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ABSTRACT:Purpose: The treatment of oral mucosal lesions and

mucosal hypertrophy in particular, is most often achievedby an excision with or without covering the surface of thewound. The platelet rich fibrin membrane (PRFm) is an au-togenous product containing platelets and leukocytes andtheir secreted growth factors and cytokines. The purposeof the presented clinical case is to describe a new, recenttechnique used for the covering of mucosal wounds left af-ter the removal of pathological lesions.

Material and Methods: On a single patient mucosalhypertrophy was removed by an excision with scalpel andthe resulting surgical wound was covered with an autog-enous PRF membrane. Postoperatively the healing processwas followed on the 7th, 14th and 30th day.

Results: The healing period went smoothly withminimal postoperative discomfort and no complications.

Conclusion: The results of the presented clinicalcase demonstrate that the PRF membrane can successfullybe used to cover postoperative mucosal defects.

Key words: oral mucosal hypertrophy, PRF, oral mu-cosal reconstruction

INTRODUCTION:The treatment of oral mucosal lesions involves the

elimination of the cause, medical and surgical treatment.[1]The surgical treatment of different mucosal lesions, andmucosal hypertrophy in particular, consists of an excisionwith or without placing a graft. [2, 3] Platelet rich fibrin(PRF) is defined as an autogenous, containing increasedamount of leukocytes and platelets, solid biomaterial. [4,5] For the first time PRF is used in 2001 in France byChoukroun J, et al. [6] for purpose of the maxillo-facial sur-gery. The PRF polymerization is slow and occurs when theblood is being centrifugated and, due to the autogenousthrombin, a physiological autogenous fibrin begins its for-mation. This is an essential condition for the formation ofthe 3D fibrin network. [7] Such configuration suggests theprolonged survival of the growth factors (GF) and their pro-longed release in the initial healing stages. GFs are avail-able in situ longer among the surrounding cells and havemore time to stimulate the healing process. [8,9] Releaseof the growth factors and matrix glycoproteins(glycosaminoglycans) may continue for up to 7 days, oraccording to other studies – up to 28 days. [10] PRF is

made out of patient’s blood in clinical conditions and doesnot contain any chemical or biological supplements. PRFis used as a stimulating factor for the bone and soft tissueregeneration in dental implantology and periodontal sur-gery.[11] It is used for the healing of extraction wounds,[12]treatment of interosseous defects, [13] radicular cysts, [14]influencing the jaw bones in the case of biophosphonateosteonecrosis, [15] etc. Some authors [16, 17] use PRF mem-brane (PRFm) to cover excision defects of the mucosa whileothers [18, 19] cover palatinal defects left when taking freegingival graft (FGG). The aim of the presented clinical caseis to clinically observe a new recently used technology tocover mucosal wounds left in the treatment of pathologi-cal lesions.

METHODS AND MATERIALS:The patient was a woman aged 69 admitted in the

department of oral surgery at the Medical University –Plovdiv for surgical treatment. The clinical examinationuncovered mucosal hypertrophy on the right side due tochronic irritation by a denture. There were no other sub-jective complaints by the patient – Fig. 1.

Fig. 1.

TREATMENT OF ORAL MUCOSAL LESIONS BYSCALPEL EXCISION AND PLATELET-RICHFIBRINMEMBRANE GRAFTING: A case report

Ivan Chenchev, Radka CholakovaDepartment of Oral Surgery, Faculty of Dental Medicine, Medical University –Plovdiv, Bulgaria

Journal of IMAB - Annual Proceeding (Scientific Papers) 2016, vol. 22, issue 3Journal of IMABISSN: 1312-773Xhttp://www.journal-imab-bg.org

http://dx.doi.org/10.5272/jimab.2016223.1212

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The surgery was held under local anesthetics with4% Articaine and 1/200 000 Adrenaline. Excision of thealtered tissue was done using a scalpel. The resulting mu-cosal wound was covered by PRFm prepared in advance.PRFm was stitched using resorbable thread 0000 to themargins of the mucosal defect – Fig. 2 a-c.

Fig. 2a.

Fig. 2c.

Fig. 2b.

The PRF membrane was prepared following themethod of Choukroun J et al. [6] After the venipunctureof v. cubity with a 10ml vacuum test-tube (Advanced-PRF™), 9ml of blood is taken from the patient. The bloodis then immediately put into a PRF DUO (ProcessforPRF®-France) centrifuge for 8 minutes at 1500 RPM. Theresulting PRF clot is put back into a test-tube using a long,straight anatomical tweezers and using surgical scissorsor scalpel it is separated from the red part (erythrocytes).The PRF membrane is formed out of two PRF clots byputting two of them on top of one another - Fig. 3a, b.The areas bordering with the red part are put on the oppo-site ends and it is then dried in a special for this case boxA-PRF Box® - Fig. 3c.

Fig. 3a.

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Fig. 3b. surgical intervention. The postoperative pain was measuredusing a standard VAS on 24 hours and the 7th day after thesurgery. The value on the 24th hour was 3cm, while thefinal value on the 7th day was 2cm. Clinical measurementof the wound healing was done using the 5-score ClinicalHealing Score. [17] The score on the 7th day after the treat-ment was 3 and on the 15th and 30th day it was 0 – Table1 end Fig. 4 a, b.

Fig. 4a. 7th day after the treatment

Fig. 3c.

Postoperatively the patient was assigned oral intakeof NAIDs (Aulin 0.10g) for a period of 3 days. The patientwas also given instructions for irrigation of the oral cavitywith 0.2% solution of chlorehexidine for 7 days. Check-up examinations were assigned on the 1st, 7th, 14th and30th day after the surgery.

RESULTS:The postoperative period was free of anxiety and

complications. The threads were removed 7 days after the

Fig. 4b. 30th day after the treatment

Table 1. Clinical Healing Score (Sum of 5 criteria)

Criteria Score 7 day 14 day 30 day

Redness absent 0 1 0 0

Redness present 1

Edema absent 0 1 0 0

Edema present 1

Healthy granulation tissue present 0 0 0 0

Healthy granulation tissue absent 1

Signs of epithelization present 0 1 0 0

Signs of epithelization absent 1

Note – The sum of 5 criteria is the clinical healing score; the score is to 0, the better the healing, and vice versa.

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DISCUSSION:Excision of oral lesions is preferred over drug treat-

ment especially in cases with potential malignancy. [1]There is a variety of different care options for the resultingin the process wounds of the mucosa with different results.Initial covering of adjacent tissues is possible in cases ofmucosal defects with small surface. In the case of biggerdefects this is harder and can lead to complications. Thehealing afterwards is associated with a lot of discomfort forthe patient with a possibility of early and late bleeding in-fections. [17, 19] The usage of the autogenous mucosalFGG or dermal graft for the covering of mucosal excisionwounds results in an additional operative trauma. [3] Thecovering of postexcision wounds of the mucosa is done bya variety of auto-plastic material such as hyperdry amni-

otic membrane, artificial derma and collagen membrane. [2,17] PRFm was initially used to cover mucosal defects ofthe palate, after taking FGG, with very good results. [16,18, 19] Pathak H, et al. [17] use PRFm to cover mucosaldefects after excision in different areas of the oral cavityand report some very good clinical results. The results ofour study coincide with the results published by someother authors. [16 - 19]

CONCLUSION:The results of our study allow us to assume that PRF

membrane with its qualities can successfully be used tocover mucosal wounds for the purposes of the oral surgery.More and larger studies are necessary for better evaluationof the effects of the PRFm when covering mucosal wounds.

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Address for correspondence:Dr. Ivan Chenchev,Department of Oral Surgery, Faculty of Dental Medicine, Medical University –Plovdiv, BulgariaE-mail: ivan_chenchev@yahoo.com,

19. Shakir Q, Bhasale P, Pailwan N,Patil D. Comparison of Effects of PRFDressing in Wound Healing of PalatalDonor Site During Free Gingival Graft-ing Procedures with No Dressing at theDonor Site. J Res Adv Dent 2015;4:(1):69-74.

Please cite this article as: Chenchev I, Cholakova R. Treatment of Oral Mucosal Lesions by Scalpel Excision and Plate-let-Rich FibrinMembrane Grafting: A case report. J of IMAB. 2016 Jul-Sep;22(2):1212-1216. DOI: http://dx.doi.org/10.5272/jimab.2016223.1212

Received: 15/05/2016; Published online: 18/07/2016