title: Platelet-Rich Fibrin (PRF) in Implants Dentistry in Combination with New Bone Regenerative Flapless Technique: Evolution of the Technique and Final Results.
abstract: Most common techniques for alveolar bone augmentation are guided bone regeneration (GBR) and autologous bone grafting. GBR studies demonstrated long-term reabsorption using heterologous bone graft. A general consensus has been achieved in implant surgery for a minimal amount of 2 mm of healthy bone around the implant. A current height loss of about 3-4 mm will result in proper deeper implant insertion when alveolar bone expansion is not planned because of the dome shape of the alveolar crest. To manage this situation a split crest technique has been proposed for alveolar bone expansion and the implants' insertion in one stage surgery. Platelet-rich fibrin (PRF) is a healing biomaterial with a great potential for bone and soft tissue regeneration without inflammatory reactions, and may be used alone or in combination with bone grafts, promoting hemostasis, bone growth, and maturation.
  
  
  OBJECTIVE
  The aim of this study was to demonstrate the clinical effectiveness of PRF combined with a new split crest flapless modified technique in 5 patients vs. 5 control patients.
  
  
  METHODS
  Ten patients with horizontal alveolar crests deficiency were treated in this study, divided into 2 groups: Group 1 (test) of 5 patients treated by the flapless split crest new procedure; Group 2 (control) of 5 patients treated by traditional technique with deeper insertion of smaller implants without split crest. The follow-up was performed with x-ray orthopantomography and intraoral radiographs at T0 (before surgery), T1 (operation time), T2 (3 months) and T3 (6 months) post-operation.
  
  
  RESULTS
  All cases were successful; there were no problems at surgery and post-operative times. All implants succeeded osteointegration and all patients underwent uneventful prosthetic rehabilitation. Mean height bone loss was 1 mm, measured as bone-implant most coronal contact (Δ-BIC), and occurred at immediate T2 post-operative time (3 months). No alveolar bone height loss was detected at implant insertion time, which was instead identified in the control group because of deeper implant insertion.
  
  
  CONCLUSIONS
  This modified split crest technique combined with PRF appears to be reliable, safe, and to improve the clinical outcome of patients with horizontal alveolar crests deficiency compared to traditional implanting techniques by avoiding alveolar height-loss related to deeper insertion of smaller implants.
authors.affiliation: Department of Medicine and Surgery, Unit of Maxillofacial Surgery, University of Salerno, Salerno, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Cortese
authors.affiliation: Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II of Naples, Naples, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Pantaleo
authors.affiliation: Department of Medicine and Surgery, University of Salerno, Salerno, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Amato
authors.affiliation: Department of Radiology, University of Mississippi Medical Center, Jackson, MS, USA.
authors.forename: Candace M
authors.initials: CM
authors.lastname: Howard
authors.affiliation: Second University of Naples, Naples, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Pedicini
authors.affiliation: Department of BioMolecular Sciences, and Department Radiation Oncology, University of Mississippi, Jackson Cancer Center, 2500 N. State St, Jackson, MS 39216, USA.
authors.forename: Pier Paolo
authors.initials: PP
authors.lastname: Claudio
keywords: Bone regeneration; Elderly patients; PRF; Split crest