Omar Najah Salman Al-ani 2021, 5
thyear group 12
EFFICACY OF PRF-PLATELET RICH FIBRIN ON IMMEDIATE IMPLANTS VERSUS CONVENTIONAL
IMPLANTS: A LITERATURE REVIEW
Supervisor: Gintaras Juodžbalys Professor, DDS, PhD
Kaunas, 2021
2
FINAL MASTER‘S THESIS IS CONDUCTED
AT THE DEPARTMENT OF ORAL AND MAXILLOFACIAL SURGERY.
STATEMENT OF THESIS ORIGINALITY
I confirm that the submitted Final Master‘s Thesis (
tittle). “EFFICACY OF PRF-PLATELET RICH FIBRIN ON IMMEDIATE IMPLANTS VERSUS CONVENTIONAL IMPLANTS”
1. Is done by myself.
2. Has not been used at another university in Lithuania or abroad.
3. I did not used any additional sources that are not listed in the Thesis, and I provide a complete list ofreferences.
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(2021.04.14) (Omar Al-ani) ( )
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) ( )FINAL MASTER‘S THESIS IS APPROVED AT THE DEPARTMENT
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LITHUANIAN UNIVERSITY OF HEALTH SCIENCES
MEDICAL ACADEMY
FACULTY OF ODONTOLOGY
DEPARTMENT OF ORAL SURGERY
EFFICACY OF PRF-PLATELET RICH FIBRIN ON IMMEDIATE IMPLANTS VERSUS CONVENTIONAL
IMPLANTS
The thesis was done
by student ... Supervisor ...
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Kaunas 2021
4 EVALUATION TABLE OF THE MASTER’S THESIS
OF THE TYPE OF SYSTEMIC REVIEW OF SCIENTIFIC LITERATURE Evaluation: ...
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requirements and evaluation Yes Partially No 1
Summary (0.5 point)
Is summary informative and in compliance with the
thesis content and requirements?
0.3 0.1 0
2 Are keywords in compliance with the thesis
essence?
0.2 0.1 0
3 Introduc- tion, aim and tasks (1 point)
Are the novelty, relevance and significance of the work justified in the introduction of the thesis?
0.4 0.2 0
4 Are the problem, hypothesis, aim and tasks formed clearly and properly?
0.4 0.2 0
5 Are the aim and tasks interrelated? 0.2 0.1 0
6 Selection criteria of the studies, search methods
and strategy (3.4 points)
Is the protocol of systemic review present? 0.6 0.3 0 7
Were the eligibility criteria of articles for the selected protocol determined (e.g.,
year, language,
publication condition, etc.)
0.4 0.2 0
8
Are all the information sources (databases with dates of coverage, contact with study authors to identify additional studies) described and is the last search day indicated?
0.2 0.1 0
9
Is the electronic search strategy described in such a way that it could be repeated (year of search, the last search day; keywords and their combinations;
number of found and selected articles according to the combinations of keywords)?
0.4 0.1 0
10
Is the selection process of studies (screening, eligibility, included in systemic review or, if applicable, included in the meta-analysis) described?
0.4 0.2 0
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Is the data extraction method from the articles (types of investigations, participants,
interventions, analysed factors, indexes) described?
0.4 0.2 0
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Are all the variables (for which data were sought and any assumptions and simplifications made) listed and defined?
0.4 0.2 0
13
Are the methods, which were used to evaluate the
risk of bias of individual studies and how this 0.2 0.1 0
information is to be used in data synthesis, described?
14 Were the principal summary measures (risk ratio, difference in means) stated?
0.4 0.2 0
15
Systemiza- tion and analysis of
data (2.2 points)
Is the number of studies screened: included upon assessment for eligibility and excluded upon giving the reasons in each stage of exclusion presented?
0.6 0.3 0
16
Are the characteristics of studies presented in the included articles, according to which the data were extracted (e.g., study size, follow-up period, type of respondents) presented?
0.6 0.3 0
17
Are the evaluations of beneficial or harmful outcomes for each study presented? (a) simple summary data for each intervention group; b) effect estimates and confidence intervals)
0.4 0.2 0
18
Are the extracted and systemized data from studies presented in the tables according to individual tasks?
0.6 0.3 0
19
Discussion (1.4
points)
Are the main findings summarized and is their relevance indicated?
0.4 0.2 0
20 Are the limitations of the performed systemic review discussed?
0.4 0.2 0
21 Does author present the interpretation of the results?
0.4 0.2 0
22
Conclusion s (0.5 points)
Do the conclusions reflect the topic, aim and tasks of the Master’s thesis?
0.2 0.1 0
23 Are the conclusions based on
the analysed material?
0.2 0.1 0
24 Are the conclusions clear and laconic? 0.1 0.1 0
25
Reference s (1 point)
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0.4 0.2 0
26
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Are the literature sources cited correctly and precisely?
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27 Is the scientific level of references suitable for
Master’s thesis? 0.2 0.1 0
28
Do the cited sources not older than 10
years old form at least 70% of sources, and the not older than
5 years – at least 40%?
0.2 0.1 0
Additional sections, which may increase the collected number of points
29 Annexes Do the presented annexes help to understand the analysed topic?
+0.2 +0.1 0
30
Practical recommen - dations
Are the practical recommendations suggested and
are they related to the received results? +0.4 +0.2 0
31
Were additional methods of data analysis and their results used and described (sensitivity analyses, meta-regression)?
+1 +0.5 0
3 2
Was meta-analysis applied? Are the
selected statistical methods indicated? Are the result s of each meta-analysis presented?
+ 2
+1 0
6
General requirements, non-compliance with which reduce the number of points3 3
Is the thesis volume sufficient (excluding annexes)?
15-20 pages
(-2 points)
<15 page s
(- 5 points) 3
4
Is the thesis volume increased artificially?
-2 points
-1 point 3
5
Does the thesis structure satisfy the requirements of Master’s thesis?
-1 point
-2 points 3
6
Is the thesis written in correct language, scientifically, logically and laconically?
-0.5 point
-1 points 3
7
Are there any grammatical, style or computer literacy-related mistakes?
-2 points
-1 points 3
8
General require- me nts
Is text consistent, integral, and are the volumes of its structural parts balanced?
-0.2 point
-0.5 points 3
9
Amount of plagiarism in the thesis. >20%
(not evalu ated) 4
0
Is the content (names of sections and sub- sections and enumeration of pages) in compliance with the thesis structure and aims?
-0.2 point
-0.5 points
4 1
Are the names of the thesis parts in compliance with the text? Are the titles of sections and sub-sections distinguished logically and correctly?
-0.2 point
-0.5 points 4
2
Are there explanations of the key terms and abbreviations (if needed)?
-0.2 point
-0.5 points 4
3
Is the quality of the thesis typography (quality of printing, visual aids, binding) good?
-0.2 point
-0.5 points
*In total (maximum 10 points):
*Remark: the amount of collected points may exceed 10 points.
Reviewer’s comments:
Table of content
Abstract ... 8
Key words ... 8
Abbreviations ... 9
1. Introduction ... 10
1.1. Aim ... 12
1.2. Task ... 12
1.3. Hypothesis ... 12
2. Materials and methods ... 13
2.1. Literature searching strategy ... 14
2.1.1. Protocol ... 15
2.1.2. Selection of studies ... 15
2.1.3. Assessment of bias ... 16
3. Systemization and analysis of data ... 17
3.1. Results ... 21
3.2. Comparative results ... 21
4. Discussion ... 23
5. Conclusion ... 25
6. Acknowledgments and disclosure statements ...25
7. Practical recommendations ... 25
8. References ... 26
8
ABSTRACT SUMMARY
Introduction:
PRF has been widely used in oral surgery and periodontology due to its great success in improvement of implants. PRF has been combined with immediate and conventional implants to enhance their osseointegration. Many studies have tested the efficacy of PRF on conventional and immediate implants and compared the outcomes without a PRF graft. However, there were no studies that compared PRF’s efficacy on immediate and conventional implants, therefore the aim of this study is to review and compare the efficacy of PRF on immediate and conventional implants, where implant stability, probing depth and alveolar bone height are measured and compared.
Materials and methods:
In this study seven articles in English language of randomized clinical trials were used to review the results and outcomes after a follow-up period. Measurements values post follow-up were compared to the values that were recorded at the time of the surgery. The mean numbers were compared between the two typed of implants to review the results of each testing.
Results:
ISQ values showed greater mean stability in immediate implants compared to conventional after a one-month period, although the increased marginal bone resorption and reduced probing depth compared to conventional implants.
Conclusion:
The wider peri-implant gap in immediate implants might be the crucial factor. Due to it the bone resorption was greater and probing depth were reduced in immediate implants.
Keywords- Immediate implants, osseointegration, implant stability, PRF, platelet rich fibrin
ABBREVIATIONS
PRF- Platelet Rich Fibrin LA- Local Anaesthesia Epi- Epinephrine AB- Antibiotics
ISQ- Implant Stability Quotient F-U- Follow-up
M- Male F- Female PIG- Perioglas
+/- with and withoutIBD- Infra bony defect
RFA- Resonance frequency analysis
FD- Fractal dimension
1. INTRODUCTION
Tooth extraction is nowadays a very common surgical procedure. However, after tooth extraction the alveolar bone undergoes physiologic changes that lead to bone resorption and remodelling. Immediate implant refers to placement of an implant in the alveolar socket immediately after tooth extraction. Such physiological changes might lead to 11-22% loss of alveolar bone height within first 12 months post extraction. Placement of immediate implant can limit those changes on the alveolar socket [5,10,15].
Other benefits of immediate implants are fewer surgeries that makes the treatment shorter which also reduce the risk of infection [8]
Immediate implant requires sufficient primary stability. Presence of infection or a cyst peri- apically weakens the bone and therefore osseointegration of the implant will not be ideal [1,3].
Studies have compared common bone grafting materials, different synthetic and natural material. Study by Medikeri et al. [1] showed that a combination of PRF to the implant as a grafting material placed in per-implant gaps provided greater and faster implant stability and better osseointegration even at infected areas with periapical lesions and cysts as well as weaker type IV of alveolar bone [4,19]. PRF has been used as a grafting material in sinus lift procedures [11,18,20,21], and even in IBD, as it provided a great healing as well as great bone regeneration. PRF membrane has also showed a good soft tissue healing as it might increase gingival thickness and reduced post-operative swelling [9,13,17,22]. In
periodontology injectable-PRF is also used to increase the keratinization of the gingiva [12].
However, some doctors still prefer using conventional implants. Where they are placed until full bone healing that usually takes 3-6 months. The reason for that might be that PRF start to be active only between day 7 and 14, as it releases platelet-derived growth factor AB (PDGF- AB) at day 7 and at day 14 will be the release of the maximum amount of transforming growth factor beta 1 (TGF-B1) together with highest amount of alkaline phosphate.
Conventional implants are still a favourite to many doctors since reaching sufficient primary stability in immediate implants is challenging. Diana et al. [3] have recommended a sufficient primary stability for immediate implant to be at ISQ of 30-60 and they have recommended that a primary stability with ISQ of 20 and less should be avoided, graft the alveolar ridge for preservation and conventional implants are then placed after full bone healing [3].
PRF contains a large amount of platelet and leukocytes. The bone regeneration process is
enhanced by the platelets and leukocytes since they release cytokines. The important growth
factors that PRF is rich with are vascular endothelia growth factor (VEGF) which is important for the skeletal development since it influences angiogenesis. Bone morphogenic protein-1 (BMP-1) is essential for the deposition of extra cellular matrix. Platelet derived growth factor (PDGFs) and insulin-like growth factor-1 (IGF-1) showed great enhancement for the
generation of osteoblasts [14,15].
Other types of cells are macrophages. They are essential for bone regeneration as they promote osteogenesis and enhance the activity of bone formation, therefor using of PRF might decrease the post-surgical inflammation and increases the production of osteoblasts by inhibiting osteoclasts regeneration [22].
Preparation of PRF
Blood was taken from antecubital vein and collected in a 9 ml glass-coated plastic tubes without adding anti-coagulators. The tubes are centrifuged at 3000 rpm for 10 minutes. A fibrin clot is formed as shown in Fig.2 A, the clot is removed with sterile gauze Fig2 C. The clot is placed in a PRF compressing perforated tray (process Ltd) and slight pressure applied by the cover. The serum if the compressed clot is transferred to a syringe Fig.2B [18].
Fig.1 Preparation of PRF [16]
Implant Stability Quotients ISQ
The stability of conventional and immediate implants were measures using the Osstell device
for evaluation of RFA. The healing cap is removed, and the transducer (SmartPeg) is screwed
into the implant. The transducer will be sending a magnetic resonance and the frequency is
measured by the Osstell device and indicate the stability values. An implant that has an ISQ
higher than 60 is indicated as a successful implant, and primary stability of 30-60. [4]
12
Probing Depth and Bleeding on ProbingThe pockets were measured by William’s periodontal probe starting after one month.
Bleeding on probing was indicated if there is bleeding 15 seconds after probing or undetected bleeding [7].
Crestal Bone Hight
Periapical radiographs were taken to assess bone levels and peri-implant bone quality. Bone high is measured on the x-ray from implant shoulder to the level of the bone [3].
1.1.Aim: the purpose of this systematic review is to evaluate and compare the efficacy of PRF on immediate implants versus conventional implants.
1.2.Task: to evaluate the outcomes of each study group with immediate and conventional implants and compare the results to determine the efficacy of PRF on immediate and conventional implants.
1.3. Hypothesis: this systematic review hypothesizes that PRF ensures a higher stability of
conventional implants as well as reduced marginal bone resorption and probing depth
compared to immediate implants.
2. SEARCH METHODS AND STRATEGY
Bioethics approval code: BEC-OF-93 Focus question:
The following focus question was developed according to the population, intervention, comparison and outcome (PICO) study design.
Table 1. PICOS criteria
PICOS CRITERIA
Population Adult patients in need of implant treatment
Intervention Immediate and conventional implants
outcomes in combination with PRF
Comparison Immediate and conventional implant with
PRF
Outcomes Improved healing for soft and hard tissues
as well as improved implant stability
Study type Randomized controlled trials
Focus question Does the efficacy of PRF on implants differ
between immediate and conventional implants?
Types of publications
The systematic review included studies on humans published in the English language.
Types of studies
The systematic review included all human studies published on 2015-2021, that reported the treatment outcomes of immediate and conventional implant with a combination of PRF as a grafting material.
Population
Adult patients with no underlying systemic diseases or periodontal infection, that have
undergone tooth extraction and required a dental implant treatment.
14 Information sources
Information sources were searched on PubMed and ScienceDirect, Biomed Central, Sage journals and Taylor & Francis databases.
Systematic review organization
This systematic review was conducted under the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) Fig.2. Regulations and recommendations in order to analyse and determine the possible effects and outcomes of the use of PRF as a grafting material with immediate and conventional implants.
2.1. Literature searching strategy
2.1.1. Protocol
The electronic data research was performed on PubMed for articles in English language that were published year 2015-2021. An electronic literature research was carried out for
searching of different articles from different scientific recourses and included the keywords that were selected. MesH terms in medical and dental subjects’ headings were used to increase the precision of the search as well as finding articles with those keywords regardless the terminologies that were given by the author. Therefore, the keywords that were used in the search were as the following combination: "immediate implants" [Text Word] OR "immediate implants" [Mesh] AND "PRF-platelet rich fibrin" [Text Word] OR "PRF-platelet rich fibrin"
[Mesh] AND "implant stability" [Text Word] OR "implant stability" [Mesh] AND "implants"
[Text Word] OR "implants" [Mesh]. Additional keywords that were used: "immediate implant", "PRF", "platelet rich fibrin", "bone graft", "mineralized bone", "implant stability",
"bone regeneration","bone augmentation", "osteoinduction", "osteoconduction" and
"osseointegration". Then the search was narrowed to studies in English language that were performed on humans and that were published on January 1st, 2015, till January 25th, 2021.
2.1.2. Selection of studies
The articles presented randomized clinical trials where PRF was combined with conventional and immediate implants. The author reviewed all the articles that were selected from
electronic resources. Titles and abstracts were screened and reviewed to evaluate the inclusion
and exclusion criteria. RCT with Patients in need of implant and that did not present any periapical nor periodontal lesion were included in the studies. Studies that used a different method than ISQ for implant stability measurement were excluded from the review. Studies which investigated patients with smoking habits were excluded as smoking might affect the outcomes.
The articles that were found and after duplication removal were 1643. After screening and abstract reading, they were narrowed down to 48. Those articles were full text read and narrowed further down to 7 that were included in this study.
Inclusion and exclusion criteria
Those criteria were adjusted in order to help the author to find and identify relevant articles for the review. In order to assess the references for eligibility, titles, and abstracts of the initially selected articles, when electronic research for database was done, were reviewed to evaluate if the articles meet inclusion criteria. Articles that did not meet the inclusion criteria were not added to this study. The criteria were as followed:
Inclusion criteria
- Randomized clinical trials and clinical trials not older than 6 years
- Healthy patients in need of implants, absent of any systemic diseases or drug use that could compromise the study
- Patients with no periodontal diseases or periapical infections - Adult patients
- Articles using immediate and conventional implants with PRF - English language articles
Exclusion criteria
- Implant stability evaluated in other ways than ISQ
- Systematic reviews, meta-analysis, case series or single case studies, commentaries, letters.
- Animal studies
- Unhealthy patients or with parafunctional habits
16
2.1.3. Assessment of biasIncluded articles were reviewed and assessed by The Cochrane recommendations for systematic reviews of interventions by using bias assessment tool Cochrane Rob 2. The six key domains were included when evaluating studies.
Two of the studies were unclear risk of bias and five were at low risk. (table 2)
Table 2
Cochrane Rob 2 risk of bias
Study Year of
publicat ion
Random selection
Allocation concealment
Binding of participants and personnel
Binding of outcome assessment
Incomplete data outcome
Selective reporting
Bias conclusion
Diana et al.
[3]
2018 + + - ? - + Low risk
Öncu et al.
[2]
2015 ? + - ? - + Unclear
Tabrizi et al.
[4]
2017 + + - ? - + Low risk
Öncu et al.
[5]
2015 + + - ? - + Low risk
Kalash et al.
[6]
2017 + + - ? - ? Unclear
Boora et al.
[7]
2015 + + - ? + + Low risk
Shabaz et al.
[8]
2020 + + - ? - + Low risk
+ = low risk, ? = unclear Bias, - = high risk
Table 3
Searching method and databases
Date of Search Database Keywords Results
2021-03-10 Pubmed ((((((((Immediate implant) OR (prf)) OR
(platelet rich fibrin)) OR (implant stability)) OR (dental implant) ) OR (platelet rich fibrin
immediate implants)) OR (immediate implants osseointegration)) OR (immediate implant stability)) OR (prf implant)
1434
2021-02-23 BioMed Central Search 1 - platelet rich fibrin implant
Search 2- platelet rich fibrin immediate implant 98 78
2021-02-23 Sage journals Search 1
All platelet rich fibrin implant within Research Article
[Publication Date] 2015-2021
111
2021-02-23 Taylor & Francis Search 1
[All: platelet rich fibrin implant] AND [All Subjects: Dentistry] AND [Publication Date: (01/01/2015 TO 31/12/2021)]
3
18 Records identified through
database searching (n = 1724)
Records after duplicates removed (n = 1643)
Additional records identified through other sources
(n = 0 ) Taylor &
Francis (n=3) Sage
journals (n=111) BioMed
Central (n=176) PUBMED
(n=1434)
search: 2021-02-23
Fig. 2
PRISMA flowchart diagram [23]
Full-text articles assessed for eligibility (retrieved through hand
search
Studies included in qualitative synthesis
(n = 7)
Full-text articles excluded, with reasons
(n = 41) Irrelevant objective: 11 Unrelated outcome: 10 Medical (non-odontology): 3 Non-implant: 7
Study design:
• Not a study: 1
• Review: 2
• Case report: 2
• Non-randomized clinical study: 2 Records excluded (by
abstract reading) (n = 1595) Records screened
(n = 1643)
IncludedEligibilityScreeningIdentification
3. SYSTEMIZATION AND ANALYSIS OF DATA
Table 4
Characteristics of included studies
Reference Year Partici pants
Mean Age or
age range
Intervention Duration of treatment (months)
Surgical procedure Outcomes Follow-
ups
Diana et al. [3]
2018 31 patien
ts (18M,
13F)
Mean age 28,5 years
Immediate implant +/-
PRF
12 months F-U
- PRF prepared (Choukroun’s protocol), then compressed.
- LA (lidocaine + epinephrine).
- Extraction.
- examination of the socket.
- Osstem TS implants were prepared and inserted.
- suturing the socket using buccal/labial advancement flap.
- peri implant probing depth was not significant between groups.
- FD value was lower in testing group.
- bone Hight was slightly greater in testing group.
- similar ISQ in both groups
1 week 3 months 6 months 1 year
Oncu et al. [5]
2015 26 patien
ts (16M,
10F)
Mean age 40,2 years
Immediate Implants +/-
PRF
12 months F-U
- preparation and centrifuging of PRF then
compressing.
- LA (Ultracaine).
- crestal incision and flap reflection.
- tooth extraction and socket irrigation.
- implants placed 2mm below socket margin.
- flap brought to place.
-implant stability was greater in the study
group.
-marginal bone resorption was greater
in the control group.
1 month 3 months 1 year
Kalash [6]
2017 18 patien
ts (10M,
8F)
Mean age 31,64 years
Immediate implant +/-
PRF
9 Months
F-U
- LA (articaine + epi) - Atraumatic extraction
- Curettage and irrigation of the socket
- Drill implant site - Implant placement
- PRF in the peri-implant gap
PRF enhances osseointegration, stability and wound
healing but not a significant difference
between the groups.
2nd day 1 week 2 weeks 3 months 9 months
Oncu et al. [2]
2015 20 patien
ts (14M,
6F)
Mean age 44,2 yea
rs
Conventional implant +/-
PRF
1 month F- U
- LA (Ultracaine) - Crestal incision and flap elevated
- osteotomy according Ankylos implant system - Implant placed 1.5 mm below alveolar crest - PRF in the Peri-implant gaps
- Healing caps left uncovered - Flap suturing
-Grafting the peri implant space increased the stability
during the initial phases according to
ISQ measurements as well as improved
osseointegration.
1 week 4 weeks
Tabrizi et al. [4]
2017 20 patien
ts (9M,1
1F)
Mean age 39,6 years
Conventional implant +/-
PRF
12 weeks - Crestal incision - Full-thickness flap
elevated - Implant was prepared
according BEGO
- PRF enhances the osseointegration of the implant at type IV
bone
2 weeks 4 weeks 6 weeks 12 weeks
20
- PRF prepared and placed in peri-implant gap - Healing abutment placed
- Flaps sutured back together
Boora et 2015 20 Mean One-Stage 3 months F- - Full-thickness flap - All implants with 1 month
al. [7] Patien age Implant +/- U elevated and without PRF were 3 months
ts 24,6 PRF - Osteotomy for implant osseointegrated
(15M, years insertion successfully
5F) - PRF placed in the peri- - Crestal bone high
implant spaces was similar in both - laps were sutured back group but slightly
greater in PRF+
- No noticed difference in periodontal pockets
and bleeding on probing between the
groups.
Alam et 2020 30 Age Immediate 12 months - AB prophylaxis (2g All the immediate 3 months al. [8] patien range: implant +/- F-U amoxicillin + potassium implants that were 6 months
ts 18-45 PRF, clavunate) combined with PIG 12 months
(ungiv years PRF+Periogla - LA (2% Lidocaine + by itself, PRF by itself
en s Epi) 1:200 000 and PRF together with
gende - Atraumatic tooth PIG have showed
rs) extraction good results and
- Curettage and irrigation successful of the socket osseointegration.
- Osteotomy and implant placement 2mm below
CEJ of adjacent tooth - Peri-implant gap was
filled with PRF
PRF- Platelet Rich Fibrin; LA- Local Anaesthesia; Epi- Epinephrine; AB- Antibiotics; F-U- Follow-up; M- Male; F- Female; PIG- Perioglas; +/- with and without; FD- Fractal
dimension; ISQ- Implant stability quotient
Results
The highest mean implant stability was achieved by immediate implants with PRF.
Conventional implants with PRF had lowest marginal bone resorption as well as deepest pocket depth.
Seven studies were included in qualitative analysis where five of them were at low risk of bias and two were at unclear risk. The studies included 165 adult patients with need of implant treatment. The post-operative follow-up ranged between 1 week and 12 months. Every study combined PRF as a grafting material in both immediate and conventional implants for enhancement of implant outcomes.
The patients were observed and followed-up for the periods between 1 week and 12 months.
3.1.Comparative results Table 5
Implant stability quotient
Önu et al. [5]
Immediate implant + PRF (mean±SD)
Önu et al. [2]
Conventional implant + PRF (mean±SD)
Baseline 26.10 ± 12.83 59.39±15.88
1 week 54.39 ± 15.88 69.29±10.51
4 weeks 69.99 ± 11.87 77.19±6.6
When comparing mean ISQ of immediate implant with PRF from baseline till first month of follow up the result was 43.83 ± 0,96. Conventional implants with PRF had a mean ISQ of 17.81 ± 14,16 after the fourth week. Those results indicating that immediate implants together with PRF achieved a significant mean stability, although conventional implants ISQ was greater at baseline and after 4 weeks.
Fig. 3 ISQ during F-U periods
Implant stability
80 60 40 20 0
baseline 1 week 2 weeks 3 weeks 4 weeks conventional immeddiate
22
Table 6Marginal Bone Resorption (mm) Diana et al. [3]
Immediate implants + PRF (mean±SD)
Boora et al. [7]
Conventional implant + PRF (mean±SD)
Baseline:
Mesial: 1.64 ± 1.47 Distal: 1.39 ± 1.48
Baseline-3 months:
Mesial: 0.25 ± 0.06 Distal: 0.27 ± 0.07 3 months:
Mesial: 1.18 ± 1,26 Distal: 0.9 ± 1.32
Mean marginal bone loss was greater in immediate implants with PRF was 0.46 ± 0.21 mm on mesial side and 0.49 ± 0.16 mm on distal side compared to 0.25 ± 0.06 mm mesial and 0.27 ± 0.07 mm distal side in conventional implants with PRF.
Table 7
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