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. 2025 Nov-Dec;15(6):1183-1189.
doi: 10.1016/j.jobcr.2025.07.028. Epub 2025 Aug 7.

Dual-action platelet-rich fibrin in periodontal therapy: Assessing the efficacy of injectable versus metronidazole-enhanced platelet-rich fibrin in non-surgical periodontal treatment - A clinical study

Devadharshini Chandrasekar  1 , Burnice Nalina Kumari Chellathurai  1 , Jaideep Mahendra  1 , Vijayalakshmi Rajaram  1
Affiliations

Dual-action platelet-rich fibrin in periodontal therapy: Assessing the efficacy of injectable versus metronidazole-enhanced platelet-rich fibrin in non-surgical periodontal treatment - A clinical study

Devadharshini Chandrasekar et al. J Oral Biol Craniofac Res. 2025 Nov-Dec.

Abstract

Background: Adjunctive therapies play a crucial role in enhancing the efficacy of non-surgical periodontal therapy (NSPT) by addressing the multifactorial nature of periodontal disease. Injectable platelet-rich fibrin (i-PRF) and metronidazole-infused PRF gel have emerged as potential biomaterials that promote periodontal regeneration and antibacterial effects, respectively.

Objective: To evaluate and compare the clinical efficacy of i-PRF and metronidazole-infused PRF gel as adjuncts to NSPT in patients with periodontitis.

Method: ology: A randomized controlled trial was conducted on 20 periodontal sites in patients with Stage II-III periodontitis. Sites were divided into two groups (n = 10 each), receiving either i-PRF or metronidazole-infused PRF gel following NSPT. Clinical parameters, including Oral Hygiene Index (OHI), Gingival Index (GI), Bleeding on Probing (BOP), Probing Pocket Depth (PPD), and Clinical Attachment Level (CAL), were assessed at baseline, 4 weeks, and 3 months. Statistical analyses included the Mann-Whitney U test for intergroup comparisons and the Friedman test for intragroup comparisons.

Results: Both groups showed significant improvement in PPD and CAL over the study period (p < 0.001). The metronidazole-infused PRF gel group demonstrated a more pronounced reduction in GI and BOP compared to the i-PRF group (p = 0.01 and p = 0.66, respectively). Improvements in OHI were observed in both groups but were not statistically significant.

Conclusion: The study highlights the potential of metronidazole-infused PRF gel as a superior adjunct to NSPT due to its enhanced antimicrobial effects and periodontal tissue healing properties. Personalized therapeutic strategies incorporating bioactive materials can optimize periodontal treatment outcomes.

Keywords: Adjunctive therapy; Injectable PRF; Metronidazole-infused PRF gel; Non-surgical periodontal therapy; Periodontitis.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
– Study design flowchart.
Fig. 2
Fig. 2
Metronidazole infused PRF Gel.
Fig. 3
Fig. 3
– Group A – Subgingival application of i-PRF and follow up (3a) Baseline clinical photograph showing a probing pocket depth (PPD) of 8 mm prior to intervention. (3b) Subgingival administration of injectable PRF (i-PRF) following non-surgical periodontal therapy (NSPT) using a blunt-tipped cannula. (3c) Post-operative clinical photograph at 3-month review visit showing significant reduction in probing depth to 3 mm.
Fig. 4
Fig. 4
Group B Subgingival application of Metronidazole infused PRF gel and follow - up (4a) Baseline clinical photograph showing a probing pocket depth (PPD) of 5 mm prior to treatment. (4b) Preparation and subgingival delivery of Metronidazole-infused PRF gel using a syringe following non-surgical periodontal therapy (NSPT). (4c) Post-operative clinical photograph at 3-month review visit demonstrating reduction in probing depth to 3 mm.
See this image and copyright information in PMC

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