Use of Fibrin Sealant in Guided Tissue Regeneration of Intrabony Defect

Abstract

Background: The treatment of periodontal intrabony defect can be a challenge to clinicians especially with the use of barrier membrane in guided tissue regeneration (GTR). The mechanical and biological regenerative potential of barrier membrane could be enhanced with the use of fibrin sealant. The purpose of this case report was to describe a surgical procedure achieving regeneration with fibrin sealant application in combination with guided tissue regeneration (GTR) to eliminate intrabony defect. Methods: A 21 year old systemically healthy female had the complaint of swelling and bleeding from gingiva in maxillary anterior region since 6 months. On clinical examination, there was a high frenal attachment penetrating deep into the palatine papilla leading to midline diastema. The papilla caused opening of the gingival margin in the palatine region leading to pocket formation in mesial side of 7 mm and 5 mm in relation to 21, 12. Radiographic examination revealed an intrabony defect in the same region. Due to persistence of pocket after frenum excision, surgical treatment for GTR was planned with use of bio-resorbable collagen membrane and fibrin sealant application. Results: The patient was followed for 9 months post-operatively. Reduction in probing depth was observed in 6 month and radiographic bone fill at 9 months. The probing depth was reduced to 3 mm in relation to 21 and 12. The gingival tissues appeared healthy with no bleeding on probing or gingival recession. Conclusion: This case report shows the possibility of achieving periodontal regeneration over a localized intrabony defect with the combined use of GTR membrane and fibrin sealant. An adjunctive regenerative technique is presented that allowed space making, stabilization of membrane, early wound healing as well as local taxis of growth factors for regeneration of periodontal tissues. Clinical implication: The use of fibrin sealant boosted the regenerative potential of barrier membrane showing potential of new bone formation and early wound healing.