Clinical effect of platelet-rich fibrin on the preservation of the alveolar ridge following tooth extraction

Yingdi Zhang, Zheng Ruan, Minhua Shen, Luanjun Tan, Weiqin Huang, Lei Wang, Yuanliang Huang, Yingdi Zhang, Zheng Ruan, Minhua Shen, Luanjun Tan, Weiqin Huang, Lei Wang, Yuanliang Huang

Abstract

The aim of the present study was to evaluate the clinical efficacy of platelet-rich fibrin (PRF) in preserving the alveolar ridge following human tooth extraction. A total of 28 patients were divided into two groups: The experimental and control groups (n=14 each). Following tooth extraction, the experimental group was implanted with PRF membrane, whereas the control group was not. The gingival healing effect was assessed at 7 days, 1 and 3 months later. Cone-beam computed tomography was performed immediately and at 3 months following tooth extraction. The changes in alveolar ridge height, width, and bone mineral density were compared between the two groups. The alveolar bone was removed using the ring drill during the implant surgery at 3 months following tooth extraction. Histomorphometric evaluation was performed to compare new bone formation between groups. The patients in the experimental group reportedly felt better compared with the patients in the control group. The healing of gingival tissue was better in the experimental group than in the control group. A significantly greater novel bone area was observed in the PRF group compared with the control group (P<0.01). However, no statistically significant differences were observed in the mean value of buccal alveolar ridge height, lingual/palatal alveolar ridge height and alveolar ridge width between the two groups. These results suggested that PRF was advantageous in human alveolar ridge preservation with ease of use and simple handling. Histological analysis of novel bone formation confirmed that PRF increased the quality of the novel bone and enhanced the rate of bone formation, despite the effect of PRF was not significant to reduce alveolar bone resorption in the extraction socket alone.

Keywords: alveolar ridge preservation; cone-beam computing tomography; dental implant; platelet-rich fibrin.

Figures

Figure 1.
Figure 1.
Preparation of radiation guide. (A and B) The diseased tooth was abraded from the plaster model. (C) Radiation guide produced using self-curing plastic with zirconium beads in the middle. (D and E) The radiation guide placed into the plaster model.
Figure 2.
Figure 2.
CBCT data measurement. (A) The horizontal blue line coincided with the maxillary or mandibular alveolar crest, and the vertical blue line passed through the center of the position of the zirconium beads. (B) The CBCT image obtained at T1, where S, h1 and h2 were obtained. (C) On the CBCT at 3 months following tooth extraction, the horizontal line S' and the vertical distance h1′ and h2′ were obtained by the same method. w2 was measured by drawing a horizontal line through the buccal or lingual alveolar ridge vertex position. (D) w1 on the CBCT image of T1 was obtained at the same distance from the vertebral alveolar ridge. CBCT, cone-beam computed tomography; T1, immediately following tooth extraction; S, line through center of zirconium bead; h1, vertical distance of the buccal alveolar crest to the line; h2, vertical distance of the palate/lingual alveolar crest to the line; w1, buccal-lingual alveolar ridge width at T1; w2, buccal-lingual alveolar ridge width at T2.
Figure 3.
Figure 3.
Appearance of PRF. (A) Three fractions of blood generated by centrifugation: PPP, PRF and red blood cells. (B) PRF gel with translucent jelly structure and smooth surface, was durable and elastic. (C) PRF membrane. PRF, platelet-rich fibrin; PPP, platelet-poor plasma.
Figure 4.
Figure 4.
Scanning electron microscopy image of platelet-rich fibrin (magnification, ×5,000). Many fibrin fibers assembled to form a tight three-dimensional fibrin network structure. Numerous platelets, leukocytes, and red blood cells were embedded in the network. F, fibrin fibers; P, platelets; L, leukocytes; R, red blood cells.
Figure 5.
Figure 5.
Process of minimally invasive tooth extraction and the application of PRF. (A) Clinical manifestations of the tooth prior to extraction. (B) Extraction socket. (C) Application of PRF in the extraction socket. (D) Suturing of the extraction socket. PRF, platelet-rich fibrin.
Figure 6.
Figure 6.
Healing of local gingival tissue following tooth extraction. Gingival tissue of the experimental group at (A) 7 days and (B) 3 months following tooth extraction. Gingival tissue of the control group at (C) 7 days and (D) 3 months following tooth extraction.
Figure 7.
Figure 7.
Variation values of the buccal and lingual/palatal alveolar crest height and the alveolar crest width in the two groups. Data are presented as the mean ± standard deviation (n=14). PRF, platelet-rich fibrin; Con, control.
Figure 8.
Figure 8.
Implant surgery of the experimental group. (A) The surface of the alveolar crest following the mucoperiosteal flap was completed. (B-E) Alveolar bone was collected via annular drilling. (F) The implant surgery was completed, and the soft tissue was sutured.
Figure 9.
Figure 9.
Observation of the novel bone following Goldner's trichrome staining. The formation of novel bone was more abundant in the experimental group than in the control group. (A) Experimental group (magnification, ×100); (B) experimental group (magnification, ×200); (C) control group (magnification, ×100); and (D) control group (magnification, ×200). Red arrows indicate novel bone.
Figure 10.
Figure 10.
% OAr, which corresponds to the percentage of novel bone formation area in the experimental and control groups. Data are presented as the mean ± standard deviation (n=14). *P
All figures (10)

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