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The Relevance of Choukroun’s Platelet-Rich Fibrin and Metronidazole During Complex Maxillary Rehabilitations Using Bone Allograft. Part I: A New Grafting Protocol

Simonpieri, Alain DDS*; Del Corso, Marco DDS; Sammartino, Gilberto MD, PhD; Dohan Ehrenfest, David M. DDS, MS, PhD§

doi: 10.1097/ID.0b013e318198cf00
Clinical Science and Techniques

Extensive bone grafting remains a delicate procedure, because of the slow and difficult integration of the grafted material into the physiological architecture. The recent use of platelet concentrates aims to improve this process of integration by accelerating bone and mucosal healing. Choukroun’s platelet-rich fibrin (PRF) is a healing biomaterial that concentrates in a single autologous fibrin membrane, most platelets, leukocytes, and cytokines from a 10 mL blood harvest, without artificial biochemical modification (no anticoagulant, no bovine thrombin). Whether used as a membrane or as fragments, PRF allows a significant postoperative protection of the surgical site and seems to accelerate the integration and remodeling of the grafted biomaterial. These properties are particularly helpful for vestibular bone grafting on the alveolar ridges. Moreover, it provides a very high quality of gingival maturation.A small quantity of a 0.5% metronidazole solution (10 mg) can also be used to provide an efficient protection of the bone graft against unavoidable anaerobic bacterial contamination. This article describes a new technique of total maxillary preimplant bone grafting using allograft, Choukroun’s PRF membranes and metronidazole. This first part focused on the preimplant reconstructive treatment using allogeneic bone granules. PRF membranes are particularly helpful to protect the surgical site and foster soft tissue healing. This fibrin biomaterial represents a new opportunity to improve both the maturation of bone grafts and the final esthetic result of the peri-implant soft tissue.

*Private Practice, Monte Carlo, Monaco.

†Private Practice, Department of Periodontology, Turin University, Turin, Italy.

‡Professor, Department of Odonto-stomatological and Maxillo-facial Sciences, University Federico II of Naples, Italy.

§Researcher, Department of Biomaterials, Institute of Clinical Sciences, The Sahlgrenska Academy at University of Gothenburg, Sweden; Professor, Department of Odonto-stomatological and Maxillo-facial Sciences, University Federico II of Naples, Italy; Researcher, the LoB5 Foundation for research, AP-HP, Paris, France.

Reprint requests and correspondence to: David M. Dohan Ehrenfest, DDS, MS, PhD; Department of Biomaterials; Institute for Clinical Sciences; The Sahlgrenska Academy at University of Gothenburg; Medicinaregatan 8B, 41390 Gothenburg, Sweden; Phone: 00 33 6 64 72 95 40; E-mail: or

© 2009 Lippincott Williams & Wilkins, Inc.