Leukocyte and Platelet-Rich Fibrin Combined With Autogenous Bone Graft in the Management of Gap Distances around Immediately Placed Implants

Abstract

Implant placement immediately after tooth extraction is a widely accepted procedure revealing high survival rates and aimed originally at preserving the pre-extraction contours of the alveolar process because a marked resorption of the buccal bone plate after tooth loss was observed. However, dimensional ridge alterations could not be prevented when implants were immediately placed into fresh extraction sockets. Recentliterature provides information on different factors influencing the success of implants placed immediately after tooth extraction. These factors range from implant positioning, the use of grafting material, the soft tissue biotype, the use of soft tissue augmentation and presence or absence of periapical pathologies. The presence of a bonedefect around an implant could promote in-growthof soft tissue and compromise osseointegration inthe crestal bone area. When using immediatepostextraction implants, it is almost always necessaryto resort to osteopromoting techniques.Graft materials and barrier membranes have been used extensively when placing immediate implants. They are often used to prevent soft tissue in-growth and to allow bone-forming cells to exclusively populate osseous defects around the implants. Leukocyte and Platelet-Rich Fibrin (L- PRF) has beenrecently proposed as an aid to enhance regenerationof osseous and epithelial tissues in oral surgery.Several in vitro studies, animal experiments, and clinicalstudies have shown that Leukocyte and Platelet-Rich Fibrin can effectively trigger stimulation of osseousand soft tissue regeneration, as well as reduce inflammation,pain, and unwanted side effects. The purpose of the present study was to evaluate the clinical and radiographic outcome of implants immediately placed into fresh extraction sockets using L- PRF and autogenous bone as an adjunct during the surgical procedure. Fourteen patients, 6 males and 8 females were included in this study. They were selected from (the outpatient clinic of Oral Medicine and Periodontology department, Faculty of Dentistry, Ain Shams University) coming for extraction of a non-restorable maxillary tooth in the (esthetic zone) and placement of a dental implant into fresh extraction sockets. • Group 1: included seven implants, which were placed immediately into the fresh extraction sockets with the use of L-PRF only to fill the gap between the implants and extraction sockets walls. • Group 2: included seven implants, which were placed immediately into the fresh extraction sockets with the use of L-PRF combined with bone grafts to fill the gap between the implants and extraction sockets walls. Six months after implant placement, the abutment was screwed and conventional loading was applied using permanent metal ceramic crown. Cone beam computed tomography (CBCT) was used at baseline and after six months of implant placement to measure changes in Vertical facial bone level (VFBL), Vertical mesial bone level (VMBL), Vertical distal bone level (VDBL), Overall vertical bone level,Horizontal facial bone thickness (HFBT) at (2,4 and 6 mm) and Bone density.