Effect of platelet‐rich fibrin to ridge width and height using CBCT measurement in immediate implant placement in esthetic zone

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Background The immediate placement of implants provides significant advantages, including fewer surgical procedures, shorter treatment time, and improved esthetics. Many studies were also to compare many biomaterial placed between gap distance for evaluating buccal plate. There were many following arguments that what kind of biomaterial was the best for grafting inside fresh socket. This study would evaluate the effect of PRF in fresh socket with simultaneous implant placement. Aim/Hypothesis Aim - To measure radiographically buccal extraction socket using autologous platelet rich fibrin (PRF). Hypothesis -It is hypothesized that if PRF can produce and maintain ridge width and height after immediate placement then PRF can be used as grafting material. Material and Methods All 17 adult patients (over 18 years old) with inclusion criteria who need one or more immediate placement in area 13–23 were eligible for this study. The immediate implant placement was performed (Osstem TSIII SA fixture) and the shoulder of implant would be at least 1 millimeter deeper compared with the original position of tooth. The PRF preparation with venous blood was collected in sterile vacutainer tube of 10 ml. capacity without anticoagulant and placed in a centrifugal machine (Medifuge MF200, Silfradent, Italy). Then 12 minutes later (manufacturer recommendation) it was divided into PRF layer. After implant was placed, the PRF was carefully filled in the buccal gap and no suture obtained. Cone-Beam Computed Tomography (Kodak Carestream CS9000 3D; Carestream Health Inc., USA) was performed immediately after implant was placed and 6 months follow-up examination. CBCT landmark was located for indicating ridge width and height at the day of surgery and 6 months follow-up. Results All 17 inserted implants were integrated. There were no implant failure and clinical exposure of fixtures in this study. CBCT was performed at 6 months after implant insertion with the following landmark- - Outer crest at top level of implant (OT) to Palatal aspect at top level of implant (PT), indicating the ridge width at the top of implant.- Outer crest at apical level of implant (OA) to Palatal aspect at apical level of implant (PA), indicating the ridge width at the apex of implant.- Outer crest at apical level of implant (OA) to top of crest (C) indicating the ridge height. The study demonstrated that the extraction of a tooth and the immediate insertion of an implant together with PRF resulted in alterations of the bone width and bone height of alveolar ridge using Paired samples T-Test. The width of ridge at top and apical of implant was reduced at 6 months (respectively, P = 0.000 and 0.001). the height of ridge was also reduced at 6 months (P = 0.009). Conclusion and Clinical Implications Although buccal bone were still presented in CBCT, the results of this study show that implant placement into extraction socket together with PRF alone can result even in the evident alterations of alveolar ridge width and height with statistical significant. For clinical benefit, PRF can produce and maintain ridge width and height after immediate placement. So PRF can be used as grafting material but clinicians have to concern about limitation and selection of the cases with this procedure.