TL;DR
Using RST for socket sealing achieves comparable bone preservation to the GBR in severe defect molars, while simplifying the surgical procedure and reducing costs.
In edentulous maxilla with insufficient bone width, both the association of i-PRF+DBBM and DBBM alone were effective in providing bone width gain for implant placement, and the association of DBBM with i-PRF showed similar outcomes compared with DBBM alone for the studied parameters.
Within the limitations of this study, intentionally exposing the xenogeneic collagen matrix seal yielded comparable outcomes in non-contained and contained sockets, which may reflect the material's ability to reduce the adverse effects of socket-wall resorption.
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, which may represent a simple, autologous, and clinically useful adjunct for socket preservation prior to implant placement.
Adequate peri-implant soft tissue thickness and keratinized mucosa width are crucial for implant health and aesthetics. Autogenous subepithelial connective tissue grafts (CTG) are the gold-standard for augmenting thin biotypes, but they require a second surgical site. This trial evaluated whether a human fascia lata allograft (FLA) or platelet-rich fibrin (PRF) membrane could comparably enhance peri-implant soft tissue phenotype and serve as less invasive alternatives of CTG. Forty-five patients with a thin gingival phenotype (≤ 1 mm thickness) requiring upper anterior implant were randomly assigned to receive soft tissue augmentation with either (1) FLA allograft, (2) PRF membrane, or (3) CTG (control). Interventions were applied concurrently with implant placement in a standardized manner. Gingival thickness (GT) and keratinized tissue width (KTW) were measured at baseline and 6 months using transgingival probing and clinical indices. Labial bone thickness was assessed by cone-beam CT at implant placement and 6 months. Forty-five enrolled patients completed the study. All treatment modalities showed improvements in gingival and bone parameters, with the connective tissue graft consistently demonstrating the greatest gains. The median keratinized tissue width increased to 4.00 mm in the Connective Tissue Graft group, slightly higher than the Fascial Lata Allograft and Platelet-Rich Fibrin groups (3.75 mm). Gingival thickness showed significant increases in all groups, with the Connective Tissue Graft reaching 2.15 mm, followed by Fascia Lata Allograft (1.80 mm) and Platelet-Rich Fibrin (1.55 mm). Labial bone thickness also increased, with the Connective Tissue Graft achieving the highest mean value of 2.300 mm, and after 6 months, significant gains were observed in both this group (p = 0.032) and in the Platelet-Rich Fibrin group (p = 0.044), while Fascia Lata Allograft showed a smaller, non-significant increase. Both fascia lata allograft (FLA) and PRF improved peri-implant soft tissue parameters, however the connective tissue graft (CTG) remains the gold standard for achieving the greatest thickness and best aesthetic results. FLA is a promising alternative that avoids a second surgical site with comparable outcomes, whereas PRF offers faster healing but lacks the volume necessary for significant tissue modification.
Alveolar dehiscence and gingival recession are periodontal defects that impair aesthetics and function, especially when present in the anterior region. Conventional surgical techniques, such as coronally advanced flaps and connective tissue grafts, may enhance soft tissue coverage but fail to correct the bone defects. To rectify this, regenerative strategies that include guided bone and tissue regeneration (GBR/GTR) and autologous platelet concentrates like platelet-rich fibrin (PRF) have shown potential with promising results. However, reports combining GBR/GTR and PRF treatment of anterior alveolar dehiscence defects remain limited. This case series demonstrating the combined use of guided bone/tissue regeneration, connective tissue grafting, and both injectable and membrane forms of platelet-rich fibrin for the management of anterior alveolar dehiscence defects. This report discusses two cases of anterior alveolar dehiscence with gingival recession that were treated with a combined regenerative protocol. In Case 1, a 28-year-old female with a peri-implant dehiscence defect was treated with “sticky bone”, which was made by mixing her own bone with injectable PRF, a connective tissue graft (CTG), and an advanced PRF membrane. In Case 2, a similar presentation maxillary central incisor of a 25-year-old female was treated with allogeneic bone graft, injectable PRF, CTG, and a PRF membrane. Both cases adhered to minimally invasive surgical protocols, complemented by postoperative injectable PRF applications. After six months, both patients showed a big improvement in gingival thickness, bone regeneration, soft tissue stability, and aesthetic results. There were no reported problems, and the patients were satisfied with the results. The combined application of guided regeneration, connective tissue grafting (CTG), and platelet-rich fibrin (PRF) presents a minimally invasive and biologically orientated technique that improves outcomes for both hard and soft tissues. Additional long-term studies are necessary to validate its predictability and clinical stability.
Both study groups showed a statistically significant increase in bone width at 6 months, with the highest increase observed in group A2 (ABG + rhBMP-2), with the highest increase observed in group A2 (ABG + rhBMP-2).
