ENDORET vs L-PRF: Differences and literature support. An actual overview

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Posted on By Bernardo Mira Correa In Bio-modifiers: BMP-2 / PRGF

We would like to invite everyone to share their own main criteria of choice, in between these two major ways, of obtaining plasma derived growth factors for clinical use, and also to show how their clinical results are fulfilling their expectations.


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10 Comments

Hi nice case, wouldnt waiting only 2 months for restoring a case like this (within sockets in maxilla.. .)be a bit early plus anterior implants bone doesnt seem amazing , at least on initial x ray..
How come have u gone this way with it?


Reply

Hi Aryeh Gellman, the panoramic Xray doesn't reveal indeed the correct amount of bone around the medial implant,(maybe because of mispositioning during Xray acquisition). This exams was only performed to check the adequate passive fit of the provisional bridge over the implants. In order to accurately evaluate the bone amount around both implants, a CBCT scan is going to be done after finishing the case, with the definitive prosthodontics placement.
Since i am using BTI implants, with the new Unicca® surface, my judgment, on when it is the best moment to load these implants, relies on the clinical evaluation first, and also on the Favero and Lang implant surface's comparative study, that showed that 77% of new bone formation occurs after 8 weeks around Unicca® surface implants.

Favero V, Lang NP, Favero R, Martins Neto EC, Salata LA, Botticelli D. Sequential morphometric evaluation at UnicCa" and SLActive" implant surfaces. An experimental study in the dog. Clin. Oral Impl. Res. 00, 2016

Thank you for your comment
Best regards
Bernardo


Reply

Dear Bernardo,
Amazing, great volume management, fantastic result!
You called us for voting: ENDORET vs. L-PRF. I know you prefer ENDORET and have great results using it, and you won`t like my contribution to the discussion. But at least, we`ll have a discussion:))

Doubtless, platelet concentrate are great help for wound healing and augmentation.
There is no chance for us to come to the conclusion, until different platelet concentrates are not compared in split mouth design. Comparing PRGF and PRF we can argue if the leukocytes, absence of additive and anticoagulants are advantageous - in my opinion, it is an advantage.
In our clinic we have both: PRGF and PRF and use platelet concentrates a lot. Since we introduced PRF, PRGF centrifuge is less active. Surgeons have a feeling that PRF gives better results, but we have no statistic to prove it.
We prefer L-PRF membranes also because they have stronger mechanical properties than membranes produced by PRGF-Endoret system. And i-PRF makes particulate graft handling easier and should enhance the vascularization even more.
Personally, I found in three cases PRGF failure - not complication, but PRGF shrinkage, dead peaces of PRGF. May be I`ll find the same with PRF.
The literature about platelet concentrate is exploding, especially for Choukroun`s PRF. The paper of Jonathan du Toit, Maurice Salama and Howard Gluckman “ Platelet-rich fibrin (PRF): a growth factor-rich biomaterial. Part 1 – the platelet concentrates milieu & review of the literature” gives
a great overview and concludes:
“…currently is no gold standard as to which platelet concentrate supersedes all others as an intraoral graft material or as a biomaterial to accelerate healing”.
Best regards,
Snjezana


Reply

Dear Snjezana:

Of course i won't mind about you having a different opinion!!!

In fact i thank you for sharing it with us! that's the main goal of this post at the Forum: healthy and scientific debate!

As regarding to the L-PRF fibrin mechanical properties that you claim to be stronger, from the scientific point of view, it should be weaker, once the leucocyte's release of mettaloproteinases, neutrophil elastase, etc, will weaken and promote Fibrin dissolution.
(N. Wohner. Role of Cellular Elements in Thrombus Formation and Dissolution . Cardiovasc Hematol Agents Med Chem. 2008 Jul; 6(3): 224–228.)

I share with you a couple of photos more, one to show you the difference between the dense and thick fibrin membranes,(on the right) i am obtaining and the Endoret membrane (gfs releasing membrane, on the left), applied below the fibrin membrane. IMHO it looks really great...

Regarding the second photo, i would like to ask you, if you also see a significant diference on manipulating particulated grafting material, between the two systems.

I agree with the Du Toit review publication's conclusion, "..currently is no gold standard as to which platelet concentrate supersedes all others as an intraoral graft material or as a biomaterial to accelerate healing", because we still lack of impartial comparative studies.

Yet, since we are dealing with blood derived products, for me is crucial that the System I am using, has all the legal certifications, to protect my patients and also to protect me as much as possible in a medical-legal situation.

The Endoret System is FDA and CE certified, and is also considered a Medical drug for Humans by the AEMPS.
I am not sure if all the other similar Systems have these certifications too.

Thank you so much for your opinion Snjezana!
Best regards
Bernardo


Reply

Bernardo,

thank you for your response.
Speaking about mechanical stability I was referring on machanical properties of early L-PRF and PRGF membranes. "Comparison of the Mechanical Properties of Early Leukocyte- and Platelet-Rich Fibrin versus PRGF/Endoret Membranes"
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4736579/

At least one study with comparison of these two products:))
Nevertheless, bot of them are very fotogenic, camera loves them as your images show:)
Looking forward to your lecture in New York!


Best regards

Snjezana


Reply

I read it too...yet i found the chosen Universal testing machine from Zwick/Roell, inappropriate to test the Fibrin!
Did you see the devise for grasping the fibrin membranes?(pic #1)
I find a test like in pic #2 much more reliable....don't you agree?
It will be a pleasure to join you in NYU!
Best regards Snjezana!


Reply

Bernardo, thank you for another input, interesting.
The camera doesn`t like device nr. 1, it looks so retro:))
Yes, material and methods are often more important than conclusion....
See you soon
Snjezana


Reply

Bernardo,

Beautiful work and discussion- tell me my friend are you showing technique to demonstrate that in cases where it is difficult to attain adequate closure this technique be it Endo or L-P can be used like a free gingival overlay graft? And endo was allowed to heal without any pressure ? Was only one layer used directly on top or multiple as can be done with PRF- what factors about patients medical history that can contribute to quality/performance of Endo/ PRF

Cheers,

Richard


Reply

Hi my dear friend Richard!
I can only share with you my experience with the ENDORET System, since i never used the LPRf.
Depending on the socket type, we use only the Endoret graft to feel the Gap,(on socket type I), or GBR with xenograft biomodulated with ENDORET (on Socket type II). The top layer is always a dense fibrin membrane, that we suture to keep in place.(not to close the wound).
We call this technique the "Open Wound Concept".

Best regards my good friend! Hope to see you in NYU next Agost.

Bernardo


Reply

And the main objective is to grow keratinised mucosa around the implants, by second intention healing.


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