Clinical and radiographic evaluation of platelet-rich fibrin gel on the outcome of mandibular fracture Ebrahim Al-Khawlani a , Osama Antar Adly b , Tamer Abd Albari Hamed a , Ashraf Hussein Abass b and Abdelbadia Abdallah Abdelmabood a Aim The aim of this study was to evaluate the application of platelet-rich fibrin on the outcome of mandibular fractures. Patients and methods Prospective comparative study carried on 24 patients ranging in age from 20 to 42 years. The patients were divided into two equal groups. Group I (control group): included eight patients treated by open reduction and direct osteosynthesis using 2.0-mm miniplate with conventional screw where nothing was locally applied on the fracture line. Group II [platelet-rich fibrin (PRF) group]: included eight patients treated by open reduction and direct osteosynthesis using 2.0-mm miniplate with conventional screw where the PRF was locally added to the fracture line. Results PRF seem to be of clinical advantage in acceleration of bone healing in mandibular fractures. From the result of the present study we can concluded that: (a) the use of PRF seem to be of clinical advantage in acceleration of bone healing in mandibular fractures. (b) No adverse reaction that could be related to the use of PRF was reported. Egypt J Oral Maxillofac Surg 5:77–83  c 2014 The Egyptian Association of Oral & Maxillofacial Surgeons. Egyptian Journal of Oral & Maxillofacial Surgery 2014, 5:77–83 Keywords: bone healing, mandibular fracture, platelet-rich fibrin Departments of a Oral and Maxillofacial Surgery and b Plastic Surgery, Suez Canal University, Ismailia, Egypt Correspondence to Ebrahim Al-Khawlani, MD, Departments of Oral and Maxillofacial Surgery, Suez Canal University, Ismailia, Egypt Tel: + 20 100 861 6425; e-mail: ebrahim.yahya887@gmail.com Received 3 July 2014 accepted 22 July 2014 Introduction and review of literature Mandibular fractures are common facial injuries and their treatment is one of the most frequent forms of therapy provided by oral and maxillofacial surgery. In the management of any fracture of bone, the goals are to restore function to the affected bone by ensuring union of the fractured segments and re-establish prefracture strength of the bone, to restore any contour defect that might arise as a result of the injury, and to prevent infection at the fracture site [1]. The effects of platelet-rich fibrin (PRF) membranes on the proliferation of many different cell types have already been assessed in vitro, and the influence of leukocytes on both cell reactions and growth factor release has already been hypothesized [2]. Several applications of PRF have already been described in oral surgery, ear–nose–throat, and plastic surgery; PRF seems to be particularly useful as an osteoconductive filling material during sinus-lift procedures [3]. Platelet-derived growth factor (PDGF) is angiogenic and known to stimulate the production and chemotaxis of connective tissue cells and matrix deposition. These properties are all critical to bone healing [4]. Insulin-like growth factor (IGF) has shown a capacity to promote bone cell mitoses and increase the deposition of matrix. PDGF and IGF have shown an ability to work together during the reparative stages of bone healing. PDGF-impregnated and IGF-impregnated devices have been proven to increase bone healing in defects associated with dental implants and teeth [5]. Choukroun’s PRF is defined as an autologous leukocyte- rich and platelet-rich fibrin biomaterial. This easy and open-access procedure was developed in France by Choukroun and colleagues [3]. Blood is collected in 9 ml tubes and gently centrifuged for 12 min to divide the blood sample into three layers: a base of red blood cells at the bottom, acellular plasma on the top, and a clot of PRF in the middle. The success of this technique depends entirely on the speed of blood collection and transfer to the centrifuge. If the duration required to collect blood and initiate centrifugation is too long, the technique will fail; the fibrin will polymerize in a diffuse manner in the tube and only a small blood clot without consistency will be obtained. The PRF membranes release high quantities of growth factors (such as transforming growth factor b-1, PDGF-AB, or vascular endothelial growth factor) and matrix proteins (such as thrombospondin-1, fibronectin, and vitronectin) over at least 7 days. PRF seems to be particularly useful as an osteoconductive filling material during a sinus-lift procedure. In all clinical applications, PRF has to be considered and used as a fibrin-based living biomaterial and not just as a simple source of growth factors [6]. Jang et al. [7] created two monocortical defects in each of 10 New Zealand white rabbits using a trephine bur and these defects were prepared to receive two dental implants into the tibia (diameter 3.0 mm, length 10.0 mm). In the experimental group, the peri-implant defect was filled with a combination graft of silk fibroin powder and Choukroun’s PRF. The control was left in an unfilled state. The animals were killed at 8 weeks. They concluded from the results of the study that peri-implant defects can be repaired successfully by the application of Choukroun’s PRF and silk fibroin powder compared with the control group. Original article 77 2090-097X  c 2014 The Egyptian Association of Oral & Maxillofacial Surgeons DOI: 10.1097/01.OMX.0000452512.32326.e8 Copyright © Egyptian Journal of Oral & Maxillofacial Surgery. Unauthorized reproduction of this article is prohibited.