Aaqil, Malik
(2008)
Influence of platelet rich plasma on
osseointegration in controlled
diabetic patients.
Masters thesis, Universiti Sains Malaysia.
Abstract
Success rates of dental implants in controlled diabetics is less than normal
patients and considering the large number of diabetic patients a solution and
improvement is needed. Diabetic patients are known to have delayed bone and
wound healing compared to normal patients. The objective of this study was to
improve success rates by employing a minimally invasive implant to decrease
the size of the wound and autogenous platelet rich plasma (PRP) to enhance
the bone healing. This was a Non-randomized clinical trial employing a splitmouth
design consisting of patients selected from the diabetic clinic at the
Hospital University Sains Malaysia. Using a one-stage surgical protocol, a total
of 28 Mini Drive Lock implants (Intra-lock® USA) implants with lengths of 10,
11.5, 13 and a diameter of 2.0 mm of 2.5 mm were inserted in edentulous and
partially edentulous patients. Patients included as controlled diabetic had
HbA1c = 7 or less, FBS = 7 mmoi/L or less, RBS = 10 mmoi/L or less. Total
sample size was 14 patients, each patient received two implants (n=28 implants,
14 = trial & 14 = control), where one implant (without PRP) is placed, and
another implant (with PRP) is placed on the contra lateral side of the same jaw.
Implants were placed in the maxilla or the mandible in each patient. Results of
14 test and 14 control implants is reported. Radiographic density evaluation was
done at 3, 6 and 9 weeks after placement. Measurements were done at five
points around the implants using histogram and densitometry with the VIXWIN
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2000 Ver. 1.8 software. A total of 28 implants were placed, 1 implant did not
attain primary stability at placement due to lack of bone width and was removed,
it was not considered failure to integrate. At 9 weeks all 27 mini implants placed
showed osseointegration on radiographs. Statistically, results showed no
significant difference between radiographic density of the two groups (P=0.125)
during the time period of the study, however mini implants were successfully
followed up at 9 weeks. This study showed no significant difference of wound
healing when comparing groups of PRP and non-PRP in controlled diabetic
patients. However both groups have shown good osseointegration
radiographically and the stability of implants was still maintained over the period
of nine weeks although with immediate loading. The use of minimally invasive
implant procedure can help to improve the soft tissue wound healing and bone
osseointegration in diabetic patients with or without PRP. In conclusion the
wound healing in diabetic patients is highly dependant upon the severity of
tissue trauma, therefore emphases on implant placement technique should be
considered.
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