Three-dimensional volumetric analysis of bone regeneration following jaw cyst enucleation with and without an autologous albumin gel-platelet-rich fibrin mixture (Alb-PRF): a randomized controlled clinical trial

Abstract

Introduction: The presence of an osseous cavity after cyst enucleation is a clinical challenge that needs to be considered. Using pure autologous concentrations of platelets, platelet-rich fibrin (PRF), as a graft material after cyst removal has shown promising effects. However, PRF has limitations in terms of durability, as it usually resorbs within 10-14 days, thus Mourão et al. introduced a new technique for PRF preparation to obtain an albumin gel-platelet-rich fibrin mixture (Alb-PRF), a new autologous material, that can remain stable for 4-6 months with the ability to regenerate bone. This research aimed to evaluate the effect of Alb-PRF on bone regeneration after jaw cyst enucleation via 3-dimensional (3D) volumetric analysis.

Methods: Twenty participants, with jaw cysts, were split into two groups. The Alb-PRF group included 10 individuals treated by enucleation and Alb-PRF application, and the control group included 10 individuals treated conventionally by enucleation without any additives. Cone beam computed tomography (CBCT) was conducted immediately following surgery (T1) and six months later (T2) to measure the volume of the residual bone cavity and the mean bone density of the regenerated bone using On-demand 3D viewer. Paired t test was used to compare the postoperative immediate results with the post-6-months results, whereas Student t test was used to compare the Alb-PRF group with the control group.

Results: At the 6-month follow-up, the volume of the residual bone cavity had declined and the bone density had increased significantly in both the Alb-PRF group and the control group (P₁ < 0.001) compared with the immediate postoperative values. Although the changes in volume and density were greater in the Alb-PRF group than in the control group, there was no a noticeable difference between the two groups. (P = 0.821) and (P = 0.533), respectively.

Conclusion: There was no difference in bone regeneration between Alb-PRF and conventional blood clots after jaw cyst enucleation.

Trial registration: The trial was retrospectively registered at the Clinicaltrial.gov registry (Registration ID #NCT05658900). It was first submitted on 12/12/2022 and first posted on 21/12/2022.

Keywords: Albumin Gel-Platelet-Rich Fibrin Mixture; Bone Density; Bone Regeneration; Centrifugation; Cone Beam Computed Tomography; Jaw Cysts; Spontaneous Healing; Three-Dimensional Volumetric Analysis.

Fig. 1

Flow chart showing the participants’ progression in the trial in adherence to the CONSORT guidelines

Fig. 2

A 80–1 centrifuge machine. B Venous blood in a sterile plastic centrifuge tube with a blue cap after centrifugation at 700 × g for 8 min. C The PPP was removed and heated at a uniform temperature of 75 °C for 10 min using, D A Thermostatic water bath incubator. E Albumin gel formation after denaturation of the albumin protein. F & G Albumin gel was mixed with the buffy coat layer of PRF via a 3-way stopcock and 2 plastic syringes with a Luer lock to obtain H Albumin PRF

Fig. 3

A Empty osseous cavity after cyst enucleation. B Alb-PRF application inside the osseous cavity. (Alb-PRF group)

Fig. 4

A Empty osseous cavity after cyst enucleation. B The cyst lining. (Control group)

Fig. 5

A The osseous cavity was cropped via semiautomatic segmentation in coronal, axial, sagittal, and 3D sections. The white arrow refers to the volume of interest (VOI) icon, while the red arrows refer to cropping procedures. B The 3D osseous cavity was obtained via manual segmentation. The white arrow refers to the draw mask icon to do manual segmentation, the red arrows refer to the part that will be removed, and the green arrow refers to drawing types. C Changing the fine-tuning of the obtained object to be easily detected. The white arrow refers to the fine-tuning threshold scale. D Pick up some points on the obtained object to calculate the volume automatically via the On-demand 3D viewer. The white arrow refers to a 3D picker icon, the red arrow refers to picking points on the interested object, and the green arrow refers to the pick icon

Fig. 6

A Postoperative immediate 3D reconstruction showing segmentation of the residual bone cavity after cyst enucleation via the on-demand 3D viewer. B The segmented postoperative immediate residual bone cavity is used for volume calculation. C 3D reconstruction showing the residual bone cavity after 6 months. D The segmented residual bone cavity significantly declined in volume after 6 months. The black arrows refer to the segmented residual bone cavity. (Alb-PRF group)

Fig. 7

A Postoperative immediate 3D reconstruction showing segmentation of the residual bone cavity after cyst enucleation via the on-demand 3D viewer. B The segmented postoperative immediate residual bone cavity is used for volume calculation. C 3D reconstruction showing the residual bone cavity after 6 months. D The segmented residual bone cavity significantly declined in volume after 6 months. The black arrows refer to the segmented residual bone cavity. (Control group)

Fig. 8

The graph shows the percentage of decline in volume for both groups

Fig. 9

A Coronal view showing the residual bone cavity postoperative immediately (T1). B Coronal view showing bone formation and a significant increase in bone density after 6 months (T2). (Alb-PRF group)

Fig. 10

A Sagittal view showing the residual bone cavity postoperative immediately (T1). B Sagittal view showing bone formation and a significant increase in bone density after 6 months (T2). (Control group)

Fig. 11

The graph shows the percentage of increase in density for both groups