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Official Publication of Orofacial Chronicle , India

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CASE REPORT
THE USE OF PRF IN COVERING EXPOSED IMPLANT
Ahmed Halim Ayoub
President of Egyptian society of oral implantology
Fellow of Seville university , Spain


ABSTRACT:
Abstract: Dental implants are becoming the treatment of choice to replace missing
teeth, especially if the adjacent teeth are free of restorations. When planning for the
placement of a single-tooth implant, there must be an adequate space between the
crowns and roots (adequate bone height). Both the quantity and the quality of
alveolar bone must be assessed before implant placement is considered.
KEY WORDS: Dental Implants, platelet rich fibrin

Cite this Article: Ahmed Halim Ayoub: The use of PRF in covering exposed Implant, J ournal of
Head & Neck physicians and surgeons Vol 2 I ssue 1 2014 : Pg


INTRODUCTION:

When minimal bone width is present, implant placement becomes a challenge and
often resulting in recession and dehiscence around the implant that leads to
subsequent gingival recession. To correct such defect, soft tissue autografting and
allografting to correct a buccal dehiscence around a malpositioned Implant placed
by a different surgeon is used
1,2
. Platelet-rich brin (PRF) belongs to a new
generation of platelet concentrates, with simplied processing and without

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biochemical blood handling, it is a strictly autologous fibrin matrix containing a
large quantity of platelet and leukocyte cytokines. The use of platelet gel to
improve soft and hard tissue regeneration is a recent technique in Implantology
2
.
So in this case the PRF is used to the dehiscence.

CASE REPORT

A healthy 24-year-old woman presented with chief complaint of my implant is
showing through my gingival tissue. Patient was wondering if there is any
periodontal treatment available to mask the showing of implant threads through the
gingival tissue and prevent further recession. She presented with excellent oral
hygiene, no history of periodontal disease, nonsmoker, and radiographic X-ray
revealed normal bone morphology. Upon clinical examination, there was minimal
buccal gingival thickness around the implant in upper central incisor. Her recent
dental history included extraction of permanent tooth # and an immediate implant
(Microdent system, Spain 3.8 X 12mm ) was placed in site #24. Her previous
dental treatment was rendered by a different surgeon. The patient presented to
Dental smile center 4 months after implant placement. The implant appeared to be
osseointegrated with a buccal dehiscence and 10%20% of facial implant showing
through gingival tissue due to minimal bone width (Figures 1 and 2).
Since the implant was osseointegrated, removal of implant was not considered
fearing damage to adjacent teeth when trephining the implant. Also, due to loss of
buccal bone cortex, the positioning of implant outside the bony envelope and
possible sloughing of fragile buccal Gingival tissue-guided bone regeneration were
not recommended. Faced with the esthetic concerns And possible future recession
around that implant, soft tissue gingival grafting was recommended to augment the
keratinized gingiva and improve esthetics.

SURGICAL PROCEDURE:

The aim of the first surgery was to increase the zone of gingiva above the implant.
The patient was anesthetized using 2% lidocaine with 1:100,000 epinephrine
followed by a partial thickness envelope flap including reflection of the papilla and
extending the flap from tooth #22 to #11 and noticed buccal dehiscence and

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implant thread exposure 2 mm from implant platform coronally to osseous bone
level apically. A blood sample is taken from the patient without anticoagulant in
10-ml tubes Then Immediately centrifuged at 3000 rpm (approximately 400g
according to Chokrouns calculations) for 10 minutes
3
.



Within a few minutes, the absence of anticoagulant allows activation of the
majority of platelets contained in the sample to trigger a coagulation cascade.
Fibrinogen is at first concentrated in the upper part of the tube, until the effect of
the circulating thrombin transforms it into A fibrin network
4
. Fibrinogen is
initially concentrated in the high part of the tube, before the circulating thrombin
transforms it into brin. A brin clot is then obtained in the middle of the tube, just
between the red corpuscles at the bottom and acellular plasma at the top (Figs. 3
and 4). Platelets are theoretically trapped massively in the brin meshes. The clot
is removed from the tube and the attached red blood cells scraped off and
discarded (figures 5.6). The PRF clot (figure 7) is then placed on the grid in the
PRF Box (figure8) and covered with the compressor and lid. This produces an
inexpensive autologous fibrin membrane in approximately one minute (figure
9a.9b).


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The PRF Box was devised to produce membranes of constant thickness that
remain Hydrated for several hours and to recover the serum exudate expressed
from the fibrin clots which is rich in the proteins vitronectin and fibronectin. The
exudate collected at the bottom of the box may be used to hydrate graft materials,
rinse the surgical site (fig10), and store autologous grafts
2
. After removing the
cover of PRF box 3 membranes obtained from 3 PRF clots(fig11). with a specific
tweezer the membranes is applied one after another to cover the defected site
(Fig12, 13).

Flap was coronally positioned and sutured using 30 Monocryl sutures (fig13)
Healing was uneventful, and the patient was followed up for 6 months (1, 2, 3, 4,
5, 6 weeks) postoperatively, making sure to enforce oral hygiene and rinsing with
chlorhexidine 0.12%. 3 months later, the patient cameback for 2
nd
surgery and we
noticed that the buccal depression over the implant was filled with soft tissue and
disappeared, also about 0.8 mm of newly formed bone covered the implant (fig 14-
15) incision was done to uncover the implant. This incision is midcrestal or a few
millimeters toward the palate with a U shape and opens toward the buccal aspect of
the implant site with slightly divergent arms cover screw is now exchanged for a
healing abutment. Once the healing abutment is placed, the flap should be split in
whole thickness through its center, separating it into mesial and distal parts
6,7,
( fig

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16) 3 weeks later the healing abutment is removed and an implant level impression
was taken prior to final prosthesis fabrication
8
.


CONCLUSION:

From a radiologic and histologic point of view at 4 months after surgery, the use of
PRF as the sole lling or covering material stabilized a high volume of natural
regenerated bone and soft tissue over the exposed implant threads. Choukrouns
PRF is a simple and inexpensive biomaterial, and its systematic use during
covering bony defect above implant seems a relevant option.

REFERENCES:

1. Shroff B, Siegel SM, Feldman S, Siegel SC. Combined orthodontic and prosthetic therapy.
Special considerations. Dent Clin North Am. 1996;40(4):911943
2. Allen EP. AlloDerm: an effective alternative to palatal donor tissue for treatment of gingival
recession. Dent Today. 2006;25(1):48, 5052.
3. Soft tissue grafting to improve implant esthetics. Moawia M Kassab Clinical, Cosmetic and
investigation dentistry 16 spet. 2010.
4. Choukroun J, Adda F, Schoefer C, Vervelle A. Une opportunite en paro-implantologie: le PRF.
Implantodontie 2000;42:55-62. French.
5. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006 Mar;101(3):e45-50. Epub 2006 Jan 10.
Platelet-rich fibrin (PRF): a second-generation platelet concentrate. Part II: platelet-related
biologic features. Dohan DM, Choukroun J, Diss A, Dohan SL, Dohan AJ, Mouhyi J, Gogly B.
6. Interimplant papilla preservation in the esthetic zone: a report of six consecutive cases. Kan
JY, Rungcharassaeng K. Int J Periodontics Restorative Dent. 2003 Jun;23(3):249-59.
7. Simonpieri A, Choukroun J, Girard MO, Ouaknine T, Dohan D.Immediate post-extraction
implantation: interest of the PRF. Implantodontie 2004;13:177-89.
8. Dohan D, Donsimoni J-M, Navarro G, Gaultier F. [Platelet concentrates. Part 1: Technologies.]
Implantodontie 2003;12:5-16. French.

Acknowledgement- None

Source of Funding- Nil

Conflict of Interest- None Declared

Ethical Approval- Not Required

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Correspondence Addresses :
Ahmed Halim Ayoub
Address: Dental Smile 178 Omar Lotfy St.,
Sporting Alexandria, Egypt
Fax: +20 3 5910843 Mob: +20 12 2205513
Email: dr.ayoub@gmail.com
Director Dental smile training and educational center
President of Egyptian society of oral implantology
Fellow of Seville university , Spain
Private practice limited to dental implants
Clinical advisor of Dooox German dental academy
Board member of International group of oral rehabilitation , France
www.esoiegypt.com



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