Int J Med Sci 2012; 9(10):872-880. doi:10.7150/ijms.5119 This issue

Research Paper

Platelet Rich Fibrin (P.R.F.) in Reconstructive Surgery of Atrophied Maxillary Bones: Clinical and Histological Evaluations

Marco Tatullo1,2,3 *✉, Massimo Marrelli2,3 *, Michele Cassetta4, Andrea Pacifici4, Luigi Vito Stefanelli4, Salvatore Scacco1, Gianna Dipalma2, Luciano Pacifici4 *, Francesco Inchingolo2,5 *

1. Dept. of Basic Medical Science, University of Bari, Italy;
2. Unit of Maxillofacial Surgery, Calabrodental clinic, Crotone, Italy;
3. Tecnologica, Research Institute in Regenerative Medicine, Crotone, Italy;
4. Department of Oral and Maxillofacial sciences, University of Rome "Sapienza", Italy;
5. Department of Dental Sciences and Surgery, University of Bari, Italy.
* These Authors contributed equally to this work.

This is an open access article distributed under the terms of the Creative Commons Attribution (CC BY-NC) License. See for full terms and conditions.
Tatullo M, Marrelli M, Cassetta M, Pacifici A, Stefanelli LV, Scacco S, Dipalma G, Pacifici L, Inchingolo F. Platelet Rich Fibrin (P.R.F.) in Reconstructive Surgery of Atrophied Maxillary Bones: Clinical and Histological Evaluations. Int J Med Sci 2012; 9(10):872-880. doi:10.7150/ijms.5119. Available from

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Introduction. Maxillary bone losses often require additional regenerative procedures: as a supplement to the procedures of tissue regeneration, a platelet concentrate called PRF (Platelet Rich Fibrin) was tested for the first time in France by Dr. Choukroun.

Aim of the present study is to investigate, clinically and histologically, the potential use of PRF, associated with deproteinized bovine bone (Bio-Oss), as grafting materials in pre-implantology sinus grafting of severe maxillary atrophy, in comparison with a control group, in which only deproteinized bovine bone (Bio-Oss) was used as reconstructive material.

Materials and Methods. 60 patients were recruited using the cluster-sampling method; inclusion criteria were maxillary atrophy with residual ridge < 5mm. The major atrophies in selected patients involved sinus-lift, with a second-look reopening for the implant insertion phase. The used grafting materials were: a) Bio-Oss and b) amorphous and membranous PRF together with Bio-Oss. We performed all operations by means of piezosurgery in order to reduce trauma and to optimize the design of the operculum on the cortical bone. The reopening of the surgical area was scheduled at 3 different times.

Results. 72 sinus lifts were performed with subsequent implants insertions.

We want to underline how the histological results proved that the samples collected after 106 days (Early protocol) with the adding of PRF were constituted by lamellar bone tissue with an interposed stroma that appeared relaxed and richly vascularized.

Conclusions. The use of PRF and piezosurgery reduced the healing time, compared to the 150 days described in literature, favoring optimal bone regeneration. At 106 days, it is already possible to achieve good primary stability of endosseous implants, though lacking of functional loading.

Keywords: Reconstructive Surgery, Platelet Rich Fibrin, Grafting Materials, Bone replacement.