Healing and Regeneration Driven by L-PRF™ and the Bioactive OSSEAN® Surface: Poised to Transform Implant Dentistry
According to Nelson R. Pinto, DDS, of the University of the Andes in Chile, the complex regenerative procedures used in combination with implant placement to enhance bone, soft tissue and to improve implant survival and esthetics can now be simplified.
Pinto says, instead of introducing various regenerative substances, dentists can use the patient’s own blood to obtain leukocyte and platelet-rich fibrin (L-PRF), which is one of the four main families of platelet concentrates for surgical use. L-PRF is used to improve healing and promote tissue regeneration in implant dentistry as well as in other surgical procedures. Describing the centrifuge and L-PRF application process for this at a conference in Rome this year, Pinto explained how a blood sample is taken without anticoagulant and immediately centrifuged to obtain a L-PRF clot that can be used directly or compressed into a membrane without damaging the cells and growth factors content.1
This biological material, which stimulates and accelerates tissue repair, he explains, is drawn from the patient’s blood using a specific FDA–cleared protocol, which generates an autologous product that has an exact biological and clinical signature.
The unique fibrin architecture, containing the leukocytes, platelets, mesenchymal stem cells, and growth factors promotes healing in any type of wound, he says. It can transform dental surgeries involving hard and soft tissues, and is currently being studied in other areas of medicine for use in burns and chronic wounds.
In implant dentistry in particular, Pinto says the impact of L-PRF can be especially transformational when used in combination with implants with a nano-profilomatry and a calcium impregnated surface that is uniquely receptive to the L-PRF. This, he says, is the case with Intra-Lock Dental Implants. “They are biologically driven, with an advanced bioactive OSSEAN surface, which encourages physiologic harmony and ensures an ideal tissue response when compromised bone volume, density and/or extraction site defects are encountered.” According to Pinto, the L-PRF “really attaches to the nano-rough OSSEAN implant surface." This, he explained at a Harvard School of Dental Medicine Conference this year, opens the door to using it “as a biological scaffold alone or in combination with a biomimetic implant surface to regenerate soft and hard tissue in such a way that was not possible before."2
Describing the properties of the OSSEAN surface, he says, “The OSSEAN surface from Intra-Lock has a very unique design. It uniquely binds to fibrin, which binds to it in a way not commonly seen with other implant surfaces. Its fractal design mimics nature at the nano-level; the OSSEAN surface repeats a similar structural pattern to that of natural bone over and over. This essentially makes the body accept the implant as a natural substance and ignites the healing process far sooner than would occur with a substance smooth at the nano-level, which does not have a natural-seeming pattern repetition.”
This, he says, can greatly enhance the overall outcome. “It improves the quality and quantity of bone because it can guide bone regeneration; if bone is apart from the implant surface, the bone will grow toward the surface with the L-PRF as a scaffold.”
Pinto notes challenges that have hindered efforts to regenerate hard and soft tissue, including the sinus lift technique, which provides satisfactory and predictable clinical results but requires a long healing time, discomfort, and lengthy rehabilitation treatment, according to a study presented by Cruzat, Wolnitzky, Pinto, and others as a poster at the Academy of Osseointegration's 30th Annual Meeting earlier this year.3 In contrast, Pinto says L-PRF is an easily retrieved autologous graft known to regenerate both bone and gingiva. “It is changing the way surgical procedures are approached using only natural substances.” In this case, Intra-Lock’s FDA-cleared IntraSpin™ System is designed to enable an efficient, cost-effective, and simple chair-side protocol for the fabrication of the L-PRF just prior to an implant or most surgical procedures. The impact of this protocol on the L-PRF is described in a study by Pinto et al.4
Also according to the study referenced above, which evaluated the effect of L-PRF as sole grafting material in maxillary sinus lift with simultaneous implant compared to its association with an allograft, the authors concluded, “L-PRF as a lone grafting material developed new bone of better quality (histologically), but in a smaller amount (radiologically) than that obtained by associating it with an allograft, for the sample. It represented a reduction in the waiting time with a survival rate of 100%."3
Using the understanding of these complex mechanisms of healing present in every living being is, says Pinto, now opening new horizons and possibilities for greater success. As stated in an Abstract for the 30th Annual Meeting of the Academy of Osseointegration, “Natural guided regeneration is achievable today. Utilizing L-PRF as an autologous graft material, along with the latest biomimetic concepts, has the potential to alter our vision and elevate the level of care we offer our patients in the future. What we thought impossible yesterday, could be routine tomorrow.”3
References
1. Pinto NR. Leukocyte-Platelet Rich Fibrin Membrane (L-PRF) alone or associated with a Biomimetic Implant Surface act as a Biological Scaffold for Hard and Soft Tissue Regeneration. 4th International Conference on Tissue Science and Regenerative Medicine, July 2015. Rome, Italy.
2. Pinto NR. Natural Guided Regeneration; Leukocyte-Platelet Rich Fibrin (L-PRF) as a Biological Scaffold for Hard and Soft Tissue Regeneration. Harvard School of Dental Medicine Clinical Leadership Conference,. 2015.
3. Cruzat TP, Wolnitzky A, Pinto NR et al. L-PRF as Sole Grafting Material in Maxillary Sinus Elevation with Simultaneous Implant Placement Compared to its Association with Mineralized Allograft Cortical Bone: 1-Year Pilot Controlled Clinical Trial. Conference: Academy of Osseointegration, 30th Annual Meeting, San Francisco, California, March 2015.
4. Pinto NR, Pereda A, Jiménez P et al. The impact of the centrifuge characteristics and centrifugation protocols on the cells, growth factors and fibrin architecture of a Leukocyte- and Platelet-Rich Fibrin (L-PRF) clot and membrane. Part 2: macroscopic, photonic microscopy and Scanning Electron Microscopy analysis of 4 kinds of L-PRF clots and membranes. POSEIDO. 2014:2(2):141-154.
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