Oogqirha botyando ngomlomosebenzisa i-fibrin etyebileyo kwiiseli zegazi ezimhlophe kunye neeplatelet (L-PRF) kutyando lweklinikhi, kubandakanywa ukutshintshwa, ukutshintshwa kwezicubu ezithambileyo, ukuxutywa kwethambo kunye nobuninzi bokufakelwa.Uthe i-L-PRF "ifana neyeza lomlingo".Kwiveki enye emva kokuhlinzwa, indawo yokuhlinzwa esebenzisa i-L-PRF ibonakala iphilise iiveki ezintathu ukuya kwezine, eziqhelekileyo kakhulu, "u-Hughes uthe. Ikhawuleza kakhulu ukusabela kwe-cascade yonyango.''
IPlatelet rich fibrin (PRF)yaye eyandulelayo iplatelet rich plasma (PRP) ihlelwa njengeautologous blood concentrates, ezizimveliso zegazi ezenziwe ngegazi lomguli.Oogqirha bakhupha iisampulu zegazi kwizigulana baze basebenzise i-centrifuge ukuze bagxininise kuzo, besahlula iinxalenye zegazi ezahlukeneyo zibe kuluhlu olwahlukileyo olunokusetyenziswa ngoogqirha bezonyango.Nangona kukho iintlobo ngeentlobo zobu bugcisa namhlanje ezibeka phambili iinxalenye zegazi ezahlukeneyo, ingcamango iyonke yonyango lwamazinyo iyafana - basebenzisa igazi lomguli ukukhuthaza ukuphiliswa emva kotyando lomlomo.
U-Hughes uthe ukuphiliswa ngokukhawuleza sesinye sezibonelelo.Xa exoxa ngokuthe ngqo nge-L-PRF, wachaza uluhlu lweenzuzo kwizigulane kunye noogqirha bamazinyo: kunciphisa ukopha kwe-intraoperative kunye nokunciphisa ukuvutha.Yongeza ukuvalwa kokuqala kweflap yotyando ukuze kuphinde kusondele.I-L-PRF ityebile kwiiseli ezimhlophe zegazi, ngaloo ndlela inciphisa umngcipheko wokosuleleka emva kotyando.Kuba yenziwe ngegazi lomguli, iyayiphelisa ingozi yokwaliwa okanye ukuchaswa kwamajoni omzimba.Ekugqibeleni, uHughes wathi kulula ukwenza.
"Kwiminyaka yam ye-30 yokusebenza kweklinikhi, azikho ezinye iziyobisi, izixhobo, okanye iteknoloji enokuphumeza zonke ezi zinto ezifana ne-L-PRF," u-Hughes uthe. I-Autologous blood concentrates inokunceda izigulane ngexesha nangemva kokuhlinzwa komlomo, kodwa eziqhelekileyo. oogqirha bamazinyo badla ngokujamelana nemingeni xa befaka i-PRP/PRF ekusebenzeni kwabo.Imingeni ethile yokwandisa ukusetyenziswa kwe-autologous blood concentrates iquka ukulawula imarike yezixhobo ezikhulayo, ukuqonda utshintsho oluhlukeneyo kunye nendlela yokuyisebenzisa, kunye nokuchaza ukusetyenziswa kwabo kwizicelo zamazinyo.
I-PRP kunye ne-PRF: Iiyantlukwano eziBalulekileyo ekufuneka ziQondwe ngooGqirha bamazinyo Jikelele
I-PRP kunye ne-PRF azikho imveliso efanayo, nangona iingcali kunye nabaphandi batshintshana ukusetyenziswa kwezi migaqo mibini kwisizukulwana esilandelayo se-biomaterials kwithambo kunye nokuvuselelwa kwe-periodontal "kunye" nePlatelet ecebileyo ye-fibrin kwi-dentistry yokuvuselela: imvelaphi yezinto eziphilayo kunye nezibonakaliso zeklinikhi ". UMiron uthe. I-PRP yaqala ukusetyenziswa kuqhaqho lomlomo ngo-1997.
''Xa kuthelekiswa ne-PRP, idatha evela kwiinkalo ezininzi zonyango ibonisa ngokucacileyo iziphumo ezingcono ze-PRF, njengoko i-coagulation iyisiganeko esibalulekileyo kwinkqubo yokuphulukisa isilonda, "u-Miron uthe. Wathi inzuzo yokusebenzisa i-PRP kunye ne-PRF kukuba banokukhuthaza izicubu. "Nangona kunjalo, ingxabano yokuba i-PRP" ihlala "isebenzisa i-Anticoagulant ibangele ingxabano phakathi kuka-Arun K. Garg, i-DMD, i-co-discoverer ye-PRP.
"Kwiintsuku zokuqala zokusebenzisa i-PRP, ngamanye amaxesha siyayishiya i-Anticoagulant ngokukhawuleza xa kufuneka sisebenzise le nto," kusho uGarg."Ngexesha elide lokusebenza, songeze i-Anticoagulant yokugcina i-platelet-derived growth factor de sikulungele ukusebenzisa le nto, kwaye emva koko siya kubangela i-coagulation xa siyisebenzisa."U-Hughes usebenzisa ngokukodwa i-PRF ekusebenzeni kwakhe, wongezelela ukuba inxalenye yesizathu sokuphucula i-PRP kukuba izixhobo ze-PRP zangaphambili zibiza kakhulu, kwaye iteknoloji iyinkimbinkimbi kwaye ichitha ixesha - i-PRP idinga ukujikeleza kabini kwi-centrifuge kunye nokongezwa. yethrombin, ngelixa iPRF ifuna ukujikeleziswa kube kanye ngaphandle kwesidingo sokongezwa.'' I-PRP ekuqaleni yayisetyenziswa ngokuqhelekileyo kwiimeko ezinkulu zokuhlinzwa ngomlomo okanye zeplastiki kwizibhedlele, "u-Hughes uthe. I-PRP iboniswe ukuba ayinakwenzeka ukuba isetyenziswe kwiikliniki zamazinyo eziqhelekileyo.
Ukususela kwi-theory ukuya kwi-practice: Igazi ligxininise, i-PRF, kunye ne-PRP kwiindawo zekliniki zamazinyo ziqokelelwa kwaye ziveliswe ngendlela efanayo.Bachaza ukuba igazi lithathwa kwizigulana lize lifakwe kwibhotile encinane.Emva koko ujikelezisa i-vial kwi-centrifuge ngesantya esimiselweyo kunye nobude bokwahlula i-PRF egazini ngexesha lenkqubo.I-PRF efunyenwe yijeli etyheli efana nenwebu, edla ngokucinezelwa ibe yi-flatter membrane."Ezi zimbumbulu zinokuthi zilungelelaniswe kwizinto zokufakelwa kwe-Bone, zidibaniswe nezinto zokufakelwa kwe-Bone, okanye zibekwe ngeenxa zonke okanye phezulu kwezinyo zamazinyo ukubonelela nge-biofilm ekhuthaza ukuvuthwa kwamathambo kunye nokuphucula impilo yesigulane. I-Keratized gingival tissue, "kusho uKussek.I-PRF isenokusetyenziswa njengenye kuphela imathiriyeli yofakelo kuqhaqho lwe periodontal.Ukongezelela, le nto iluncedo kakhulu ekulungiseni i-perforations ngexesha lokwandiswa kwe-sinus, ukukhusela izifo, kunye nokuphucula iziphumo zeklinikhi.''
'' Ukusetyenziswa okuqhelekileyo kwe-PRP kubandakanya ukudibanisa kunye ne-PRF kunye neengqungquthela zethambo ukwenza ithambo 'elinamathele' ekulula ukulungelelanisa nokusebenza kwisigxina somlomo ngexesha lenkqubo yokutshintshwa, "uKusek waqhubeka. Izinto ze-PRP nazo zinokujovwa kwi-injection indawo yokutshintshwa ukuze kwandiswe uzinzo kunye nokujova kwizicubu ezijikelezileyo ukuphucula ukuphilisa.'' "Eziqhelanisweni, zisetyenziselwa ukuxutywa kweBone ngokuxuba i-PRP kunye ne-Bone yokuxutywa kwezinto kunye nokuzibeka, emva koko ubeke i-membrane ye-PRF phezulu, kwaye emva koko ibeka i-polytetrafluoroethylene membrane. kuyo, "uRogge uthe. Ndisasebenzisa i-PRF njengehlwili emva kokukhutshwa kwezinyo - kubandakanywa namazinyo obulumko - ukunceda ukunciphisa isokhethi eyomileyo kunye nokukhuthaza ukuphilisa. Ukunyaniseka, andizange ndibe nesokhethi eyomileyo ukususela ekuphunyezweni kwePRF. Ukuphelisa isokhethi esomileyo ku ayisiyiyo kuphela inzuzo uRogge ayibonayo.
''Andizange ndibone nje ukuphilisa ngokukhawuleza kunye nokwanda kwamathambo, kodwa ndabona ukuncipha kwentlungu emva kokuhlinzwa okuchazwe xa usebenzisa i-PRP kunye ne-PRF.'' ''Ukuba i-PRP/PRF ingasetyenziswanga, ngaba isigulane siya kuphila?"Watts uthe. Kodwa ukuba unokwenza kube lula kwaye ukhawuleze ukuba bafezekise umphumo wokugqibela, kunye neengxaki ezimbalwa, kutheni ungenzi?'
Iindleko zokongeza i-PRP/PRF ziyahluka kwizenzo zamazinyo ngokubanzi, ubukhulu becala ngenxa yophuhliso olukhulayo lwe-autologous blood concentrates.Ezi mveliso zivelise ushishino lweedola ezizibhiliyoni ezininzi, kunye nabavelisi abohlukeneyo benza izinto ezifihlakeleyo (ngamanye amaxesha zobunikazi) zeecentrifuges kunye neebhotile ezincinci.'' I-Centrifuges enezicwangciso ezahlukeneyo zesantya ziye zaziswa kwiimarike, kwaye utshintsho kwi-centrifugation lunokuchaphazela amandla kunye nokusebenza kweeseli kuzo, "u-Werts uthe. Ngaba intsingiselo yekliniki? Andiqinisekanga ukuba umntu uya kulinganisa njani oku.' ' Ukongeza kwi-centrifuge investment kunye noqeqesho lwe-phlebotomy, u-Werts uthe ezinye iindleko ezibandakanyekayo ekusebenziseni i-PRP / PRF ekusebenzeni, ezifana ne-vacuum etywiniweyo yokuqokelela iityhubhu, i-Winged infusion set kunye ne-suction tubes, "zincinci".
''Ukusetyenziswa kwenwebu ezifunxwayo kutyando lofakelo kunokuxabisa i-$50 ukuya kwi-$100 inye, "utshilo uWerts. Ngokwahlukileyo, ukusebenzisa iPRF yesigulana njengexabiso langaphandle lenwebu kunye nexesha lakho linokuhlawuliswa. Iimveliso zegazi ezizenzekelayo zinekhowudi ye-inshorensi. , kodwa i-inshorensi ayifane iyihlawule le mali.
UPaulisick, uZechman, kunye noKusek baqikelela ukuba iindleko zokuqala zokongeza ii-centrifuges kunye ne-PRF inwebu compressors kwindlela yabo yokusebenza ukusuka kwi-2000 yeedola ukuya kwi-4000 yeedola, kunye neendleko ezongezelelweyo kuphela zekiti yokuqokelela igazi elilahlayo, elixabisa ngaphantsi kwe-$ 10 ngebhokisi.Ngenxa yokhuphiswano lweshishini kunye nenani elikhulu le-centrifuges ekhoyo kwimarike, oogqirha bamazinyo kufuneka bakwazi ukufumana izixhobo kumaxabiso ahlukeneyo.Uphando lubonise ukuba okoko nje iprothokholi ihambelana, akunakubakho mahluko ubalulekileyo kumgangatho wePRF eveliswe kusetyenziswa iicentrifuge ezahlukeneyo.
'' Iqela lethu lophando kutshanje lipapashe ukuphononongwa okucwangcisiweyo apho sifumene ukuba i-PRF iphucule kakhulu iziphumo zekliniki kwi-periodontal kunye nokulungiswa kwezicubu ezithambileyo, "u-Miron uthe. Nangona kunjalo, siye sagqiba ukuba kusekho ukungabikho kophando olulungileyo ukubonisa ngokunyanisekileyo indima. yePRF ekunyanzeliseni ukwakheka kwamathambo (ukufakwa kwethambo) Ngoko ke, oogqirha bezonyango kufuneka baziswe ukuba i-PRF inamandla okuvuselela izicubu ezithambileyo kunezicubu ezinzima.''
Uninzi lophando lwezenzululwazi lubonakala luxhasa ibango likaMiron.Kukho ubungqina obubonisa ukuba i-PRP/PRF inegalelo kwinkqubo yokuphilisa, nangona inqanaba lokuphucula lingabalulekanga ngokwezibalo.Nangona kukho ubungqina obuninzi be-Anecdotal, abaphandi bakholelwa ukuba ubungqina obungakumbi bufunekayo.Ekubeni i-PRF yaqala ukusetyenziswa kunyango lomlomo ngo-2001, kukho utshintsho oluninzi-i-L-PRF, i-A-PRF (i-advanced platelet rich fibrin), kunye ne-i-PRF (i-injectable platelet rich fibrin) i-fibrin).Njengoko uWerts watshoyo, "kwanele ukukukwenza ube nesiyezi kwaye uzame ukufunda nokubakhumbula.''
''Ngokwenene, konke oku kunokulandelwa kwingcamango yokuqala ye-PRP / PRF, "watsho. Ewe, iingenelo zolu phuculo lutsha lunokuqinisekiswa ngokwesayensi, kodwa ekusebenzeni kweklinikhi, iziphumo zazo zonke. ngokufanayo - zonke zikhuthaza kakhulu ukuphilisa.'' U-Hughes wavuma waza wabonisa ukuba i-L-PRF, i-A-PRF, kunye ne-i-PRF zonke "zincinci" ezahlukeneyo zePRF. kwisikimu se-centrifugal (ixesha kunye namandla okujikeleza) '' Ukudala iintlobo ezahlukeneyo ze-PRFs, kuyimfuneko ukutshintsha ixesha lokujikeleza okanye ukuguqulwa ngomzuzu (RPM) yegazi ngexesha lenkqubo ye-centrifugation, "u-Hughes wachaza.
Umahluko wokuqala we-PRF yi-L-PRF, ilandelwa yi-A-PRF.Udidi lwesithathu, i-i-PRF, lulwelo, uhlobo olutofwayo lwePRF olubonelela ngenye indlela kwi-PRP.''Kubalulekile ukuqonda ukuba i-PRF ngokuqhelekileyo ithatha ifom ye-clumps, "u-Hughes uthe. '' Ukuba ufuna ukufaka i-PRF, kufuneka utshintshe ixesha le-centrifugation kunye ne-RPM ukuze uyenze ibe yi-liquid form - oku ku- i- I-PRF.'' Ukuba akukho Anticoagulant, i-PRF ayiyi kuhlala imanzi ixesha elide. U-Hughes uthe ukuba ayifakwanga ngokukhawuleza, iya kuba yijeli ye-colloidal encamathelayo, kodwa imveliso nayo iluncedo kakhulu. sisinxulumanisi esigqwesileyo kwigranular okanye enkulu yeBone grafting, enceda ukuzinzisa kunye nokulungisa uxhulumaniso, "watsho. ''Ndibonile ukuba ukuyisebenzisa kwesi sikhundla kuzuze iziphumo ezilungileyo kakhulu.''
Ukuba iintlobo ezahlukeneyo, izifinyezo, kunye nemigaqo yokubiza amagama zibhidanisa iingcali kwimizi-mveliso, oogqirha bamazinyo abaqhelekileyo bafanele bayichaze njani ingcamango yegazi le-autologous elimiliselwe kwizigulana?
(Imixholo yeli nqaku ishicilelwe, kwaye asiboneleli nasiphi na isiqinisekiso esicacileyo okanye esichaziweyo sokuchaneka, ukuthembeka okanye ukugqibelela kokuqulathwe kweli nqaku, kwaye abanaxanduva ngezimvo zeli nqaku, nceda uqonde.)
Ixesha lokuposa: Jul-24-2023