ABSTRACT
Background:
Immediate implant placement after tooth extraction has been found to be a workable and reliable treatment for tooth loss based on clinical and radiographic evaluation.
Aim:
This study was conducted for comparative evaluation of immediate implant placement in fresh extraction socket with and without the use of platelet-rich fibrin (PRF).
Materials and Method:
Forty sites in all were chosen, and they were split into two groups at random. Twenty of these were placed immediately with PRF (test category), while the remaining 20 were placed immediately without the use of any comparable adjunct (control group). Using cone beam computed tomography, radiographic characteristics were evaluated both at the time of implant implantation and a year later.
Results:
The crestal bone at the mesial surface was 2.74 ± 1.44 and 1.96 ± 1.41 mm at baseline and 12-month follow-up in the control group. The crestal bone at the mesial surface was 2.93 ± 1.44 and 2.57 ± 1.57 mm at baseline and 12-month follow-up in the test group.
Conclusion:
Immediate implant placement in fresh extraction socket showed better results with the use of PRF.
KEYWORDS: Extraction socket, immediate implant placement, PRF
INTRODUCTION
Due to the steadily rising rate of achievement of dental implants, doctors are now focusing on shortening treatment times and improving patient comfort. The need to preserve alveolar volume for the person receiving treatment is what motivates the need for prompt implant implantation. Since their introduction in 1970, dental implants have been a well-recognized option for replacing lost teeth. This procedure enables the restoration of speech, masticatory function, and esthetics.[1,2]
Furthermore, since the socket has already been located, no surgical drill work is required for immediate implant placement—the only modification made to the socket length is a minor one meant to enhance primary stability.[3,4]
Because there would be less surgical trauma, there will be less chance of bone disintegration and more time for the procedure of bone remodeling to take place, allowing the woven bone to become lamellar bone and heal quickly. Nevertheless, a gap exists between the implant surface and socket wall with immediate implant placement.[5,6] To improve osseointegration, different materials, including xenografts, autografts, allografts, and alloplasts, are utilized to fill this gap, also known as the “jumping distance.” But these materials are not very effective, or they are quite pricey. The first platelet-rich fibrin (PRF) was created in France by Choukroun and associates.[7,8]
This concentrate of platelets of the second generation is extensively used to speed up the healing of both soft and hard tissues, and it does away with the risk that comes with using bovine thrombin. During centrifugation, a significant amount of platelet and leukocyte cytokines gets stuck in an autologous fibrin matrix, which promotes blood clot formation and prevents immunologic rejection and cross infection.[9,10] This study was conducted for comparative evaluation of immediate implant placement in fresh extraction socket with and without the use of PRF.
MATERIALS AND METHODS
Adults from the local community who had their dentition replaced and were recommended for extraction to use endosseous implants participated in the study (IEC- NHDC and RI/2023/FAC/OMDR.21/SS-16-ECC). Forty sites in all were chosen, and they were split into two groups at random. Twenty of these were placed immediately with PRF (test category), while the remaining 20 were placed immediately without the use of any comparable adjunct (control group). The minimum age of 18 years, existence of a maxillary or mandibular tooth that was recommended for extraction in the absence of an ongoing infection, existence of a gingival architecture that was adequate as well as harmonious with the encompassing dentition, presence a sufficient volume of bone (bone height as well as width), and good oral hygiene were the requirements for inclusion. Every patient had a comprehensive diagnostic examination that included a thorough case history record, a study cast, all clinical photos, standard blood tests, cone beam computed tomography (CBCT) radiography, and oral prophylaxis. Using CBCT, radiographic characteristics were evaluated both at the time of implant implantation and a year later.
Statistical analysis
The data was fed in MS Excel sheet and subjected to statistical analysis. Statistical Package for the Social Sciences version 21 was used for statistical analysis. P value ≤0.05 was considered statistically significant.
RESULTS
The crestal bone at the mesial surface was 2.74 ± 1.44 and 1.96 ± 1.41 mm at baseline and 12-month follow-up, respectively, in the control group. The crestal bone at the mesial surface was 2.93 ± 1.44 and 2.57 ± 1.57 mm at baseline and 12-month follow-up, respectively, in the test group.
The crestal bone at the distal surface was 2.44 ± 1.15 and 1.69 ± 1.15 mm at baseline and 12-month follow-up, respectively, in the control group. The crestal bone at the distal surface was 2.50 ± 1.56 and 2.15 ± 1.51 mm at baseline and 12-month follow-up, respectively, in the test group.
The crestal bone at the buccal/facial surface was 2.86 ± 1.50 and 1.87 ± 1.46 mm at baseline and 12-month follow-up, respectively, in the control group. The crestal bone at the buccal/lingual surface was 2.64 ± 1.45 and 2.24 ± 1.39 mm at baseline and 12-month follow-up, respectively, in the test group.
The crestal bone at the lingual/palatal surface was 2.49 ± 1.28 and 1.52 ± 1.0 mm at baseline and 12-month follow-up, respectively, in the control group. The crestal bone at the buccal/lingual surface was 2.36 ± 0.87 and 1.84 ± 0.87 mm at baseline and 12-month follow-up, respectively, in the test group.
It was observed that the crestal bone loss was greater in the control group compared to the test group [Table 1].
Table 1.
Changes in the level of crestal bone from the time of implant placement to 12 months follow-up
| Control | Test | |||
|---|---|---|---|---|
|
|
|
|||
| Baseline | 12 months | Baseline | 12 months | |
| Mesial | 2.74±1.44 | 1.96±1.41 | 2.93±1.44 | 2.57±1.57 |
| Distal | 2.44±1.15 | 1.69±1.15 | 2.50±1.56 | 2.15±1.51 |
| Buccal/facial | 2.86±1.50 | 1.87±1.46 | 2.64±1.45 | 2.24±1.39 |
| Lingual/palatal | 2.49±1.28 | 1.52±1.0 | 2.36±0.87 | 1.84±0.87 |
DISCUSSION
This study was conducted for comparative evaluation of immediate implant placement in fresh extraction socket with and without the use of PRF. The crestal bone at the mesial surface was 2.74 ± 1.44 and 1.96 ± 1.41 mm at baseline and 12-month follow-up, respectively, in the control group. The crestal bone at the mesial surface was 2.93 ± 1.44 and 2.57 ± 1.57 mm at baseline and 12-month follow-up, respectively, in the test group. It was observed that the crestal bone loss was greater in the control group compared to the test group.
We draw the conclusion that rapid implant implantation after tooth extraction is a workable and reliable treatment for tooth loss based on clinical and radiographic evaluation. The key benefits of this treatment are its less-invasive surgical technique, simplicity, and quicker recovery time, along with its low rate of postextraction problems. The keys to success, however, are appropriate case selection, careful postoperative care, and appropriate surgical and prosthetic procedure. To optimize early wound closure, minimize crestal/vertical bone loss, and promote rapid soft tissue regeneration, PRF is beneficial. All these factors contribute to greater patient acceptance and an esthetic result.
When an implant is placed directly into an extraction socket that has been created, there are several benefits that could increase patient acceptance of the process, including a shorter edentulous period, no requirement to wait for socket ossification, less surgical sessions needed, lower overall costs, and maintenance of alveolar bone height.[3,4,5] The early formation of coagulum in this area must stabilize for bone healing and osseointegration to occur. Studies using animals have demonstrated that the implant’s surface characteristics and the distance between the bone and the implant are important variables for stabilization of the coagulum.[6,7,8]
CONCLUSION
Immediate implant placement in fresh extraction socket showed better results with the use of PRF.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
REFERENCES
- 1.Schropp L, Isidor F, Kostopoulos L, Wenzel A. Patient experience of, and satisfaction with delayed-immediate vs. delayed single-tooth implant placement. Clin Oral Implants Res. 2004;15:498–503. doi: 10.1111/j.1600-0501.2004.01033.x. [DOI] [PubMed] [Google Scholar]
- 2.Kumar P, Kumar P, Tiwari A, Patel M, Gadkari SN, Sao D, et al. A cross-sectional assessment of effects of imprisonment period on the oral health status of inmates in Ghaziabad, Delhi National Capital Region, India. Cureus. 2022;14:e27511. doi: 10.7759/cureus.27511. doi: 10.7759/cureus.27511. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Barzilay I, Graser GN. Immediate implantation of a pure titanium implant into extraction sockets of macacafascicularis. Part-I clinical and radiographic assessment. Int J Oral Maxillofac Implants. 1996;11:299–310. [PubMed] [Google Scholar]
- 4.Tiwari A, Ghosh A, Agrawal PK, Reddy A, Singla D, Mehta DN, et al. Artificial intelligence in oral health surveillance among under-served communities. Bioinformation. 2023;19:1329–35. doi: 10.6026/973206300191329. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Anneroth G, Hedstrom KG, Kjellman O, Kondell PA, Norderam A. Endosseous titanium implants in extraction sockets –An experimental study in monkeys. Int Oral Surg. 1985;14:50–4. doi: 10.1016/s0300-9785(85)80010-7. [DOI] [PubMed] [Google Scholar]
- 6.Shulman LB. Surgical considerations in implant dentistry. J Dent Educ. 1988;52:712–20. [PubMed] [Google Scholar]
- 7.Weiss MB, Rostoker W. Development of a new endosseous dental implant, Part 1: Animal studies. J Prosthet Dent. 1981;46:646–51. doi: 10.1016/0022-3913(81)90073-1. [DOI] [PubMed] [Google Scholar]
- 8.Schwartz-Arad D, Chaushu G. The ways and wherefores of immediate placement of implants into fresh extraction sites: A literature review. J Periodontol. 1997;68:915–23. doi: 10.1902/jop.1997.68.10.915. [DOI] [PubMed] [Google Scholar]
- 9.Botticelli D, Berglundh T, Buser D, Lindhe J. The jumping distance revisited: An experimental study in the dog. Clin Oral Implant Res. 2003;14:35–42. doi: 10.1034/j.1600-0501.2003.140105.x. [DOI] [PubMed] [Google Scholar]
- 10.Prakash S, Thakur A. Platelets concentrations: Past, present, and future. J Maxillofac Oral Surg. 2011;10:455–75. doi: 10.1007/s12663-011-0182-4. [DOI] [PMC free article] [PubMed] [Google Scholar]
