Comparative Radiographic Evaluation of Bone Regeneration At Mandibular Symphysis and Parasymphysis Fracture Site With or Without Application of Platelet Rich Plasma (Prp)

Abstract

Introduction: In order to treat maxillofacial traumatic injuries (MFT), platelet-rich plasma (PRP) has become the most preferred option due to a recent paradigm shift towards a regenerative strategy. However, it could be challenging to quickly assess bone regeneration using standard radiography tools like OPG and RVG. Furthermore, conflicting findings have been documented regarding the same.

Aim: To compare radiographic evaluation of bone regeneration at different time intervals in mandibular symphysis and parasymphysis fracture site with or without application of PRP.

Materials & Method: A total of twenty patients (n=20) participated in a prospective clinical trial conducted at Department of Oral and Maxillofacial Surgery, School of Dental Sciences, Krishna Vishwa Vidyapeeth (KVV), Karad, Maharashtra, India during the period of June 2023 to December 2024. The total samples were split into two groups at random using the odd-even sequence randomization approach wherein the odd-numbered serials were allocated as “Group A” designated as the study group & even numbered serials were allocated as “Group B” designated as the control group. Group A (study group) underwent ORIF with PRP and Group B (control group) underwent ORIF without PRP. Bone regeneration over time in both the groups were quantitatively assessed by observing bone density variations radiographically using Orthopantomagram (OPG) & Radiovisiography (RVG) at different time intervals (preoperative, immediate post operative, one-month post-operative & six-month post-operative follow up). Pixel values and resolution values were visualized using Microsoft Paint (Version 11.2210.4.0) software at each time interval by precisely observing gray scale changes in width and height of bone formation.  SPSS software version 26 was used to compute the data. Inter-group comparisons were measured using the Shapiro-Wilk test, Bonferroni post hoc testing, unpaired t test, and ANOVA.

Results: During the pre-operative phase, there was no statistically significant difference in pixel values in OPG and RVG between Group A & Group B (p-value=0.2) whereas the resolution values for RVG indicated no statistically significant difference between groups with p-values of 0.16 and 0.15 respectively. Immediate post-operative OPG pixel values & resolution values showed a statistically significant difference between the two groups with a p-value of 0.0106. Immediate post-operative RVG pixel & resolution values showed no discernible difference between the two groups with a p-value of 0.726.  In case of OPG values for pixel and resolution values at 1 month and 6 months demonstrated a statistically significant difference for resolution at 6 months, with the Group A exhibiting greater post-operative resolution values than Group B, as indicated by the Chi-square value of 49.39 (p =0.025). RVG values between the study and control groups for pixel and resolution values at one and six months demonstrated significant differences between both groups with p = 0.023 and p = 0.015 respectively.

Conclusion: This study demonstrated that PRP treated group demonstrated superior healing and improve bone regeneration in cases of mandibular parasymphysis and symphysis fractures in ORIF treated cases that were assessed radiographically using RVG and OPG at different time intervals.