|Year : 2020 | Volume
| Issue : 1 | Page : 1-4
Compare the efficacy of healing in mandibular third-molar sockets using the combination of platelet-rich fibrin and Biograft-HT®with that of platelet-rich fibrin alone
MD Shakeeb Ullah1, Sumanth Unakalkar2, HK Ramya2, Prathibha Reddy2, KB Srikanth3, G Vijayalakshmi4
1 Senior Lecturer, Department of Oral and Maxillofacial Surgery, Bangalore Institute of Dental Sciences, Bangalore, Karnataka, India
2 Reader and Senior Lecturer, Department of Oral and Maxillofacial Surgery, K. V. G. Dental College and Hospital, Sullia, Karnataka, India
3 Senior Lecturer, Department of Oral and Maxillofacial Surgery, K. V. G. Dental College and Hospital, Sullia, Karnataka, India
4 Department of Oral and Maxillofacial Surgery, K. V. G. Dental College and Hospital, Sullia, Karnataka, India
|Date of Submission||05-Mar-2020|
|Date of Acceptance||09-Mar-2020|
|Date of Web Publication||24-Mar-2020|
Department of Oral and Maxillofacial Surgery, K. V. G. Dental College and Hospital, Kurunjibagh, Dakshina Kannada, Karnataka
Source of Support: None, Conflict of Interest: None
Aim and Objectives: The aim of this prospective clinical study was to compare the efficacy of a combination of Platelet Rich Fibrin (PRF) and biograft- HT® with that of platelet rich fibrin alone in healing of impacted mandibular third molar sockets after surgical removal of the same. Objectives were to compare the post-operative pain, swelling, trismus, periodontal health distal to mandibular second molar, quality of bone healing at the mandibular third molar socket at various time intervals.
Methodology : This was split mouth study where PRF and biograft- HT® was placed on one side of the third molar extraction socket and PRF alone was placed on the other side in 15 patients with bilaterally impacted 3rd molars.
Results: There was no statistically significant difference seen in any of the parameters
Conclusion: This study does not prove statistically significant improvement in the efficacy of combination of PRF with Biograft- HT® when compared to PRF alone. The addition of Biograft- HT® to PRF increases the cost of the treatment while PRF alone is cost effective as it is prepared with patient“s own blood. Hence, the addition of Biograft- HT® to PRF can”t be recommended based on our study alone.
Keywords: Biograft-HT®, healing, mandibular third-molar, pain, platelet-rich fibrin
|How to cite this article:|
Shakeeb Ullah M D, Unakalkar S, Ramya H K, Reddy P, Srikanth K B, Vijayalakshmi G. Compare the efficacy of healing in mandibular third-molar sockets using the combination of platelet-rich fibrin and Biograft-HT®with that of platelet-rich fibrin alone. Int J Prev Clin Dent Res 2020;7:1-4
|How to cite this URL:|
Shakeeb Ullah M D, Unakalkar S, Ramya H K, Reddy P, Srikanth K B, Vijayalakshmi G. Compare the efficacy of healing in mandibular third-molar sockets using the combination of platelet-rich fibrin and Biograft-HT®with that of platelet-rich fibrin alone. Int J Prev Clin Dent Res [serial online] 2020 [cited 2020 Aug 14];7:1-4. Available from: http://www.ijpcdr.org/text.asp?2020/7/1/1/281339
| Introduction|| |
Third molars are present in 90% of the population, with 33% having at least one impacted third molar. In most of the situations, it results in recurrent pericoronitis, caries to adjacent tooth, cyst, etc. Because of these, the surgical removal of the third molar is one of the most frequently performed procedures in oral and maxillofacial surgery. Socket healing is a highly co-ordinated sequence of biochemical, physiologic, cellular, and molecular responses involving numerous cell type growth factors, hormones, cytokines, and other proteins, which is directed toward restoring tissue integrity and functional capacity after injury. Third-molar socket provides a very good study model to assess the role of various biomaterials in healing. It is known that platelets play a crucial role not only in hemostasis but also in the wound-healing process. Platelet-rich growth factors as described by Choukroun et al., a second-generation platelet concentrate, are very successful in stimulating bone regeneration and promote healing after the surgical removal of third-molar tooth. Alloplastic bone graft materials are believed to promote the healing of bone defects through osteoconduction. Several calcium phosphate biomaterials have been tested since the mid-1970s. The two types of calcium phosphate ceramics which have been used are hydroxyapatite (HA) and tricalcium phosphate. Biograft-HT® is a biphasic calcium phosphate consisting of HA and beta-tricalcium phosphate in the weight percentage ratio of approximately 60:40 that is biocompatible, nontoxic, resorbable, noninflammatory, bioactive and has the excellent osteoconductive ability. HA has a stoichiometry similar to natural bone and provides an osteoconductive scaffold in the bone regenerative process. There are several studies to assess the role of platelet-rich fibrin (PRF) in healing sockets as well as bony defects; similarly, there are studies to establish the role of alloplastic materials such as HA as well as Biograft-HT® in healing of bony defects in the oral cavity.[5-9] However, there is no single study that compares the efficacy of PRF with that of a combination of PRF with Biograft-HT® in third-molar healing sockets. We believed that there is a need to continuously look for newer biomaterials or combinations of existing alloplastic materials with autografts to find out any additional advantage and superiority exists in terms of healing. This study is an attempt in that direction. Hence, we felt that there is a need for a study to compare the efficacy of a combination of PRF and Biograft-HT® with that of PRF alone in impacted mandibular third-molar sockets.
| Methodology|| |
Fifteen individuals with the age group of 18–40 years who reported with bilateral impacted lower third molars were the study participants.The patients were selected as per the inclusion and exclusion criteria. This was a split-mouth study where the impacted lower third molars on either side were divided into two groups:
- Group A – Those in which PRF in combination with Biograft-HT® was placed in the extraction socket
- Group B – Those in which only PRF was placed into the extraction socket.
In every patient, one side belonged to Group A, and the other belonged to Group B. In every odd patient, PRF in combination with Biograft-HT® was placed in the left socket, and PRF alone was placed in the right socket. In every even patient, PRF in combination with Biograft-HT® was placed in the right socket, and PRF alone was placed in the left socket. All the patients were informed about the study, and necessary consent was obtained. All necessary preoperative, intraoperative, and postoperative photographic records were maintained for these patients. Moreover, all treatments were performed on an outpatient basis. Both right and left impacted molars were treated by the same surgeon, with a time interval of minimum 30 days.
| Results|| |
Pain was more on the 1st postoperative day and is gradually reducing from the 1st postoperative day to 14th postoperative day for both the groups. However, the mean Visual Analog Scale (VAS) scores between the study groups did differ significantly, P < 0.5, P = 0.45, and P = 0.26 for day 1, 3, and 7, respectively [Table 1]. The swelling measurements were obtained on the 1st, 3rd, 7th, and 14th postoperative days for both Group A and Group B in 15 patients. The swelling was more on the 1st postoperative day and is gradually reducing from the 1st postoperative day to 14th postoperative day in both the groups, but statistically insignificant (P > 0.5) [Table 1]. The highest measurement was 114 mm in tragus to oral commissure and 99 mm when measured from the angle of mandible to lateral canthus of the eye. The interincisal opening was less on the 1st postoperative day and is gradually increasing from the 1st postoperative day to 14th postoperative day for both the groups. In both the groups, there was a statistically significant reduction in trismus from day 1 to day 7 as per the repeated measures of ANOVA at P < 0.001. However, there was no statistically significant difference in terms of trismus reduction between the two groups on postoperative day 1, but was significant on the 3rd and 7th postoperative day (P < 0.5) [Table 1].
|Table 1: Comparision of mean pain score, swelling, trismus at different post-operative days|
Click here to view
[Table 2] depicts lamina dura scores and trabecular pattern scores and overall density is less on 8 weeks postoperative values and improved in 16 weeks postoperative values.
|Table 2: Comparison of bone-healing parameters among the study groups using the McNemar Test|
Click here to view
| Discussion|| |
The present study compares the clinical effectiveness of PRF in combination with Biograft-HT® with that of PRF alone. The values of pain was assessed at specific time intervals post operatively using VAS and there was significant decrease in pain in the socket placed with PRF similar to the study done by Ogundipe et al. According to the study done by Ogundipe et al. reduced swelling was noticed after the use of platelet rich concentrates in 3rd molar extraction socket. In our study, the swelling was more on 1st post-operative day and is gradually reducing from 1st post- operative day to 14th post – operative day in both the groups, but it was statistically insignificant (P>0.5). The method described by Ogundipe et al. for trismus reported reduced mouth opening after the use of platelet rich concentrates in 3rd molar extraction socket. In our study the interincisal opening was less on the 1st postoperative day and gradually increased from the 1st postoperative day to 14th postoperative day for both the groups. However, there was no statistically significant difference in terms of trismus reduction between the two groups. The fourth parameter was periodontal health. Probing depth was measured at specific time intervals, and after evaluating the values, the data obtained were not statistically significant. These results did not show a significant improvement in periodontal healing in both the sockets in Group A and Group B patients, in terms of probing depth and alveolar bone height in relation to the second molar, and the study results were seen by the similar to the study done by Pradeep et al. This can be attributed to significant slow-sustained release of key growth factors for at least 7–28 days, and growth factors play a vital role in increasing angiogenesis, vessel permeability, and acts as chemoattractant for neutrophils and fibroblasts.
| Conclusion|| |
Our study does not prove a statistically significant improvement in the efficacy of the combination of PRF with Biograft-HT® when compared to PRF alone. Further, the addition of Biograft-HT® to PRF increases the cost of the treatment while PRF alone is cost-effective as it is prepared with the patient's own blood.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Ogundipe OK, Ugboko VI, Owotade FJ. Can autologous platelet-rich plasma gel enhance healing after surgical extraction of mandibular third molars? J Oral Maxillofac Surg 2011;69:2305-10.
Del Fabbro M, Bortolin M, Taschieri S. Is autologous platelet concentrate beneficial for post-extraction socket healing? A systematic review. Int J Oral Maxillofac Surg 2011;40:891-900.
Célio-Mariano R, de Melo WM, Carneiro-Avelino C. Comparative radiographic evaluation of alveolar bone healing associated with autologous platelet-rich plasma after impacted mandibular third molar surgery. J Oral Maxillofac Surg 2012;70:19-24.
Choukroun J, Diss A, Simonpieri A, Girard MO, Schoeffler C, Dohan SL, et al
. Platelet-rich fibrin (PRF): A second-generation platelet concentrate. Part IV: clinical effects on tissue healing. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;101:e56-60.
Chandrashekar KT, Saxena C. Biograft-HT as a bone graft material in the treatment of periodontal vertical defects and its clinical and radiological evaluation: Clinical study. J Indian Soc Periodontol 2009;13:138-44.
] [Full text]
Nazaroglou I, Stavrianos C, Kafas P, Matoulas E, Upile T, Barlas I, et al
. Radiographic evaluation of bone regeneration after the application of plasma rich in growth factors in a lower third molar socket: A case report. Cases J 2009;2:9134.
Gröndahl HG, Lekholm U. Influence of mandibular third molars on related supporting tissues. Int J Oral Surg 1973;2:137-42.
Dohan DM, Choukroun J, Diss A, Dohan SL, Dohan AJ, Mouhyi J, et al
. Platelet-rich fibrin (PRF): A second-generation platelet concentrate. Part III: Leucocyte activation: A new feature for platelet concentrates? Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;101:e51-5.
García AG, Sampedro FG, Rey JG, Vila PG, Martin MS. Pell-Gregory classification is unreliable as a predictor of difficulty in extracting impacted lower third molars. Br J Oral Maxillofac Surg 2000;38:585-7.
Pradeep AR, Rao NS, Agarwal E, Bajaj P, Kumari M, Naik SB. Comparative evaluation of autologous platelet-rich fibrin and platelet-rich plasma in the treatment of 3-wall intrabony defects in chronic periodontitis: A randomized controlled clinical trial. J Periodontol 2012;83:1499-507.
Ozdemir H, Ezirganli S, Isa Kara M, Mihmanli A, Baris E. Effects of platelet rich fibrin alone used with rigid titanium barrier. Arch Oral Biol 2013;58:537-44.
[Table 1], [Table 2]