Titanium-prepared Platelet-rich Fibrin for Treatment of Gingival Recession Using the VISTA Technique

Titanium-prepared Platelet-rich Fibrin Versus Connective Tissue Graft in Gingival Recession Treatment: a Split-mouth Randomized Clinical Trial

This split-mouth randomized clinical trial aims to compare the effectiveness of titanium-prepared platelet-rich fibrin (T-PRF) and connective tissue graft (CTG) in the treatment of Miller Class I and II gingival recession using the Vertical Incision Subperiosteal Tunnel Access (VISTA) technique. Twenty systemically healthy adult participants with bilateral gingival recession defects will receive both interventions, with one side randomly assigned to T-PRF and the contralateral side assigned to CTG. Clinical outcomes including recession depth, attached gingival width, probing depth, relative attachment level, healing, and patient satisfaction will be evaluated over a 6-month follow-up period.

Study Overview

• Status: Completed
• Conditions: Gingival Diseases; Gingival Recession
• Intervention / Treatment: Procedure: Titanium-Prepared Platelet-Rich Fibrin (T-PRF) with VISTA Technique; Procedure: Connective Tissue Graft (CTG) with VISTA Technique

Detailed Description

Gingival recession is a common periodontal condition characterized by apical displacement of the gingival margin, resulting in root exposure, dentin hypersensitivity, esthetic concerns, and increased susceptibility to root caries. Connective tissue grafts (CTG) are widely considered the gold standard for root coverage procedures due to their predictable clinical outcomes. However, CTG requires harvesting tissue from a secondary surgical donor site, which may increase postoperative discomfort and patient morbidity.

Titanium-prepared platelet-rich fibrin (T-PRF) is a second-generation autologous platelet concentrate prepared using titanium tubes, which may enhance fibrin network quality and improve soft tissue healing and regeneration. T-PRF has been proposed as a less invasive alternative to CTG in periodontal plastic surgery.

The present study is designed as a split-mouth randomized controlled clinical trial to compare T-PRF and CTG in the treatment of bilateral Miller Class I and II gingival recession defects using the Vertical Incision Subperiosteal Tunnel Access (VISTA) technique. Twenty systemically healthy adult participants with symmetrical gingival recession defects will be enrolled. Each participant will receive both interventions: one side of the mouth will be randomly assigned to treatment with VISTA combined with CTG, while the contralateral side will receive VISTA combined with T-PRF.

Randomization will be performed using a computer-generated allocation sequence prepared by an independent investigator. Due to the nature of the interventions, operator blinding is not feasible; however, all clinical measurements and outcome assessments will be conducted by a blinded examiner.

Clinical parameters including gingival recession depth, attached gingival width, probing depth, and relative attachment level will be measured at baseline, 3 months, and 6 months postoperatively using a UNC-15 periodontal probe. Early wound healing will be assessed at 1, 2, and 4 weeks using a healing index. Patient-reported satisfaction and postoperative outcomes will be evaluated using a visual analog scale (VAS).

The study aims to determine whether T-PRF can provide comparable clinical and patient-centered outcomes to CTG while reducing the morbidity associated with donor site harvesting.

• Study Type: Interventional
• Enrollment (Actual): 20
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Syria
  • Damascus, Syria
    • School of Dental Medicine

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. Systemically healthy
2. Bilateral gingival recession
3. Good oral hygiene

Exclusion Criteria:

1. Smokers
2. Pregnant/lactating women
3. Systemic diseases affecting healing
4. Previous surgery

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Crossover Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: VISTA + Titanium-Prepared Platelet-Rich Fibrin (T-PRF); Sites allocated to the test group will be treated using the Vertical Incision Subperiosteal Tunnel Access (VISTA) technique in combination with titanium-prepared platelet-rich fibrin (T-PRF). T-PRF membranes will be prepared from autologous venous blood collected in titanium tubes and centrifuged according to a standardized protocol before placement beneath the tunneled gingival tissue.	Procedure: Titanium-Prepared Platelet-Rich Fibrin (T-PRF) with VISTA Technique; The gingival recession defects assigned to the test group will be treated using the Vertical Incision Subperiosteal Tunnel Access (VISTA) technique combined with titanium-prepared platelet-rich fibrin (T-PRF). T-PRF membranes will be prepared from the participant's autologous venous blood collected in titanium tubes and centrifuged according to a standardized protocol before placement beneath the tunneled flap.
Active Comparator: VISTA + Connective Tissue Graft (CTG); Sites allocated to the control group will be treated using the Vertical Incision Subperiosteal Tunnel Access (VISTA) technique in combination with an autogenous connective tissue graft (CTG) harvested from the palatal donor site and placed beneath the tunneled gingival tissue for root coverage.	Procedure: Connective Tissue Graft (CTG) with VISTA Technique; The gingival recession defects assigned to the control group will be treated using the Vertical Incision Subperiosteal Tunnel Access (VISTA) technique combined with an autogenous connective tissue graft (CTG). The graft will be harvested from the palatal donor site and positioned beneath the tunneled gingival tissue to achieve root coverage and soft tissue augmentation.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Gingival Recession Depth	Change in gingival recession depth measured in millimeters (mm) from the cementoenamel junction to the free gingival margin using a UNC-15 periodontal probe. Lower values indicate better root coverage outcomes.	Baseline, 3 months, and 6 months postoperatively.
Width of Attached Gingiva	Change in the width of attached gingiva measured in millimeters (mm) using a UNC-15 periodontal probe. Higher values indicate improved gingival tissue augmentation and periodontal stability.	Baseline, 3 months, and 6 months postoperatively.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Periodontal Probing Depth	Change in periodontal probing depth measured in millimeters (mm) using a UNC-15 periodontal probe at treated sites. Lower values indicate better periodontal health.	Baseline, 3 months, and 6 months postoperatively.
Relative Clinical Attachment Level	Change in relative clinical attachment level measured in millimeters (mm) using a UNC-15 periodontal probe. Lower values indicate improved periodontal attachment.	Baseline, 3 months, and 6 months postoperatively.
Early Wound Healing Index	Early wound healing assessed clinically using the Early Healing Index (EHI). The scale ranges from 1 to 5, where: 1 = Complete flap closure without fibrin line (best healing) 5 = Incomplete flap closure with complete tissue necrosis (worst healing) Lower scores indicate better healing outcomes.	1 week, 2 weeks, and 4 weeks postoperatively.
Patient Satisfaction	Patient satisfaction assessed using a Visual Analog Scale (VAS). The scale ranges from 0 to 10, where: 0 = Completely dissatisfied 10 = Completely satisfied Higher scores indicate greater patient satisfaction with the treatment outcome.	3 months and 6 months postoperatively.
Postoperative Pain	Postoperative pain assessed using a Visual Analog Scale (VAS). The scale ranges from 0 to 10, where: 0 = No pain 10 = Worst imaginable pain Lower scores indicate less postoperative pain and discomfort.	1 week and 2 weeks postoperatively.

Collaborators and Investigators

• Sponsor: Arab International University
• Collaborators: Damascus University
• Investigators: Study Director: Saleh Al Kurdi, PhD, Arab International University; Principal Investigator: Rania Daadoush, DDs, Damascus University; Study Chair: Tarek Qasem, PhD, Damascus University

Publications and helpful links

General Publications

• Miller PD Jr. A classification of marginal tissue recession. Int J Periodontics Restorative Dent. 1985;5(2):8-13. No abstract available.
• Cairo F, Nieri M, Cincinelli S, Mervelt J, Pagliaro U. The interproximal clinical attachment level to classify gingival recessions and predict root coverage outcomes: an explorative and reliability study. J Clin Periodontol. 2011 Jul;38(7):661-6. doi: 10.1111/j.1600-051X.2011.01732.x. Epub 2011 Apr 20.
• Tunali M, Ozdemir H, Kucukodaci Z, Akman S, Yaprak E, Toker H, Firatli E. A novel platelet concentrate: titanium-prepared platelet-rich fibrin. Biomed Res Int. 2014;2014:209548. doi: 10.1155/2014/209548. Epub 2014 Jan 21.
• Chambrone L, Sukekava F, Araujo MG, Pustiglioni FE, Chambrone LA, Lima LA. Root-coverage procedures for the treatment of localized recession-type defects: a Cochrane systematic review. J Periodontol. 2010 Apr;81(4):452-78. doi: 10.1902/jop.2010.090540.
• Abdelhaleem M, Saleh W, Elmeadawy S. Treatment of gingival recession with vestibular incision subperiosteal tunnel access and advanced platelet-rich fibrin. BMC Oral Health. 2025 Jan 14;25(1):63. doi: 10.1186/s12903-024-05398-w.

Study record dates

Study Major Dates

• Study Start (Actual): August 12, 2025
• Primary Completion (Actual): January 12, 2026
• Study Completion (Actual): April 25, 2026

Study Registration Dates

• First Submitted: May 9, 2026
• First Submitted That Met QC Criteria: May 9, 2026
• First Posted (Actual): May 15, 2026

Study Record Updates

• Last Update Posted (Actual): May 15, 2026
• Last Update Submitted That Met QC Criteria: May 9, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: Connective tissue graft; VISTA technique; Titanium-prepared platelet-rich fibrin; Root coverage surgery
• Additional Relevant MeSH Terms: Periodontal Atrophy; Periodontal Diseases; Mouth Diseases; Stomatognathic Diseases; Gingival Recession; Gingival Diseases
• Other Study ID Numbers: DN-14072025-3109

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No