Clinicoradiographic evaluation of polymer of injectable platelet rich fibrin (i-PRF) and hydroxyapatite as bone graft substitute in maxillomandibular bony defects: A double blinded randomised control trial

Purpose: Enucleation of the maxillo-mandibular cysts will create post-surgical bone defects, which may take more than a year for complete bone healing. Bone grafts are common to aid bone regeneration in large defects. The aim was to evaluate the clinical and radiographical healing and bone formation capabilities of polymer of i-PRF and hydroxyapatite in maxilla-mandibular defects compared to hydroxyapatite (HA) alone. The primary objective was to do a clinical assessment of healing at postoperative days 1, 3, and 7; and a radiological evaluation of bone formation postoperatively at the 2 nd month and 4 th month. A secondary objective was to identify if any, local or systemic side/ill effects of polymer of i-PRF with HA. Material and Methods: After surgical enucleation of 19 maxillo-mandibular cysts/tumors, either HA or HA + i-PRF graft was adapted to the defect. Clinical outcome variables such as Pain (VAS score), edema, and mucosal color were evaluated on postoperative days 01, 03, and 07 while radiological outcome variables such as volume of the defect (cc), and Density of new bone (HU) on Computed Tomography were evaluated at 2 nd and 4 th month. The results obtained were tabulated and compared with the inferential analysis. Results: Clinical parameters are better in the HA + i-PRF group but the result was non-significant. Radiologically, the mean healing ratios were significantly greater in the HA + i-PRF group (63.5 ± 2.34 at 2 nd month, 90.3 ± 7.32 at 4 th month) compared to the HA group (57.2 ± 5.21at 2 nd month, 80.8 ± 5.33 at 4 th month). When comparing the mean density of new bone, there was a statistically significant difference with a mean difference of 95.2 HU more in the HA + i-PRF (623 HU ± 42.9) compared to the HA group (528 HU ± 96.5) in 2 nd month. Conclusion: The polymer of i-PRF and HA prepared as the sticky bone yields faster and better bone healing in post-enucleation maxilla-mandibular bony defects as compared to hydroxyapatite alone based on radiological findings till 4 months.