Keywords
periodontal regeneration
platelet-rich fibrin
Abstract
Introduction: Periodontitis is a chronic bacterial infection leading to destruction of supporting structures of teeth which may ultimately result in a variety of periodontal intraosseous defects. Goal of periodontal therapy is to regenerate lost periodontal tissue for optimal function and aesthetics. Platelet-rich concentrates are widely being used as regenerative biomaterials as they stimulate and accelerate healing by continuous release of growth factors.
Objective: To evaluate the clinical efficacy of autologous platelet-rich fibrin (PRF) along with open flap debridement (OFD) or OFD alone in the treatment of periodontal intrabony defects.
Methods: This non-randomised clinical study was conducted from June 2015 - May 2016 at Bir Hospital. Patients diagnosed with Chronic Periodontitis were selected using convenience sampling and divided into two groups: Control (OFD only) and Test (OFD+PRF) with 16 in each group. All subjects underwent periodontal examination by a single examiner. The periodontal parameters were assessed and compared between control and test groups at baseline and six months. Data analysis was done using SPSS 22 software program.
Results: The mean PI scores, GI scores, PD reduction, and CAL gain scores improved in both control and test groups at six months compared to baseline. The comparison of mean difference for every parameter measured showed statistically significant difference (p <0.05) at baseline and after six months for both the groups. However, the results were superior in the test group.
Conclusions: The addition of autologous PRF to OFD stimulated a significant improvement in the clinical parameters as compared to OFD alone at six months.
References
Zander HA, Polson AM, Heijl LC. Goals of periodontal therapy. J Periodontol. 1976;47(5):261-6.
Wang HL, Pappert TD, Castelli WA, Chiego DJ, Jr., Shyr Y, Smith BA. The effect of platelet-derived growth factor on the cellular response of the periodontium: an autoradiographic study on dogs. J Periodontol. 1994;65(5):429-36.
Dohan DM, Choukroun J, Diss A, Dohan SL, Dohan AJ, Mouhyi J, 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(3):e37-44.
Thorat M, Pradeep AR, Pallavi B. Clinical effect of autologous platelet-rich fibrin in the treatment of intra-bony defects: a controlled clinical trial. J Clin Periodontol. 2011;38(10):925-32.
Ajwani H, Shetty S, Gopalakrishnan D, Kathariya R, Kulloli A, Dolas RS, et al. Comparative evaluation of platelet-rich fibrin biomaterial and open flap debridement in the treatment of two and three wall intrabony defects. J Int Oral Health. 2015;7(4):32-7.
Okuda K, Tai H, Tanabe K, Suzuki H, Sato T, Kawase T, et al. Platelet-rich plasma combined with a porous hydroxyapatite graft for the treatment of intrabony periodontal defects in humans: a comparative controlled clinical study. J Periodontol. 2005;76(6):890-8.
Ilgenli T, Dundar N, Kal BI. Demineralized freeze-dried bone allograft and platelet-rich plasma vs platelet-rich plasma alone in infrabony defects: a clinical and radiographic evaluation. Clin Oral Investig. 2007;11(1):51-9.
Markou N, Pepelassi E, Vavouraki H, Stamatakis HC, Nikolopoulos G, Vrotsos I, et al. Treatment of periodontal endosseous defects with platelet-rich plasma alone or in combination with demineralized freeze-dried bone allograft: a comparative clinical trial. J Periodontol. 2009;80(12):1911-9.
Machtei EE. Outcome variables for the study of periodontal regeneration. Ann Periodontol. 1997;2(1):229-39.
Pradeep AR, Shetty SK, Garg G, Pai S. Clinical effectiveness of autologous platelet-rich plasma and Peptide-enhanced bone graft in the treatment of intrabony defects. J Periodontol. 2009;80(1):62-71.
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.
Trombelli L, Kim CK, Zimmerman GJ, Wikesjo 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.
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.
Schallhorn RG, Hiatt WH, Boyce W. Iliac transplants in periodontal therapy. J Periodontol. 1970;41(10):566-80.
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.
Marx RE. Platelet-rich plasma: evidence to support its use. J Oral Maxillofac Surg. 2004;62(4):489-96.
Del Fabbro M, Bortolin M, Taschieri S, Weinstein R. Is platelet concentrate advantageous for the surgical treatment of periodontal diseases? A systematic review and meta-analysis. J Periodontol. 2011;82(8):1100-11.
Choukroun J, Diss A, Simonpieri A, Girard MO, Schoeffler C, Dohan SL, et al. Platelet-rich fibrin (PRF): a second-generation platelet concentrate. Part IV: clinical effects on tissue healing. Oral Surg, Oral Med, Oral Pathol, Oral Radiol, Endod. 2006;101(3):56-60.
Feng X, Clark RA, Galanakis D, Tonnesen MG. Fibrin and collagen differentially regulate human dermal microvascular endothelial cell integrins: stabilization of alphav/beta3 mRNA by fibrin1. J Investig Dermatol. 1999;113(6):913-9.
Soffer E, Ouhayoun JP, Anagnostou F. Fibrin sealants and platelet preparations in bone and periodontal healing. Oral Surg, Oral Med, Oral Pathol, Oral Radiol, Endod. 2003;95(5):521-8.
Ramseier CA, Abramson ZR, Jin Q, Giannobile WV. Gene therapeutics for periodontal regenerative medicine. Dent Clin North Am. 2006;50(2):245-63, ix.
Dohan Ehrenfest DM, Doglioli P, de Peppo GM, Del Corso M, Charrier JB. Choukroun's platelet-rich fibrin (PRF) stimulates in vitro proliferation and differentiation of human oral bone mesenchymal stem cell in a dose-dependent way. Arch Oral Biol. 2010;55(3):185-94.