had an effect on the level of Platelet Derived Growth Factor (PDGF-BB) post-surgical flap in patients with chronic periodontitis, and elevated levels of PDGF-BB post-surgical flap with PRF application higher than surgical flap without the PRF application. Increased levels of PGDF-BB in the group applied to the PRF were higher than those that were not applied PRF, although statistically significant differences were not found, there was a tendency for the healing process of the PRF group to be better than the Non PRF group.

• Periodical: Key Engineering Materials (Volume 829)
• Pages: 211-219
• DOI: https://doi.org/10.4028/www.scientific.net/KEM.829.211
• Online since: December 2019
• Authors: R. Heni Puspitadewi*, Ina Hendiani, Nunung Rusminah
• Keywords: Bone Graft, Chronic Periodontitis, Flap Surgery, PDGF-Bb, Platelet Rich Fibrin (PRF)

References

[1] M.G. Newman, H.H. Takei, P.R. Klokkevold, Carranza's Clinical Periodontology, tenth ed., Elsevier Saunders, St. Missouri, (2006).

[2] H.F. Wolf, E.M. and K.H. Rateitschak, T.M. Hassell, Color Atlas of Dental Medicine, third ed., Thieme, New York, (1985).

[3] A. Sculean., Periodontal Regenerative Therapy, Quintessence Publishing, London, (1995).

[4] D.A. Roopa, I. Gupta, S.S. Chuhan and S. Singh, Platelet rich fibrin in tissue engineering: A Boon to periodontal regeneration, Journal of Dental Research Updates. 1 (2014) 50-54.

[5] S. Shetty, N. Yadav, M. Mehta, S. Vaish and V. Dodwad, Autologous platelet-rich fibrin: A boon to periodontal regeneration – report of two cases, Journal of Dental Specialities. 2 (2014) 112-119.

[6] A. Ahuja, S. Mavi, S. Kalra and A. Gakhar, Platelet-rich fibrin a second generation autologous platelet concentrate for the treatment of inadequate width of attached gingiva, International Journal of Scientific Studies Case Report & Review. 1 (2015) 53-56.

[7] E. Borie, D.G. Olivi, I.A. Orsi, K. Garlet, B. Weber, V. Beltran, and R. Fuentes, Platelet-rich fibrin application in dentistry : a literature review, Int. J. Clin. Exp. Med. 8 (2015) 7922-7929.

[8] P. Chandran and A. Sivadas, Platelet-rich fibrin: its role in periodontal regeneration, Saudi J. Dent. Res. 5 (2014) 117-122.

[9] M. Tatullo, M. Marrelli, M. Cassetta, A. Pacifici, L.V. Stefanelli, S. Scacco, G. Dipalma, L. Pacifici, F. Inchingolo, Platelet rich fibrin (PRF) in reconstructive surgery of atrophied maxillary bones : clinical and histological evaluations, Int. J. Med. Sci. 9 (2012) 872-880.

DOI: 10.7150/ijms.5119

[10] M. Agrawal and V. Agrawal, Platelet rich fibrin and its applications in dentistry – a review articles, National Journal of Medical and Dental Research. 2 (2014) 51-58.

[11] W. Pluemsakunthai, S. Kuroda, H. Shimokawa and S. Kasugai, Original article a basic analysis of platelet-rich fibrin : distribution and release of platelet-derived growth factor-BB, Inflamm. Regen. 33 (2013) 1-5.

DOI: 10.2492/inflammregen.33.164

[12] M. Bayani, A. Alireza, R. Ghahroudi, A. Khorsand, A. Rezaee and S. Torabi, Comparison of epidermal growth factor levels in the gingival krevicular fluid of patients with gingivitis and advanced periodontitis, Global Journal of Medical Research. 15 (2015) 17-26.

[13] Z. Khurshid, M. Mal, M. Naseem, S. Najeeb and M.S. Zafar, Human gingival crevicular fluids (GCF) proteomics : An overview, Dent. J. 5 (2017) 1-8.

DOI: 10.3390/dj5010012

[14] A.S. Alzahrani, Gingival crevicular fluid release profile of vascular endothelial cell growth factor and platelet-derived growth factors-bb following minimally invasive flap reflection during treatment of intrabony defect : A randomized clinical trial, J. Int. Acad. Periodontol. 20 (2017) 1-9.

DOI: 10.1111/jre.12321

[15] D.M. Dohan, J. Choukroun, A. Diss, S.L. Dohan, A.J. Dohan, J. Mouhyi and B. Gogly, Platelet-rich fibrin (PRF): A second-generation platelet concentrate part II, Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod. 101 (2006) 45-50.

DOI: 10.1016/j.tripleo.2005.07.009

[16] C.H. Heldin and B. Westermark, Mechanism of action and in vivo role of platelet-derived growth factors, Physiol. Rev. 79 (1999) 1283-1316.

DOI: 10.1152/physrev.1999.79.4.1283

[17] G.F. Pierce, T.A. Mustoe, B.W. Altrock, T.F. Deuel, and A. Thomason, Role of platelet-derived growth factor in wound healing, J. Cell. Biochem. 326 (1991) 319-326.

DOI: 10.1002/jcb.240450403

[18] G.S. Ashcroft, Sex differences in wound healing, Advance in Molecular and Cell Biology. 34 (2004) 321-328.

[19] P.A. Kurdukar, A.A. Kurdukar, S.A. Mahale and A.M. Beldar, Biomarkers in gingival crevicular fluid, J. Dent. Med. Sci. 14 (2015) 104-109.