ABSTRACT
Introduction:
Many adjuvant methods have been researched to enhance the immediate implant success in the recent times. The study’s goal was to compare the aesthetic and biological results of immediate dental implants in the aesthetic zone to standard tapered root form implants that had not undergone pre-treatment with platelet-rich plasma or photofunctionalization.
Materials and Methods:
The study used a randomized controlled trial as its design. Ninety subjects were chosen at random and placed into three groups: a control group, a case group, and a group that needed replacement of their maxillary anterior teeth right away following extraction. The interventional groups received the “Platelet-Rich Plasma (PRP)” or “Photofunctionalization (PF)” group before the implant placement. After the delayed loading approach, the prosthesis was given after 6 months. At the second and fourth weeks, as well as 2, 4, 6, and 12 months (P 0.05), follow-up was conducted. The success and survival rate, aesthetic, and biological outcomes were assessed. One-way ANOVA was used to compare outcomes, and repeated-measures ANOVA was used to assess intragroup variations over baseline and follow-up.
Results:
The distal, mesial, and mean marginal bone loss as well as the aesthetic scores for pink and white did not differ significantly between groups. The implant stability however was significantly higher in the PF and PRP groups as compared to the controls. A single implant failed in all the three groups. The success percentage was similar for all the groups.
Conclusion:
The stability of immediate dental implants pre-treated with PRP or PF differed statistically significantly than the subjects in the control group, while other parameters remained the similar between the groups.
KEYWORDS: Implants, photofunctionalization, platelet-rich plasma, stability, success
INTRODUCTION
The use of dental implants to replace missing teeth has produced well-researched, dependable results.[1] Research has shown that after extraction or tooth loss for various reasons, the alveolar process significantly resorbs and loses volume.[2] A small number of authors have suggested using immediate dental implant placement during treatment procedures to stop this resorptive process;[3] however, a small number of preclinical studies have produced contradictory results, indicating that immediate replacement of lost teeth with the implants may not stop bone resorption.[4] It is debatable that implant placement immediately for the tooth that is extracted may be beneficial for the alveolar height prevention.[5] Failure in the early stages of the implant placement is caused by insufficient osseointegration; therefore, bioactive surface treatment is necessary. This therapy may improve osseointegration in the implants and validate a long-lasting “Bone to Implant Contact (BIC)” with no significant loss of the marginal bone.[6] There are numerous innovative surface treatments that, with consistent success rates, assist in the rehabilitation of patients in challenging clinical settings.[7] These processes include “Photofunctionalization (PF),” “Platelet Rich Plasma (PRP),” “Ion Beam Aided Deposition,” “Pulsed Laser Deposition,” “Sputter Coating,” and “Electrostatic Spray Deposition.”[7] PF is a procedure where implants are treated with UV rays. UV treatment boosts osteoconductivity,[8] lowers the amount of hydrocarbon on the surface, and improves surface energy and wettability.[9]
MATERIAL AND METHODS
The study used a randomized controlled trial as its design after attained the ethics approval from the institute. The study was conducted for a period of 2 years from 2020–2022 at a tertiary care center. After receiving institutional ethical committee permission, this assessor and statistician-blinded parallel randomized controlled study was carried out in a tertiary care referral hospital. Referred individuals were chosen as the subjects for rapid replacement of anterior teeth with poor prognosis. In accordance with the Helsinki Declaration, each subject gave their written informed permission.
RESULTS
When the groups were compared among each other, a significant variance was seen at all the follow-up time lines of 2 and 4 months with P values 0.001 and 0.005, respectively. The bone loss was at all the times below 2.25; hence, it was not considered as clinically considerable [Table 1]. In the first month after the placement of the implant, there was no significant variance noted between the groups when estimated at 2 and 4 weeks. However, a statistically significant increase in implant stability among the groups was discovered at 2, 4, 6, and 12 months (P < 0.001). The intragroup evaluation also depicted a statistically significant value for the time lines (P < 0.001) [Table 2]. Esthetic score differences between groups showed no statistical significance [Table 3]. The success was observed in 32,33,31 implants of the PF, control, and PRP groups, respectively. One each in PF and control groups and two implants in the PRP failed. The percentage of the success and survival rates was 96.96%, 97.05%, and 93.90%, respectively, for PF, control, and PRP groups [Table 4].
Table 1.
Marginal bone loss (in millimeters presented as Mean±SD)
| Time line | PF | Control | PRP | P |
|---|---|---|---|---|
| Mesial side | ||||
| 2 months | 1.19±0.11 | 1.11±0.12 | 1.12±0.12 | <0.001 |
| 4 months | 1.44±0.31 | 1.29±0.15 | 1.33±0.11 | 0.088 |
| 6 months | 1.65±0.11 | 1.50±0.23 | 1.59±0.12 | 0.072 |
| 12 months | 1.88±0.11 | 1.81±0.11 | 1.79±0.12 | 0.510 |
| Intra group | P<0.001 | P<0.001 | P<0.001 | |
| Distal side | ||||
| 2 months | 1.01±0.11 | 0.94±0.12 | 1.00±0.11 | 0.140 |
| 4 months | 1.28±0.11 | 1.11±0.15 | 1.22±0.15 | 0.090 |
| 6 months | 1.50±0.12 | 1.45±0.11 | 1.49±0.14 | 0.514 |
| 12 months | 1.69±0.17 | 1.67±0.09 | 1.71±0.11 | 0.757 |
| Intra group | P<0.001 | P<0.001 | P<0.001 | |
| Mean loss | ||||
| 2 months | 1.10±0.18 | 0.89±0.10 | 0.94±0.09 | <0.001 |
| 4 months | 1.31±0.13 | 1.25±0.10 | 1.30±0.14 | 0.005 |
| 6 months | 1.60±0.15 | 1.55±0.07 | 1.50±0.11 | 0.111 |
| 12 months | 1.80±0.11 | 1.77±0.04 | 1.74±0.11 | 0.857 |
| Intra group | P<0.001 | P<0.001 | P<0.001 |
Table 2.
Assessment of the stability among the subjects for the various time periods
| Stability | Mean±SD | P | ||
|---|---|---|---|---|
|
| ||||
| PF | Control | PRP | ||
| 2 weeks | 38.00±1.21 | 39.00±1.25 | 38.12±1.02 | 0.511 |
| 4 weeks | 41.01±1.22 | 40.45±1.00 | 40.11±1.58 | 0.411 |
| 2 months | 52.58±3.00 | 49.25±2.88 | 52.00±1.47 | <0.001 |
| 4 months | 66.00±2.00 | 52.33±2.47 | 62.00±1.52 | <0.001 |
| 6 months | 70.00±0.12 | 62.00±1.47 | 69.00±1.52 | <0.001 |
| 12 months | 71.08±1.34 | 64.09±1.75 | 70.17±1.32 | <0.001 |
| Intra group | P<0.001 | P<0.001 | P<0.001 | |
Table 3.
Assessment of the aesthetic outcome among the subjects for the various time periods
| PF | Control | PRP | P |
|---|---|---|---|
| 13.11±0.92 | 13.21±0.44 | 13.12±0.47 | 0.871 |
Table 4.
Success and survival rate among the three groups
| Health scale | PF | Control | PRP |
|---|---|---|---|
| Success | 32 | 33 | 31 |
| Satisfactory survival | 0 | 0 | 0 |
| Compromised survival | 0 | 0 | 0 |
| Failure | 1 | 1 | 1 |
| Percentage | 96.96 | 97.05 | 96.96 |
DISCUSSION
In this study, participants with implants treated with photofunctionalization or PRP graft had considerably higher implant stability than subjects without any pretreatment. No variance was however noted for the marginal bone loss among the groups. In PF, titanium dioxide is modified on the surface, resulting in bioactivity and osseointegration. Although UV-treated titanium surfaces are superhydrophilic and electropositive, which results in increased BIC,[10] this study observed no variation between the PF or PRP group and the control group in terms of mean marginal bone loss on the follow-ups later. Despite conflicting outcomes, the use of PRP in conjunction with endosseous dental implants dramatically enhanced bone remodeling.[11] When PRP was applied to implant sites in the front maxilla, implant stability was shown to be much higher than when PRP was not applied, according to Thor et al.,[12] but there were no differences for implants placed in the posterior areas. Growth factors and a fibrin mesh make up the protein stratum that covers the implant surface and facilitates the first contact of surrounding tissues with the implant surface. Moreover, it improves the formation of bone matrix and cellular proliferation, attachment, and differentiation.[13,14,15] However, this investigation did not reveal that pretreatment individuals had higher success and survival rates. The causes were unchecked increasing bone loss and unchecked exudate, which may have been caused by infection in those patients, and the statistical analyses utilized were of the intent to treat kind. Hence, a large cohort and longer follow-up intervals may aid in making better-informed decisions.
CONCLUSION
As compared to standard tapered root implants without any preparation, commercial dental implants with PF and PRP surface treatments may exhibit improved statistically significant results when placed immediately in the anterior maxillary region, although clinical significance is lacking. Additionally, the advantages of this method are that they are not expensive and acceptable for the patients.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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