Odokotela abahlinza ngomlomosebenzisa i-fibrin ecebile ngamangqamuzana egazi amhlophe nama-platelet (L-PRF) ekuhlinzeni komtholampilo, okuhlanganisa ukufakelwa kabusha, ukufakelwa kwezicubu ezithambile, ukuxhunyelelwa kwethambo kanye nokufakelwa okuningi.Uthe i-L-PRF “ifana nesidakamizwa esiwumlingo”.Isonto elilodwa ngemva kokuhlinzwa, indawo yokuhlinza esebenzisa i-L-PRF ibonakala iphulukisa amasonto amathathu kuya kwamane, okuyinto evamile kakhulu, "kusho u-Hughes. Kusheshisa kakhulu ukusabela kwe-cascade yokwelapha.''
I-Platelet rich fibrin (PRF)futhi eyandulela i-platelet rich plasma (PRP) ihlukaniswa njenge-autologous blood concentrates, okuyimikhiqizo yegazi eyenziwe ngegazi leziguli.Odokotela bakhipha amasampula egazi ezigulini futhi basebenzise i-centrifuge ukuze bagxilise, bahlukanise izingxenye zegazi ezihlukene zibe izingqimba ezihlukene zokugxilisa ingqondo ezingasetshenziswa odokotela basemtholampilo.Nakuba kunezinhlobonhlobo eziningi zalobu buchwepheshe namuhla ezibeka kuqala izingxenye zegazi ezihlukene, umqondo ophelele wokwelapha amazinyo uyafana - zisebenzisa igazi lesiguli ukukhuthaza ukuphulukiswa ngemva kokuhlinzwa ngomlomo.
U-Hughes uthe ukuphulukiswa okusheshayo kungenye yezinzuzo.Lapho exoxa ngokuqondile nge-L-PRF, waveza uchungechunge lwezinzuzo zeziguli nodokotela bamazinyo: kunciphisa ukopha kwangaphakathi futhi kunciphisa ukuvuvukala.Ithuthukisa ukuvala okuyinhloko kwe-flap yokuhlinzwa ukuze kusondele kabusha.I-L-PRF inothile ngamangqamuzana amhlophe egazi, ngaleyo ndlela inciphisa ingozi yokutheleleka ngemva kokuhlinzwa.Ngenxa yokuthi lenziwe ngegazi lesiguli, lisusa ingozi yokungezwani komzimba nezinto ezithile noma ukunqatshwa kwamasosha omzimba.Ekugcineni, u-Hughes uthe kulula futhi ukwenza.
''Eminyakeni yami engu-30 yokusebenza komtholampilo, azikho ezinye izidakamizwa, amathuluzi, noma ubuchwepheshe obungakwazi ukufeza zonke lezi zinto njenge-L-PRF, "kusho u-Hughes. I-autologous blood concentrates ingasiza iziguli ngesikhathi nangemva kokuhlinzwa ngomlomo, kodwa okuvamile. odokotela bamazinyo bavame ukubhekana nezinselele lapho bengeza i-PRP/PRF emsebenzini wabo.Izinselele ezithile zokwandisa ukusetshenziswa kwe-autologous blood concentrates zihlanganisa ukuphatha imakethe yemishini ekhulayo, ukuqonda izinguquko ezihlukene kanye nendlela yokuzisebenzisa, kanye nokuchaza ukusetshenziswa kwazo ekufakweni kwamazinyo.
I-PRP kanye ne-PRF: Umehluko Obalulekile Okufanele Odokotela Bamazinyo Abavamile Bawuqonde
I-PRP ne-PRF akuwona umkhiqizo ofanayo, nakuba odokotela nabacwaningi beshintshanisa ukusetshenziswa kwalawa magama amabili esizukulwaneni esilandelayo sezinto eziphilayo zokuvuselelwa kwamathambo kanye ne-periodontal "kanye" ne-Platelet ecebile i-fibrin kumazinyo avuselelayo: isizinda sezinto eziphilayo kanye nezinkomba zomtholampilo ". Kusho uMiron. ukuthi i-PRP yaqala ukusetshenziswa ekuhlinzweni komlomo ngo-1997. Ibhekisela ekugxiliseni okucebile kwe-platelet exutshwe ne-Anticoagulant I-PRF yethulwa njenge-concentrate yesizukulwane sesibili seplatelet ngo-2001, ngaphandle kwe-Anticoagulant.
''Uma kuqhathaniswa ne-PRP, idatha evela emikhakheni eminingi yezokwelapha ibonisa ngokucacile imiphumela engcono ye-PRF, njengoba i-coagulation iyisenzakalo esibalulekile enqubweni yokuphulukisa isilonda, "kusho u-Miron. Wathi inzuzo yokusebenzisa i-PRP ne-PRF yukuthi bangakhuthaza izicubu. "Nokho, impikiswano yokuthi i-PRP" njalo "isebenzisa i-Anticoagulant ibangele impikiswano phakathi kuka-Arun K. Garg, DMD, umtholi-ndawonye we-PRP.
"Ezinsukwini zokuqala zokusebenzisa i-PRP, kwesinye isikhathi siyayishiya i-Anticoagulant ngokushesha nje lapho sidinga ukusebenzisa le nto," kusho uGarg."Ngesikhathi eside sokusebenza, sengeze i-Anticoagulant ukuze silondoloze isici sokukhula esisuselwa ku-platelet kuze kube yilapho sesilungele ukusebenzisa le nto, bese sifaka i-coagulation lapho siyisebenzisa."U-Hughes usebenzisa ngokuqondile i-PRF ekusebenzeni kwakhe, enezela ukuthi ingxenye yesizathu sesidingo sokuthuthukisa i-PRP kungenxa yokuthi imishini ye-PRP yasekuqaleni iyabiza, futhi ubuchwepheshe bunzima kakhulu futhi budla isikhathi - i-PRP idinga ukujikeleza okubili ku-centrifuge nokwengezwa. ye-thrombin, kuyilapho i-PRF idinga ukuphendukiswa kanye kuphela ngaphandle kwesidingo sokwengezwa.''I-PRP ekuqaleni yayivame ukusetshenziswa kakhulu ezimweni ezinkulu zokuhlinzwa ngomlomo noma epulasitiki ezibhedlela, "kusho u-Hughes. I-PRP iboniswe ukuthi ayinakwenzeka ukusetshenziswa emitholampilo yamazinyo evamile.
Kusukela kumbono wokuzijwayeza: Ukugxila kwegazi, i-PRF, ne-PRP ezindaweni zamazinyo emtholampilo kuqoqwe futhi kukhiqizwa ngendlela efanayo.Bachaza ukuthi igazi lithathwa ezigulini lifakwe ebhodleleni elincane.Bese uzungezisa i-vial ku-centrifuge ngesivinini esinqunywe kusengaphambili kanye nobude besikhathi ukuze uhlukanise i-PRF egazini phakathi nale nqubo.I-PRF etholiwe ijeli eliphuzi njenge-membrane, elivame ukucindezelwa libe ulwelwesi oluyisicaba."Lawa ma-membrane angakwazi ukuguqulwa ku-Bone grafting materials, kuhlanganiswe ne-Bone grafting materials, noma abekwe nxazonke noma phezulu kwezimila zamazinyo ukuze anikeze i-biofilm ekhuthaza ukuvuthwa kwamathambo futhi ithuthukise impilo yesiguli. Izicubu ze-gingival ze-Keratized, "kusho u-Kussek.I-PRF ingasetshenziswa futhi njengokuphela kwezinto zokufakelwa kokuhlinzwa kwe-periodontal.Ngaphezu kwalokho, le nto iwusizo kakhulu ekulungiseni izimbobo ngesikhathi sokukhulisa i-sinus, ukuvimbela izifo, kanye nokwenza ngcono imiphumela yomtholampilo.''
''Ukusetshenziswa okuvamile kwe-PRP kuhlanganisa ukuyihlanganisa ne-PRF kanye nezinhlayiya zethambo ukwenza ithambo 'elinamathelayo' okulula ukuzivumelanisa nalo futhi lisebenze emgodini womlomo ngesikhathi senqubo yokufakelwa, "u-Kusek waqhubeka. Izinto ze-PRP zingaphinde zijovwe emgodleni womlomo. ukufakelwa indawo ukuze kwandiswe ukuzinza kanye nokujova ezicutshini ezizungezile ukuze kuthuthukiswe ukuphulukiswa.'' "Ezintweni, zisetshenziselwa ukuxhunyelelwa kwe-Bone ngokuxuba i-PRP nezinto zokuxhunyelelwa kwe-Bone bese ziyibeka, bese ibeka ulwelwesi lwe-PRF phezulu, bese ibeka i-polytetrafluoroethylene membrane. kuyo, "kusho u-Rogge. Ngisasebenzisa i-PRF njengehlule ngemva kokukhipha izinyo - kuhlanganise namazinyo okuhlakanipha - ukusiza ukunciphisa isokhethi eyomile nokukhuthaza ukuphulukiswa. Uma sikhuluma iqiniso, angizange ngibe nesokhethi elomile kusukela ngisebenzisa i-PRF. Ukuqeda isokhethi esomile akuyona inzuzo uRogge kuphela ayibonayo.
''Angibonanga nje kuphela ukuphulukiswa okusheshayo nokwandisa ukukhula kwamathambo, kodwa ngiphinde ngabona ukuncipha kobuhlungu be-postoperative okubikwe lapho usebenzisa i-PRP ne-PRF.'' ''Uma i-PRP/PRF ingasetshenziswa, ingabe isiguli sizolulama?"U-Watts uthe. Kodwa uma ungenza kube lula futhi kusheshe ukuba bathole umphumela wokugcina, ngezinkinga ezimbalwa, kungani ungenzi?''
Izindleko zokwengeza i-PRP/PRF ziyahlukahluka ekusebenzeni kwamazinyo okuvamile, ikakhulukazi ngenxa yokuthuthukiswa okuchumayo kwe-autologous blood concentrates.Le mikhiqizo ikhiqize imboni yezigidigidi zamadola, ngabakhiqizi abahlukene abakha okuhlukile okucashile (ngesinye isikhathi okuphathelene nobunikazi) bama-centrifuge namabhodlela amancane.'' Ama-Centrifuges anezilungiselelo ezahlukene zejubane ziye zethulwa emakethe, futhi izinguquko ku-centrifugation zingathinta amandla nokusebenza kwamaseli kuwo, "kusho u-Werts. Ingabe kunengqondo emtholampilo? Angiqiniseki ukuthi umuntu uzokulinganisa kanjani lokhu.' ' Ngaphezu kokutshalwa kwezimali kwe-centrifuge nokuqeqeshwa kwe-phlebotomy, u-Werts uthe ezinye izindleko ezihilelekile ekusebenziseni i-PRP/PRF ekusebenzeni, njengamashubhu okuqoqa avaliwe, isethi yokufaka amaphiko kanye namashubhu okumunca, "zincane".
''Ukusetshenziswa kolwelwesi olumuncayo ekuhlinzeni ukufakelwa kungase kubize u-$50 kuya ku-$100 lilinye, "kusho u-Werts. Ngokuphambene, ukusebenzisa i-PRF yesiguli njengezindleko zangaphandle zolwelwesi kanye nesikhathi sakho kungakhokhiswa. Imikhiqizo yegazi ezenzakalelayo inekhodi yomshwalense. , kodwa umshwalense awuvamile ukuyikhokhela le mali.Ngivame ukukhokhisa ukuhlinzwa bese ngikunikeza isiguli njengesipho.''
U-Paulisick, u-Zechman, no-Kusek balinganisela ukuthi izindleko zokuqala zokwengeza ama-centrifuge nama-compressor olwelwesi lwe-PRF ekusebenzeni kwawo zisukela ku-$2000 kuya ku-$4000, okuwukuphela kwezindleko ezengeziwe okuyikhithi yokuqoqwa kwegazi elilahlwayo, ngokuvamile ebiza ngaphansi kuka-$10 ibhokisi ngalinye.Ngenxa yokuncintisana kwezimboni kanye nenani elikhulu lama-centrifuge atholakalayo emakethe, odokotela bamazinyo kufanele bakwazi ukuthola amathuluzi ngamanani amanani ahlukahlukene.Ucwaningo luye lwabonisa ukuthi inqobo nje uma iphrothokholi ihambisana, kungase kungabi khona umehluko omkhulu kwikhwalithi ye-PRF ekhiqizwa kusetshenziswa ama-centrifuge ahlukene.
''Ithimba lethu labacwaningi lisanda kushicilela ukubuyekezwa okuhlelekile lapho sithole khona ukuthi i-PRF ithuthukise kakhulu imiphumela yomtholampilo ekulungiseni izicubu ze-periodontal nezithambile, "kusho u-Miron. Noma kunjalo, siphethe ngokuthi kusenokuntuleka kocwaningo oluhle ukuze kuboniswe indima ngokugculisayo. ye-PRF ekukhuthazeni ukwakheka kwamathambo (ukufakwa kwethambo) Ngakho-ke, odokotela basemtholampilo kufanele baziswe ukuthi i-PRF inamandla aqinile okuvuselela izicubu ezithambile kunezicubu eziqinile.''
Ucwaningo oluningi lwesayensi lubonakala lusekela isimangalo sikaMiron.Kunobufakazi bokuphakamisa ukuthi i-PRP/PRF iyafaka isandla enqubweni yokuphulukisa, ngisho nalapho izinga lokuthuthuka lingabalulekile ngokwezibalo.Nakuba kunobufakazi obuningi be-Anecdotal, abacwaningi bakholelwa ukuthi ubufakazi obuphelele buyadingeka.Njengoba i-PRF yaqala ukusetshenziswa ekuhlinzeni ngomlomo ngo-2001, kube nezinguquko eziningana - i-L-PRF, i-A-PRF (i-advanced platelet rich fibrin), kanye ne-i-PRF (umjovo we-platelet rich fibrin) fibrin).Njengoba u-Werts esho, "kwanele ukukubangela ukuba ube nesiyezi futhi ulwele ukufunda nokubakhumbula.''
''Eqinisweni, konke lokhu kungalandelwa emuva kumqondo wokuqala we-PRP/PRF, "esho. Yebo, izinzuzo zalokhu 'kuthuthukiswa' okusha zingafakazelwa ngokwesayensi, kodwa ekusebenzeni komtholampilo, imiphumela yazo yonke. okufanayo - zonke zikhuthaza kakhulu ukuphulukiswa.'' U-Hughes wavuma futhi waveza ukuthi i-L-PRF, A-PRF, kanye ne-i-PRF zonke izinhlobo "ezincane" ze-PRF. Lezi zinhlobonhlobo azidingi imishini ekhethekile, kodwa kunalokho zidinga ukulungiswa. ohlelweni lwe-centrifugal (isikhathi namandla ajikelezayo). ''Ukuze udale izinhlobo ezihlukene zama-PRF, kuyadingeka ukushintsha isikhathi sokuzungezisa noma ukuphenduka ngomzuzu (RPM) wegazi phakathi nenqubo yokuhlanganisa i-centrifugation," kuchaza u-Hughes.
Okuhlukile kokuqala kwe-PRF yi-L-PRF, kulandele i-A-PRF.Uhlobo lwesithathu, i-i-PRF, iwuketshezi, uhlobo lomjovo lwe-PRF oluhlinzeka ngenye indlela kune-PRP.''Kubalulekile ukuqonda ukuthi i-PRF ivamise ukuthatha uhlobo lwama-clumps, "kusho u-Hughes. ''Uma udinga ukujova i-PRF, udinga kuphela ukushintsha isikhathi se-centrifugation kanye ne-RPM ukuze ukwenze kube uketshezi - lokhu i- i- I-PRF.'' Uma ingekho i-Anticoagulant, i-i-PRF ngeke ihlale iwuketshezi isikhathi eside. U-Hughes uthe uma ingajovwa ngokushesha, izoba ijeli ye-colloidal enamathelayo, kodwa umkhiqizo nawo uwusizo kakhulu. " kuyisithasiselo esihle kakhulu sokuxhunyelelwa kwe-granular noma okukhulu kwe-Bone, esiza ukuzinzisa kanye nokulungisa ukuxhunyelelwa," esho. ''Ngibonile ukuthi ukuyisebenzisa ngale ndlela kuzuze imiphumela emihle kakhulu.''
Uma izinhlobo ezihlukahlukene, izifinyezo, nezimiso zokuqamba amagama kudida ochwepheshe bezimboni, odokotela bamazinyo abavamile kufanele bawuchaze kanjani umqondo wegazi elizenzakalelayo eligxile ezigulini?
(Okuqukethwe yile ndatshana kuphrintwe kabusha, futhi asinikezeli nganoma yisiphi isiqinisekiso esicacile noma esishiwoyo sokunemba, ukwethembeka noma ukuphelela kokuqukethwe okuqukethwe kulesi sihloko, futhi asinasibopho ngemibono yalesi sihloko, sicela uqonde.)
Isikhathi sokuthumela: Jul-24-2023