Evaluation of the Hyaluronic Acid Versus the Injectable Platelet-Rich Fibrin in the Management of the Thin Gingival Phenotype: A Split-Mouth Randomized Controlled Clinical Trial

Abstract

Background Several procedures have been used to enhance thin gingival phenotype and the majority of these procedures have been surgical. A new minimally invasive approach that involved multiple injections of platelet-rich fibrin (i-PRF) to enhance the thin gingival phenotype has been proposed. As the hyaluronic acid (HA) and the i-PRF share similar properties in terms of promoting periodontal regeneration, the present trial aimed to evaluate the effectiveness of multiple injections of the i-PRF in patients with thin gingival phenotypes in comparison with those of the HA in increasing the gingival thickness (GT) and the keratinized tissue width (KTW). Materials and methods Eighty-four sites from 14 systematically healthy patients who had thin gingival phenotypes (GT ≤1 mm) were included in this split-mouth randomized controlled trial. For each patient, each side of the anterior mandible was randomly allocated to one of the two materials (HA or i-PRF). In the HA group, the selected sites of the gingiva were injected with cross-linked HA using a 30-gauge microneedle. In the i-PRF group, the i-PRF was injected in the same manner. This procedure was repeated in both groups three times with intervals of 7 days. The GT, KTW, and periodontal indices: gingival index (GI), bleeding on probing (BOP), and probing depth (PD) were measured at baseline, 1 month, and 3 months following the initial injection. Results The GT increased significantly in both groups at the three assessment times (p<0.001). The KTW also showed a statistically significant increase in the intragroup comparisons in both groups (p<0.05). No statistically significant difference was observed between the two groups at the three assessment times for the GT and the KTW (p>0.05). The GI significantly decreased after 1 month and 3 months compared to the baseline values in both groups (p<0.05). The intergroup comparisons for the GI revealed no statistically significant differences at the three assessment times (p>0.05). As for the BOP and the PD, no statistically significant differences were found between the three assessment times (p>0.05) and between the two groups at each assessment time (p>0.05). Conclusion Multiple injections of the i-PRF and the HA in the thin gingival phenotype resulted in an increased GT and increased KTW, with no statistically significant differences between the two methods. Both minimally invasive techniques were more effective in improving the GT rather than the KTW.

Keywords: bleeding on probing; gingiva; gingival index; gingival thickness; hyaluronic acid; i-prf; injectable platelet-rich-plasma; phenotype; probing depth.

Conflict of interest statement

The authors have declared that no competing interests exist.

Copyright © 2022, Faour et al.

Figures

Figure 1. The probe can be visible through the gingival margin if the phenotype is thin.

Figure 2. The hyaluronic acid used in the current trial.

Figure 3. The injection of hyaluronic acid (HA). A) Injecting the HA until blanching of the gingiva is seen. B) The injection of the HA was apical to the mucogingival margin.

Figure 4. Preparation of the injectable platelet-rich fibrin (i-PRF). A) 5 ml of blood sample was collected just before the intervention. B) Blood was then placed in a plastic tube without any added material or coagulant and was centrifuged using the shown device at 700 rpm for 3 min. C) The tube containing the centrifugated blood.

Figure 5. Injection of the platelet-rich fibrin (PRF). A) The injection is done until blanching of the gingiva is seen. B) The injection was positioned apical to the mucogingival margin.

Figure 6. Measurement of the gingival thickness. A) A no. 15 endodontic file was inserted perpendicularly through the gingiva at 2 mm apical to the gingival margin through the soft tissue until a hard surface was reached. A flowable light-curing composite was used to mark the penetration depth on the file. B) A digital caliper was used to measure the penetration depth between the file’s tip and the light-cured composite.