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Official Publication of Orofacial Chronicle , India

www.jhnps.weebly.com

CASE REPORT

THE USE OF PRF IN COVERING EXPOSED IMPLANT

Ahmed Halim Ayoub

President of Egyptian society of oral implantology Fellow of Seville university , Spain

ABSTRACT:

Abstract: Dental implants are becoming the treatment of choice to replace missing

teeth, especially if the adjacent teeth are free of restorations. When planning for the

placement of a single-tooth implant, there must be an adequate space between the

crowns and roots (adequate bone height). Both the quantity and the quality of

alveolar bone must be assessed before implant placement is considered.

KEY WORDS: Dental Implants, platelet rich fibrin

Cite this Article: Ahmed Halim Ayoub: The use of PRF in covering exposed Implant, Journal of

Head & Neck physicians and surgeons Vol 2 Issue 1 2014 : Pg

INTRODUCTION:

When minimal bone width is present, implant placement becomes a challenge and

often resulting in recession and dehiscence around the implant that leads to

subsequent gingival recession. To correct such defect, soft tissue autografting and

allografting to correct a buccal dehiscence around a malpositioned Implant placed

by a different surgeon is used1,2

. Platelet-rich fibrin (PRF) belongs to a new

generation of platelet concentrates, with simplified processing and without

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biochemical blood handling, it is a strictly autologous fibrin matrix containing a

large quantity of platelet and leukocyte cytokines. The use of platelet gel to

improve soft and hard tissue regeneration is a recent technique in Implantology2 .

So in this case the PRF is used to the dehiscence.

CASE REPORT

A healthy 24-year-old woman presented with chief complaint of “my implant is

showing through my gingival tissue”. Patient was wondering if there is any

periodontal treatment available to mask the showing of implant threads through the

gingival tissue and prevent further recession. She presented with excellent oral

hygiene, no history of periodontal disease, nonsmoker, and radiographic X-ray

revealed normal bone morphology. Upon clinical examination, there was minimal

buccal gingival thickness around the implant in upper central incisor. Her recent

dental history included extraction of permanent tooth # and an immediate implant

(Microdent system, Spain 3.8 X 12mm ) was placed in site #24. Her previous

dental treatment was rendered by a different surgeon. The patient presented to

Dental smile center 4 months after implant placement. The implant appeared to be

osseointegrated with a buccal dehiscence and 10%–20% of facial implant showing

through gingival tissue due to minimal bone width (Figures 1 and 2).

Since the implant was osseointegrated, removal of implant was not considered

fearing damage to adjacent teeth when trephining the implant. Also, due to loss of

buccal bone cortex, the positioning of implant outside the bony envelope and

possible sloughing of fragile buccal Gingival tissue-guided bone regeneration were

not recommended. Faced with the esthetic concerns And possible future recession

around that implant, soft tissue gingival grafting was recommended to augment the

keratinized gingiva and improve esthetics.

SURGICAL PROCEDURE:

The aim of the first surgery was to increase the zone of gingiva above the implant.

The patient was anesthetized using 2% lidocaine with 1:100,000 epinephrine

followed by a partial thickness envelope flap including reflection of the papilla and

extending the flap from tooth #22 to #11 and noticed buccal dehiscence and

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implant thread exposure 2 mm from implant platform coronally to osseous bone

level apically. A blood sample is taken from the patient without anticoagulant in

10-ml tubes Then Immediately centrifuged at 3000 rpm (approximately 400g

according to Chokroun’s calculations) for 10 minutes3.

Within a few minutes, the absence of anticoagulant allows activation of the

majority of platelets contained in the sample to trigger a coagulation cascade.

Fibrinogen is at first concentrated in the upper part of the tube, until the effect of

the circulating thrombin transforms it into A fibrin network4. Fibrinogen is

initially concentrated in the high part of the tube, before the circulating thrombin

transforms it into fibrin. A fibrin clot is then obtained in the middle of the tube, just

between the red corpuscles at the bottom and acellular plasma at the top (Figs. 3

and 4). Platelets are theoretically trapped massively in the fibrin meshes. The clot

is removed from the tube and the attached red blood cells scraped off and

discarded (figures 5.6). The PRF clot (figure 7) is then placed on the grid in the

PRF Box (figure8) and covered with the compressor and lid. This produces an

inexpensive autologous fibrin membrane in approximately one minute (figure

9a.9b).

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The PRF Box was devised to produce membranes of constant thickness that

remain Hydrated for several hours and to recover the serum exudate expressed

from the fibrin clots which is rich in the proteins vitronectin and fibronectin. The

exudate collected at the bottom of the box may be used to hydrate graft materials,

rinse the surgical site (fig10), and store autologous grafts2. After removing the

cover of PRF box 3 membranes obtained from 3 PRF clots(fig11). with a specific

tweezer the membranes is applied one after another to cover the defected site

(Fig12, 13).

Flap was coronally positioned and sutured using 3–0 Monocryl sutures (fig13)

Healing was uneventful, and the patient was followed up for 6 months (1, 2, 3, 4,

5, 6 weeks) postoperatively, making sure to enforce oral hygiene and rinsing with

chlorhexidine 0.12%. 3 months later, the patient cameback for 2nd

surgery and we

noticed that the buccal depression over the implant was filled with soft tissue and

disappeared, also about 0.8 mm of newly formed bone covered the implant (fig 14-

15) incision was done to uncover the implant. This incision is midcrestal or a few

millimeters toward the palate with a U shape and opens toward the buccal aspect of

the implant site with slightly divergent arms cover screw is now exchanged for a

healing abutment. Once the healing abutment is placed, the flap should be split in

whole thickness through its center, separating it into mesial and distal parts6,7,

( fig

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16) 3 weeks later the healing abutment is removed and an implant level impression

was taken prior to final prosthesis fabrication8.

CONCLUSION:

From a radiologic and histologic point of view at 4 months after surgery, the use of

PRF as the sole filling or covering material stabilized a high volume of natural

regenerated bone and soft tissue over the exposed implant threads. Choukroun’s

PRF is a simple and inexpensive biomaterial, and its systematic use during

covering bony defect above implant seems a relevant option.

REFERENCES:

1. Shroff B, Siegel SM, Feldman S, Siegel SC. Combined orthodontic and prosthetic therapy.

Special considerations. Dent Clin North Am. 1996;40(4):911–943

2. Allen EP. AlloDerm: an effective alternative to palatal donor tissue for treatment of gingival

recession. Dent Today. 2006;25(1):48, 50–52.

3. Soft tissue grafting to improve implant esthetics. Moawia M Kassab Clinical, Cosmetic and

investigation dentistry 16 spet. 2010.

4. Choukroun J, Adda F, Schoeffler C, Vervelle A. Une opportunite en paro-implantologie: le PRF.

Implantodontie 2000;42:55-62. French.

5. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006 Mar;101(3):e45-50. Epub 2006 Jan 10.

Platelet-rich fibrin (PRF): a second-generation platelet concentrate. Part II: platelet-related

biologic features. Dohan DM, Choukroun J, Diss A, Dohan SL, Dohan AJ, Mouhyi J, Gogly B.

6. Interimplant papilla preservation in the esthetic zone: a report of six consecutive cases. Kan

JY, Rungcharassaeng K. Int J Periodontics Restorative Dent. 2003 Jun;23(3):249-59.

7. Simonpieri A, Choukroun J, Girard MO, Ouaknine T, Dohan D.Immediate post-extraction

implantation: interest of the PRF. Implantodontie 2004;13:177-89.

8. Dohan D, Donsimoni J-M, Navarro G, Gaultier F. [Platelet concentrates. Part 1: Technologies.]

Implantodontie 2003;12:5-16. French.

Acknowledgement- None

Source of Funding- Nil

Conflict of Interest- None Declared

Ethical Approval- Not Required

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Correspondence Addresses :

Ahmed Halim Ayoub

Address: Dental Smile 178 Omar Lotfy St.,

Sporting Alexandria, Egypt Fax: +20 3 5910843 Mob: +20 12 2205513

Email: dr.ayoub@gmail.com

Director Dental smile training and educational center President of Egyptian society of oral implantology

Fellow of Seville university , Spain

Private practice limited to dental implants Clinical advisor of Dooox German dental academy

Board member of International group of oral rehabilitation , France

www.esoiegypt.com

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