Effect of Titanium-Prepared Platelet-Rich Fibrin on Extraction Socket Preservation: A CBCT-Based Volumetric Analysis
DOI:
https://doi.org/10.58600/eurjther3149Keywords:
cone-beam computed tomography, extraction socket healing, socket preservation, titanium-prepared platelet-rich fibrin, tooth extractionAbstract
Objective: Alveolar ridge remodeling following tooth extraction may compromise subsequent implant placement. Titanium-prepared platelet-rich fibrin (T-PRF) has been proposed as an autologous biomaterial that may enhance socket healing and minimize post-extraction dimensional changes. This study aimed to compare the radiographic healing of extraction sockets treated with T-PRF and those left to heal spontaneously using cone-beam computed tomography (CBCT)-based volumetric analysis.
Methods: A total of 30 systemically healthy patients (18 males and 12 females) requiring tooth extraction followed by implant placement were enrolled in this randomized clinical trial. A total of 58 extraction sockets were included, with 27 sockets allocated to the T-PRF group and 31 sockets assigned to spontaneous healing (control group). The initial CBCT examination (baseline assessment) was performed 7–10 days after tooth extraction, and a follow-up CBCT examination was performed 3 months after extraction. Baseline socket volume, residual non-ossified socket volume, and the estimated percentage of socket fill were assessed using dedicated volumetric analysis software. Because some participants contributed more than one extraction socket, generalized estimating equations (GEE) were used to account for within-patient clustering.
Results: Baseline socket volumes were comparable between the groups (p = 0.752). At 3 months, the residual non-ossified socket volume was significantly lower in the T-PRF group than in the control group (0.043 cm³ vs. 0.087 cm³; p = 0.013). Both groups demonstrated progressive socket healing over time; however, the estimated percentage of socket fill was significantly higher in the T-PRF group than in the control group (80.1% vs. 57.3%).
Conclusion: Within the limitations of this randomized clinical trial, T-PRF was associated with improved radiographic healing of extraction sockets, as reflected by a lower residual non-ossified socket volume after 3 months compared with spontaneous healing. T-PRF may represent a simple, autologous, and clinically useful adjunct for socket preservation prior to implant placement.
References
[1] Schropp L, Wenzel A, Kostopoulos L, Karring T (2003) Bone healing and soft tissue contour changes following single-tooth extraction: a clinical and radiographic 12-month prospective study. Int J Periodontics Restorative Dent. 23(4):313–323.
[2] Tan WL, Wong TLT, Wong MCM, Lang NP (2012) A systematic review of post-extractional alveolar hard and soft tissue dimensional changes in humans. Clin Oral Implants Res. 23(Suppl 5):1–21. https://doi.org/10.1111/j.1600-0501.2011.02375.x
[3] Araújo MG, Lindhe J (2005) Dimensional ridge alterations following tooth extraction. An experimental study in the dog. J Clin Periodontol. 32(2):212–218. https://doi.org/10.1111/j.1600-051x.2005.00642.x
[4] Van der Weijden F, Dell’Acqua F, Slot DE (2009) Alveolar bone dimensional changes of post-extraction sockets in humans: a systematic review. J Clin Periodontol. 36(12):1048–1058. https://doi.org/10.1111/j.1600-051x.2009.01482.x
[5] Cardaropoli G, Araújo M, Lindhe J (2003) Dynamics of bone tissue formation in tooth extraction sites. An experimental study in dogs. J Clin Periodontol. 30(9):809–818. https://doi.org/10.1034/j.1600-051x.2003.00366.x
[6] Avila-Ortiz G, Elangovan S, Kramer KW, Blanchette D, Dawson DV (2014) Effect of alveolar ridge preservation after tooth extraction: a systematic review and meta-analysis. J Dent Res. 93(10):950–958. https://doi.org/10.1177/0022034514541127
[7] Araújo MG, Sukekava F, Wennström JL, Lindhe J (2005) Ridge alterations following implant placement in fresh extraction sockets: an experimental study in the dog. J Clin Periodontol. 32(6):645–652. https://doi.org/10.1111/j.1600-051x.2005.00726.x
[8] Chappuis V, Araújo MG, Buser D (2017) Clinical relevance of dimensional bone and soft tissue alterations post-extraction in esthetic sites. Periodontol. 2000. 73(1):73–83. https://doi.org/10.1111/prd.12167
[9] Horváth A, Mardas N, Mezzomo LA, Needleman I, Donos N (2013) Alveolar ridge preservation. A systematic review. Clin Oral Investig. 17(2):341–363. https://doi.org/10.1007/s00784-012-0758-5
[10] Madi M, Almindil I, Alrassasi M, Alramadan D, Zakaria O, Alagl AS (2023) Cone-beam computed tomography and histological findings for socket preservation techniques using different grafting materials: a systematic review. J Funct Biomater. 14(5):282. https://doi.org/10.3390/jfb14050282
[11] Avila-Ortiz G, Elangovan S, Kramer KW, Blanchette D, Dawson DV (2014) Effect of alveolar ridge preservation after tooth extraction: a systematic review and meta-analysis. J Dent Res. 93(10):950–958. https://doi.org/10.1177/0022034514541127
[12] Sakkas A, Wilde F, Heufelder M, Winter K, Schramm A (2017) Autogenous bone grafts in oral implantology—is it still a “gold standard”? A consecutive review of 279 patients with 456 clinical procedures. Int J Implant Dent. 3(1):23. https://doi.org/10.1186/s40729-017-0084-4
[13] Dohan Ehrenfest DM, Del Corso M, Diss A, Mouhyi J, Charrier JB (2010) Three-dimensional architecture and cell composition of a Choukroun’s platelet-rich fibrin clot and membrane. J Periodontol. 81(4):546–555. https://doi.org/10.1902/jop2009.090531
[14] Miron RJ, Fujioka-Kobayashi M, Bishara M, Zhang Y, Hernandez M, Choukroun J (2017) Platelet-rich fibrin and soft tissue wound healing: a systematic review. Tissue Eng Part B Rev. 23(1):83–99. https://doi.org/10.1089/ten.TEB.2016.0233
[15] Dohan Ehrenfest DM, Rasmusson L, Albrektsson T (2009) Classification of platelet concentrates: from pure platelet-rich plasma (P-PRP) to leucocyte- and platelet-rich fibrin (L-PRF). Trends Biotechnol. 27(3):158–167. https://doi.org/10.1016/j.tibtech.2008.11.009
[16] Kobayashi E, Flückiger L, Fujioka-Kobayashi M, sawada K, Sculean A, Schaller B, Miron RJ (2016) Comparative release of growth factors from PRP, PRF, and advanced-PRF. Clin Oral Investig. 20(9):2353–2360. https://doi.org/10.1007/s00784-016-1719-1
[17] Fujioka-Kobayashi M, Schaller B, Mourão CFDA, Zhang Y, Sculean A, Miron RJ (2021) Biological characterization of an injectable platelet-rich fibrin mixture consisting of autologous albumin gel and liquid platelet-rich fibrin (Alb-PRF). Platelets. 32(1):74–81. https://doi.org/10.1080/09537104.2020.1717455
[18] Tunalı M, Özdemir H, Küçükodacı Z, Akman S, Fıratlı E (2013) In vivo evaluation of titanium-prepared platelet-rich fibrin (T-PRF): a new platelet concentrate. Br J Oral Maxillofac Surg. 51(5):438–443. https://doi.org/10.1016/j.bjoms.2012.08.003
[19] Arabaci T, Albayrak M (2018) Titanium-prepared platelet-rich fibrin provides advantages on periodontal healing: a randomized split-mouth clinical study. J Periodontol. 89(3):255–264. https://doi.org/10.1002/JPER.17-0294
[20] Koutouzis T, Lipton D (2016) Regenerative needs following alveolar ridge preservation procedures in compromised and noncompromised extraction sockets: a cone beam computed tomography study. Int J Oral Maxillofac Implants. 31(4):849–854. https://doi.org/10.11607/jomi.4437
[21] Ben Amara H, Kim JJ, Kim HY, Lee J, Song HY, Koo KT (2021) Is ridge preservation effective in the extraction sockets of periodontally compromised teeth? A randomized controlled trial. J Clin Periodontol. 48(3):464–477. https://doi.org/10.1111/jcpe.13412
[22] Agbaje JO, Jacobs R, Maes F, Michiels K, van Steenberghe D (2007) Volumetric analysis of extraction sockets using cone beam computed tomography: a pilot study on ex vivo jaw bone. J Clin Periodontol. 34(11):985–990. https://doi.org/10.1111/j.1600-051X.2007.01134.x
[23] Faul F, Erdfelder E, Lang AG, Buchner A (2007) G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 39(2):175–191. https://doi.org/10.3758/bf03193145
[24] Aldommari EA, Omair A, Qasem T (2025) Titanium prepared platelet-rich fibrin enhances alveolar ridge preservation: a randomized controlled clinical and radiographic study. Sci Rep. 15:24065. https://doi.org/10.1038/s41598-025-09528-4
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