Clinical evaluation of autologous platelet rich fibrin in horizontal alveolar bony defects

Abstract

Background: Horizontal bone loss is the most common periodontal problem confronting the clinician but has received little attention. Platelet rich fibrin (PRF) is a second generation platelet concentrate. The platelets, leucocytes, growth factors and cytokines contained within PRF make it a healing biomaterial with tremendous potential for bone and soft tissue regeneration.

Aim: This interventional clinical trial evaluates the clinical effectiveness of Autologous Platelet Rich Fibrin (PRF) in the management of horizontal bony defects.

Settings and design: Department of Periodontics. Design was Non Randomized Clinical Trial with split mouth design.

Materials and methods: A total of 45 sites with horizontal bone loss in 15 patients were studied, 15 sites were treated with PRF gel (experimental group I) and 15 sites were treated with PRF gel and PRF membrane (experimental group II). Control group (15 sites) were treated with open flap debridement.

Statistical analysis: All the parameters were assessed at baseline and after nine months which included Pocket Depth (PD), Clinical Attachment level (CAL), Gingival Recession (REC) and Relative Crest Height (RCH). The mean changes at baseline and after 9 months within each group were compared using Wilcoxon Signed Ranks Test. The mean changes for each parameter between groups were compared using Kruskal Wallis Test.

Results: Re-evaluation at nine months revealed that all groups showed a significant reduction in probing depth (1.1±0.38 mm in control, 1.73±0.53 mm in group I, 1.7±0.45 mm in group II)(p<0.05) and clinical attachment gain (0.86±0.58 mm in control, 1.56±0.62 mm in group I, 1.7±0.52 in group II)(p<0.05) as compared to baseline. Intergroup comparisons of reduction in probing depth and clinical attachment gain showed significant differences in the experimental groups as compared to control (p<0.05), but there was no significant difference between the experimental groups (p>0.05). There was no significant difference in gingival recession and radiographic bone levels at 9 months post surgery (p>0.05) in all the three groups.

Conclusion: Within the limitations of this study, it can be concluded that, clinically the use of PRF in both gel and membrane form is more effective than open flap debridement alone in the management of horizontal periodontal defects at nine months post surgery.

Keywords: Bone regeneration; Clinical trials; Growth factors; Osseous defects; Periodontal regeneration.

[Table/Fig-1]:

Radiographic assessment of bone levels using Schei ruler., CA = Crest to Apex distance, RCH = Relative Crest Height,

[Table/Fig-2A-G]:

Clinical Photographs, Experimental Group 1 (PRF Group), A. Surgical site; B. Defects Exposed; C,D,E. Preparation of PRF gel; F. PRF gel placed between 24 & 25, 25 & 26; G. Surgical site after 9 months

[Table/Fig-3A-G]:

Clinical photoraphs, Experimental Group II (PRF gel plus PRF membrane group); A. Surgical Site; B. Defects Exposed; C,D. Preparation of PRF gel & PRF membrance; E. PRF gel placed between 11 & 12, 12 & 13; F. PFG membrance placed over the PRF gel; G. Surgical site after 9 months

[Table/Fig-4A-D]:

Clinical photographs, Control Group (Open Flap Debridement group); A. Surgical Site; B. Defects exposed between 43, 44, 45 & 46; C. Sutures placed; D. Surgical site after 9 months.

[Table/Fig-5]:

Pre and Post operative Radiograph.; A. Baselne radiograph; B. 9 months post operative radiograph

[Table/Fig-6]:

Pre and Post operative Radiograph with Schei ruler.; A. Baseline radiograph; B. 9 months post operative radiograph