Abstract
AimTo assess platelet-rich fibrin (PRF) with ascorbic acid (AA) versus PRF in intra-osseous defects of stage-III periodontitis patients.MethodologyTwenty stage-III/grade C periodontitis patients, with ≥ 3 mm intra-osseous defects, were randomized into test (open flap debridement (OFD)+AA/PRF; n = 10) and control (OFD+PRF; n = 10). Clinical attachment level (CAL; primary outcome), probing pocket depth (PPD), gingival recession depth (RD), full-mouth bleeding scores (FMBS), full-mouth plaque scores (FMPS), radiographic linear defect depth (RLDD) and radiographic defect bone density (RDBD) (secondary-outcomes) were examined at baseline, 3 and 6 months post-surgically.ResultsOFD+AA/PRF and OFD+PRF demonstrated significant intragroup CAL gain and PPD reduction at 3 and 6 months (p < 0.001). OFD+AA/PRF and OFD+PRF showed no differences regarding FMBS or FMPS (p > 0.05). OFD+AA/PRF demonstrated significant RD reduction of 0.90 ± 0.50 mm and 0.80 ± 0.71 mm at 3 and 6 months, while OFD+PRF showed RD reduction of 0.10 ± 0.77 mm at 3 months, with an RD-increase of 0.20 ± 0.82 mm at 6 months (p < 0.05). OFD+AA/PRF and OFD+PRF demonstrated significant RLDD reduction (2.29 ± 0.61 mm and 1.63 ± 0.46 mm; p < 0.05) and RDBD-increase (14.61 ± 5.39% and 12.58 ± 5.03%; p > 0.05). Stepwise linear regression analysis showed that baseline RLDD and FMBS at 6 months were significant predictors of CAL reduction (p < 0.001).ConclusionsOFD+PRF with/without AA significantly improved periodontal parameters 6 months post-surgically. Augmenting PRF with AA additionally enhanced gingival tissue gain and radiographic defect fill.Clinical relevancePRF, with or without AA, could significantly improve periodontal parameters. Supplementing PRF with AA could additionally augment radiographic linear defect fill and reduce gingival recession depth.
Highlights
Periodontitis is an inflammatory destructive disorder of the periodontal supporting structures, associated with microbial dysbiosis [1]
The study was designed as double-blind, parallel arms, randomized controlled clinical trial, with 1:1 allocation ratio to compare clinical and radiographic parameters of open flap debridement (OFD) with Ascorbic acid (AA) incorporated into Platelet-rich fibrin (PRF) (OFD+AA/PRF; test group) versus PRF alone (OFD+PRF; control group) in intra-osseous defects’ therapy
OFD+AA/PRF group contained 50% combined one-two-wall, 40% two-wall and 10% combined two-three-wall defects, while OFD+PRF group comprised 60% two-wall, 30% three-wall and 10% combined twothree-wall defects (p = 0.038, Chi-square)
Summary
Periodontitis is an inflammatory destructive disorder of the periodontal supporting structures, associated with microbial dysbiosis [1]. (VEGF) and fibroblast growth factor-β (FGF-β) [4,5,6,7], with a potential to promote periodontal repair/regeneration [8]. It has been investigated in combination with open flap debridement (OFD) and with a variety of biomolecules, including statins, metformin, bisphosphonates, and enamel matrix derivatives (EMD), to achieve a sustained release into periodontal defects [9]. Ascorbic acid (AA) is a potent antioxidant biomolecule, with a multitude of positive effects on oral and periodontal health [10, 11], on non-surgical periodontal therapy in smokers [12] and on periodontal disease prevention [11]. Little evidence supports the clinical use of AA incorporated into PRF (AA/PRF) in management of intra-osseous periodontal defects
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