Randomized Clinical Trial on the efficacy of PRGF in combination with immediate implant placement for the treatment of infected post-extraction sites
Progetto Background
Dental implants are a predictable treatment for replacing missing teeth, allowing restoration of function and aesthetics. Often, compromised teeth are still present in the patient’s mouth. Usually such teeth are removed and extraction sockets are left to heal for a few months to 1 year before placing dental implants. However, alveolar ridge resorption after tooth extraction may considerably reduce the residual bone volume and compromise the favorable positioning of implants required for optimal restoration. Following the correct clinical indications, early implant placement into the extraction socket may avoid this resorption.
Immediate postextraction implant placement is a well accepted protocol for aesthetics preservation, shorter treatment time, maintenance of socket walls, reduced surgical time, and better actual implant placement. The concept of placing implants soon after removal of a tooth with periapical or periodontal pathology, however, is a matter of debate. In fact, the presence of infectious conditions usually contraindicate immediate replacement with dental implants for the risk of implant contamination during the initial healing period due to remnants of the infection. Scarce evidence exists in the dental literature to document the feasibility of this approach, while favourable results have been reported in orthopedics. Subacute bone infection in vertebral osteomyelitis can be successfully managed by meticulous bone debridement and antibiotic therapy combined with titanium mesh cages that provide immediate support and stability for the weakened vertebrae. Despite the infectious state, titanium cages achieve radiographic bone fusion, which is the orthopedic equivalent of osseointegration in implant dentistry.
Plasma rich in growth factors (PRGF) has been recently proposed as an aid for enhancing tissue regeneration in oral surgery. In vitro studies, animal experiments and clinical studies have shown that PDGF may in fact trigger stimulation of osseous and soft tissue regeneration, as well as reduce inflammation, pain and unwanted side effects.
Description
In this study 40 partially edentulous patients candidate to extraction of teeth affected by chronic periapical pathology will randomly undergo immediate post-extraction implant placement in association or not with PRGF. Prostheses will be applied after 4 months of healing. Primary variables will be prosthesis and implant success, occurrence of complications, patient satisfaction, radiographic peri-implant bone level up to 3 years of function.
Objective
This randomized study will evaluate the clinical outcome of implants immediately placed into fresh extraction sockets of teeth affected by chronic periapical pathology, using or not PRGF as an adjunct during the surgical procedure. The hypothesis is that PRGF may enhance hard and soft tissue healing at immediate implants, achieving a more predictable clinical and radiographic outcome as compared to cases treated wi