Blood components for non-transfusion use in oral surgery

OBJECTIVES Platelet derivates are widely used for tissue regeneration, in dentistry and beyond, with shorter healing time and fewer side effects associated with the surgical trau-ma or with pathologic conditions. They are autologous products ob-tained from a little amount of ve-nous blood, through manipulation with closed circuit systems. Among these, L-PRF has a safe and promising use in the dental field. It can be used alone or to-gether with other materials and is, due to its peculiarities, the most used among the blood components in oral surgery. This paper has the aim to make an overview about the various ap-plications of the platelet deriva-tives in the dental field. Moreover, three clinical cases managed with L-PRF will be presented. MATERIALS AND METHODS Three clinical cases have been se-lected among those managed at the Oral-Maxillofacial Surgery Unit, at the Policlinico of Modena, Italy. Case 1: one patient with third mo-lar impaction, 3.8. This element, shows a significant sagittal incli-nation, greater than 50°, and a high impact on the II left molar; these conditions may lead to a periodontal damage to the 3.7. Due to this clinical situation, the surgical extraction of tooth 3.8 has been performed, with the ap-position of L-PRF within the residual alveolar socket. Case 2: patient with an osteolytic lesion at the pre-maxilla. After surgical removal of the inflamma-tory cystic lesion, the residual defect has been filled with L-PRF mixed with particulated bovine deproteinized bone to promote the regeneration of the defect and to make the graft material easier to handle for the operator. At the out-er aspect of the lesion L-PRF membranes have been used. Case 3: medical-related osteone-crosis of the lower jaw. After the re-moval of the necrotic bone and the surgical debridement, L-PRF has been used to obtain filling of the re-sidual bone defect. In this case, L-PRF was used to bring a higher quantity of growth factors to the site and due to its neangiogenetic proprieties, in order to create a good mucous seal and to promote the regeneration of the defect. RESULTS The three cases have been managed with L-PRF. The post-opera-tive sequelae have been very low in terms of incidente and severity. As a matter of fact, we note mild post-operative swelling and mild pain. At 6 months re-evaluation, the mucous seals were all main-tained and the soft tissue healing was perfectly achieved. Upon ra-diographic examination, bone regeneration could be appreciated. CONCLUSIONS Within the limits of this presenta-tion of only three clinical cases we just formulate some first im-pressions. We can confirm the versatility of L-PRF production and application in oral surgery. These preliminare data goes along with the data already exist-ing in the scientific literature. However, more observational and prospective studies are neces-sary, in order to provide the prac-titioner with specific guide-line for the application of L-PRF in the dental field. CLINICAL SIGNIFICANCE The blood components, and among them L-PRF, could be a valid alternative material for tissue regeneration. In a very close future it could lead us to reduce the use of etherologous biomatherials in favour of a completely autolo-gous one, cheaper and potentially very effective. At last, L-PRF in combination with an etherologous graft material could improve its potential and make it easer to handle for the operator itself.