Extraction Socket Management Utilizing Platelet Rich Fibrin: A Proof-of-Principle Study of the “Accelerated-Early Implant Placement” Concept
Dental implants are widely accepted as the golden standard for the rehabilitation of an edentulous site following the extraction of a tooth. The ideal time for implant placement is dependent on the time required for partial or complete tissue healing and the adequacy of socket dimensions. The use of autologous growth factors is a promising new concept that aids clinicians in minimizing treatment time and increasing patient satisfaction. The purpose of this paper is to introduce a protocol for “accelerated-early” implant placement. In this protocol, platelet rich fibrin is employed to accelerate soft and hard tissue healing and to provide a better-healed recipient site for accelerated, early implant placement. Histological analysis revealed that at 6 weeks postextraction, the application of our approach resulted in delicate newly formed bone showing intense osteoblastic activity surrounded by connective tissue as well as areas of mineralized tissue. The present study is a proof-of-principle study of the acceleration of the physiologic postextraction healing sequelae with the use of autologous growth factors. The accelerated-early implant placement concept is a bioengineered protocol that may aid clinicians to achieve increased primary stability, by placing implants in ridges in an advanced stage of bone healing, while offering patients the benefits associated with early implant placement. Controlled studies are warranted to verify the reproducibility of this treatment concept and identify specific indications where the use of the presented technique can lead to significant clinical results.
Figure 1. Baseline clinical view of the hopeless maxillary first premolar. Figure 2. Intraoperative view following tooth extraction. Note the maintenance of gingival contours owing to the atraumatic extraction technique. Figure 3. Platelet rich fibrin (PRF) clot immediately following extraction from the centrifuged blood sample vial. Figure 4. Fibrin membrane formed following manipulation of the PRF clot. Figure 5. Clinical view at the end of the surgical procedure. Figure 6. Clinical view at 2 weeks postoperatively showing complete epithelization.
Figure 7. (a) Radiograph showing radiopaque tissue forming in the site that may be indicative of incipient trabecularization. The coronal aspect of the bundle bone is still noticeable as expected at 6 weeks postextraction. (b) Implant placement was performed with good primary stability. Figure 8. Clinical view at the 30-month follow-up appointment. Note the adequate preservation of buccal tissue contours. Figure 9. Photomicrograph showing trabeculae of delicate newly formed bone with numerous lacunae occupied by osteocytes, in a fibrous vascular connective tissue matrix (hematoxylin and eosin stain, original magnification ×100). Figure 10. (a) and (b) High power photomicrographs showing numerous osteocytes and focal lining by osteoblasts (hematoxylin and eosin stain, original magnification ×400).
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