Clinical and radiographic effects of ascorbic acid-augmented platelet-rich fibrin versus platelet-rich fibrin alone in intra-osseous defects of stage-III periodontitis patients: a randomized controlled clinical trial

Mohamed Talaat Elbehwashy, Manal Mohamed Hosny, Ahmed Elfana, Alaa Nawar, Karim Fawzy El-Sayed, Mohamed Talaat Elbehwashy, Manal Mohamed Hosny, Ahmed Elfana, Alaa Nawar, Karim Fawzy El-Sayed

Abstract

Aim: To assess platelet-rich fibrin (PRF) with ascorbic acid (AA) versus PRF in intra-osseous defects of stage-III periodontitis patients.

Methodology: Twenty stage-III/grade C periodontitis patients, with ≥ 3 mm intra-osseous defects, were randomized into test (open flap debridement (OFD)+AA/PRF; n = 10) and control (OFD+PRF; n = 10). Clinical attachment level (CAL; primary outcome), probing pocket depth (PPD), gingival recession depth (RD), full-mouth bleeding scores (FMBS), full-mouth plaque scores (FMPS), radiographic linear defect depth (RLDD) and radiographic defect bone density (RDBD) (secondary-outcomes) were examined at baseline, 3 and 6 months post-surgically.

Results: OFD+AA/PRF and OFD+PRF demonstrated significant intragroup CAL gain and PPD reduction at 3 and 6 months (p < 0.001). OFD+AA/PRF and OFD+PRF showed no differences regarding FMBS or FMPS (p > 0.05). OFD+AA/PRF demonstrated significant RD reduction of 0.90 ± 0.50 mm and 0.80 ± 0.71 mm at 3 and 6 months, while OFD+PRF showed RD reduction of 0.10 ± 0.77 mm at 3 months, with an RD-increase of 0.20 ± 0.82 mm at 6 months (p < 0.05). OFD+AA/PRF and OFD+PRF demonstrated significant RLDD reduction (2.29 ± 0.61 mm and 1.63 ± 0.46 mm; p < 0.05) and RDBD-increase (14.61 ± 5.39% and 12.58 ± 5.03%; p > 0.05). Stepwise linear regression analysis showed that baseline RLDD and FMBS at 6 months were significant predictors of CAL reduction (p < 0.001).

Conclusions: OFD+PRF with/without AA significantly improved periodontal parameters 6 months post-surgically. Augmenting PRF with AA additionally enhanced gingival tissue gain and radiographic defect fill.

Clinical relevance: PRF, with or without AA, could significantly improve periodontal parameters. Supplementing PRF with AA could additionally augment radiographic linear defect fill and reduce gingival recession depth.

Keywords: Ascorbic acid; Intra-osseous defects; Periodontal regeneration; Periodontitis; Platelet-rich fibrin; Vitamin C.

Conflict of interest statement

The authors declare no competing interests.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Intra-osseous defect radiographic measurements. a Identifying reference points: cementoenamel junction (CEJ), defect base (DB) and alveolar crest (AC). b Identifying reference lines (in green): vertical line corresponding to long axis and horizontal perpendicular line passing through AC, and identifying radiographic linear defect depth (RLDD) in blue. c Radiographic angle connecting CEJ, DB and the lateral border of the defect
Fig. 2
Fig. 2
Clinical steps in representative cases of the control group, using open flap debridement (OFD) and platelet-rich fibrin (PRF) (a–f) and test group using OFD and AA/PRF combination [81]: a 7-mm probing pocket depth mesial to lower left six at baseline. b Intra-osseous defect with vertical component of 5 mm. c Preparation of PRF. d Application of PRF plug into the periodontal defect. e Internal vertical mattress sutures. f 3-mm probing pocket depth after 6 months. g 8-mm probing pocket depth mesial to lower right six at baseline. h Intra-osseous defect with vertical component of 5 mm. i Pure AA vial (left) and AA/PRF (right). j Application of the AA/PRF plug into the periodontal defect. k Internal vertical mattress suture. l 2-mm probing pocket depth after 6 months

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