A COMPARATIVE EVALUATION OF IMPLANT STABILITY AND BONELOSS IN IMMEDIATELY PLACED IMPLANT IN FRESH EXTRACTION SOCKET WITH PLATELET RICH FIBRIN AND WITH ADVANCED-PLATELET RICH FIBRIN-A CLINICAL AND RADIOGRAPHIC STUDY

The goal of modern dentistry is to prevent tooth loss and provide a healthy dentition with optimal functional efficiency, structural balance, and esthetic harmony. Implants have been used to support dental prostheses for a few decades. They are the nearest equivalent replacement of natural teeth and are therefore used in the management of patients who are missing teeth due to caries, trauma, or developmental anomalies.

Traditionally, before placing dental implants, the compromised teeth are removed and the extraction socket is left to heal for a period of few months to 1 year. This waiting period is associated with unavoidable bone loss that occurs after tooth extraction, which may lead to difficulties such as insufficient bone at the time of implantation and prolonged waiting period for the patient. To overcome this, Lazzara (1989) first reported placement of immediate implant in an extraction socket in humans.

Immediate Implant Placement (IIP) has several advantages such as fewer surgical procedures, preservation of bone volume and the overall treatment time has been reduced, a second surgical intervention is avoided by combining extraction, and implant placement into one appointment. Atraumatic or minimally traumatic extraction is crucial for the success of IIP as the need for alveolar preservation is necessary to have a good functional and aesthetic outcome with implant therapy. To ensure the same; luxators and periotomes were used, thus inflicting the least mechanical trauma to the buccal and lingual cortical bone. With Immediate post-extraction implants it is possible to obtain a very high long-term success percentage (90%), and better and faster functional results. Therefore, it can be a viable treatment alternative in implant dentistry, to improve clinical outcomes and provide better patient compliance and satisfaction.

The implants are placed based on the extraction socket classification given by Smith R B et al (2013), which comprises Type A, Type B, and Type C based on the bone available within the socket for stabilization of an immediately placed implants.

The use of platelet concentrates such as Platelet-Rich Plasma (PRP), Platelet-Rich Fibrin (PRF) has gained increasing awareness in recent years for regenerative procedures in modern dentistry. PRF was first developed in France by Choukron et al. It is nothing more than centrifuge blood without any anticoagulant, or bovine thrombin. The various platelet concentrates have quite different release kinetics; the advantage of PRP is the release of significantly higher proteins at an earlier period whereas PRF displayed a continual steady release of growth factors like transforming growth factor β (TGFβ-1), platelet-derived growth factors (PDGFs), and insulin-like growth factors (IGFs) over a 10-day period. Furthermore, new formulations of PRF i.e., Advanced-PRF released significantly higher total quantities of growth factors when compared to traditional PRF, hence recommended for long-term release. The presence of immune cells in A-PRF influences the differentiation and maturation of macrophages. This may lead to soft and hard tissue regeneration, mainly through macrophages by growth factor release.

The criteria for success of an implant include no mobility of implant, no peri-implant radiolucency, less marginal bone loss, and no persistent symptoms such as pain, infections, paresthesia, etc., Literature has shown that A-PRF has higher benefits when compared with traditional PRF.

Thus, this study aims to focus on the comparative evaluation of implant stability and bone loss in immediately placed implant in fresh extraction socket with PRF and with A-PRF.