INTRABONY DEFECT TREATMENT WITH PLATELET-RICH FIBRIN, GUIDED TISSUE REGENERATION AND OPEN-FLAP DEBRIDEMENT: A RANDOMIZED CONTROLLED TRIAL

Abstract

• There was improvement in the periodontal clinical, radiographic and wound healing parameters in the platelet-rich fibrin, guided tissue regeneration, and open-flap debridement groups. • Platelet-rich fibrin yielded similar improvements in the periodontal clinical, radiographic and wound healing parameters as guided tissue regeneration. To comparatively assess the outcomes of the treatment of periodontal intrabony defects with platelet-rich fibrin (PRF) combined with open-flap debridement (OFD), guided tissue regeneration (GTR) or OFD alone based on clinical, radiographic, and wound healing parameters for 12 months of follow-up. Ninety intrabony defects were randomly divided into 3 different groups and treated as group 1 (PRF + OFD), group 2 (GTR), or group 3 (OFD alone). Clinical parameters, including the plaque index, gingival index, bleeding on probing, probing depth (PD), clinical attachment loss (CAL), and tooth mobility were assessed at 3, 6, and 12 months. Additionally, the wound healing index was assessed at 7 and 14 days postsurgery. Radiographic parameters, including bony defect fill and alveolar crestal resorption, were measured at 6 and 12 months postsurgery and calculated using image analysis software. Intragroup comparisons showed consistently significant improvements in all the clinical and radiographic parameters in the 3 groups at 12 months postsurgery. Compared to baseline, in group 1, the PD decreased to 2.37 ± 0.56; 3.30 ± 0.84; 4.80 ± 0.71 mm, and CAL decreased to 2.23 ± 0.90; 3.33 ± 0.71; 5.00 ± 0.46 mm; in group 2, the PD decreased to 2.30 ± 0.60; 3.23 ± 0.86; 4.63 ± 0.67 mm, and CAL decreased to 2.00 ± 0.98; 3.20 ± 0.71; 4.53 ± 0.57 mm); and in group 3, the PD decreased to 1.87 ± 0.68; 2.57 ± 1.36; 3.37 ± 1.00 mm, and CAL decreased to 1.60 ± 0.93; 2.23 ± 1.22; 3.37 ± 1.22 mm at 3, 6, and 12 months postsurgery, respectively. The bone fill percentages in group 1 (26.45 ± 16.47 and 45.25 ± 5.20%), group 2 (22.20 ± 15.76 and 42.15 ± 6.39%) and group 3 (10.21 ± 6.47 and 23.13 ± 6.98%) were observed at 6 and 12 months postsurgery. The alveolar crestal resorption levels were -1.07 ± 0.52 and -1.70 ± 0.60 mm in group 1, -1.03 ± 0.72 and -1.47 ± 0.73 mm in group 2 and 0.37 ± 0.62 and 0.43 ± 0.73 mm in group 3, respectively. The percentages of sites with a WHI score of 1 were 93% and 100% in group 1, 81%, and 94% in group 2 and 45% and 71% in group 3 at 7 and 14 days postsurgery, respectively. Compared to GTR, PRF yielded comparable treatment outcomes and periodontal tissue healing in terms of improvements in clinical and radiographic parameters. Compared to OFD alone, PRF also significantly improved these parameters in the treatment of intrabony defects.