Does Injectable Platelet-Rich Fibrin Combined With Autogenous Demineralized Dentine Enhance Alveolar Ridge Preservation? A Randomized Controlled Trial

Abstract

Objective: The present trial evaluated the first-time application of autogenous demineralized dentin graft with injectable platelet-rich fibrin (ADDG + i-PRF) versus autogenous demineralized dentin graft (ADDG), in alveolar ridge preservation (ARP) in the maxillary aesthetic zone.

Material and methods: Twenty-two maxillary (n = 22) non-molar teeth indicated for extraction were randomized into two groups (n = 11/group). Extracted teeth were prepared into ADDG, implanted into extraction sockets with or without i-PRF amalgamation and covered by collagen sponge. Cone-beam computed tomography scans at baseline and 6 months were compared to assess ridge-dimensional changes. Keratinized tissue width, patient satisfaction, pain score and chair time were recorded. In the course of dental implant placements at 6 months, bone core biopsies of engrafted sites were obtained and analysed histomorphometrically.

Results: Reduction in ridge width was 1.71 ± 1.08 and 1.8 ± 1.35 mm, while reduction in ridge height was 1.11 ± 0.76 and 1.8 ± 0.96 mm for ADDG + i-PRF and ADDG, respectively (p > 0.05). Significant differences in keratinized tissue width reduction were notable between ADDG + i-PRF and ADDG (0.12 ± 0.34 and 0.58 ± 0.34 mm respectively; p = 0.008). Postoperative pain scores were significantly lower in ADDG + i-PRF (p = 0.012). All patients in the two groups were satisfied with no differences in chair time (p > 0.05). No differences in total percentage area of newly formed bone, soft tissue or graft particles were observed between the groups (p > 0.05).

Conclusions: ADDG alone or in combination with i-PRF yields similar results regarding ARP clinically, quality of the formed osseous tissues, as well as patients' satisfaction. Yet, the addition of i-PRF to ADDG tends to preserve the keratinized tissue and lessen postoperative pain.

Keywords: alveolar; autogenous; dentin; extraction; platelets; preservation.

FIGURE 1

Clinical steps of graft harvesting, demineralization, placement, suturing and 6 months of follow‐up for the test and control groups. i‐PRF withdrawal, mixture of ADDG with i‐PRF in the test group. Biopsy harvesting steps using trephine bure and implant placement.

FIGURE 2

CBCT images illustrating ridge width measurements (a–c) and ridge height measurements (d–f), (a) initial CBCT scan with ridge width measurements at 1, 3 and 5 mm below the most coronal aspect of the crest, (b) fusion superimposition of the initial and 6 months post‐operative scans, (c) 6 months postoperative scan, (d) initial CBCT scan showing a tangential line drawn at the most apical point of the socket depth parallel to the horizontal plane (*), points marked at the most crestal parts of the buccal and palatal ridges (+) and line dropped from (*) to (+) to measure buccal and palatal ridge heights, (e) fusion superimposition of the initial and 6 months post‐operative scans, (f) 6 months postoperative scan.

FIGURE 3

Qualitative histological examination. Representative microscopic images (100× magnification) with haematoxylin and eosin staining of histological sections of ADDG + i‐PRF (a) and ADDG (d) biopsies. Masson trichrome staining of histological sections of ADDG + i‐PRF (b, c) and ADDG (e, f) biopsies. B, newly formed bone; GP, graft particles; OSS, osseous tissue; OST, unmineralized osteoid tissue; ST, soft tissue.