A network meta-analysis of randomized controlled trials evaluating the evidence of pharmacological agents and growth factors in the regeneration of bony defects in chronic periodontitis.

The topical use of platelet concentrates is recent, and its efficiency remains controversial. The present study aims to explore the clinical and radiographic effectiveness of autologous platelet-rich fibrin (PRF) and platelet-rich plasma (PRP) in the treatment of intrabony defects in patients with chronic periodontitis. Ninety intrabony defects were treated with either autologous PRF with open-flap debridement or autologous PRP with open-flap debridement or open-flap debridement alone. Clinical and radiologic parameters, such as probing depth (PD), clinical attachment level (CAL), intrabony defect depth, and percentage defect fill, were recorded at baseline and 9 months postoperatively. Mean PD reduction and CAL gain were greater in PRF (3.77 ± 1.19 and 3.17 ± 1.29 mm) and PRP (3.77 ± 1.07 and 2.93 ± 1.08 mm) groups than the control group (2.97 ± 0.93 and 2.83 ± 0.91 mm). Furthermore, significantly greater percentage of mean bone fill was found in the PRF (55.41% ± 11.39%) and PRP (56.85% ± 14.01%) groups compared with the control (1.56% ± 15.12%) group. Within the limit of the present study, there was similar PD reduction, CAL gain, and bone fill at sites treated with PRF or PRP with conventional open-flap debridement. Because PRF is less time consuming and less technique sensitive, it may seem a better treatment option than PRP. However, long-term, multicenter randomized, controlled clinical trials will be required to know their clinical and radiographic effects on bone regeneration.

Background: Man's insatiable desire to create the lost part has led to a plethora of opportunities in periodontal regenerative treatment. One such name, platelet -rich fibrin (PRF) is an autologous concentration of human platelets which along with the platelet derived growth factor (PDGF) has been found to be more favourable for periodontal regeneration amongst all the growth factors found in plasma. Objective: The present study was aimed at comparing the clinical and radiographic evaluation of Leukocyte PRF (3000 rpm; 12 minutes) and Advanced PRF (1500 rpm; 14 minutes) along with demineralized freeze dried bone allograft (DFDBA) in the treatment of periodontal intrabony defects. Materials and Methods: Forty chronic periodontitis patients with intrabony defects (IBDs) were randomly treated by L -PRF or A -PRF with DFDBA. Probing pocket depth (PPD), clinical attachment level (CAL) and radiographic bone fill (RBF) were recorded at baseline, three and six months post -surgery. Results: The mean PPD reduction was greater in the A -PRF group (2.43±0.69 mm) than in the L -PRF group (1.65±0.78 mm) and the mean CAL gain were 2.43±0.67, 1.78±0.91 mm respectively. Greater percentage of mean bone fill was found in the A -PRF group (35.27%) compared to the other group (20.71%). Conclusion: Advanced PRF can be used predictably to reconstruct the lost periodontal structures as indicated by PPD reduction, CAL gain, intrabony defect fill and gives more definitive outcome than L -PRF.

A wide variety of materials have been proposed for treatment of periodontal intrabony defects (IBDs); recently, platelet-rich fibrin (PRF) has been suggested as a grafting material. The aim of this study is to report changes in clinical attachment level (CAL) and bone fill of periodontal IBDs treated with demineralized freeze-dried bone allograft (DFDBA) compared with PRF in humans. Thirty-six patients completed the study protocol. Each patient contributed a single IBD, which was randomized to receive either DFDBA or PRF. Clinical and standardized radiographic data were collected at baseline and 6 months after treatment. Primary outcome measures included: 1) radiographic bone fill as measured from the cemento-enamel junction to base of bony defect and 2) change in CAL. Both treatment groups had significant gains in CAL as well as bone fill, with no significant differences in outcomes between groups. DFDBA had a mean CAL gain of 1.16 ± 1.33 mm, mean clinical bone fill of 1.53 ± 1.64 mm, and mean radiographic bone fill of 1.14 ± 0.88 mm. PRF had a mean CAL gain of 1.03 ± 0.86 mm, mean clinical bone fill of 1.35 ± 1.60 mm, and mean radiographic bone fill of 1.10 ± 1.01 mm. Treatment of IBDs with either DFDBA or PRF resulted in a significant gain in CAL as well as bone fill after 6 months of healing, with no significant difference between materials.

Background: Periodontal regeneration, a multifactorial and complex procedure relates to the reconstruction of the periodontal tissues to maintain a clinically healthful state. Attaining a complete periodontal regeneration with the current regenerative procedures offer a limited success. Platelet Rich Fibrin is a polymerized fibrin matrix having a simple strategy of enhancing healing capacity of natural blood clot by supplementing the natural blood clot with growth factors. This unique structure acts as a vehicle for growth factor delivery system and also carry cells that are essential for tissue regeneration. The potential limitations of PRF include cross-contamination with silica, a lack of rigidity, and fast degradation. To overcome these limitations, the third generation of platelet concentrate Titanium PRF was introduced by Tunali et al 2013 by using biocompatible material titanium, where the fibrin network has a longer absorption time, increased capacity for osseointegration, better hemocompatibility, greater cellular support, and it promotes periodontal regeneration. Aims and Objectives: The aim and objectives of this controlled clinical trial is to compare the clinical and Radiographic effectiveness of Leukocyte Rich Platelet rich fibrin [L-PRF] with open flap debridement, Titanium -Platelet Rich Fibrin[T-PRF] and Open Flap Debridement [OFD] in the management of 3 walled intrabony periodontal defects. Materials and Methods: This Randomized controlled clinical trial was conducted in the Department of Periodontics, Rural Dental College, Loni .25 patients with 3 walled intrabony defects at three sites were treated with OFD and L-PRF (experimental group), OFD and T-PRF (experimental group), OFD alone (control group). Evaluation of change in probing pocket depth, Gain in clinical attachment level was done at 9 Months, and defect fill and alveolar crestal bone resorption were evaluated at 6 and 9 Months after surgery by Analysis of Variance (ANOVA) with Post hoc Tukey’s test. Probing Pocket depth was measured from the gingival margin to the base of the pocket, Clinical attachment Level was measured from the cementoenamel junction of each tooth to the soft tissue base of the pocket by using a stent. Prior to surgery a standardized digital periapical radiograph was made using the customized bite-plate and the paralleling technique. Radiographic measurements was done as (1) distance from the Cemento Enamel Junction [CEJ] to the deepest point of the vertical bone defect (BD), (2) distance from the CEJ to the alveolar crest (AC). Measurements were obtained utilizing a millimetre grid. The differences between 6, 9 months and baseline values of CEJ-BD indicated the amount of bone fill. The differences between CEJ-AC will be identified as the amount of crestal bone resorption respectively. Results: The Change in Plaque Scores from Baseline to 9 Months at different time intervals depicted that the difference in mean PI Scores from Baseline to 1 Month, Baseline to 3 Months, Baseline to 6 Months and Baseline to 9 Months was statistically significant in all the patients. For the clinical parameters, the comparison of Change of PPD and gain in CAL (Baseline-9 Months) between OFD, L-PRF & T-PRF depicted that the mean change was highest for T-PRF, followed by L-PRF, followed by OFD. Radiographic Parameters which included defect fill demonstrated that for the T-PRF group the bone formation was more followed by L-PRF followed by OFD where bone formation was least at 6 and 9 Months. When the crestal bone resorption was assessed from baseline to 9 Months the mean distance in OFD Group was observed to be increased whereas in L-PRF there was no change and in T-PRF the mean distance from CEJ to AC was observed to be decreased (depicting bone formation only in T-PRF Group). Conclusion: With in the limitations of this study it can be concluded that the application of Titanium Platelet-rich fibrin presents new possibilities for enhanced healing and functional recovery in the treatment of IBDs with greater reduction in Pocket Depth, more Clinical Attachment gain and could produce more new bone in less time when compared to L-PRF and OFD.

Intrabony defects resulting from chronic periodontitis can compromise oral health, necessitating regenerative interventions to restore lost periodontal structures. Using bone graft materials like NovaBoneand biologics like platelet-rich fibrin (PRF) has shown favorable outcomes. Decortication, a technique that enhances angiogenesis and graft stability, may improve regeneration. This study aimed to assess the clinical and radiographic outcomes of PRF combined with NovaBone putty, with and without decortication, in managing intrabony defects. A randomized controlled clinical study was conducted on 15 patientswith 30 intrabony defect sites. Subjects were divided into two groups: Group I received PRF and NovaBone without decortication, while Group II received the same combination with decortication. Clinical parameters,including plaque index, gingival index, gingival bleeding index (GBI), probing pocket depth (PPD), clinical attachment level (CAL), and gingival recession (GR), along with radiographic bone fill, were evaluated at baseline, three months, and six months. Both groups demonstrated significant improvements in PPD reduction, CAL gain, and bone fill over time (p < 0.05). Group II showed a greater reduction in GBI (93.33%) compared to Group I (80%). Mean CAL gain was 2.66 mm in Group I and 3.04 mm in Group II. Radiographic assessment revealed greater bone fill in Group II (27.26%) than Group I (20.93%). Changes in GR were minimal and statistically insignificant. Combining PRF with NovaBone yields positive regenerative outcomes in intrabony defects, and incorporating decortication offers additional clinical benefits.

Background:Intrabony defects in periodontal diseases create a serious problem in periodontal treatment, and regenerative procedure is usually used to achieve the best result. Platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) are platelet concentrates of autologous origin that has been extensively studied in its capacity to hasten soft and hard tissue regeneration.Materials and Methods:In a randomized controlled clinical trial using 30 patients with chronic periodontitis, having at least one intrabony defect, the treatment was conducted targeting the presence of an intrabony defect surface at the site of delivery. Patients were randomly separated into two categories: Group A meant PRF with open flap debridement, and Group B meant PRP with open flap debridement. Clinical measurements, such as probing pocket depth (PPD), clinical attachment level (CAL), and radiographic defect depth (RDD), were followed at baseline, three months, and six months postoperative.Results:Both groups had great results in changes in clinical parameters as compared to baseline to six months. The mean PPD reduction (4.1 0.5 mm) and CAL gain (3.6 0.4 mm) in group (PRF) were higher than the reduction in PPD (3.4 0.6 mm) and gain in CAL (2.8 0.5 mm) in group (PRP). The fill with radiographic defect was greater in PRF (62%) when compared to PRP (49%) (P = 0.04).Conclusion:PRF and PRP are practical in intrabony periodontal defects treatment. Nevertheless, PRF had better clinical and radiographic results because it released growth factors more slowly and could easily be prepared.

The present study aims to evaluate and compare the clinical and radiographic changes obtained through Bioactive Glass (BG) with and without autologous platelet-rich fibrin (PRF) in the treatment of intrabony defects in chronic periodontitis patients. The present study was a split-mouth randomized controlled clinical trial comprising 20 chronic periodontitis patients (mean age: 35.9 years) having at least one pair of bilateral intrabony defect. Group 1 included 20 sites treated with a combination of BG and autologous PRF whereas 20 sites in Group 2 were treated with BG alone. Probing pocket depth (PPD), clinical attachment level (CAL) and gingival recession (GR) were evaluated at 3 and 6 months and bone fill at 6 months by using cone beam computed tomography (CBCT) analysis. Primary study outcomes were changes in PPD, CAL, GR, and bone fill. CAL gain was greater in Group 1 (5.05 ± 1.09mm) when compared with Group 2 (4.2 ± 1.70mm). Furthermore, a significantly greater bone fill was found in Group 1. At 6 months, statistically significant reduction in PPD in Group 1 and Group 2 was evident. BG morsel when used in combination with PRF is found to be more effective in gain in CAL, reduction in PPD and achieving greater bone fill as compared with treatment with BG alone in periodontal intrabony defects and is indicative of enhanced periodontal regeneration.

Background Platelet-rich fibrin (PRF) is a kind of autologous platelet concentrate which is easy to obtain and cheap. In recent years, it has been studied to improve the effect of periodontal regeneration. However, few studies have systematically evaluated the complementary effect of PRF in the treatment of intrabony defects. The present review is aimed at systematically assessing the effects of PRF on clinical and radiological outcomes of the surgical treatment of periodontal intrabony defects. Methods The protocol was registered at PROSPERO (International Prospective Register of Systematic Reviews) as CRD42020206056. An electronic search was conducted in MEDLINE, Cochrane, and EMBASE databases. Only randomized clinical trials were selected. Systematically healthy patients with two or three walls of intrabony defects were considered. Intrabony defect (IBD) depth reduction and bone fill (BF) % were set as primary outcomes while probing depth (PD) reduction, clinical attachment level (CAL) gain, and gingival margin level (GML) gain were considered as the secondary outcome. When possible, a meta-analysis was performed. Results Eighteen articles fulfilled the inclusion criteria, and seventeen studies were quantitatively analyzed. Of 17 studies, four were rated as high risk of bias and thirteen as the moderate risk of bias. Two comparisons were set: (1) open flap debridement (OFD) combined with PRF and OFD alone and (2) bone grafting (BG) combined with PRF and BG alone. Compared to OFD alone, OFD+PRF showed significantly greater in all primary and secondary outcomes. Compared to BG alone, BG+PRF showed significantly greater in IBD depth reduction, PD reduction, CAL gain, and GML gain. Conclusions The use of PRF was significantly effective in the treatment of periodontal intrabony defects. The benefit of OFD+PRF may be greater than BG+PRF. PRF can promote early wound healing in periodontal surgery. As all included studies were not at low risk of bias, well-designed RCTs having a high methodological quality are needed to clarify the additional effectiveness of PRF in the treatment of intrabony defects in the future.

Background: Autologous platelet rich fibrin (PRF) and Recombinant human bone morphogenetic protein 2 (rhBMP 2) technologies have been shown to significantly support alveolar bone. The present randomized, controlled clinical trial was conducted to compare the clinical and radiographic efficacy of autologous platelet rich fibrin (PRF) and recombinant human bone morphogenetic protein 2 (rhBMP 2) in the treatment of intrabony defects (IBDs) in patients with chronic periodontitis. Methods: A randomized controlled clinical trial conducted where in the IBDs were treated with either autologous PRF with open flap debridement (OFD) or recombinant rhBMP 2 with OFD or OFD alone. Clinical and radiologic parameters including probing pocket depth, clinical attachment level (CAL), IBD depth, defect fill, and percentage of original defect resolved were recorded at baseline and 6 months postoperatively. Results: The mean pocket depth reduction was greater in PRF (1.3 ± 0.78 mm) than rhBMP 2 group (1.3 ± 0.78 mm). No significant difference was seen in CAL gain in PRF and rhBMP 2 groups (3.3 ± 0.43 mm and 1.2 ± 0.74 mm, respectively). However, the percentage of original defect resolved was significantly greater in rhBMP 2 group (41.1% ± 19.2%) compared to PRF group (26.75% ± 6.03%). Conclusions: Within the limits of the present study, results suggest that in terms of hard tissue regeneration, rhBMP 2 has shown significantly better outcome in treatment of IBDs. However, PRF encourages superior soft tissue healing compared to rhBMP 2. Furthermore, added advantages of PRF being readily available and cost effective cannot be disregarded.

The aim of this study is to explore and compare the clinical efficacy of locally delivered 1.2% Rosuvastatin (RSV) and 1% Metformin (MF) gel as an adjunct to scaling and root planning (SRP) in the treatment of intrabony defects in chronic periodontitis patients. A total of 90 volunteers were randomly assigned to three treatment groups; 1) SRP plus placebo gel; 2) SRP plus 1.2% RSV gel; 3) SRP plus 1% MF gel. Clinical parameters like modified sulcus bleeding index (mSBI), plaque index (PI), pocket probing depth (PD) and clinical attachment level (CAL) were recorded at baseline, 6 and 12 months and the radiologic assessment of bone defect fill was performed at 6 and 12 months. mSBI, BP, PD, and CAL were improved in all the groups, however mean reductions in PD, CAL gain, and percentage of bone fill was found to be higher in RSV and MF groups than placebo group at all visits. Adjunctive use of locally delivered 1.2% RSV and 1% MF gel stimulates a significant PD reduction, CAL gains and improved bone fill when compared with placebo gel. Results were significantly better with the use of 1.2% RSV gel than 1% MF gel.

Porous hydroxyapatite (HA) bone grafting material has been used to fill periodontal intrabony defects (IBDs), resulting in clinically acceptable responses. Platelet-rich fibrin (PRF) is a leukocyte and platelet preparation that concentrates various polypeptide growth factors and, therefore, has the potential for use as regenerative treatment for periodontal defects. The present study aims to explore the clinical and radiographic effectiveness of autologous PRF versus PRF + HA in treatment of IBDs in patients with chronic periodontitis. Ninety IBDs were treated with autologous PRF with open-flap debridement (OFD), PRF + HA with OFD, or OFD (controls) alone. Clinical and radiologic parameters, including probing depth (PD), clinical attachment level (CAL), IBD depth, and percentage defect fill were recorded at baseline and 9 months postoperatively. Mean PD reduction was greater in PRF (3.90 ± 1.09 mm) and PRF + HA (4.27 ± 0.98 mm) groups than the control group (2.97 ± 0.93 mm), and mean CAL gain was greater in PRF (3.03 ± 1.16 mm) and PRF + HA (3.67 ± 1.03 mm) compared to controls (2.67 ± 1.09 mm). Furthermore, significantly greater percentage of mean bone fill was found in the PRF (56.46% ± 9.26%) and PRF + HA (63.39% ± 16.52%) groups compared to controls (15.96% ± 13.91%). Treatment of IBD with PRF results in significant improvements of clinical parameters compared to baseline. When added to PRF, HA increases the regenerative effects observed with PRF in the treatment of 3-wall IBDs.

Regenerative periodontal therapy encompasses use of various bioactive agents that are not only inflammomodulatory but also osteoclast-inhibitory or, rather, osteostimulative. Hypolipidemic statin drugs, particularly rosuvastatin (RSV), are known to be associated with alveolar bone formation and periodontal improvements. Platelet analogs such as platelet-rich fibrin (PRF), being rich sources of growth factors, have also come into widespread periodontal regenerative use. The aim of this study is to evaluate and compare efficacy of open flap debridement (OFD) with or without PRF or PRF + 1.2% RSV gel in treatment of intrabony defects (IBDs) in patients with chronic periodontitis (CP). Ninety individuals with a total of 90 IBDs were randomly assigned to one of three treatment groups: 1) OFD alone; 2) OFD + PRF; and 3) OFD + PRF + 1.2% RSV gel placement. Measurements recorded at baseline and 9 months after surgery were: 1) plaque index (PI); 2) modified sulcus bleeding index (mSBI); 3) probing depth (PD); 4) clinical attachment level (CAL); and 5) IBD depth. Significant PI and mSBI reductions were observed in all three groups. PRF placement significantly enhanced improvements in periodontal parameters compared with OFD alone. Addition of 1.2% RSV gel to PRF resulted in significantly greater CAL gain and PD and IBD depth reductions over 9 months compared with other groups. OFD with RSV (1.2%) and PRF results in significantly greater periodontal benefits compared with OFD alone or with PRF.

Platelet-rich fibrin (PRF) is a second-generation platelet concentrate that releases various growth factors that promote tissue regeneration. Metformin (MF), a member of the biguanide group, has been shown to facilitate osteoblast differentiation and thus may exhibit a favorable effect on alveolar bone. The current study is designed to evaluate the efficacy of open-flap debridement (OFD) combined with PRF, 1% MF gel, and PRF + 1% MF gel in the treatment of intrabony defects (IBDs) in patients with chronic periodontitis (CP). One hundred twenty patients with single defects were categorized into four treatment groups: OFD alone, OFD with PRF, OFD with 1% MF, and OFD with PRF plus 1% MF. Clinical parameters such as site-specific plaque index (PI), modified sulcus bleeding index (mSBI), probing depth (PD), relative attachment level (RAL), and gingival marginal level (GML) were recorded at baseline (before surgery) and 9 months postoperatively. Percentage radiographic IBD depth reduction was evaluated using computer-aided software at baseline and 9 months. PRF, 1% MF, and PRF + 1% MF groups showed significantly more PD reduction and RAL gain than the OFD-only group. Mean PD reduction and mean RAL gain were found to be greater in the PRF + 1% MF group compared to just PRF or MF at 9 months. Furthermore, PRF + 1% MF group sites showed a significantly greater percentage of radiographic defect depth reduction (52.65% ± 0.031%) compared to MF (48.69% ± 0.026%), PRF (48% ± 0.029%), and OFD alone (9.14% ± 0.04%) at 9 months. The PRF + 1% MF group showed greater improvements in clinical parameters, with greater percentage radiographic defect depth reduction compared to MF, PRF, or OFD alone in treatment of IBDs in patients with CP.

Platelet-rich fibrin (PRF) is a reservoir of concentrated platelets that provides a pool of biologic growth-promoting factors and cytokines, which help in mediating regeneration of lost bone and soft tissue maturation. Alendronate (ALN), a member of the amino-bisphosphonate group, is known to enhance periodontal tissue regeneration by inhibiting osteoclast-mediated bone resorption and promoting osteoblast-mediated osteogenesis. The current intervention aims to assess combined effectiveness of PRF and 1% ALN with access therapy in intrabony defect (IBD) treatment in patients with chronic periodontitis (CP). Single IBDs in 90 patients were categorized into three groups: 1) group 1 had access therapy alone; 2) group 2 had access therapy with PRF; and 3) group 3 had access therapy with PRF + 1% ALN. Site-specific plaque index, modified sulcus bleeding index, probing depth (PD), clinical attachment level (CAL), and gingival marginal level, included as parameters for clinical assessment, were evaluated before surgery at baseline and 9 months postoperatively. Percentage IBD depth reduction, assessed using radiographs, was evaluated at baseline and postoperatively. Compared with groups 1 and 2, group 3 exhibited significantly greater reduction in PD and gain in CAL postoperatively. Significantly greater IBD depth reduction was shown in group 3 (54.05% ± 2.88%) compared with group 2 (46% ± 1.89%) and group 1 (7.33% ± 4.86%) postoperatively. Combined approach therapy of PRF + 1% ALN for IBD treatment in patients with CP showed better clinical parameter outcomes with greater IBD depth reduction compared with PRF and access therapy alone.

THE AIM OF THIS RETROSPECTIVE three-center study was to evaluate guided tissue regeneration (GTR) therapy in a clinical periodontal setting. The material consisted of 203 consecutively treated intrabony defects > or = 4 mm in 143 patients using a bioabsorbable matrix barrier. Each center followed the same protocol for presurgical, intrasurgical, and follow up examinations. Initial therapy, surgical, and follow-up treatments followed the routine of each center. Treatment was evaluated after 1 year by clinical assessments for probing depth (PD) reduction and clinical attachment level (CAL) gain and by bone fill from computer digitized radiographs. Initial intrabony defect depth averaged 6.3 +/- 1.0 mm clinically and 5.7 +/- 1.8 mm radiographically. Mean PD was reduced from 9.0 +/- 1.0 mm to 3.3 +/- 1.0 mm. Mean CAL gain amounted to 4.8 +/- 1.5 mm corresponding to 79 +/- 13% of the initial intrabony defect depth; 78% of the defects exhibited CAL gain > or = 4 mm. Bone fill averaged 3.2 +2- 1.8 mm. Together with a crestal resorption of 1.1 +/- 1.4 mm this resulted in a defect resolution of 4.3 +/- 1.9 mm or 72%. Forty-seven percent (47%) of the variability in CAL gain could be explained by defect depth, defect width, early barrier exposure, and presence of plaque in the treated area. CAL gain and bone fill were positively correlated to the intrabony defect depth; i.e., the deeper the defect the more the CAL gain and bone fill. Sites with barrier exposure during the first 2 weeks of healing showed significantly less CAL gain than sites at which exposure occurred at a later stage or not at all. Presence of plaque in the treated area had a significant negative impact on both CAL gain and bone fill. It was concluded that GTR-treatment of intrabony defects > or = 4 mm in a periodontal specialist practice will result in clinical attachment level gain and bone fill comparable to what has been demonstrated in case studies and controlled clinical trials. The predictability to obtain CAL gain > or = 4 mm in defects > or = 4 mm was 78%.