Three-dimensional evaluation of the effects of injectable platelet rich fibrin (i-PRF) on alveolar bone and root length during orthodontic treatment: a randomized split mouth trial

Talar S Zeitounlouian, Kinan G Zeno, Bassel A Brad, Rania A Haddad, Talar S Zeitounlouian, Kinan G Zeno, Bassel A Brad, Rania A Haddad

Abstract

Background: The role of injectable platelet rich fibrin (i-PRF) in orthodontic treatment has not been investigated with focus on its effect on dental and bony periodontal elements.

Objective: To evaluate the efficacy of i-PRF in bone preservation and prevention of root resorption.

Methods: A randomized split-mouth controlled trial included 21 patients aged 16-28 years (20.85 ± 3.85), who were treated for Class II malocclusion with the extraction of the maxillary first premolars. Right and left sides were randomly allocated to either experimental treated with i-PRF or control sides. After the leveling and alignment phase, the canines were retracted with 150gm forces. The i-PRF was prepared from the blood of each patient following a precise protocol, then injected immediately before canine retraction on the buccal and palatal aspects of the extraction sites. Localized maxillary cone beam computed tomography scans were taken before and after canine retraction to measure alveolar bone height and thickness and canine root length (indicative of root resorption), and the presence of dehiscence and fenestration. Paired sample t-tests and Wilcoxon signed rank tests were used to compare the changes between groups.

Results: No statistically significant differences in bone height, bone thickness were found between sides and between pre- and post-retraction period. However, root length was reduced post retraction but did not differ between sides. In both groups, postoperative dehiscence was observed buccally and palatally and fenestrations were recorded on only the buccal aspect.

Conclusions: I-PRF did not affect bone quality during canine retraction or prevent canine root resorption. I-PRF did not reduce the prevalence of dehiscence and fenestration. Trial registration ClinicalTrials.gov (identifier number: NCT03399760. 16/01/2018).

Keywords: Alveolar bone preservation; Class II division I; Dehiscence; Fenestration; Injectable platelet rich fibrin; Maxillary canine retraction; Platelet concentrate; Root resorption; i-PRF.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
CONSORT flow diagram
Fig. 2
Fig. 2
Intraoral photograph of i-PRF injection technique: a buccal injection, b Palatal injection, c Canine retraction initiated using a NiTi coil activated after the first i-PRF injection
Fig. 3
Fig. 3
Three-dimensional orientation of the CBCT scans on different sections relative to the position of the upper canine. A: Axial section: B: Coronal section:, C: Sagittal section
Fig. 4
Fig. 4
A Bucco-palatal section of canine CBCT scan with the defined landmarks for measurements in red. B Schematic representation of the reported measurements. Alveolar bone height: buccal (a) and palatal (b) alveolar crest heights were measured as the vertical distances between the line passing through the buccal and palatal CEJ to the corresponding buccal and palatal alveolar crest. Alveolar bone thickness: buccal and palatal alveolar plate thicknesses were measured perpendicular to the long axis from the root surface to the corresponding buccal and palatal alveolar bone plate at two different distances from the CEJ: 3 mm (c, d) and 6 mm (e, f). Root length was measured as the distance (g) along the long axis of the tooth perpendicular to two reference lines, the first line passing through the buccal and palatal CEJ of the canine and the other line through the canine root apex

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