Effect of leukocyte‐platelet‐rich fibrin in bone healing around dental implants placed in conventional and wide osteotomy sites: A pre‐clinical study

Abstract

Leukocyte‐platelet‐rich fibrin (L‐PRF) has been suggested for gap management for immediate implant placement when the distance is greater than 2 mm. However, there remains a paucity in hierarchically designed research to support this application. The present study aimed to evaluate the effect of L‐PRF on the osseointegration parameters of dental implants placed after conventional osteotomy of surgically created bone defects that simulate post extraction sockets in a canine model after 3, 6, and 12 weeks in vivo. Eighty dental implants (Intra‐Lock, Boca Raton, FL) were placed in the radius of 13 beagle dogs. The experiment consisted of 4 groups (n = 20 implants/group): 1) Regular osteotomy (Reg n/L‐PRF); 2) Regular osteotomy and implant placement with L‐PRF membrane (Reg L‐PRF); 3) Wide osteotomy with no gap management performed, where an osteotomy/bony defect (6 mm of diameter and ~5 mm deep) was created to simulate immediate implant placement in post‐extraction sockets, and the gap was left for spontaneous healing (Wide nL‐PRF); and 4) Wide osteotomy with L‐PRF gap management (Wide L‐PRF). L‐PRF membranes were obtained by blood drawn from each subject and centrifuged at 2700 rpm (408 RCF‐clot) for 12 min. In the experimental groups where L‐PRF was utilized, the membrane was inserted into the osteotomy site prior to implant placement. Six dogs had implants placed in the radius for 3 weeks; and 7 dogs had implants placed in the left radius for 6 weeks and in the right radius for 12 weeks. At the corresponding experimental time points, samples were harvested, and subjected to histological processing for qualitative and quantitative analyses, via bone‐to‐implant contact (BIC) and bone‐area‐fraction occupancy (BAFO). Qualitative analysis demonstrated increased amounts of bone formation around the implant and within the healing chambers over time for all groups. While comparable histological features were observed for both Reg groups (L‐PRF and nL‐PRF), the gap management performed in Wide L‐PRF group resulted in effective gap filling with improved bone growth in close proximity to the implant surface. Quantitative analyses of BIC and BAFO yielded higher values for both variables at 3 weeks for Wide L‐PRF (~38% and ~56% respectively) compared to Wide nL‐PRF (~20% for BIC and BAFO) (p < .03). No statistical differences were detected between Wide groups at 6 and 12 weeks, neither between Reg groups, independent of the association with or without the L‐PRF membrane at all healing times. L‐PRF placed within wide osteotomies, prior to implant placement, resulted in increased early bone formation compared to unfilled wide osteotomies at the early healing time (3 weeks in vivo).

The effect of leukocyte- and platelet-rich fibrin on the bone loss and primary stability of implants placed in posterior maxilla: a randomized clinical trial

“…Thus the opportunity for soft tissue intervention in bone repair has been denied. This justification agrees with the results obtained from the study of Benalcázar et al [ 59 ]; the study demonstrated that before implantation, L-PRF placement within wide osteotomies led to increased early bone growth as compared to unfilled wide osteotomies at the early healing time (three weeks in-vivo). In our study, the delayed placement of implants eliminated the need for scaffolding and physical barriers.…”

The Use of Nano-Hydroxyapatite (NH) for Socket Preservation: Communication of an Upcoming Multicenter Study with the Presentation of a Pilot Case Report

“…Therefore, studies that take into consideration the dentin and pulp of extracted teeth subjected to decalcification to fill postextraction sites are not interesting; the shredded dentin continues to progress as part of the bone and presents a cost-free autologous material [42][43][44][45]. Further, in this regard, researchers [46][47][48][49][50][51][52] have paid great attention to platelet concentrates and the different ways of preparing them. The results obtained using platelet concentrates are by far the best, especially for soft tissues and less so for bone.…”

Biological and Cellular Properties of Advanced Platelet-Rich Fibrin (A-PRF) Compared to Other Platelet Concentrates: Systematic Review and Meta-Analysis

“…The fibrin network is responsible for supporting the entire cell distribution in platelet concentrates and providing a membrane property for these blood products [ 24 , 25 , 26 ]. One study [ 16 ] investigated the formation and structure of the fibrin network.…”