1

‫ِل‬ ‫ِذ‬
‫اْلَحْمُد ا ي َهَداَنا َذا "‬ ‫َّل‬ ‫ِه‬ ‫ِل‬
‫َّل‬
‫َٰه‬ ‫ِد‬ ‫ِل‬
‫َوَما ُكَّنا َنْه َت َي َلْواَل َأْن َهَداَنا‬
‫ُه‬‫َّل‬ ‫ل‬‫ا‬ ‫"‬
‫األعراف (‪)43‬‬
 CLINICAL AND RADIOGRAPHICAL ASSESSMENT OF
THE ROLE OF PLATELET RICH FIBRIN WITH DELAYED
SHORT DENTAL IMPLANTS PLACEMENT
(COMPARATIVE CLINICAL STUDY)

Thesis submitted as a partial fulfillment for obtaining

Master degree in Oral Medicine and periodontology

By
Amr Yousef Kamal Aly Elshahawy
B.D.S (2013), Diploma (2020)
Faculty of Dentistry, Mansoura University
 SUPERVISORS

Dr. Laila Ibrahim Ragab

Associate Professor of Oral Medicine and Periodontology.
Oral Medicine , Periodontology, Oral Diagnosis and Radiology Department
Faculty of Dentistry - Mansoura University

Dr. Ayman Abdel Rahim Elkashty

Lecturer of oral medicine & Periodontology
Oral medicine, Periodontology, Oral Diagnosis and Radiology Department
Faculty of Dentistry - Mansoura University

Dr. Mohamed Abd El-Rahman Ellayeh

Associate Professor of Fixed Prosthodontics.
Fixed Prosthodontics Department.
Faculty of Dentistry - Mansoura University
Introduction
 6

In severe alveolar resorption, standard-length implant (≥10mm) placement is not possible without additional surgical
interventions including bone grafting, sinus floor augmentation, distraction osteogenesis, mandibular nerve transposition and
zygomatic implant placement.
Over the years, various strategies have been proposed to overcome the dimensional limitations of the bone available for
implant placement. Short implants have been proposed as an alternative choice for the prosthetic treatment of atrophic
alveolar ridges, which may provide surgical advantages including reducing morbidity, treatment time, and costs.
Although the predictability of short implants was initially controversial due to decreased bone-to-implant
contact, The survival rate of single crowns in the posterior area showed no significant differences between
the short implant group and the long implant group [1].
Enveloping the implant with platelet rich fibrin significantly speeds up the healing process and tissue
regeneration. The soft tissue healing occurs at an accelerated rate. It also reduces and repairs the small
osseous defects.
One of the most desirable features of PRF is its efficacy in providing concentrated growth factors at the surgical site to
stimulate the healing process. PRF is considered as a healing biomaterial and it has a stimulating effect on various aspects
of healing of soft and hard tissues including angiogenesis, immune control, harnessing the circulating stem cells.
AIM OF THE
WORK
 The primary objective of this study was to evaluate the primary and
secondary implant stability of the short dental implants placed in the posterior
edentulous area alone or with the application of platelet rich fibrin.

Whereas the secondary objective was to assess the marginal bone loss
radiographically using CBCT and digital periapical parallel technique.
PATIENTS AND
METHODS
I– Study population and patients' selection:

A total of sixteen short implant (length = 6-8 mm) were placed in periodontally healthy
patients with missing posterior molar teeth in need of implant placement. Participants were
selected from the outpatient clinic in the department of Oral Medicine and Periodontology,
Faculty of Dentistry, Mansoura University. All participants had thorough clinical
examination as well as a preoperative Cone Beam Computed Tomography (CBCT), putting
in our concern the following inclusion and exclusion criteria.
• I N C L U S I O N C R I T E R I A :

 Patients with missing posterior molar tooth /teeth.

 Patient’s age range between 18 and 60 years old included both genders.

 Sufficient bone width mesio-distally and bucco-lingually at least 6 mm in both

directions.

 Maximum bone height not more than 10 mm.

• EXCLUSION CRITERIA:

 Patients having any uncontrolled systemic disease which could affect bone healing.

 Patients treated with radiotherapy to the head and neck area within the past 12 months.

 Heavy Smokers (more than 20 cigarette per day).

 Inability or unwillingness to return for follow-up visits.

 Known pregnancy.

 Patients with abnormal parafunctional behaviors such as clenching and grinding, etc.
II- STUDY DESIGN:
Patients were classified into two main groups:
1) Study group: A total of 8 patients were included in this group. They received short dental implants with PRF application at
the osteotomy sites.
2) Control Group: A total of 8 patients were included in this group. They received short dental
implants only at the osteotomy sites.
METHODOLOGY :
CLINICAL EXAMINATION & PREOPERATIVE MEASURES:

Complete medical and dental histories were taken from all patients before the beginning of any surgical procedures. After
that, the planned surgical sites were assessed for [Mesio-distal and the bucco-lingual dimensions of the surgical site.
• A detailed medical and dental history of each subject was obtained along with preoperative
photographs and radiographs. The surgical area selected for dental implant placement was
evaluated clinically for width and to assess for any deep undercuts.

• CBCT was used to accurately evaluate the amount of bone and proximity from vital
structures for each patient. A complete oral prophylaxis along with prescription of 0.2%
chlorhexidine gluconate mouth rinse, twice daily for a period of 15 days before dental
implant placement was advised.

• All subjects were motivated to maintain good oral hygiene.

Study group :
Surgical phase:
PROSTHETIC PHASE:
RADIOGRAPHIC
EVALUATION:
CONTROL GROUP :
SURGICAL PHASE:
PROSTHETIC AND RADIOGRAPHIC PHASE:
• Periodontal assessment:

All patients were seen once monthly for three months following the surgical
procedures to ensure that they were maintaining good oral hygiene measures and
that there were no any complications related to these surgical procedures.

Moreover, the following criteria were evaluated for all patients once after
three months from implant placement (T1) and again after another three months
(T2):
IMPLANT STABILITY ASSESSMENT:

Implant stability was evaluated by recording the ISQ (implant stability

quotient) levels measured by Osstell ISQ device at the time of implant

placement (T0) and at the time of the prosthetic phase before abutment

placement (T1).
SOFT TISSUE ASSESSMENT : -

Soft tissue assessment was conducted at (T1) three months after the implant

placement during the prosthetic phase and at (T2) three months after

prosthesis placement which included the following:

 MODIFIED PLAQUE INDEX (MPI):-

score criteria

0 No detection of plaque.

1 Plaque only recognized by running the probe across the smooth marginal surface of the dental implant.

2 Plaque can be seen by the naked eye

3 Abundance of the soft matter.

PERI-IMPLANT PERIODONTAL PROBING DEPTH (PPD):

Measurements were evaluated at six sites per each implant which were
measured by taking the reading from the free gingival margin to the
base of the pocket. The mean score of the implant was obtained by
adding the six scores and dividing it by six.
RESULTS
TABLE (1) SHOWS THE DEMOGRAPHIC DATA OF THE STUDY
GROUPS:

Control Study
Groups P value
N=8 N=8
Age/years
41.75±10.47 45.38±11.71 P= 0.5245
Mean±SD
Sex N (%)
4 (50%) 3 (37.5%)
Female P= 1
4 (50%) 5 (62.5%)
Male
TABLE (2): SHOWS THE MODIFIED PLAQUE INDEX (MPI) OF THE STUDY GROUPS:

Control Study
Groups P value
N=8 N=8

T1 1.03± 0.28 0.66 ± 0.23 P = 0.0073*

mPI
Mean±SD
T2 0.59 ± 0.19 0.34 ± 0.19 P = 0.0297*

Comparison between T1-T2 P= 0.0012* P= 0.021*

TABLE (3): SHOWS THE PERI-IMPLANT PROBING DEPTH (PPD) OF THE STUDY
GROUPS:

Control Study
Groups P value
N=8 N=8

T1 3.56± 0.18 2.63± 0.23 P = 0.0002*

PPD
Mean±SD T2 2.88± 0.44 2.06± 0.32 P = 0.004*

Comparison between T1-T2 P= 0.0012* P= 0.0044*

 TABLE (4): SHOWS THE RESONANCE FREQUENCY ANALYSIS (RFA) BUCCO-
LINGUAL (BL) AND MESIO-DISTAL (MD) OF THE STUDY GROUPS:

Control Study
P value
Groups N=8 N=8

BL MD BL MD BL MD

T0 57.88±1.13 58.13±1.36 59.50±2.20 60.13±2.85 P=0.0688 P=0.1675

RFA
Mean±SD
T1 63.75±1.6 66.75±1.4 69.50±1.0 70.25±1.4 P=0.0002* P=0.0005*

Comparison
P=0.0002* P=0.0002* P=0.0002* P=0.0002*
between T0-T1
 TABLE (5): SHOWS THE AMOUNT OF CRESTAL BONE LOSS IN THE STUDY
GROUPS MESIAL AND DISTAL:

Control Study
P value
Groups N=8 N=8

M D M D M D

T0 0.98±0.21 0.93±0.17 0.98±0.31 0.94±0.18 P>0.9999 P=0.8891

Crestal bone loss

T1 0.83±0.14 0.84±0.13 0.49±0.19a 0.58±0.17a P=0.0011* P=0.0035*
Mean±SD

T2 0.71±0.08a 0.75±0.12 0.36±0.14a 0.38±0.15a P<0.0001* P<0.0001*

Comparison between T0-T1 P=0.0266* P= 0.067 P=0.0003* P<0.0001*

CONCLUSIONS & RECOMMENDATIONS
1. PRF improved the hard tissue conditions around short dental implants
placed more than short implants placed without PRF, as it was found that the
osseointegration obtained at the study group with PRF was much improved
than the control group without PRF, also the amount of crestal bone loss at the
control group was less than that at study group. PRF might enhance implant
stability during the early phase of osseointegration.
2. Improve soft tissue conditions around the short dental implants placed.
There is a lack of adequate studies for implant placement, soft tissue healing,
and postoperative pain, although the preliminary data seems promising.
Recommendations:

1. Further studies with longer follow up period are required to adequately assess the
effect of PRF on the soft and hard tissue surrounding short dental implants and also
to assess the effect of PRF on periodontal clinical parameters.

2. Further studies to assess any other therapeutic protocols and any limitations and
indications of the use of PRF.

3. Further studies compare sufficient data and therapeutic advantages of PRF over other
agents.
THANK YOU FOR YOUR
ATTENTION