Injectable platelet rich fibrin versus hyaluronic acid with bovine derived xenograft for alveolar ridge preservation. A randomized controlled clinical trial with histomorphometric analysis

IF 3.7 2区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE Clinical Implant Dentistry and Related Research Pub Date : 2023-10-31 DOI:10.1111/cid.13289

Gehad Abaza, Hala Kamal Abdel Gaber, Nermeen Sami Afifi, Doaa Adel-Khattab

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Abstract

Background

Alveolar ridge preservation (ARP) is a technique that aims to maintain bone volume and minimize resorption after tooth extraction.

Objective

This study aimed to compare the effectiveness of injectable platelet-rich fibrin (I-PRF) versus hyaluronic acid (HA) in combination with xenografts for ARP.

Methods

This randomized controlled trial included 36 patients (20 females and 16 males) who required implant placement in the upper arch. The patients were randomly allocated to one of three groups (n = 12 each): I-PRF with xenografts, HA with xenografts, or xenografts alone. All patients underwent ARP, and the extraction sockets were sealed with a free gingival graft harvested from the palate, a total of 36 implants were inserted. Cone-beam CT scans were performed before and 4 months postoperatively to measure radiographic bone gain as the primary outcome. Clinical parameters, including soft tissue thickness and clinical bone width, were evaluated preoperatively, and at 4 months and 1 year postoperatively. Additionally, histological assessment of core bone biopsies was performed 4 months postoperatively using histomorphometric analysis to determine the percentages of newly formed bone, mature bone, and residual grafts.

Results

Regarding the radiographic bone gain 4 months postoperative the HA group exhibited the highest value (9.78 ± 0.87), which was significantly greater than the values observed in the I-PRF and control groups (8.60 ± 1.27 and 7.99 ± 0.89, respectively) (one-way ANOVA, p = 0.007). Crestal bone loss was significantly higher in the control group (−0.98 ± 0.18) than in the I-PRF group (−0.53 ± 0.11) and HA group (−0.33 ± 0.15) groups (one-way ANOVA, p < 0.001). In the histomorphometric analysis, the mean area fraction of newly formed bone trabeculae was significantly higher in the HA group (56.66 ± 7.35) than in the I-PRF group (28.74 ± 5.15) and the control group (24.05 ± 3.64) (repeated measures ANOVA, p < 0.001). Additionally, the mean area fraction of residual graft material was higher in the I-PRF group (6.76 ± 2.59), followed by the control group (2.71 ± 1.24), while the HA group had the lowest value (2.63 ± 1.27) (Repeated measures ANOVA, p < 0.001).

Conclusion

The combination of HA with xenografts yielded better radiographic and histological outcomes in terms of new bone formation and degree of bone maturation than the I-PRF and control groups. Furthermore, I-PRF improved soft tissue thickness.

Please note that clinical trial registration was not completed prior to participant recruitment and randomization. The registration link for this trial is https://clinicaltrials.gov/ct2/show/NCT05781529.

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注射用富含血小板的纤维蛋白与透明质酸与牛源异种移植物用于牙槽嵴保存。一项采用组织形态计量学分析的随机对照临床试验。

背景：牙槽嵴保存（ARP）是一种旨在保持骨体积并最大限度地减少拔牙后吸收的技术。目的：本研究旨在比较注射用富含血小板的纤维蛋白（I-PRF）与透明质酸（HA）联合异种移植物治疗ARP的有效性。方法：这项随机对照试验包括36名需要在上弓植入物的患者（20名女性和16名男性）。患者被随机分配到三组中的一组（n = 每个12个）：I-PRF与异种移植物，HA与异种移动物，或单独的异种移植物。所有患者都接受了ARP，并用从腭上取下的游离牙龈移植物密封拔牙窝，总共插入了36个植入物。锥束CT扫描于术前和术后4天进行术后数月测量放射学骨增重作为主要结果。临床参数，包括软组织厚度和临床骨宽度，在术前和4 月和1 术后一年。此外，对核心骨活检进行了组织学评估4 术后数月，使用组织形态计量学分析来确定新形成骨、成熟骨和残余移植物的百分比。结果：关于放射学骨增重4 术后数月，HA组表现出最高值（9.78 ± 0.87），显著高于I-PRF组和对照组中观察到的值（8.60 ± 1.27和7.99 ± 0.89）（单因素方差分析，p = 0.007）。对照组的胸骨丢失明显更高（-0.98 ± 0.18）高于I-PRF组（-0.53 ± 0.11）和HA组（-0.33 ± 0.15）组（单因素方差分析，p 结论：在新骨形成和骨成熟度方面，HA与异种移植物的组合比I-PRF组和对照组产生了更好的放射学和组织学结果。此外，I-PRF改善了软组织厚度。请注意，在参与者招募和随机化之前，临床试验注册尚未完成。此试用的注册链接为https://clinicaltrials.gov/ct2/show/NCT05781529.

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来源期刊

Clinical Implant Dentistry and Related Research 医学-牙科与口腔外科

CiteScore

6.00

自引率

13.90%

发文量

103

审稿时长

4-8 weeks

期刊介绍： The goal of Clinical Implant Dentistry and Related Research is to advance the scientific and technical aspects relating to dental implants and related scientific subjects. Dissemination of new and evolving information related to dental implants and the related science is the primary goal of our journal. The range of topics covered by the journals will include but be not limited to: New scientific developments relating to bone Implant surfaces and their relationship to the surrounding tissues Computer aided implant designs Computer aided prosthetic designs Immediate implant loading Immediate implant placement Materials relating to bone induction and conduction New surgical methods relating to implant placement New materials and methods relating to implant restorations Methods for determining implant stability A primary focus of the journal is publication of evidenced based articles evaluating to new dental implants, techniques and multicenter studies evaluating these treatments. In addition basic science research relating to wound healing and osseointegration will be an important focus for the journal.