Comparative evaluation of platelet-rich fibrin biomaterial and open flap debridement in the treatment of two and three wall intrabony defects

Himanshu Ajwani, Sharath Shetty, Dharmarajan Gopalakrishnan, Rahul Kathariya, Anita Kulloli, R S Dolas, A R Pradeep, Himanshu Ajwani, Sharath Shetty, Dharmarajan Gopalakrishnan, Rahul Kathariya, Anita Kulloli, R S Dolas, A R Pradeep

Abstract

Background: Platelet-rich concentrates are the most widely used regenerative biomaterials. Stimulation and acceleration of soft and hard tissue healing are due to local and continuous delivery of growth factors and proteins, mimicking the needs of the physiological wound healing and reparative tissue processes. This article aims to evaluate the clinical efficacy of open flap debridement (OFD) with or without platelet-rich fibrin (PRF) in the treatment of intrabony defects.

Materials and methods: Twenty subjects with forty intrabony defects were treated with either autologous PRF with open-flap debridement (test, n = 20) or open-flap debridement alone (control, n = 20). Soft tissue parameters included: Plaque index, sulcus bleeding index, probing depth, relative attachment level and gingival marginal level (GML). The hard tissue parameters included-distances from: Cement enamel junction to the base of the defect (CEJ-BOD): Alveolar crest to the base of the defect (AC-BOD): And CEJ to AC. The parameters were recorded at baseline and at 9 months postoperatively calculated using standardized radiographs by image-analysis software.

Results: Statistically significant (0.005*) intragroup improvements were seen with all the hard and soft parameters in both test and control groups, except for GML. Statistically significant improvements were seen with the mean defect fill (CEJ-BOD and AC-BOD) (P = 0.003*) when intergroup comparisons were made.

Conclusions: Adjunctive use of PRF with OFD significantly improves defect fill when compared to OFD alone. PRF has consistently been showing regenerative potential; it is simple, easy and inexpensive biomaterial compared with bone grafts.

Keywords: Intrabony defect; open flap debridement; periodontal grafts; platelet rich fibrin; reconstructive osseous surgery.

Conflict of interest statement

Conflicts of Interest: None

References

    1. Karring T, Lindhe J, Cortellini P. Regenerative periodontal therapy. In: Lindhe J, Karring T, Lang NP, editors. Clinical Periodontology, and Implant Dentistry. Copenhagen: Blackwell Munksgaard; 2003. pp. 650–704.
    1. Polimeni G, Xiropaidis AV, Wikesjö UM. Biology and principles of periodontal wound healing/regeneration. Periodontol 2000. 2006;41:30–47.
    1. Zander HA, Polson AM, Heijl LC. Goals of periodontal therapy. J Periodontol. 1976;47(5):261–6.
    1. Pradeep AR, Shetty SK, Garg G, Pai S. Clinical effectiveness of autologous platelet-rich plasma and platelet-rich fibrin in intrabony defect treatment. J Periodontol. 2009;80:62–71.
    1. Siciliano VI, Andreuccetti G, Siciliano AI, Blasi A, Sculean A, Salvi GE. Clinical outcomes after treatment of non-contained intrabony defects with enamel matrix derivative or guided tissue regeneration: A 12-month randomized controlled clinical trial. J Periodontol. 2011;82(1):62–71.
    1. Wu SY, Chen YT, Chen CW, Chi LY, Hsu NY, Hung SL, et al. Comparison of clinical outcomes following guided tissue regeneration treatment with a polylactic acid barrier or a collagen membrane. Int J Periodontics Restorative Dent. 2010;30(2):173–9.
    1. Yukna RA, Krauser JT, Callan DP, Evans GH, Cruz R, Martin M. Multi-center clinical comparison of combination anorganic bovine-derived hydroxyapatite matrix (ABM)/cell binding peptide (P-15) and ABM in human periodontal osseous defects 6-month results. J Periodontol. 2000;71(11):1671–9.
    1. Kwon DH, Bennett W, Herberg S, Bastone P, Pippig S, Rodriguez NA, et al. Evaluation of an injectable rhGDF-5/PLGA construct for minimally invasive periodontal regenerative procedures: A histological study in the dog. J Clin Periodontol. 2010;37(4):390–7.
    1. Shirakata Y, Taniyama K, Yoshimoto T, Miyamoto M, Takeuchi N, Matsuyama T, et al. Regenerative effect of basic fibroblast growth factor on periodontal healing in two-wall intrabony defects in dogs. J Clin Periodontol. 2010;37(4):374–81.
    1. Sharma A, Pradeep AR. Treatment of 3-wall intrabony defects in patients with chronic periodontitis with autologous platelet-rich fibrin: A randomized controlled clinical trial. J Periodontol. 2011;82(12):1705–12.
    1. Choukroun J, Adda F, Schoeffler C, Vervelle A. An opportunite’ in paro-implantology: The PRF (in French) Implantodontie. 2000;42:55–62.
    1. Brown LF, Lanir N, McDonagh J, Tognazzi K, Dvorak AM, Dvorak HF. Fibroblast migration in fibrin gel matrices. Am J Pathol. 1993;142(1):273–83.
    1. Dohan Ehrenfest DM, Del Corso M, Diss A, Mouhyi J, Charrier JB. Three-dimensional architecture and cell composition of a Choukroun's platelet-rich fibrin clot and membrane. J Periodontol. 2010;81(4):546–55.
    1. Dohan Ehrenfest DM, Bielecki T, Jimbo R, Barbé G, Del Corso M, Inchingolo F, et al. Do the fibrin architecture and leukocyte content influence the growth factor release of platelet concentrates? An evidence-based answer comparing a pure platelet-rich plasma (P-PRP) gel and a leukocyte- and platelet-rich fibrin (L-PRF) Curr Pharm Biotechnol. 2012;13(7):1145–52.
    1. Dohan Ehrenfest DM, de Peppo GM, Doglioli P, Sammartino G. Slow release of growth factors and thrombospondin-1 in Choukroun's platelet-rich fibrin (PRF): A gold standard to achieve for all surgical platelet concentrates technologies. Growth Factors. 2009;27(1):63–9.
    1. Zumstein MA, Berger S, Schober M, Boileau P, Nyffeler RW, Horn M, et al. Leukocyte- and platelet-rich fibrin (L-PRF) for long-term delivery of growth factor in rotator cuff repair: Review, preliminary results and future directions. Curr Pharm Biotechnol. 2012;13(7):1196–206.
    1. Ozdemir H, Ezirganli S, Isa Kara M, Mihmanli A, Baris E. Effects of platelet rich fibrin alone used with rigid titanium barrier. Arch Oral Biol. 2013;58(5):537–44.
    1. Charrier JB, Monteil JP, Albert S, Collon S, Bobin S, Dohan Ehrenfest DM. Relevance of Choukroun's platelet-rich fibrin (PRF) and SMAS flap in primary reconstruction after superficial or subtotal parotidectomy in patients with focal pleiomorphic adenoma: A new technique. Rev Laryngol Otol Rhinol (Bord) 2008;129(4-5):313–8.
    1. Mazor Z, Horowitz RA, Del Corso M, Prasad HS, Rohrer MD, Dohan Ehrenfest DM. Sinus floor augmentation with simultaneous implant placement using Choukroun's platelet-rich fibrin as the sole grafting material: A radiologic and histologic study at 6 months. J Periodontol. 2009;80(12):2056–64.
    1. Aroca S, Keglevich T, Barbieri B, Gera I, Etienne D. 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. Gassling V, Douglas T, Warnke PH, Açil Y, Wiltfang J, Becker ST. Platelet-rich fibrin membranes as scaffolds for periosteal tissue engineering. Clin Oral Implants Res. 2010;21(5):543–9.
    1. Sander L, Karring T. Healing of periodontal lesions in monkeys following the guided tissue regeneration procedure. A histological study. J Clin Periodontol. 1995;22(4):332–7.
    1. Pradeep AR, Rao NS, Agarwal E, Bajaj P, Kumari M, Naik SB. Comparative evaluation of autologous platelet-rich fibrin and platelet-rich plasma in the treatment of 3-wall intrabony defects in chronic periodontitis: A randomized controlled clinical trial. J Periodontol. 2012;83(12):1499–507.
    1. Pradeep AR, Bajaj P, Rao NS, Agarwal E, Naik SB. Platelet-rich fibrin combined with a porous hydroxyapatite graft for the treatment of three-wall intrabony defects in chronic periodontitis: A randomized controlled clinical trial. J Periodontol. 2012;83(3):1–8.
    1. Sharma A, Pradeep AR. Autologous platelet-rich fibrin in the treatment of mandibular degree II furcation defects: A randomized clinical trial. J Periodontol. 2011;82(10):1396–403.
    1. Machtei EE. Outcome variables for the study of periodontal regeneration. Ann Periodontol. 1997;2(1):229–39.
    1. Trombelli L, Kim CK, Zimmerman GJ, Wikesjö UM. Retrospective analysis of factors related to clinical outcome of guided tissue regeneration procedures in intrabony defects. J Clin Periodontol. 1997;24(6):366–71.
    1. Tonetti MS, Prato GP, Cortellini P. Factors affecting the healing response of intrabony defects following guided tissue regeneration and access flap surgery. J Clin Periodontol. 1996;23(6):548–56.
    1. Schallhorn RG, Hiatt WH, Boyce W. Iliac transplants in periodontal therapy. J Periodontol. 1970;41(10):566–80.
    1. Prichard JF. The intrabony technique as a predictable procedure. J Periodontol. 1957;28:202–16.
    1. Blumenthal NM, Alves ME, Al-Huwais S, Hofbauer AM, Koperski RD. Defect-determined regenerative options for treating periodontal intrabony defects in baboons. J Periodontol. 2003;74(1):10–24.

Source: PubMed

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