Clinical and histological evaluation on application of platelet concentrates on depigmented gingival epithelium

Clinical and Histological Comparison of Platelet-Rich Fibrin with Periodontal Dressing and Non-Eugenol Periodontal Dressing Alone on the Depigmented Gingival Epithelium

Background

This study aims to assess and contrast the healing results, in terms of both histology and clinical appearance, after gingival depigmentation using diode laser application of the platelet-rich fibrin (PRF) membrane in contrast to non-eugenol periodontal dressing (Coe-Pak).

Materials and Method

Thirty individuals in good health, aged between 18 and 50 years, were randomly divided into two groups, with each group consisting of 15 participants. One group underwent application of a PRF membrane along with periodontal dressing, while the other group received solely non-eugenol periodontal dressing. This procedure was performed in the intercanine region of the maxillary or mandibular arch for all participants. PRF was processed following the standardized procedure outlined by Choukroun. Patients underwent assessments for pain intensity using the visual analog scale (VAS) and for healing advancement using the Healing Index (HI) on the third and fifth days following treatment.

Results

Statistically significant disparities were noted between the two study groups concerning the VAS, HI, epithelialization assessment, and histological observations. In the clinical assessment of epithelialization using toluidine blue, it was observed that areas treated with PRF+Coe-Pak showed significantly reduced staining, indicating enhanced wound healing compared to those treated with Coe-Pak alone.

Conclusion

After depigmentation, the PRF+Coe-Pak group demonstrated enhanced patient comfort and facilitated an efficient wound-healing process.

Injectable platelet rich fibrin effect on laser depigmented gingiva: a clinical randomized controlled split mouth trial with histological assessment

OBJECTIVE

To determine whether intra-mucosal injection of injectable platelet-rich fibrin (i-PRF) can promote healing after Diode Laser Gingival Depigmentation (DLGD).

METHODOLOGY

A total of 20 arch sites of hyperpigmented gingiva of 10 patients underwent DLGD. For each patient, two arch sites were randomly assigned for either intra-mucosal injection of i-PRF (G1-i-PRF) (n=10 sites) or no treatment (G2-Control): (n=10 sites). Wound Healing Score (WHS), patient satisfaction, and Pigmentation Index (DOPI) were measured at 1 week and 1 and 3 months postoperatively. Histological assessment of tissue specimens was performed at baseline and 1 week.

RESULTS

The percentage change in WHS at 1 week was significantly higher in G1 (58.34±15.43) compared to G2 (37.50±11.79). At day 1, 50% of patients in G1 were pain free compared with 75% in G2, who had mild pain. Mean DOPI decreased significantly at 3 months in both groups (P-value <0.001), without significant differences between groups. G1 specimens showed significantly higher epithelial thickness (P-value <0.001), as well as a higher number of blood vessels and less percentage of inflammatory cells.

CONCLUSIONS

i-PRF demonstrated better clinical and histological healing potential and less patient discomfort compared to sites without treatment after DLGD. Registered at https://clinicaltrials.gov/ as (NCT05283668).

The effects of injectable platelet-rich fibrin application on wound healing following gingivectomy and gingivoplasty operations: single-blind, randomized controlled, prospective clinical study

OBJECTIVES

The aim of this study was to evaluate the effects of wound healing using injectable platelet-rich fibrin (IPRF) after gingivectomy and gingivoplasty.

MATERIALS AND METHODS

In this clinical study, 46 systemically healthy patients with chronic inflammatory gingival enlargement were randomly treated with gingivectomy-gingivoplasty + I-PRF (n=23) or gingivectomy-gingivoplasty alone (n=23). The primary outcome was to evaluate the effect of I-PRF on wound healing over a 3-week follow-up period. Samples collected from gingival crevicular fluid (GCF) were processed using enzyme-linked immunosorbent assay (ELİSA) to measure VEGF and FGF-10 biomarkers. The surgical areas were stained with Mira-2 tone and evaluated in ImageJ. Wound healing was evaluated with Modified Manchester Scar (MMS) scale and Landry, Turnbull, and Howley (LTH) index.

RESULTS

VEGF values of the control group at baseline, week 2, and week 3 were significantly higher than the test group. In weeks 2 and 3, FGF-10 values were found to be significantly higher in the control group than the test group. The amount of staining was found to be significantly higher in the control group than in the test group on days 3, 7, and 14. LTH values of the control group were significantly lower than the test group and MMS values were significantly higher than those of the test group.

CONCLUSIONS

I-PRF applications revealed positive effects on epithelial wound healing after gingivectomy and gingivoplasty operations.

CLINICAL RELEVANCE

Platelet concentrates such as I-PRF accelerate wound healing and contribute to the patient's comfort and quality of life. I-PRF application may have positive effects on wound healing after gingivectomy and gingivoplasty operations.

Laser-Assisted Gingival Depigmentation: A Case Report

The gingiva's colour varies in different individuals and is assumed to be related to cutaneous pigmentation. The most frequent natural pigment causing endogenous gingival pigmentation is melanin, a brown pigment. Depigmentation is a therapy of choice when individuals are concerned about their appearance and demand it for their aesthetic satisfaction. It is not a clinical indication. This article demonstrates gingival depigmentation using a laser diode with a 90-day follow‑up. A 23-year-old male patient visited the Periodontology Department, complaining of poor aesthetics owing to dark-coloured gums. Depigmentation with a laser diode was selected as the treatment plan for both the maxillary and mandibular arches, at an interval of a week. The choice of a procedure is largely influenced by the gingival thickness, the clinician's experience, the patient's preferences, and the rate of recurrence. According to reports, using lasers produces better aesthetic outcomes and has a low recurrence rate.

Comparative analysis of platelet-rich fibrin membrane and 0.2% hyaluronic acid gel on healing following gingival depigmentation procedure

Introduction

Platelet-rich fibrin (PRF) accelerates wound healing by promoting faster cicatricial tissue remodeling and excellent neovascularization. Hyaluronic acid (HA) being biocompatible, anti-inflammatory, and proangiogenic leads to improvement in the rate of wound healing.

Aim

The aim of this study was to compare the effect of PRF membrane and 0.2% HA gel on wounds after gingival depigmentation surgery.

Materials and Methods

This study was carried out on 30 systemically healthy individuals recruited from the pool of patients who visited the department of periodontology. After depigmentation procedure in every patient, the sites were divided into three even groups. Group A received PRF membrane and periodontal dressing, Group B received 0.2% HA gel application and periodontal dressing, and Group C served as a control group in which only periodontal dressing was placed. The individuals were evaluated for the healing index (HI) and Numerical Rating Scale (NRS) on the 3rd and 5th day. Epithelialization test (ET) was performed on the 5th day. Gingival biotype was reassessed and compared to preoperative value after 3 months. The clinical trial was expressed in terms of mean and standard deviation. Intra-group comparison and inter-group comparison were done through the Kruskal-Wallis ANOVA test. All statistical tests were performed through SPSS version 25.0 (IBM).

Results

The inter-group statistical analysis concerning NRS, HI, and ET showed statistically significant results in Groups A and B compared to Group C (P < 0.05), while gingival biotype showed statistically significant results in Group A compared to Groups B and C.

Conclusion

The use of PRF membrane and HA gel to protect the raw wound site of depigmented gingiva proved to be an effective approach, resulting in faster healing.

Despigmentación gingival mediante mucoabrasion en el sector anterior. Reporte de caso

La melanosis gingival una alteración frecuente que causa disconformidad en la sonrisa de los pacientes. Existen múltiples tratamientos que ofrecen resultados favorables y con poca o nula recidiva. El propósito de los presentes casos clínicos fue evaluar los resultados que ofrece la técnica de mucoabrasión en la remoción de manchas melánicas en el sector anterior. Los casos incluyeron a dos pacientes se sexo femenino, sin enfermedades sistémicas, las cuales al examen clínico presentaban manchas melánicas. El primer caso presentó pigmentaciones en el maxilar superior, mientras que el segundo caso presentó pigmentaciones en ambos maxilares. Se combinó la remoción de las manchas con el uso de bisturí y medios rotarios. Se logró eliminar las manchas melánicas en su totalidad en ambos casos con una técnica completa, sin la necesidad de equipos de alto costo y no se observó recidiva al cabo de 6 meses. La técnica de mucoabrasión fue efectiva para tratar la melanosis gingival resaltando que es de fácil manejo, de corto tiempo operatorio, cicatrización rápida, con un posoperatorio aceptable para el paciente y de costos económicos.

Clinical and histological comparison of platelet-rich fibrin versus non-eugenol periodontal dressing in the treatment of gingival hyperpigmentation

Background

The platelet-rich fibrin (PRF) has proven an immense role in angiogenesis and epithelization in a wound healing process. The present study aims to ascertain PRF's beneficial role in wound healing after depigmentation surgery.

Materials and Methods

A total of 12 systemically healthy controls included were divided into two groups after scalpel depigmentation procedure. PRF was prepared according to Choukroun's standard protocol. Using split-mouth design after depigmentation, one group received PRF membrane, and in second group non-eugenol periodontal dressing was placed. The participants were evaluated for visual analog scale (VAS), healing index (HI) on 3^rd and 5^th day. Epithelization test using toluidine blue and histological examination employing punch biopsy was done on the 5^th day.

Results

On statistical scale, VAS, HI, epithelization test, and histological findings were statistically significant in the two study groups. PRF group proved better epithelization test and inflammatory cell infiltration was less in PRF group which confirmed superior wound healing in the group.

Conclusion

PRF membrane postdepigmentation provided satisfactory patient comfort and enhanced the wound healing cascade.

Biological and Mechanical Properties of Platelet-Rich Fibrin Membranes after Thermal Manipulation and Preparation in a Single-Syringe Closed System

Platelet-rich fibrin (PRF) membrane is a three-dimensional biodegradable biopolymer, which consists of platelet derived growth factors enhancing cell adhesion and proliferation. It is widely used in soft and hard tissue regeneration, however, there are unresolved problems with its clinical application. Its preparation needs open handling of the membranes, it degrades easily, and it has a low tensile strength which does not hold a suture blocking wider clinical applications of PRF. Our aim was to produce a sterile, suturable, reproducible PRF membrane suitable for surgical intervention. We compared the biological and mechanical properties of PRF membranes created by the classical glass-tube and those that were created in a single-syringe closed system (hypACT Inject), which allowed aseptic preparation. HypACT Inject device produces a PRF membrane with better handling characteristics without compromising biological properties. Freeze-thawing resulted in significantly higher tensile strength and higher cell adhesion at a lower degradation rate of the membranes. Mesenchymal stem cells seeded onto PRF membranes readily proliferated on the surface of fresh, but even better on freeze/thawed or freeze-dried membranes. These data show that PRF membranes can be made sterile, more uniform and significantly stronger which makes it possible to use them as suturable surgical membranes.