A split mouth randomized controlled study to evaluate the adjunctive effect of platelet-rich fibrin to coronally advanced flap in Miller's class-I and II recession defects

Rajan Padma, Ande Shilpa, Pavaluri Aravind Kumar, Meganderao Nagasri, Chetan Kumar, Annaji Sreedhar, Rajan Padma, Ande Shilpa, Pavaluri Aravind Kumar, Meganderao Nagasri, Chetan Kumar, Annaji Sreedhar

Abstract

Background: There are various techniques developed to treat the exposed roots, a recent innovation in dentistry is the use of second generation platelet concentrate which is an autologous platelet-rich fibrin gel (PRF) with growth factors and cicatricial properties for root coverage procedures. Therefore, the present research was undertaken to study the additional benefits of PRF when used along with coronally advanced flap (CAF).

Materials and methods: Total of 15 systemically healthy subjects presenting bilateral isolated Miller's class I and II recession were enrolled into the study. Each patient was randomly treated with a combination of CAF along with a platelet-rich fibrin (PRF) membrane on the test site and CAF alone on the control site. Recession depth, clinical attachment level (CAL), and width of keratinized gingiva (WKG) were compared with baseline at 1, 3, and 6 months between test and control sites.

Results: Mean percentage root coverage in the test group after 1, 3, and 6 months was 34.58, 70.73, and 100, respectively. Differences between the control and test groups were statistically significant. This study also showed a statistically significant increase in WKG in the test group (2.94 ± 0.77 at baseline to 5.38 ± 1.67 at 6 months).

Conclusion: CAF is a predictable treatment for isolated Miller's class I and II recession defects. The addition of PRF membrane with CAF provides superior root coverage with additional benefits of gain in CAL and WKG at 6 months postoperatively.

Keywords: Coronally advanced flap; gingival recession; platelet rich fibrin; root coverage procedures.

Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Two weeks postoperative view
Figure 2
Figure 2
6 month postoperative
Figure 3
Figure 3
Centrifuged blood sample
Figure 4
Figure 4
Platelet-rich fibrin membrane
Figure 5
Figure 5
Preoperative site showing Miller's class I recession
Figure 6
Figure 6
Prepared surgical site
Figure 7
Figure 7
PRF membrane placed over the site
Graph 1
Graph 1
Comparison of mean width of keratinized gingiva

References

    1. Jan LW, Giovanni Z. Increased gingival dimensions. A significant factor for successful outcome of root coverage procedures?: A 2-year prospective clinical study. J Clin Periodontol. 1996;23:770–7.
    1. Allen E, Irwin C, Ziada H, Mullally B, Byrne PJ. Periodontics: The management of gingival recession. (538-40).Dent Update. 2007;34:534–6. 542.
    1. Moawia MK, Robert EC. The etiology and prevalence of gingival recession. J Am Dent Assoc. 2003;134:220–5.
    1. Anilkumar K, Geetha A, Umasudhakar, Ramakrishnan T, Vijayalakshmi R, Pameela E. Platelet-rich-fibrin: A novel root coverage approach. J Indian Soc Periodontol. 2009;13:50–4.
    1. David MD, Joseph C, Antoine D, Steve LD, Anthony JJ, Dohan JM, et al. Platelet-rich fibrin (PRF): A second generation platelet concentrate. Part I: Technological concepts and evolution. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;101:e37–44.
    1. Shieh AT, Wang HL, O’Neal R, Glickman GN, Mac Neil LM. Development and clinical evaluation of a root coverage procedure using a collagen membrane. J Periodontol. 1997;68:770–8.
    1. Sofia A, Tibor K, Bruno B, Istvan G, Daniel E. Clinical evaluation of a modified coronally advanced flap alone or in combination with a platelet-rich fibrin membrane for the treatment of adjacent multiple gingival recessions: A 6-month study. J Periodontol. 2009;80:244–52.
    1. Huang LH, Neiva RE, Wang HL. Factors affecting the outcomes of coronally advanced flap root coverage procedure. J Periodontol. 2005;76:1729–34.
    1. Eric L, Isabelle M, Guy G. Platelet concentrates: Effects of calcium and thrombin on endothelial cell proliferation and growth factor release. J Periodontol. 2003;74:1498–507.
    1. Chen YS, Ya PK, Yu HT, Ching-Hua S, Thierry B. In vitro release of growth factors from platelet-rich fibrin (PRF): A proposal to optimize the clinical applications of PRF. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;108:56–61.
    1. Lien HH, Hom LW. Sling and tag suturing technique for coronally advanced flap. Int J Periodontics Restorative Dent. 2007;27:379–85.
    1. Jankovic SM, Zoran AM, Lekovic MC, Bozidar DS, Kenneyy BE. The Use of platelet – rich plasma in combination with connective tissue grafts following treatment of gingival recessions. Periodontal pract today. 2007;4:63–71.
    1. Wennstrom JL, Zucchelli G. Increased gingival dimensions. A significant factor for successful outcome of root coverage procedures? A 2-year prospective clinical study. J Clin Periodontol. 1996;23:770–7.
    1. Pini prato G, Clauser C, Cortellini P, Tinti C, Vincenzi G, Pagliaro U. Guided tissue regeneration versus mucogingival surgery in the treatment of human buccal recessions. A 4-year follow-up study. J Periodontol. 1996;67:1216–23.
    1. Lee YM, Kim JY, Seol YJ, Lee YK, Ku Y, Rhyu IC, et al. A 3-year longitudinal evaluation of subpedicle free connective tissue graft for gingival recession coverage. J Periodontol. 2002;73:1412–8.
    1. Wang HL, Bunyaratavej P, Labadie M, Shyr Y, MacNeil RL. Comparision of 2 clinical techniques for treatment of gingival recession. J Periodontol. 2001;72:1301–11.
    1. Roccuzzo M, Bunino M, Needleman I, Sanz M. Periodontal plastic surgery for the treatment of localized gingival recession: A systematic review. J Clin Periodontol. 2002;29:178–94.
    1. Trombelli L, Scabbia A, Tatakis DN, Calura G. Subpedicle connective tissue graft versus guided tissue regeneration with bioabsorbable membrane in the treatment of human gingival recession defects. J Periodontol. 1998;69:1271–7.
    1. Dohan DM, Choukroun J, Diss A, Dohan SL, Dohan AJ, Mouhyi J, et al. Platelet-rich fibrin (PRF): A second generation platelet concentrate. Part II: Platelet-related biologic features. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;101:e45–50.
    1. Dohan DM, Choukroun J, Diss A, Dohan SL, Dohan AJ, Mouhyi J, et al. Platelet-rich fibrin (PRF): A second generation platelet concentrate. Part III: Leucocyte activation: A new feature of platelet concentrates? Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;101:e51–5.

Source: PubMed

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

3
Abonnieren