The impact of plasma rich in growth factors on clinical and biological factors involved in healing processes after third molar extraction.

Extraction of an impacted mandibular third molar is a common surgical procedure, although it still leads to several postoperative symptoms and complications. The study assessed the efficacy of autologous plasma rich in growth factors (PRGF) in the healing process by checking the difference of tissue cytokines and other healing factors produced by the mucosa after extraction between sites treated with PRGF and control sites and, at the same time, by evaluating the clinical efficacy of PRGF in terms of reduced pain and facial swelling. This study was a split-mouth study, in which the patient becomes his/her own control, to eliminate any individual response differences toward PRGF treatment. The parameters regarding inflammation and subsequent wound healing were all significantly higher at PRGF sites than at control sites. The increase at PRGF sites of the two proinflammatory cytokines evaluated, interleukin (IL)-1ß and IL-6, was accompanied by the increase of two anti-inflammatory cytokines, IL-10 and transforming growth factor-ß. Furthermore, IL-1ß and IL-6 induce fibroblast and keratinocyte proliferation, important events in wound healing. Postoperative pain and the swelling, measured at all experimental times, were reduced in the presence of PRGF.

Split-crest and immediate implant placement with ultrasonic bone surgery (piezosurgery): 3-year follow-up of 180 treated implant sites.

OBJECTIVE: To report and evaluate ultrasonic bone surgery (USBS), also known as piezosurgery, in split-crest procedures with immediate implant placement at 3 years of follow-up. METHOD AND MATERIALS: Sixty-one split-crest procedures were performed, and 180 implants were placed in 43 patients. Initial ridge width varied between 1.5 and 5.0 mm (mean 3.3 +/- 0.7 mm). Bone density was type I (11.1%), type II (27.8%), type III (28.9%), and type IV (32.2%). The USBS device worked with a 20 to 32 kHz vibrating frequency and 90 W peak power. RESULTS: Mean split length was 14.8 +/- 10.8 mm; mean final ridge width was 6.0 +/- 0.4 mm. At second-stage surgery, five of 180 implants failed to osseointegrate (2.8%), all in the maxilla. Also at second-stage surgery, the success rate of the implants placed simultaneously to the split crest performed with USBS was 97.2% overall, 95.1% in the maxilla and 100% in the mandible. No loaded implant failed during the 3-year follow-up; respective success rates were unchanged. CONCLUSIONS: USBS is predictable to perform split-crest procedures, without risk of bone thermonecrosis; it decreases the risk of soft tissue alteration. Bone-cutting efficiency was satisfactory with the present USBS device because of its elevated ultrasonic vibrating power, especially in soft type IV bone.