Platelet-Rich Plasma for Bone Healing in Maxillary and Mandibular Fractures
Impact of Autologous Platelet-Rich Plasma on Promoting Bone Regeneration in Maxillary and Mandibular Fractures: A Randomized Controlled Trial
The goal of this clinical trial is to learn if platelet-rich plasma (PRP) made from the patient's own blood helps broken jaw bones heal faster and stronger in adults with fractures of the upper jaw (maxilla) or lower jaw (mandible).
The main questions it aims to answer are:
- Does adding PRP during fracture surgery increase bone density at the fracture site at 6 months compared with surgery alone?
- Is the effect of PRP on bone healing similar in upper jaw and lower jaw fractures?
Researchers will compare patients who receive standard fracture fixation with titanium plates plus PRP to patients who receive the same fixation without PRP, to see if PRP improves bone healing.
Participants will:
- Give a small blood sample (12 ml) before surgery, from which PRP will be prepared (PRP group only)
- Undergo surgery under general anaesthesia to fix the fracture with two titanium plates and screws
- Take antibiotics and anti-inflammatory medicine for one week after surgery
- Return for check-ups and a CBCT (3D dental X-ray) scan at 1 week, 3 months, and 6 months after surgery to measure bone healing
Studieoversigt
Status
Status
Betingelser
Betingelser
Intervention / Behandling
Intervention / Behandling
Detaljeret beskrivelse
Background and rationale:
Fractures of the maxilla and mandible are common in facial trauma and require rapid, reliable bone healing to restore chewing function and facial appearance. Conventional management with rigid internal fixation is effective, but delayed union and incomplete bone regeneration still occur. Autologous platelet-rich plasma (PRP) contains high concentrations of growth factors, including platelet-derived growth factor (PDGF), transforming growth factor-beta (TGF-beta), and vascular endothelial growth factor (VEGF), which promote osteogenesis and angiogenesis. Because it is prepared from the patient's own blood, PRP is biocompatible, low-cost, and carries minimal risk of immune reaction. Randomized trials have reported higher radiographic bone density and faster healing with PRP in mandibular fractures; however, a recent systematic review and meta-analysis found that available trials are limited almost entirely to the mandible and that pooled estimates are heterogeneous. Evidence on PRP in maxillary trauma is scarce, and no randomized trial has assessed PRP in both maxillary and mandibular fractures within the same cohort using a standardized CBCT-based protocol.
Study design and setting:
Single-centre, parallel-group, two-arm randomized controlled trial at the Maxillofacial Center, CMH Lahore Medical College and Institute of Dentistry, Lahore, Pakistan.
Randomization and masking:
Eligible patients will be allocated in a 1:1 ratio using a computer-generated randomization list, stratified by fracture site (maxilla or mandible). Allocation will be concealed in sequentially numbered, sealed, opaque envelopes opened in the operating theatre. The investigator measuring bone density on CBCT will be blinded to group allocation.
PRP preparation:
Twelve ml of venous blood will be drawn into sodium citrate tubes and processed at room temperature by double centrifugation: 1200 rpm for 20 minutes to separate plasma, then 2000 rpm for 15 minutes to concentrate platelets. The platelet-rich fraction will be retained and platelet-poor plasma discarded. Platelet count and smear will be performed to confirm concentration and morphology. Immediately before use, PRP will be activated with calcium chloride and bovine thrombin to form a platelet gel.
Surgical procedure:
All operations will be performed under general anaesthesia by the same surgical team. The fracture will be exposed through a vestibular incision, reduced manually, and fixed with two titanium miniplates and screws. In the PRP group, activated PRP gel will be applied along the fracture line before closure; the control group will receive identical fixation without PRP. Wounds will be closed with Vicryl sutures. All patients will receive antibiotics and anti-inflammatory medication for one week and intermittent cold packs for 24 hours.
Outcome assessment:
CBCT scans will be obtained at 1 week, 3 months, and 6 months postoperatively. Bone density will be measured in Hounsfield units within a 3 x 2.5 mm rectangular region of interest placed across the fracture line above the upper plate, using Planmeca software.
Sample size:
A sample of 40 patients (20 per group) was calculated with the OpenEpi calculator from the difference in mean bone density between PRP and control groups reported in a previous randomized trial using the same PRP technique and CBCT schedule (Daif, 2013), with a two-sided significance level of 5% and 80% power.
Statistical analysis:
Data will be analysed in SPSS and presented as mean and standard deviation. Bone density between groups at each time point will be compared with the independent-samples t-test, and change over time within each group with repeated-measures ANOVA. Maxillary and mandibular fractures will be analysed separately as a secondary, exploratory comparison. A p-value below 0.05 will be considered statistically significant.
Ethics:
The study will be conducted in accordance with the Declaration of Helsinki. Written informed consent will be obtained from all participants, and confidentiality of patient data will be maintained.
Undersøgelsestype
Undersøgelsestype
Tilmelding (Anslået)
Tilmelding
Fase
Fase
- Ikke anvendelig
Kontakter og lokationer
Studiekontakt
Studiekontakt
- Navn: Shanza Razzak
- Telefonnummer: +923225467436
- E-mail: shanzarazzaq@gmail.com
Undersøgelse Kontakt Backup
- Navn: Asad A Chatha, BDS, FCPS
Studiesteder
-
-
-
Lahore, Pakistan
- Afsluttet
- CMH Lahore
-
-
Punjab Province
-
Lahore, Punjab Province, Pakistan
- Rekruttering
- Institute of Dentistry; CMH Lahore Medical College
-
Kontakt:
- Naauman Zaheer, BDS; PhD
- Telefonnummer: +92-321-4440283
- E-mail: naauman_20@hotmail.com
-
-
Deltagelseskriterier
Berettigelseskriterier
Berettigelseskriterier
Aldre berettiget til at studere
Tager imod sunde frivillige
Køn, der er berettiget til at studere
Beskrivelse
Inclusion Criteria:
- Age 18 years or older
- Fracture of the maxilla or mandible confirmed by clinical examination and panoramic radiograph
- Fracture requiring open reduction and internal fixation with titanium miniplates
- Willing and able to provide written informed consent and to attend all follow-up visits up to 6 months
Exclusion Criteria:
- Uncontrolled diabetes mellitus
- Bleeding or coagulation disorders (e.g., haemophilia, von Willebrand disease)
- Platelet disorders or thrombocytopenia
- Chronic renal failure
- Hepatic disease
- Active malignancy, or current chemotherapy or radiotherapy
- Osteoporosis or other metabolic bone disease
- Immunocompromised state (e.g., HIV/AIDS, long-term corticosteroid or immunosuppressive therapy)
- Current use of anticoagulant or antiplatelet medication
- Pregnancy or lactation
- Multiple or pathological fractures
- Refusal to provide informed consent
Studieplan
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Behandling
- Tildeling: Randomiseret
- Interventionel model: Parallel tildeling
- Maskning: Enkelt
Antal våben
Våben og indgreb
Deltagergruppe / ArmDeltagergruppe / Arm |
Intervention / BehandlingIntervention / Behandling |
|---|---|
|
Eksperimentel: PRP + Miniplate Fixation
Patients undergo open reduction and internal fixation of the maxillary or mandibular fracture under general anaesthesia with two titanium miniplates and screws. Autologous platelet-rich plasma is prepared from 12 ml of the patient's venous blood by double centrifugation, activated with calcium chloride and bovine thrombin, and applied as a gel along the fracture line before wound closure. Postoperatively, patients receive antibiotics and anti-inflammatory medication for one week. |
Twelve ml of venous blood is collected into sodium citrate tubes and processed at room temperature by double centrifugation (1200 rpm for 20 minutes, then 2000 rpm for 15 minutes). The platelet-rich fraction is retained and platelet-poor plasma discarded; platelet count and smear are checked. Immediately before use, PRP is activated with calcium chloride and bovine thrombin to form a gel, which is applied once along the fracture line after fixation and before wound closure. |
|
Aktiv komparator: Miniplate Fixation Alone
Patients undergo open reduction and internal fixation of the maxillary or mandibular fracture under general anaesthesia with two titanium miniplates and screws, identical to the experimental arm, without application of platelet-rich plasma. Postoperatively, patients receive antibiotics and anti-inflammatory medication for one week. |
Under general anaesthesia, the fracture is exposed through a vestibular incision, manually reduced, and fixed with two titanium miniplates and screws. The wound is closed with Vicryl sutures. All procedures are performed by the same surgical team. |
Hvad måler undersøgelsen?
Primære resultatmål
Primære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
|
Bone Density at the Fracture Site
Tidsramme: 6 months after surgery
|
Mean bone density in Hounsfield units (HU) measured on cone-beam computed tomography (CBCT) within a 3 x 2.5 mm rectangular region of interest placed across the fracture line above the upper miniplate, using Planmeca software. Measurements are made by an assessor blinded to group allocation. Higher values indicate greater bone mineralization. |
6 months after surgery
|
Sekundære resultatmål
Sekundære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
|
Bone Density at the Fracture Site at Early and Intermediate Follow-up
Tidsramme: 1 week and 3 months after surgery
|
Mean bone density in Hounsfield units measured on CBCT within a 3 x 2.5 mm region of interest across the fracture line above the upper miniplate, using the same method as the primary outcome. |
1 week and 3 months after surgery
|
|
Bone Density by Fracture Site (Maxilla Versus Mandible)
Tidsramme: 3 months and 6 months after surgery
|
Mean bone density in Hounsfield units on CBCT at the fracture site, analysed separately for maxillary and mandibular fractures within each group, to compare the effect of platelet-rich plasma between the two fracture sites. |
3 months and 6 months after surgery
|
Samarbejdspartnere og efterforskere
Sponsor
Sponsor
Efterforskere
Efterforskere
- Studiestol: Asad A Chatha, BDS, FCPS, CMH Lahore Medical College and Institute of Dentistry
Datoer for undersøgelser
Studer store datoer
Studiestart (Faktiske)
Studiestart
Primær færdiggørelse (Anslået)
Primær færdiggørelse
Studieafslutning (Anslået)
Studieafslutning
Datoer for studieregistrering
Først indsendt
Først indsendt
Først indsendt, der opfyldte QC-kriterier
Først indsendt, der opfyldte QC-kriterier
Først opslået (Faktiske)
Først opslået
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Faktiske)
Sidste opdatering sendt
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidst verificeret
Sidst verificeret
Mere information
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Yderligere relevante MeSH-vilkår
Andre undersøgelses-id-numre
Andre undersøgelses-id-numre
- 234/ERC/CMH/LMC
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