Augmentation with allograft mixed Platelet Rich Fibrin in anterior segmental severe bone loss

Abstract

Background: It is a common argument that severe bone loss can't be tolerated for immediate implant placement. Onlay block grafting, distraction osteogenesis, crest split, application of various growth factors to promote bone formation, bone ring, or combinations thereof, are applied in moderate or severe loss. Aim/Hypothesis: The allograft mixed Platelet Rich Fibrin material obtained from the patient's blood comes to foreground in moderate and severe bone loss for doesn't requires a second surgical site, rapid results and high success rates. Material and Methods: A 55 year‐old male patient with no systemic disease was admitted to our clinic with a No. 21 tooth missing due to severe periodontal disease. Under local anesthesia, tooth extraction was performed and the granulation tissues were curetted. A triangular envelope flap was used to prevent tension and improve the vision. An implant, 3.8 mm in diameter and 10.5 mm in length, was placed. Leukocyte‐rich fibrin (i‐PRF), which can be injected was obtained. This fluid was mixed with a fine particulated (0.5–1 mm) allograft to prepare a sticky bone and the space around the implant was completely covered and placed in such a way as to provide natural anatomical lines. The grafted site was also covered with leukocyte and thrombocyte‐rich fibrin (L‐PRF) membranes, again obtained from the patient's own blood. The flap was closed with apical mattress and simple sutures with 5‐0 polypropylene. Results: After 5 months of follow‐up, the CBCT evaluation revealed that the defect was completely filled with bone and the healing cap was attached with the second operation in which the thickness of the vestibular attached gingival was increased with the flap roll technique in order to provide the ideal aesthetic appearance. After the placement of the healing head, the prosthetic treatment was performed. Brånemark provided a protocol that requires a 6–8 month recovery period between tooth extraction and implant placement to achieve primary stability. This causes the patient to have discomfort as well as more resorption of the remaining bone. The immediate implant protocol is at the forefront of these disadvantages and makes possible to use a larger diameter and longer implant without losing existing bone. Conclusions and Clinical Implications: Reducing surgery steps and protecting the existing bone, the immediate implant protocol is preferable for surgeons and patients. PRF membrane‐enriched allografts and PRF membranes placed on top of the exposed area promote a rapid healing by increasing angiogenesis and mitogenesis by secreting growth factors and reducing the risk of infection by defense cells. Thus, ensures the immediate implantation with less complication and induced healing and remodelling. [ABSTRACT FROM AUTHOR]