Does the Use of Injectable Platelet-Rich Fibrin After Arthrocentesis for Disc Displacement Without Reduction Improve Clinical Outcomes?

PURPOSE: Many studies have reported the role of arthrocentesis to alleviate symptoms in patients with disc displacement without reduction (DDWoR). Nevertheless, the benefit of injectable platelet-rich fibrin (i-PRF) remains unclear. The aim of this study was to answer the following question: Among patients with DDWoR, do those treated with intra-articular injection of i-PRF after arthrocentesis, when compared to those treated with arthrocentesis only, have better clinical outcomes in terms of pain reduction and improvement of jaw movement? MATERIALS AND METHODS: This single-blind randomized, controlled study included patients with diagnosed DDWoR, in the Department of Oral and Maxillofacial Surgery at the School of Dentistry, Ege University, who had localized joint pain and limited range of motion. Patients were treated either with arthrocentesis (AC group) or arthrocentesis in combination with intra-articular i-PRF injection (AC + i-PRF group). The predictor variable was treatment (ie, arthrocentesis with or without i-PRF). The primary outcome variable was pain (visual analog scale). The secondary outcome variables were maximum mouth opening, lateral and protrusive movements. Outcome variables were recorded at pretreatment and at the postoperative 1st, 2nd, 3rd, 6th, and 12th months. Statistical analysis was performed using the Brunner-Langer model, with a significance level P < .05. RESULTS: This study comprised 76 patients (34 females/4 males, mean age 47.2 ± 9.1 for the AC + i-PRF group; 35 females/3 males, mean age 46.8 ± 10.2 for the AC group). The treatment success rate was 73.7% for the AC group and 100% for the AC + i-PRF group (P = .012). Pain levels in the AC + i-PRF group were found to decrease more than the AC group over 12 months postoperatively (palpation: -6.9 ± 1.2 vs -5.3 ± 1.3; chewing: -6.9 ± 1.5 vs -5.1 ± 1.7; jaw movements: -6.9 ± 1.1 vs -5.1 ± 1.4). This difference was statistically significant (P < .001). The degree of jaw movement in the AC + i-PRF group was found to increase more than the AC group over 12 months postoperatively (maximum mouth opening: 8.0 ± 2.1 vs 4.9 ± 2.0; contralateral: 1.8 ± 0.8 vs 0.2 ± 1.0; ipsilateral: 2.9 ± 1.3 vs 0.8 ± 1.5; protrusive: 2.6 ± 1.1 vs 0.8 ± 1.3). This difference was statistically significant (P < .001). CONCLUSION: Intra-articular injection of i-PRF after arthrocentesis produced greater improvements in pain reduction and jaw movement when compared to arthrocentesis only. These results indicate that i-PRF used in combination with arthrocentesis is an effective adjunctive treatment.

Injectable platelet-rich fibrin as treatment for temporomandibular joint osteoarthritis: A randomized controlled clinical trial.

The purpose of this study was to assess the treatment outcomes of intraarticular injection of injectable platelet-rich fibrin (i-PRF) after arthrocentesis in patients with temporomandibular joint osteoarthritis (TMJ-OA). Patients were randomly assigned to one of two treatment groups: those who received intraarticular injection of i-PRF after arthrocentesis procedure - the i-PRF group; and those who underwent the arthrocentesis procedure alone - the control group. The primary outcome variable was pain, the level of which was measured preoperatively and at 1, 2, 3, 6, and 12 months postoperatively. The secondary outcome variables included maximum mouth opening (MMO), and lateral and protrusive movements. Of the total of 36 patients, 18 were analyzed in the i-PRF group and 18 in the control group. There were significant differences between the groups in terms of pain levels and measurements of MMO, lateral movement, and protrusive movement over the 12 months of follow-up (p < 0.001). Significant increases in pain levels and decreases in measurements of MMO, lateral movement, and protrusive movement were observed in the control group from the 6th to 12th month postoperatively (p < 0.001). In contrast, no significant differences were found in both pain levels and measurements of MMO, lateral, and protrusive movements for the i-PRF group from the 2nd to the 12th month postoperatively. Within the limitations of the study it seems that intraarticular injection of i-PRF after arthrocentesis should be preferred whenever appropriate because when reducing pain intensity and improving functional jaw movement is the priority.

Guided bone regeneration simultaneous with implant placement using bovine-derived xenograft with and without liquid platelet-rich fibrin: a randomized controlled clinical trial.

OBJECTIVE: To assess augmentation success after guided bone regeneration (GBR) carried out simultaneously with implant placement using bovine-derived xenograft alone and in combination with liquid platelet-rich fibrin (liquid-PRF). METHODS: This randomized controlled clinical trial was conducted on patients with horizontal bone deficiency in the posterior regions of the mandible. After implant placement, GBR procedures were randomly performed using liquid-PRF-enriched bovine-derived xenograft (for the test group) and with bovine-derived xenograft alone (for the control group). To assess the change in augmentation thickness, the primary outcome of the study, cone beam computed tomography was carried out at the implant sites on completion and 6 months after surgery. The secondary outcomes were marginal bone level and implant survival rate at prosthetic delivery and at 6 months, 1 year, and 2 years follow-up after loading. The significance level was set at p<0.05 for all analysis. RESULTS: Twenty patients with 50 implants were analyzed for the test group and 20 patients with 48 implants for the control group. At 6 months postoperatively, the mean values of augmentation thickness were 1.63 ± 0.21 mm, 2.59 ± 0.34 mm, and 3.11 ± 0.36 mm for the test group and 1.34 ± 0.14 mm, 2.49 ± 0.24 mm, and 2.97 ± 0.24 mm for the control group at 2 mm, 4 mm, and 6 mm below to the implant shoulder (p < 0.001, p = 0.007, and p = 0.036, respectively). The mean marginal bone loss was found to be less than 1 mm for both study groups during the 2 years of follow-up after prosthetic loading. Implant survival rate was 100% for both study groups. CONCLUSION: Bovine-derived xenograft alone and in combination with liquid-PRF are both successful in achieving bone augmentation around the implants and produce a small change in marginal bone level and a high implant survival rate after loading. CLINICAL RELEVANCE: There is a lack of evidence in the literature regarding the augmentation success of liquid-PRF used in combination with bone graft substitutes. This study indicates that liquid-PRF could be used as a supportive material with bovine-derived xenograft in GBR procedures carried out simultaneously with implant placement.

Does Concentrated Growth Factor Used With Allografts in Maxillary Sinus Lifting Have Adjunctive Benefits?

PURPOSE: Recent studies have shown that the use of platelet concentration products alone, or in combination with variable graft materials, accelerates the new bone formation associated with sinus augmentation. The aim of this study was to measure the adjunctive effects of concentrated growth factor (CGF) used with allograft on new bone formation and augmentation stability in sinus lifting. MATERIALS AND METHODS: This randomized controlled study included patients who presented for dental implant placement in atrophic posterior maxilla at the Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ege University, and who needed maxillary sinus augmentation. All patients were treated with a 2-stage surgical technique using sinus lifting bilaterally and implant placement 6 months later. During sinus lifting surgery, one side was grafted with allograft (group 1) and the other side with allograft mixed CGF (group 2). Cone-beam computed tomography was carried out immediately postoperatively and also 6 months after the augmentation to evaluate vertical bone height and percentage of resorption. Bone specimens were obtained at the time of implant placement and evaluated histomorphometrically to analyze the percentage of new bone formation and residual graft particle. Statistical comparisons were conducted between groups for all these measurements. RESULTS: A total of 10 patients (2 females and 8 males) with a mean age of 57 years (range, 39 to 72) were enrolled in the study. Cone-beam computed tomography analysis revealed a significantly higher percentage of bone height resorption at the sixth month in group 1 (median, 9.32%) compared with group 2 (median, 6.37%) (P < .05). According to the histomorphometric examination, the percentage of new bone formation in group 2 (median, 36.41%) was higher than group 1 (median, 35.49%), but this difference did not reach statistical significance. CONCLUSIONS: Using CGF with allografts supports the stabilization of gained vertical bone height after sinus augmentation, but further research is needed to determine the accelerating effects of CGF on new bone formation.

Effect of concentrated growth factors on frequency of alveolar Osteitis following partially-erupted mandibular third molar surgery: a randomized controlled clinical study.

BACKGROUND: The aim of this prospective study was to assess the effectiveness of concentrated growth factors (CGF) in preventing the development of alveolar osteitis (AO) after the extraction of partially-erupted mandibular third molars. METHODS: Seventy patients (26 men and 44 women) 18 years or older (mean age 25.86; range 18-35) underwent 140 third molar extractions. All the patients presented with bilateral, partially-erupted mandibular third molars and underwent surgical extractions. In each case, one socket received CGF and the other served as a control. The predictor variable was the CGF application and the sides were categorized as 'CGF' and 'non-CGF'. The outcome variable was the development of AO during the first postoperative week. Other study variables included age and gender. Data were analyzed using Cochran's Q test with the significance level set at a P value less than 0.05. RESULTS: The overall frequency of AO was 11.4% for the control group. The frequency of AO in the CGF group was significantly lower than in the non-CGF group (p < 0.001). CONCLUSIONS: Based on the results of this study, application of CGF fibrin gel may decrease the risk of AO development after mandibular third molar surgery. TRIAL REGISTRATION: This study was registered in ClinicalTrials.gov database on November 1, 2019 (ID: NCT04151147 , retrospectively registered).

The effects of maxillary expansion on the soft tissue facial profile.

PURPOSE: The aims of this retrospective study were to evaluate the possible changes in soft tissue facial profile induced by orthopedic rapid maxillary expansion (RME) and surgically assisted rapid maxillary expansion (SARME), and to correlate them with the underlying hard tissue alterations. MATERIALS AND METHODS: 16 patients who received bone borne SARME and 25 patients who were subjected to RME using metal cast splint hyrax appliance were analyzed retrospectively. This research was conducted on lateral cephalometric radiographs taken on 2 occasions: before expansion (T1) and at the beginning of any further orthodontic treatment (T2). Investigated lateral cephalometric parameters consisted of Holdaway soft tissue measurements with some supplementary soft tissue, skeletal and dental assessments. RESULTS: The acquisition of T2 cephalograms which conforms to the initiation of further orthodontic treatment corresponded to 83.25±3.51 days for SARME and 85.68±4.37 days for RME after the expansion was completed. The only significant change in soft tissue profile of the SARME group was a decrease in upper lip thickness (p<0.05), whereas in the RME group, decrease in soft tissue facial profile angle and increase in H angle were found to be statistically significant (p<0.05 for each). For the RME group, the changes in soft tissue facial profile angle and H angle correlated only with the changes in SNB angle (p<0.05). CONCLUSION: While bone-borne SARME did not seem to possess the potential to alter soft tissue profile, tooth-borne RME caused a more convex soft tissue profile related to a reduction in SNB.

Does transpalatal distraction affect pharyngeal airway dimensions and related soft tissues?

PURPOSE: Previous studies of transpalatal distraction (TPD) have been based on dentoskeletal alterations of the jaws and nasal airway changes. The main aim of this study was to determine the effects of TPD on soft palate and pharyngeal airway dimensions and tongue posture. MATERIAL AND METHODS: This was a retrospective cohort study. The sample was comprised of 16 patients with skeletal maxillary deficiency who had bilateral crossbite combined with a high palatal vault and partial or near total nasal obstruction treated with TPD using bone-borne distractors (Transpalatal Distractor, SurgiTec NV, Bruges, Belgium). This research was carried out on lateral cephalometric radiographs taken before distraction and after a distraction period of 6.75 ± 1.61 months. The primary predictor variable was pharyngeal airway dimensions and tongue posture. Other variables were demographic and lateral cephalometric parameters. Changes in the length, angle, and thickness of the soft palate; nasopharyngeal, retropalatal, retroglossal, and lower pharyngeal airway dimensions; and tongue length and height were evaluated. Data were analyzed by paired t test. RESULTS: The sample included 16 adult patients (mean age, 25.13 ± 6.13 yr; 7 women, 9 men). The desired amount of distraction was achieved in all patients within 7 to 10 days. The total activation average was 8.38 ± 0.96. TPD caused statistically significant changes in sagittal nasopharyngeal airway dimensions (1.19 mm), the minimal oropharyngeal distance behind the tongue base (1.81 mm), and tongue height (2.12 mm). CONCLUSIONS: The results of this study suggest that, in adult patients with nasal obstruction, TPD has the potential to increase sagittal nasopharyngeal airway dimensions and the minimal oropharyngeal distance behind the tongue, with an elevation in tongue posture. Further studies using cone-beam computed tomography that focus on how the bone-borne expander alters pharyngeal airway volume will make valuable contributions to the literature.

Alveolar distraction osteogenesis in the human mandible: a clinical and histomorphometric study.

PURPOSE: To identify the quality of newly formed bone in the distraction region and to determine the percentage of mineralized bone formed in the distraction area. METHODS: Ten patients with vertically deficient mandibular alveolar ridges were treated by means of distraction osteogenesis. Four months after consolidation of distracted segments, a total of 40 dental implants were inserted in native bone and distracted bone. Bone biopsies were taken at the implant sites with trephine burrs for histological and histometric analyses. Four months after implant placement, abutments were connected, and prosthetic loading of the implants was started. RESULTS: The mean bone gain at the end of distraction was 7.2 ± 0.8 mm. The cumulative success rate of implants 3 years after the onset of prosthetic loading was 100%. The newly formed bone consisted of woven bone reinforced by parallel-fibered bone with bone marrow spaces and the percentage of mineralized bone ranged from 50.56% to 76.88%. CONCLUSIONS: Alveolar distraction osteogenesis is able to produce adequate mature bone for the correction of mandibular bone deficits before dental implant insertion.

Multidisciplinary approach to a nonsyndromic oligodontia patient using advanced surgical techniques.

Treatment of a woman suffering from oligodontia and multiple diastemata with insufficient alveolar ridges in both the maxilla and mandible is described in this clinical report. The total number of missing teeth was 11 (excluding the wisdom teeth). The treatment strategy consisted of an interdisciplinary team approach of orthodontic, surgical, and prosthodontic phases. Sinus floor augmentation, alveolar ridge augmentation via vertical alveolar distraction, and lateral augmentation with ramus graft procedures were performed after fixed orthodontic treatment and prior to dental implant placement. Oral rehabilitation of the patient was completed with the placement of fixed prostheses in the maxillary and mandibular posterior edentulous areas. Early dental intervention improved the patient's appearance and minimized the onset of emotional and psychosocial problems.

Dimensional changes of the nasal cavity after transpalatal distraction using bone-borne distractor: an acoustic rhinometry and computed tomography evaluation.

PURPOSE: The aims of this study were as follows: 1) evaluation of the effects of transpalatal distraction (TPD) on nasal minimum cross-sectional area (MCA) and nasal volume, and assessment of long-term stability of TPD outcomes on the nasal cavity, using acoustic rhinometry (AR); 2) quantifying the alveolar, basal, and nasal components of the maxillary expansion at both canine and molar levels by computed tomography (CT); 3) investigation of the relationship between CT transverse measurements and AR measurements. PATIENTS AND METHODS: The sample was comprised of 11 adult patients with maxillary transverse deficiency and partial/near total nasal obstruction. Standard corticotomies were carried out and bone-borne transpalatal distractors were used in all cases. AR recordings were used to determine nasal minimum cross-sectional area of the anterior (MCA1) and posterior (MCA2) and the volume of the nasal cavity in these regions (Volume1, Volume2) before surgery (T1), when the distractor was removed (T2), and at least 1 year after the expander was removed (T3). CT images were taken at T1 and T2. CT measurements included maxillary base, alveolar, and nasal cavity widths at both canine and first molar slices. RESULTS: There were significant increases in MCAs and volumes of nasal cavity between T1 and T2 and between T1 and T3 with the exception of the right MCA2 and right Volume2 at the latter time (P < .05). All maxillary transverse dimensions in canine and molar CT slices displayed significant increases (P < .05). The change in binasal width at the canine level showed significant correlations with the changes in total MCA1 and total Volume1 (P < .05). CONCLUSION: TPD provided great increases in MCA and volume of the nasal cavity, and these changes generally remained stable long term. The use of TPD in adult patients granted the opportunity of efficient maxillary expansion concurrent with increases in the nasal dimensions.

Immediate provisional restoration fabrication for immediate implant loading using a modified technique: a clinical report.

This article describes the immediate fabrication and placement of a provisional restoration, using a modified method for impressionmaking. An impression was made before surgery and provisional acrylic temporary restorations with composite resin frameworks were prepared on the solid-screw implant abutments. This article demonstrates this simple method and discusses the benefits of immediate provisionalization after surgery.

Effects of transmandibular symphyseal distraction on teeth, bone, and temporomandibular joint.

PURPOSE: The aim of this clinical study was to investigate the clinical effects and long-term results of the transmandibular symphyseal distraction technique for the correction of mandibular transverse deficiencies. This was achieved by assessing the dental, skeletal, and temporomandibular joint changes in the sagittal, vertical, and axial planes using cephalograms, dental casts, and computed tomography (CT). PATIENTS AND METHODS: Seven patients with mandibular transverse deficiencies (3 females and 4 males), aged 14.3 to 22.5 years (mean 16.2), were treated with a bone-borne transmandibular distractor. Lateral and posteroanterior cephalometric films, CT scans of both temporomandibular joints, and dental casts were obtained preoperatively, at the end of the distraction period, and at the end of 3 years (clinical follow-up period). The clinical findings were assessed according to the morphologic and functional success criteria established by the Steering Group of European Collaboration on Cranial Facial Anomalies for patients with developmental dentofacial anomalies undergoing craniofacial distraction osteogenesis. The statistical analysis of cephalometric films and dental cast measurements was done using the paired t test. The mean postoperative examination period was 40 months (range 36 to 48). RESULTS: The desired amount of distraction was achieved in all patients (mean 6.48 mm). The intraoperative and postoperative complications encountered included damage to the central incisors during vertical osteotomy (1 patient), wound dehiscence after a latent period (3 patients), mild temporomandibular joint pain during the distraction period (3 patients), and chronic gingivitis around the activation rods (7 patients). The success criteria for craniofacial distraction osteogenesis were fulfilled at the end of the 3-year follow-up period. Model analysis showed that the maximal amount of expansion was achieved at the premolar region (first premolar 5.79 mm, second premolar 5.07 mm). Frontal (posteroanterior) cephalograms taken at the end of the distraction period revealed significant increases in the bicondylar (0.35 mm), bigonion (3.43 mm), biantegonion (2.29 mm), and intermolar (4.0 mm) widths, and the ramal angle had decreased significantly (-1.64 degrees). The increase in the transverse measurements was greater at the dentoalveolar level than at the base of the mandible. Lateral cephalograms showed that transmandibular symphyseal distraction produced significant increases in the incisor mandibular plane angle (2.79 degrees) and mandibular body length (1.72 mm). The effect of the procedure on the condyle was 2.5 degrees to 3 degrees of distolateral rotation as calculated using the CT scans. Dental crowding was resolved rapidly by the movement of the teeth into the distraction regenerate. CONCLUSIONS: The clinical and radiologic results of the present study have shown that a transmandibular distractor is a clinically effective bone-borne distractor for the correction of mandibular transverse deficiencies and anterior crowding. The follow-up cephalograms and CT scans showed the transverse skeletal stability of the distraction procedure and no permanent temporomandibular dysfunction. However, additional multicenter studies with more patients are necessary to precisely evaluate the long-term postdistraction changes on the skeleton, teeth, and temporomandibular joint.

Enhanced effect of combined treatment with corticotomy and skeletal anchorage in open bite correction.

PURPOSE: To determine the effects of combined treatment with corticotomy and skeletal anchorage in open bite correction. PATIENTS AND METHODS: Ten patients (6 females, 4 males) with ages ranging from 15 to 25 years were involved. All of the individuals received combined subapical corticotomy and skeletal anchorage procedure and intrusion forces of 200 to 300 g were applied on the attachments of each molar and both premolars during 12 to 15 weeks. Mean changes for the measurements for the sample group were evaluated with Wilcoxon signed ranks test. RESULTS: Significant intrusion of maxillary posterior teeth provided counterclockwise rotation of the mandible and open bite was successfully corrected. SNB angle increased and the ANB angle decreased (P< .05). Significant decreases were noted for vertical skeletal characteristics and overbite increased accordingly (P< .05). CONCLUSIONS: Our results indicated that the use of combined treatment with corticotomy and skeletal anchorage provided safe and noncompliance intrusion of posterior teeth in a short period and may be regarded as an alternative method for skeletal open bite correction in adults who reject orthognathic surgery.

Transpalatal distraction using bone-borne distractor: clinical observations and dental and skeletal changes.

PURPOSE: The aim of this clinical study was to analyze the outcome, complications, and long-term results of transpalatal distraction for the correction of maxillary transverse deficiency (MTD) and assess skeletal and dental changes in the sagittal, vertical, and transverse planes through cephalograms and dental casts. PATIENTS AND METHODS: Ten adult patients with MTD were treated with a Transpalatal Distractor (Surgi-Tec, Bruges, Belgium). Lateral and posteroanterior cephalometric films and dental casts were taken before surgery and at the end of the consolidation period. The statistical analysis of cephalometric film and dental cast measurements was undertaken with paired t tests. RESULTS: The intraoperative and postoperative problems encountered were damage to the central incisive teeth as a result of vertical osteotomy, wound dehiscence after the latent period, pain during the distraction period, and loosening of the distractor and buccal displacement of the left alveolar segment during the consolidation period. Model analysis showed that the greatest amount of transverse increase was in the premolar region (7.07 mm for first premolar and 7.10 mm for second premolar). Frontal cephalometric analysis indicated that transverse distances increased more at the alveolar level (7.75 mm) than in the maxillary base (5.25 mm) and nasal region (4.3 mm). The asymmetries between the left and right sides in both dental and skeletal expansions were statistically nonsignificant. The changes in the Sella-nasion-point A, Sella-nasion-point B, Sella-nasion and gonion-gnasion angles were statistically significant. CONCLUSIONS: According to the results of this study, transpalatal distraction was found to be a clinically effective technique for palatal expansion in adult patients with MTD. However, treatment planning and regular clinical follow-up visits are necessary for long-term clinical success.

Results and complications of alveolar distraction osteogenesis to enhance vertical bone height.

OBJECTIVE: The aim of this retrospective study was to analyze the outcome and complications of alveolar distraction osteogenesis for the correction of vertically deficient ridges by using intraosseous and extraosseous distractors. STUDY DESIGN: Seven patients with severely atrophic alveolar crests were treated by distraction osteogenesis in 5 alveolar ridge deficiencies by intraosseous distractors and in 2 alveolar ridge deficiencies by extraosseous distractors. The bone deficiencies were secondary to atrophy after periodontal disease, tooth extraction, or trauma. Three months after consolidation of the distracted segments, implants were placed in the distracted areas. The average follow-up period after prosthetic loading was 50 months. RESULTS: The mean alveolar height achieved was 7.8 mm (range, 4-9 mm). The intraoperative and postoperative problems encountered were lack of device activation (n = 1), lingual displacement of the distracted segment (n = 1), paresthesia of the lower lip (n = 4), and dehiscence and plate exposure (n = 2). Most of these complications were considered to be minor complications and were solved without any problems. CONCLUSION: It was concluded that alveolar distraction osteogenesis seems to be an effective technique to treat vertical alveolar ridge deficiencies, but adequate treatment planning is necessary for success. The complications related to this technique can be solved with simple treatments.

Intralesional corticosteroid injection for central giant cell granuloma: a case report and review of the literature.

Central giant cell granuloma (CGCG) is a benign intraosseous lesion of the jaws that is found predominantly in children and young adults. Although benign, it may be locally aggressive, causing extensive bone destruction, tooth displacement and root resorption. The common therapy is aggressive curettage, peripheral ostectomy or resection, which may be associated with loss of teeth and, in younger patients, loss of dental germs. A number of alternative nonsurgical approaches have been advocated in recent years for the management of CGCGs. These include intralesional corticosteroid injections, calcitonin injections and subcutaneous alpha-interferon injections. In this article, an 1-year-old boy with a CGCG is successfully treated with corticosteroid injections and this treatment is discussed within a review of the literature.