The use of platelet-rich fibrin in combination therapy of mandibular delayed union

Authors

  • N. Idashkina

DOI:

https://doi.org/10.33295/1992-576X-2018-3-54-59

Keywords:

fracture of lower jaw, delayed consolidation, pathogenesis, reparative osteogenesis, enriched platelets fibrin

Abstract

Purpose: to evaluate the effectiveness of the using injectable platelet-rich fibrin techniques in the prevention and treatment of delayed consolidation of fragments in patients with mandibular fractures.
Methods. For the period from 2010 to 2016, 60 patients with a mobility of fragments in the fracture zone in one month after repositioning and fixing the fragments were observed treatment. All patients were randomized into two groups of 30 people, identical in age and sex. The injection of platelet-enriched fibrin (PRF) sub-periosteal along the line of mandibular fracture was performed in addition to the treatment complex for stimulation of reparative osteogenesis by the patients in the second group,. The control group consisted of 19 practically healthy volunteers with absents of clinical signs of acute or chronic diseases, as well as pathology of teeth and periodontal disease. Carried out the extended immunological and biochemical researches, directed on determination of factors which result in disorders of reparative osteogenesis.
Results. The use of the pathogenetically determined strategy of prevention and treatment of delayed consolidation of mandibular fractures allowed to achieve in all patients the relief of clinical symptoms of consolidation complications in a short time (up to 7 days). However, clinically reparative osteogenesis in patients in the second group proceeded with some differences: with the formation of significant bone callus in the majority of the first group (in 22 patients (73.3 %), whereas in the group of patients receiving PRF, a pronounced periosteal reaction was noted only in 11 patients (36.7 %). In the second group, a reparative reaction was more often observed in terms of the type of primary delayed contact arrest. Prognostic criteria for the emergence and success of inflammatory complications treatment of mandibular fractures in practically healthy people have been determined.
Conclusions. The main factors contributing to the development of delayed consolidation of mandibular fragments are disorders of bone metabolism, processes of free radical lipid oxidation, changes in the functioning of the main cytokines and a decrease in local humoral immunity. The basic program for the treatment of patients with delayed consolidation of the mandibular fractures should include optimization of osteogenesis processes with osteotropic drugs, elimination of the increase in free radical lipid oxidation by antioxidants, and correction of the synthesis of cytokines and immunoglobulins by immunomodulators. Inclusion in the comprehensive prevention and treatment of delayed consolidation of mandibular fractures of the PRF significantly affects the quality of the regenerate. The main laboratory criteria for the effectiveness of complex treatment of delayed consolidation of mandible fragments are the positive dynamics of the parameters of the antioxidant system (SOD and catalase) and the parameters of IL-1β and sIgA.
Key words: fracture of lower jaw, delayed consolidation, pathogenesis, reparative osteogenesis, enriched platelets fibrin.

Author Biography

N. Idashkina

Идашкина Наталья Георгиевна – канд. мед. наук, зав.кафедрой хирургической стоматологии, имплантологии и пародонтологии
ГУ «Днепропетровская медицинская академия МОЗ Украины».
Адрес: г. Днепр, 49044, ул. Вернадского, 9. E-mail: idashkina@ukr.net.

References

1. Ткаченко П.І. Репаративний остеогенез: теоретичні аспекти у практичній стома-
тології / П.І. Ткаченко, С.С. Білокінь, О.В. Гуржій, Н.П. Білокінь // Стоматолог. – 2003. –
№ 11. – С. 15–18.
2. Бруско А.Т., Гайко Г.В. Современные представления о стадиях репаративной
регенерации костной ткани при переломах / А.Т. Бруско, Г.В. Гайко // Вісник ортопедії, трав-
матології та протезування. – 2014. – № 5. – С. 5–8.
3. Корж Н.А., Дедух Н.В. Репаративная регенерация кости: современный взгляд
на проблему. Стадии регенерации / Н.А. Корж, Н.В. Дедух // Ортопедия, травматология и
протезирование. – 2006. – № 1. – С. 76–84.
4. Тимофеев А.А. Руководство по челюстно-лицевой хирургии и хирургической сто-
матологии / А.А. Тимофеев. – 4-е изд. – Киев: ООО «Червона Рута-Турс», 2004. – 1061 с.
5. Корж Н. А. Репаративная регенерация кости: современный взгляд на проблему.
Локальные факторы, влияющие на заживление перелома (сообщение 4) / Н.А. Корж,
Л.Д. Горидова, К.К. Романенко // Ортопедия, травматология и протезирование. – 2006. –
№ 2. – С. 99–106.
6. Guerrissi J.O. Fractures of mandible: is spontaneous healing possible? Why? When? /
J.O. Guerrissi // J. Craniofac. Surg. – 2001. – 12 (2). – P. 157–166.
7. Employing the biology of successful fracture repair to heal critical size bone defects /
J.A. Cameron, D.J. Milner, J.S. Lee, J. Cheng, N.X. Fang and I.M. Jasiuk // Curr. Top. Microbiol.
Immunol. – 2013. – Vol. 367. – P. 113–132. doi: 10.1007/82_2012_291.
8. Designing biomimetic scaffolds for bone regeneration: why aim for a copy of mature
tissue properties if nature uses a different approach? / Willie B.M., Petersen A., Schmidt-Bleek K.,
Cipitria A., Mehta M., Strube P., Lienau J., Wildemann B., Fratzl P., Duda G. // Soft Matter. –
2010. – Vol. 6. – P. 4976–4987.
9. Biomaterial delivery of morphogens to mimic the natural healing cascade in bone /
Mehta M., Schmidt-Bleek K., Duda G.N., Mooney D.J. // Adv. Drug. Deliv. Rev. – 2012. –
doi:10.1016/ j.addr.2012.05.006.
10. Bioresorbability, porosity and mechanical strength of bone substitutes: what is optimal
for bone regeneration?/ Hannink G., Chris Arts J.J. // Inj-Int. J. Care. Inj. – 2011. – Vol. 42. –
P. 522–525.
11. Principals of neovascularization for tissue engineering / Nomi M., Atala A., DeCoppi P.,
Soker S. // Mol. Aspects. Med. – 2002. – Vol. 2. – P. 463–483.
12. Vascularization in tissue engineering / Rouwkema J., Rivron N.C., van Blitterswijk C. //
Trends. Biotech. – 2008. – Vol. 26. – P. 434–441.
13. Vascularization is the key challenge in tissue engineering / Novosel E.C., Kleinhans C.,
Kluger P.J. // Adv. Drug. Deliv. Rev. – 2011. – Vol. 63. – P. 300–311.
14. Ефективність застосування збагаченої тромбоцитами плазми для оптимізації
репараційного остеогенезу при переломах нижньої щелепи з ускладненим клінічним перебі-
гом / С.І. Трифаненко, М.П. Продан, Н.Б. Кузняк // Буковинський медичний вісник. – 2012. –
Т. 16, № 4 (64). – С. 162–164.
15. Platelet-Rich Plasma: From Basic Science to Clinical Applications / T.E. Foster,
B.L. Puskas, B.R. Mandelbaum, M.B. Gerhardt and S.A. Rodeo // The American J. Sports Med. –
Nov. 2009. – Vol. 37. – P. 2249–2251.
16. Ахмеров Р.Р. Регенеративная медицина на основе аутологичной плазмы. Техно-
логия Plasmolifting / Р.Р. Ахмеров. – М.: Литтерра, 2014. – 160 с.
17. Choukroun J., Diss A., Simonpieri A. et al. Platelet-rich fi brin (PRF): a second-generation
platelet concentrate. Part V: histologic evaluations of PRF effects on bone allograft maturation in sinus
lift // Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod. – 2006. – Vol. 101, № 3. – P. 299–303.
18. Матрос-Таранець I.М. Bикористання остеопластичних композицiй FRР з авто-
генним тромбоцитарним концентратом у щелепно-лицевiй хiрургii та iмплантологii /
I.М. Матрос-Таранець, Д.К. Калиновський // Iмплантологiя. Пародонтологiя. Остеологiя. –
2009. – № 1. – С. 31–40.
19. Возможность ускорения репаративных процессов в костных тканях в результате
применения фибрина / И.В. Майбородин, И.С. Колесников, Д.М. Козодий и др. // Fundamental
research. – 2011. – № 2. – C. 98–105.
20. Как описывать статистику в медицине. Аннотированное руководство для авторов,
редакторов и рецензентов / Т.А. Ланг, М. Сессик; пер. с англ. под ред. В.П. Леонова. – М.:
Практическая медицина, 2011. – 480 с.: ил.

Published

2018-08-31

Issue

Section

MAXILLOFACIAL SURGERY AND SURGICAL DENTISTRY