fibrin and Dental-Fistula

In the present case of a 35-year old patient, platelet-rich fibrin, which is an autologous platelet concentrate, was used to fill the osseous defect following surgery. The case was assessed both clinically and radiographically for a period of 9 months.

Topics: Adult; Apicoectomy; Blood Platelets; Dental Fistula; Fibrin; Follow-Up Studies; Humans; Male; Periapical Diseases; Retrograde Obturation

Infectious process frequently results in extensive bone resorption and defect, periradicular or periapical lesions, or vertical fracture with infected sinus tract. When tooth extraction is mandated it typically results in additional bone loss in the buccal or lingual cortical plate. Immediate guided bone regeneration (GBR) and implant fixation at an infected site is frequently complicated by soft-tissue dehiscence, membrane exposure, and implant failure. The objective of this research is to assess the feasibility of immediate bone augmentation (IBA) after purulent tooth extraction, employing a dedicated titanium membrane. An intrasulcular incision was made around the tooth to be extracted and extended to 2 adjacent teeth while maintaining the papillae. Vertical releasing incisions were made to mobilize the mucoperiosteal flap. Cautious tooth extraction was executed utilizing conventional measures and was followed by meticulous curettage of the infected and granulated tissue in the socket. Titanium membranes were applied to the socket walls followed by socket filling with autologous platelet-rich fibrin and primary closure. Eight or more weeks later membrane removal and implant placement were performed. Of the 15 patients who underwent this procedure, 7 patients (47%) had early membrane exposure (between weeks 2 and 6), which was treated conservatively. No infection or early membrane removal was reported. All patients achieved sufficient bone augmentation, and 8 patients received implants without any additional GBR. IBA after infected tooth extraction, using titanium membrane application was feasible and safe and yielded adequate bone filling to support implant fixation at > or =8 weeks. Further studies need to evaluate if the titanium membrane helped in any way to inhibit plaque accumulation or resist infection in cases of early membrane exposure.

Topics: Adult; Bacterial Infections; Biocompatible Materials; Bone Regeneration; Curettage; Dental Fistula; Dental Implants; Feasibility Studies; Female; Fibrin; Granulation Tissue; Guided Tissue Regeneration, Periodontal; Humans; Male; Membranes, Artificial; Middle Aged; Periapical Diseases; Periodontal Diseases; Platelet-Rich Plasma; Titanium; Tooth Diseases; Tooth Extraction; Tooth Socket; Treatment Outcome