Evaluation of bone regeneration in periapical osseous defects with and without Platelet rich plasma, combined Calcium sulfate and autologous bone graft -A comparative study.

BACKGROUND: Osseous defects of the jaw occurs naturally by pathological conditions such as infections, tumors, cysts or iatrogenic causes induced during surgical treatment of preexisting periradicular bony pathologies. Management of these bone defects poses a great challenge for surgeons who are continually exploring ways to find new modalities to improvise bone substitutes.

PURPOSE: To compare and evaluate bone regeneration with and without combining Platelet rich plasma (PRP), calcium sulfate (CS) and autogenous bone graft in periapical defects of jaw.

METHODS: The study is a randomized prospective comparative study, in which 20 patients were assigned, with 10 patients each forming the study and control groups. In the first group (study group) the bone defect was filled with PRP, calcium sulfate and autologous bone graft. In the second group (control group) defect was allowed to heal without PRP, calcium sulfate and autogenous bone graft. Digital orthopantogram (OPG) were taken to analyze the bone density and bone regeneration. The parameters used to analyze the radiographs included grey scale analysis, residual bone defect calculation in pixels both performed in Corel Photopaint X3® software and radiopaque scoring scale. Statistical analysis was carried out using Kolmogorov Smirnov test, Independent t test and Anova test.

RESULTS: The mean bone defect density (BDD) measured using grey scale was significant in the study group during 5th, 13th and 20th week than the control group (p < 0.0001). The percentage bone formation analyzed using residual bone defect calculation revealed significantly higher size reduction in the study group than with the outcome obtained in the control group (p < 0.0001). The mean radiopaque score given by blinded observers also showed significance in the study group.

CONCLUSION: From the results of the study, it is clearly evident that radiographic bone density and rapid bone formation in the study group when compared to the control group. Thus the grouping of PRP, combined calcium sulfate with autologous bone graft proved to be a novel osteoinductive biomaterial.