Radiographic evaluation of bone regeneration after the application of plasma rich in growth factors in a lower third molar socket: a case report

Abstract

A 42-year-old Mediterranean male presented complaining of inability to sustain good oral care at the posterior aspect of the lower right jaw. The main problems were food impaction in the area and the subsequent malodor. The patient reported remarkable medical history. Clinical examination revealed local erytherma with noticeable bone defect distal to the second molar with obvious defect in the mesial wall of the third molar; the penetration depth was found to be up to 6 mm.Radiological evaluation confirmed the defect and it was attributed to the mesioangularly partially impacted lower third molar. It was decided that third molar should be extracted and concentrate of the patient's growth factors (PRGF) to be applied into the bony defect to stimulate bone regeneration and promote healing.The third molar tooth was, then, removed surgically and the PRGF, which was prepared preoperatively, was implanted in the socket. At the first postoperative day, moderate pain was the main complaint and was controlled by NSAIDs. One week postoperatively, the sutures were removed and there was good tissue healing on examination.On the fiftieth postoperative day, radiographic evaluation took place and showed noticeable enhancement of density and radio-opacity in the third molar socket area, in comparison with the baseline image. Further, clinical examination showed significant reduction of periodontal pocketing and evidence of new bone formation.In conclusion, PRGF was very successful in stimulating bone regeneration and promote healing following dental extraction.

Figure 1

(a) Intraoral view showing defect in the mesial wall of the third molar associated with bony defect distal to the second molar and local erythema. (b) Preoperative radiographic image showing mesially impacted third molar in contact with the distal surface of the second molar causing radiolucency at the contact point (dental decay). There is also slight periradicular radiolucency (inflammation) and dilation or thickening of the lamina dura.

Figure 2

The scaffold-like PRGF after activation with CaCl₂ is mounted on the spatula before implantation in the bony defect.

Figure 3

(a) An immediate postoperative dental panoramic tomography was obtained to be considered as a baseline image for this case study. (b) Radiographic image, obtained 50 days postoperatively showing enhancement of radiopacity in the third molar socket area.