Advanced platelet-rich-fibrin (A-PRF +) has no additional effect on the healing of post-extraction sockets of upper third molars. A split mouth randomized clinical trial.

PURPOSE: This study evaluated the effects of advanced platelet-rich fibrin (A-PRF +) on the healing of upper third molar post-extraction sockets. METHODS: Sixteen patients who underwent extractions of the upper third molars (18 and 28) were included in this randomized split-mouth study. The alveoli on the test side were filled with A-PRF + , while the control side was maintained with blood clot. The side that received treatment was randomly defined. Alveolar bone regeneration was evaluated by CBCT scans to assess healing stage, bone density, and fractal analysis 1 week and 90 days post-extraction. Additionally, pain, edema, bleeding, and soft tissue alveolar repair were evaluated by clinical analyses 3, 7, 14, 30, and 90 days after the surgical procedure using a visual analog scale. RESULTS: There were no clinical differences regarding treatments in any experimental period. In the tomographic evaluation, at 7 days, the alveoli treated with A-PRF + presented a suggestive sign of higher bone density than the control alveoli, which was not confirmed 90 days after the surgical procedure. CONCLUSION: Thus, the use of A-PRF + does not demonstrate a clinical advantage in the repair of post-extraction sockets of upper third molars.

Clinical dental management of the head and neck irradiated patient: topics of interest for clinicians

To discuss important topics regarding the dental procedures performed in patients before, during and after the radiotherapy treatment. The biological effects of ionizing radiation on bone tissue focusing on clinical care will be described. The invasive and not invasive procedures after radiotherapy treatment in the head and neck region will be addressed using scientific evidences to determine the appropriate moment for tooth extractions, periodontal management, and preventive procedures for osteoradionecrosis. Methods: Thirty-three studies including original studies and reviews were selected in MEDLINE database (PubMed). No year of publication restriction was applied. Language was restricted to the English, and the following Medical Subject Heading terms were used: radiotherapy, osteoradionecrosis, dental management. Studies of osteoradionecrosis involving clinical management of irradiated patients, with an emphasis on updated guidelines and protocols were selected. Results: Care in dental procedures were related about restorative treatment, endodontic treatment, rehabilitation for edentulous regions using prostheses and implants and periodontal procedures before, during and after RTX treatment. Conclusions: The dental procedures should and can be performed before, during but also after radiotherapy. However, the clinical procedures should be less invasive as possible. A maintenance plan that reduces the necessity for major and more invasive treatments after radiotherapy is recommended

Alendronate Impairs Healing of Calvaria Critical Defects After Bone Graft With Different Bone Substitute Materials.

PURPOSE: The aim of this preclinical study was to evaluate the healing of critical-sized defects (CSDs) in the calvarial bone of rats grafted with deproteinized bovine bone graft (DBB) and with a combination of hydroxyapatite (HA) and ß-tricalcium phosphate (TCP) and bisphosphonate treatment. MATERIALS AND METHODS: Eighty-four animals were randomly divided into 2 groups according to the type of solution administered: the control group (CTR, saline solution) and the test group (alendronate [ALD]; sodium alendronate-50 µg/kg/day). Medications were administered via oral gavage starting 15 days before the surgical procedure until the end of the experiment. A CSD (5 mm in diameter) was made in the calvaria of each animal, and the rats were randomly allocated to 3 subgroups according to the biomaterial used to fill the defect: coagulum, DBB, and HA/TCP. The animals were sacrificed 15 and 60 days after the surgical procedure (n = 7 animals/period/subgroup). Microcomputed tomography was used to evaluate the percentage of mineralized tissues (volume). The amount of newly formed bone and remaining bone substitute material in the calvaria were analyzed by histomorphometry. RESULTS: There were no differences between the CTR and ALD groups with regard to the volume of mineralized tissues. The DBB and HA/TCP subgroups of CTR animals presented a significant increase in newly formed bone compared with these subgroups of ALD animals after 60 days of healing. CONCLUSIONS: Collectively, our findings indicate that the use of oral ALD reduced bone formation in CSD in the calvaria of rats grafted with DBB and HA/TCP.