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 Table of Contents  
CASE REPORT
Year : 2016  |  Volume : 2  |  Issue : 2  |  Page : 132-135

Enhancement of healing of donor hard palate site using platelet-rich fibrin


Department of Periodontology, Subharti Dental College and Hospital, Meerut, Uttar Pradesh, India

Date of Submission07-Aug-2016
Date of Acceptance03-Dec-2016
Date of Web Publication13-Jan-2017

Correspondence Address:
Rashmi Singh
Department of Periodontology, Subharti Dental College and Hospital, Meerut - 250 005, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2455-3069.198375

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  Abstract 

Gingival recession is not only an aesthetic concern but also often is associated with problems such as tooth hypersensitivity. Among various root coverage modalities, free soft-tissue gingival graft shows promising results, but is associated with patient discomfort due to the need for second surgical palatal donor site. The purpose of this case report is to evaluate the effectiveness of platelet-rich fibrin (PRF) at donor palatal site with root coverage procedure in the treatment of recession-type defects. This paper reports a case of a 31-year-old male with a root coverage procedure, and employing PRF at donor site has been discussed below. Hence, the employment of PRF at donor site not only enhances healing but also reduces patient discomfort that occurs due to palatal plate.

Keywords: Free autogingival graft, gingival recession, mucogingival therapy, platelet-rich fibrin, root coverage


How to cite this article:
Tomar N, Singh R, Jain G, Kaushik M, Dureja D. Enhancement of healing of donor hard palate site using platelet-rich fibrin. J Curr Res Sci Med 2016;2:132-5

How to cite this URL:
Tomar N, Singh R, Jain G, Kaushik M, Dureja D. Enhancement of healing of donor hard palate site using platelet-rich fibrin. J Curr Res Sci Med [serial online] 2016 [cited 2020 Nov 30];2:132-5. Available from: https://www.jcrsmed.org/text.asp?2016/2/2/132/198375


  Introduction Top


Gingival recession (GR) has been defined as an apical shift of the gingival margin over the cementoenamel junction (CEJ) and the exposure of the root surface to the oral environment.[1] Its correction is necessary for aesthetic demands, root hypersensitivity, root caries lesions, and cervical abrasions using root coverage surgery.[2] Free gingival grafts (FGGs) is one of the mucogingival surgeries used to cover the exposed root surface. The grafts can be taken from different sites of the patient, and the palate is the usual common donor site. It has disadvantages of including a second surgical site which creates an open wound that is prone to bleeding, pain, and slow healing process.[3]

Platelet-rich fibrin (PRF), an autologous blood product, is used to deliver growth factors in high concentration to the site of a bone defect, offering several advantages including promoting wound healing, bone growth, maturation, graft stabilization, and hemostasis. PRF, when placed at the site of injury, releases an array of potent inflammatory and mitogenic factors that are involved in wound healing.[4]

Hence, the present case report describes employment of PRF membrane at the donor palatal site while treating a recession defect at lower left canine (#43) with FGG.


  Case Report Top


A 31-year-old male patient came to the department of periodontology with the chief complaint of increased sensitivity of a tooth in the lower left region for 4 weeks. The patient's medical and dental histories were noncontributory. On clinical examination Grade II recession was seen at the region of lower left canine, inadequate keratinized tissue was present with respect to lower left canine [Figure 1]. FGG procedure was planned to treat the defect, and informed consent was obtained from the patient.
Figure 1: Preoperative view showing Miller's Class II recession #43

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Surgical procedure

Gingival augmentation procedure was done by procuring FGG from hard palate. The incision extended from distal aspect of canine and mesial aspect of the first molar area and then pressure was applied to the donor area with gauze soaked in saline, to control bleeding [Figure 2].
Figure 2: Free gingival graft procured from palatal donor site

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Preparation of platelet-rich fibrin membrane

Immediately, before surgery, a 10-mL blood sample was collected by venipuncture from antecubital vein without anticoagulant in test tubes and centrifuged immediately at 3000 rpm for 10 min. After removal of acellular plasma from the top, the PRF was separated from the erythrocytes using sterile scissors; fibrin membrane was obtained by squeezing the serum from the clot with a specific mechanical press.

Application of membrane at donor site

PRF membrane obtained, cut and resized according to donor size, and placed over the donor site. The membrane was sutured at the donor site with direct, interrupted sutures using 4-0 silk [Figure 3].
Figure 3: After platelet-rich fibrin placement at donor site

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Preparation of recipient site for graft

Following administration of local anesthesia, i.e., local infiltration of 2% lidocaine with a concentration of 1:200,000 epinephrine the recession site was prepared and deepithelialized.

The graft was positioned apical to CEJ and stabilized using 5-0 silk suture on the mesial and distal aspect with sling sutures to prevent movement of the graft [Figure 4]. A periodontal dressing (Coe-Pak) was placed over the graft to stabilize and protect the donor tissue.
Figure 4: Free gingival graft placed and suture on recipient site

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Uneventful healing was observed at PRF site by 15 days followed by 1 month [Figure 5]a and [Figure 5]b. The considerably less healing time required by PRF membrane site resulted in less postoperative discomfort to the patients. Successful recession coverage was observed at recipient site at 15 days and was followed by 1 month [Figure 6]a and [Figure 6]b.
Figure 5: (a) Fifteen-day postoperative view of donor site. (b) One-month postoperative view of donor site

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Figure 6: (a) Fifteen-day postoperative view of recipient bed. (b) One-month postoperative of recipient bed

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  Discussion Top


Regenerative periodontal therapy comprises procedures which are specially designed to restore those parts of tooth-supporting apparatus which have been lost due to periodontitis.[5]

GR is a common and undesirable condition that is frequently encountered in dental practices. Its presence is disturbing for patients due to aesthetic, psychological, and functional problems, for example, dentine hypersensitivity, root caries and abrasion, cervical wear, tooth mobility, and dental erosion because of the exposure of the root surface to the oral environment.[6]

In recent decades, different surgical procedures were proposed. Coronally advanced flaps, laterally repositioned flaps, FGGs, and subepithelial connective tissue grafts appeared as novel approaches to achieve improvements in recession depth, clinical attachment level, and width of keratinized tissue.[7]

Studies on the donor sites of FGG have shown that palatal wound requires 2–4 weeks to heal with secondary intention [8] resulting in a longer healing time, and patients report more discomfort in the first 2 postoperative weeks.[9]

Many authors describe different methods for increasing the healing process, and one of them is using PRF. PRF is a fibrin matrix that contains components that favor healing and immunity.[10]

PRF also provides significant postoperative protection of the surgical site and seems to accelerate the integration and remodeling of the surgical site.[10] Aravindaksha et al. showed that the use of a PRF membrane as a palatal bandage is effective in accelerating soft-tissue healing.[11]

Hence, the employment of PRF as palatal bandage can not only enhance the healing at donor site but also reduce patient discomfort.


  Conclusion Top


This technique of using PRF membrane as a palatal bandage allows clinicians to reduce postoperative complications associated with donor sites by accelerating the healing process.

PRF membrane is an easy-to-procure, economical, autologous healing biomaterial. The use of PRF membrane as a palatal bandage appears to accelerate healing at the palatal donor sites, thereby reducing postoperative complications associated with the FGG donor site.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Kassab MM, Cohen RE. The etiology and prevalence of gingival recession. J Am Dent Assoc 2003;134:220-5.  Back to cited text no. 1
    
2.
Goldstein M, Brayer L, Schwartz Z. A critical evaluation of methods for root coverage. Crit Rev Oral Biol Med 1996;7:87-98.  Back to cited text no. 2
    
3.
Hou LT, Yan JJ, Liu CM. Treatment of the gingival recession: Literature review of current progress. Chin Dent J 2005;24:2.  Back to cited text no. 3
    
4.
Corso MD, Toffler M, Ehrenfest DM. Use of an autologous leukocyte and plate let-rich fibrin (L-PRF) membrane in post – Avulsion sites: An overview of Choukroun's PRF. J Implant Adv Clin Dent 2010;9:27-35.  Back to cited text no. 4
    
5.
Khattar S, Kaushik M, Tomar N. The use of platelet rich fibrin & demineralized freeze bone allograft in the treatment of intrabony defect. A case report. Sch J Med Case Rep 2014;2:563-7.  Back to cited text no. 5
    
6.
Dodwad V. Etiology and severity of gingival recession among young individuals in Belgaum district in India. Ann Dent Univ Malaya 2001;8:1-6.  Back to cited text no. 6
    
7.
Chambrone L, Sukekava F, Araújo MG, Pustiglioni FE, Chambrone LA, Lima LA. Root-coverage procedures for the treatment of localized recession-type defects: A Cochrane systematic review. J Periodontol 2010;81:452-78.  Back to cited text no. 7
    
8.
Del Pizzo M, Modica F, Bethaz N, Priotto P, Romagnoli R. The connective tissue graft: A comparative clinical evaluation of wound healing at the palatal donor site. A preliminary study. J Clin Periodontol 2002;29:848-54.  Back to cited text no. 8
    
9.
Farnoush A. Techniques for the protection and coverage of the donor sites in free soft tissue grafts. J Periodontol 1978;49:403-5.  Back to cited text no. 9
    
10.
Choukroun J, Adda F, Schoeffler C, Vervelle A. An opportunity in perioimplantology: The PRF. Implantodontie 2001;42:55-62.  Back to cited text no. 10
    
11.
Aravindaksha SP, Batra P, Sood V, Kumar A, Gupta G. Use of platelet-rich fibrin membrane as a palatal bandage. Clin Adv Periodontics 2014;4:246-50.  Back to cited text no. 11
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]


This article has been cited by
1 Effect of platelet-rich fibrin palatal bandage on pain scores and wound healing after free gingival graft: a randomized controlled clinical trial
Maha A. Bahammam
Clinical Oral Investigations. 2018;
[Pubmed] | [DOI]



 

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