Soft tissue regeneration using leukocyte-platelet rich fibrin after exeresis of hyperplastic gingival lesions: two case reports
© di Lauro et al. 2015
Received: 16 December 2014
Accepted: 28 September 2015
Published: 2 November 2015
Leukocyte-platelet rich fibrin belongs to a second generation of platelet concentrates that does not need biochemical blood manipulation. It is used for tissue healing and regeneration in periodontal and oral-maxillofacial surgery. We report two cases of hyperplastic gingival lesions treated by exeresis and application of leukocyte-platelet rich fibrin membranes in order to improve and accelerate tissue healing.
Two patients (a 78-year-old Caucasian woman and a 30-year-old Caucasian man) were treated for hyperplastic gingival lesions. They underwent to exeresis of lesions and application of leukocyte-platelet rich fibrin membranes. Tissue healing was clinically evaluated after 1, 3, 7, 14 and 30 postoperative days. No recurrences were observed after 2 years of semi-annual follow up.
We obtained rapid and good healing of soft tissues probably due to the elevated content of leukocytes, platelets and growth factors in the leukocyte-platelet rich fibrin. Based on our results we suggest the use of leukocyte-platelet rich fibrin to cover wounds after exeresis of oral neoformations such as hyperplastic gingival lesions.
KeywordsEpulis Hyperplastic gingival lesions PRF Soft tissue healing
Hyperplastic gingival lesions consist of fibro-epithelial reactions that are secondary to multiple factors: chronic inflammation, local irritation (e.g. dental plaque, tartar, root residues, projecting fillings and reconstructions, incongruous dentures), hormonal factors (puberty, pregnancy), and drugs such as anti-epileptic drugs (diphenylhydantoin sodium, valproate sodium, carbamazepine), immunosuppressive drugs (ciclosporin) and antianginal vasodilators (nifedipine) [1, 2]. A dysplastic hypothesis has been formulated regarding its onset [3, 4]; this hypothesis is suggested by the tendency of some hyperplastic gingival lesions to grow and not to regress spontaneously. They tend to recur unless a radical surgical therapy is performed. Examples of these lesions are giant-cell epulis and fibro-osseous epulis. Giant-cell epulis is the most common form and it is also called peripheral giant-cell granuloma (PGCG). It was first reported as fungus flesh in 1848 , then reported as giant cell reparative granuloma in 1953 . This lesion is the peripheral opponent form of central giant-cell intraosseous tumors, characterized by the presence of giant cells that seem to originate from osteoclasts in the periodontal ligament . Fibro-osseous epulis or peripheral ossifying fibroma (POsF) was first reported and described as ‘alveolar exostosis’ in 1844 . It presents a dense collagenous stroma in which thin trabecular bone can be observed.
We report two cases of hyperplastic gingival lesions treated by exeresis and application of leukocyte-platelet rich fibrin (L-PRF) membranes in order to improve and accelerate tissue healing. L-PRF belongs to a second generation of platelet concentrates which does not need biochemical blood manipulation [9, 10]. It is used for tissue healing [11, 12] and regeneration in periodontal and oral-maxillofacial surgery  because of its elevated content of leukocytes, platelets and growth factors.
Case number one
Case number two
In both cases we decided to proceed with a surgical approach characterized by complete excision of lesions and application of L-PRF membranes in order to improve and accelerate tissue healing.
Although the epulis in its form of giant-cell epulis and fibro-osseous epulis is a benign disease, it is important to find time to make the correct therapy. Both young and old patients must take prompt actions to avoid growth of oral lesions that can begin to become difficult to manage. There is unanimous consensus on the surgical excision of these lesions in toto to prevent recurrence. The target of these case reports is to focus on the management of the L-PRF and its placement on the surgical wounds. The first benefit is given by covering the surgical site, which would otherwise heal by secondary intention, which provides greater comfort to the patient in the postoperative period. The same wound healing appears to be substantially accelerated because of the structural and neoangiogenetical properties of L-PRF . In the polymerization step of the L-PRF, thrombin, which is present in physiological concentrations, allows the formation of a fibrin matrix in a slow and natural way obtaining a flexible structure capable of determining entrapment of cytokines, cell migration and tissue healing . The effect of L-PRF on reducing pain and postoperative swelling has the same importance. There are countless practices that the L-PRF offers in the dental field such as the accelerated healing of extraction sockets and use with other biomaterials in bone regeneration (GBR) . In the context of tissue regeneration we evaluated the role of L-PRF in the promotion of wound healing. We also stress the importance of such a gel in the control of hemostasis in patients taking anti-platelets and/or anticoagulants for whom extractions can be performed without discontinuation of these drugs.
According to the encouraging results obtained in these two clinical cases about tissue healing after application of L-PRF membranes, we suggest that L-PRF be used to cover wounds after exeresis of oral neoformations such as hyperplastic gingival lesions.
Written informed consent was obtained from the patients for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
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- Ficarra G. Manuale di Patologia e Medicina Orale. McGraw-Hill Education. 2006. Milano, Italy.Google Scholar
- di Lauro F, Bucci E. Chirurgia Odontostomatologica. Ed. Florio. 2000. Naples, Italy.Google Scholar
- Ramu S, Rodrigues C. Reactive hyperplastic lesions of the gingiva: a retrospective study of 260 cases. World J Dent. 2012;3(2):126–30.View ArticleGoogle Scholar
- Chaparro–Averdano A, Berini-Aytes L, Gay–Escoda C. Peripheral giant cell granuloma. A report of five case and review of the literature. Med Oral Patol Oral Cir Bucal. 2005;10(1):53–7.Google Scholar
- Tomes J. A course of lectures on dental physiology and surgery (lectures I–XV). Am J Dent Sci. 1846–1848;7:1–68. 121–134, 33–54, 120–147, 313–350.Google Scholar
- Jaffe HL. Giant-cell reparative granuloma, traumatic bone cyst, and fibrous (fibro-osseous) dysplasia of the jawbones. Oral Surg Oral Med Oral Pathol. 1953;6:159–75.View ArticlePubMedGoogle Scholar
- Katsikeris N, Kakarantza-Angelopoulou E, Angelopoulos AP. Peripheral giant cell. Granuloma: clinicopathologic study of 224 new cases and review of 956 reported cases. Int J Oral Maxillofac Surg. 1988;17:94–9.View ArticlePubMedGoogle Scholar
- Shepherd SM. Alveolar exostosis. Am J Dent Sci. 1844;4:43–4.Google Scholar
- Dohan DM, Choukroun J, Diss A, Dohan SL, Dohan AJ, Mouhyi J, et al. Platelet-rich fibrin (PRF): a second-generation platelet concentrate. Part I: technological concepts and evolution. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;101(3):e37–44.View ArticlePubMedGoogle Scholar
- Dohan Ehrenfest DM, Bielecki T, Mishra A, Borzini P, Inchingolo F, Sammartino G, et al. In search of a consensus terminology in the field of platelet concentrates for surgical use: platelet-rich plasma (PRP), platelet-rich fibrin (PRF), fibrin gel polymerization and leukocytes. Curr Pharm Biotechnol. 2012;13(7):1131–7.View ArticlePubMedGoogle Scholar
- Choukroun J, Diss A, Simonpieri A, Girard MO, Schoeffler C, Dohan SL, et al. Platelet-rich fibrin (PRF): a second-generation platelet concentrate. Part IV: clinical effects on tissue healing. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;101(3):e56–60.View ArticlePubMedGoogle Scholar
- Anitua E, Andia I, Ardonza B, Nurden P. Autologous platelet as a source of proteins for healing and tissue regeneration. Thromb Haemost. 2004;91(1):4–15.PubMedGoogle Scholar
- Simonpieri A, Del Corso M, Vervelle A, Jimbo R, Inchingolo F, Sammartino G, et al. Current knowledge and perspectives for the use of platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) in oral and maxillofacial surgery part 2: Bone graft, implant and reconstructive surgery. Curr Pharm Biotechnol. 2012;13(7):1231–56.View ArticlePubMedGoogle Scholar
- Clark RA. Fibrin and wound healing. Ann N Y Acad Sci. 2001;936:355–67.View ArticlePubMedGoogle Scholar
- Cassling VL, Açil Y, Springer IN, Hubert N, Wiltfang J. Platelet-rich plasma and platelet-rich fibrin in human cell culture. Pathol Oral Radiol Endod. 2009;108(1):48–55.View ArticleGoogle Scholar
- Tatullo M, Marrelli M. Platelet rich fibrin in reconstructive surgery of atrophied maxillary bones: clinical and histological evaluators. Int J Med Sci. 2012;9(10):872–80.View ArticlePubMedPubMed CentralGoogle Scholar