Efficacy of Platelet-Rich Fibrin in Treatment of Multiple Adjacent Gingival Recession Defects Using Minimally Invasive Coronally Advanced Flap and Modified Coronally Advanced Flap: A Split-Mouth Randomized Controlled Trial

Abstract

Background: The split-mouth randomized clinical trial evaluated and compared the clinical efficacy and patient-centered outcomes of platelet-rich fibrin (PRF) combined with modified coronally advanced flap (MCAF) and minimally invasive coronally advanced flap (MICAF) techniques for the treatment of multiple adjacent gingival recession (GR) Cairo's RT1 and/or RT2. Methods: Eighteen participants with multiple GR defects were treated using MCAF + PRF and MICAF + PRF approaches in a split-mouth design. A qualified periodontist examined the periodontal clinical parameters (recession height [RH] recession width [RW], clinical attachment level [CAL] gain, probing depth [PD], keratinized tissue width [KTW], and gingival thickness [GT]) and aesthetics at baseline and 6 months later. After 7 days, 3 months, and 6 months, patient-centered outcomes relating to pain/discomfort and aesthetics were evaluated using a visual analog scale (VAS) and a questionnaire. A statistical study was performed on the variations between the original recording and the subsequent months. Results: Both the surgical methods showed statistically significant improvements in all clinical parameters, such as RH, RW, CAL, PD, and KTW (p < 0.001). MICAF + PRF was found to have a similar clinical efficacy to MCAF + PRF for tissue gain; yet between-group differences in GT after 6 months were not statistically significant. Patient-related outcome measures (PROMs) were significantly better in MICAF + PRF with lower VAS pain scores (p < 0.001) and higher ratings of esthetic satisfaction (p < 0.001) at 6 months' follow-up. Trial Registration: Name of the Registry: Clinical Trials Registry - India (CTRI); Registration Number: CTRI/2019/01/016994.

Keywords: gingival recession; minimally invasive surgical procedures; platelet-rich fibrin; randomized controlled trial; surgical flaps.

Figure 1

(a-l) Group 1 MICAF + PRF. (a) Preoperative measurement of gingival recession using a periodontal probe. (b) Administration of local anesthesia. (c-d) Incision design to create a minimally invasive coronally advanced flap (MICAF). (e–g) Preparation of a tunnel. (h) Prepared PRF membrane obtained after centrifugation. (i) Stabilization of the PRF over the defect. (j) Suturing of the flap to secure the PRF and achieve tension-free closure. (k) Postoperative periodontal dressing for site protection. (l) Healed surgical site showing improved gingival coverage and integration.

Figure 2

(a–i) Group 2 MCAF + PRF. (a) Preoperative measurement of gingival recession using a periodontal probe. (b) Administration of local anesthesia. (c) Flap reflection showcasing root exposure and defect preparation. (d) Tension-free advancement of the flap. (e) Prepared PRF membrane after centrifugation. (f): PRF secured over the defects with flap repositioning. (g) Suturing of the flap to stabilize the graft and PRF in position. (h): Postoperative dressing applied to protect the surgical site. (i) Healed surgical site showing improved gingival coverage and integration.