Treatment Of Intrabony Defects Research Articles

Effect of Low-Level Laser Therapy and Platelet-Rich Fibrin on the Treatment of Intra-bony Defects

Introduction: Attempts to regenerate the periodontal osseous defect, which is lost as a result of periodontal disease, require the tapping of the innate healing potential of periodontium through appropriately designed therapeutic strategies. A multitude of grafted and non-grafted approaches have been used in the management of Intra-bony defects. However, they do not provide predictable periodontal regeneration. The aim of this study was to evaluate the combined effect of low-level laser therapy (LLLT) and platelet-rich fibrin (PRF), in site modulated intra-bony defects (decortication), which were accessed using a simplified papilla preservation flap (SPPF), on the clinical and radiographic outcomes of periodontal disease. Methods: A total of 30 patients with intra-bony defects were recruited for the study and randomly distributed in two groups (n=15). Test group sites were accessed with SPPF and the defects received intra-marrow Penetration (IMP) following debridement and were irradiated with a low-level laser followed by PRF grafting and suturing done. The control group defects were accessed with SPPF and grafted with PRF before being secured by sutures. The plaque and bleeding score, PPD, CAL, and the position of the gingival margin with radiographic defect depth were recorded and analyzed at baseline and six months post-intervention using the student's t test and Wilcoxon signed rank test. Results: The test group showed a clinically relevant increase in mean PPD reduction, CAL gain, and radiographic bone fill (3.6 ± 1.35 mm, 3.26 ± 1.16 mm and 2.44 ± 1.24 mm) compared to the control group (2.93 ±1.1 mm, 2.267 ± 1.33 mm and 1.26 ± 0.99 mm) six months post-intervention. However, intergroup comparison between the test and control groups did not show any statistically significant difference. Conclusion: These results highlights that test protocol had greater amelioration of the effects of periodontal disease and all the investigated clinical and radiographic parameters showed considerable improvement from baseline to 6 months within test and control group, but intergroup comparison between the test and control groups did not show any statistically significant difference, indicating statistical equivalence between the test and control protocol.

Comparison of Er,Cr:YSGG laser to minimally invasive surgical technique in the treatment of intrabony defects: Six‐month results of a multicenter, randomized, controlled study

The purpose of this publication is to report on the six-month clinical results and patient-reported outcomes (PROs) comparing the surgical use of the erbium, chromium-doped: yttrium, scandium, gallium, and garnet (Er,Cr:YSGG) laser (ERL) and minimally invasive surgical technique (MIST) for the treatment of intrabony defects in subjects with generalized periodontitis stage III, grade B. Fifty-three adults (29 females and 24 males; aged 19 to 73 years) with 79 intrabony defects were randomized following scaling and root planing (SRP) to receive ERL monotherapy (n = 27) or MIST (n = 26). Recession, probing depth (PD), clinical attachment level (CAL), treatment time, and PROs were assessed and compared for each treatment group. Clinical measurements were recorded at baseline, 4 to 6 weeks following SRP, and 6 months following surgical therapy. The following primary and secondary outcome variables were non-inferior with the following margins: CAL with a non-inferiority margin of 0.6mm (p = 0.05), PD with a non-inferiority margin of 0.5 mm (p = 0.05). Recession with a non-inferiority margin of 0.4 mm (p = 0.05). Faster procedure times were found for ERL (16.39 ± 6.21 minutes) versus MIST (20.17 ± 5.62 minutes), p = 0.0002. In the first 2 to 3 days of post-therapeutic diary outcomes, subjects reported less bruising, facial swelling, and use of ice pack for the ERL group. This is the first multicenter, randomized, masked, and controlled study demonstrating the ERL is not inferior to MIST in terms of clinical outcomes but is superior in PROs for the surgical treatment of intrabony defects.

Treatment of Intrabony Defect Using Platelet Rich Fibrin Combined with Bioactive Glass: A Case Report of a Maxillary Central Incisor

The ultimate goal of periodontal therapy is to regenerate the lost periodontal tissues caused by periodontitis. Platelet rich fibrin (PRF), a rich source of autologous growth factors and cytokines, is an upcoming therapeutic approach in the management of periodontal osseous defects. Combination of autologous PRF and the alloplastic bone substitutes holds a promising potential of enhanced bone regeneration. This case report includes the management of an intrabony osseous defect in relation to #21 with a combination of Platelet Rich Fibrin & bioactive glass (calcium phosphosilicatealloplast) with the clinical and radiographic evaluations using cone beam computed tomography (CBCT) for a 9 months follow up period.

Efficacy of regenerative therapy in aggressive periodontitis: a systematic review and meta-analysis of randomised controlled clinical trials.

To analyse evidence regarding the efficacy of periodontal regenerative procedures in intrabony defects in patients treated for aggressive periodontitis (AgP). A systematic search of the literature for randomised controlled clinical trials including patients treated for aggressive periodontitis that compared a group treated with regenerative therapy with another group treated with surgical debridement alone was conducted by two independent reviewers. Six studies were included in the meta-analysis of clinical and/or radiographic parameters at 6 and 12months. Probing pocket depth was smaller at 6months in patients treated with regenerative therapies compared with those treated with regular debridement (1.00mm, p < 0.001, 95% CI (0.67, 1.34)). At 12months this difference was more marked (0.41mm, p = 0.12, 95% CI (- 0.10, 0.91)). The distance between the cemento-enamel junction and the alveolar crest at both 6 (1.36mm, p < 0.001, 95% CI (1.03, 1.68)) and 12months (0.90mm, p = 0.01, 95% CI (0.24, 1.56)) was smaller in the group treated with regeneration. The use of biomaterials for regenerative therapy in AgP may be more effective than surgical debridement. Better outcomes were observed in terms of probing pocket depth and distance between the cemento-enamel junction and the alveolar crest at 6months. Regeneration should be considered as a therapy to prevent tooth loss, although more studies with larger sample size and longer follow-up are needed. Periodontal regeneration is effective in the treatment of intrabony defects in patients with AgP, as it leads to better outcomes in clinical and radiographic parameters.

Clinical efficacy of minimally invasive surgical (MIS) and non-surgical (MINST) treatments of periodontal intra-bony defect. A systematic review and network meta-analysis of RCT's.

The aim of this systematic review was to explore the efficacy of different minimal invasive surgical (MIS) and non-surgical (MINST) approaches for the treatment of intra-bony defect in terms of clinical attachment level (CAL) gain and periodontal pocket depth (PPD) reduction. A detailed review protocol was designed according to PRISMA guideline. Online search was conducted on PubMed, Cochrane library and Embase. Only randomized clinical trials (RCTs) testing MIS or MINST procedure, with or without the application of a regenerative tool for the treatment of intra-bony defect, were included. Cochrane checklist for risk of bias assessment was used. Network meta-Analysis (NMAs) was used to rank the treatment efficacy. Nine RCTs accounting for 244 patients and a total of 244 defects were included. Only two studies were at low risk of bias. CAL gain for included treatment ranged from 2.58 ± 1.13mm to 4.7 ± 2.5mm while PPD reduction ranged from 3.19 ± 0.71mm to 5.3 ± 1.5mm. On the basis of the ranking curve, MINST showed the lowest probability to be the best treatment option for CAL gain. Pairwise comparisons and treatment rankings suggest superiority for regenerative approaches (CAL difference 0.78mm, (0.14-1.41); P < 0.05) and surgical treatment elevating only the buccal or palatal flap (CAL difference: 0.95mm, (0.33-1.57); P < 0.05). Minimally invasive surgical (MIS) and non-surgical (MINST) periodontal therapy show promising results in the treatment of residual pocket with intra-bony defect. MIS procedures represent a reliable treatment for isolated intra-bony defect.

Clinical evaluation and comparison of platelet-rich fibrin and injectable platelet-rich fibrin (sticky bone) in the treatment of intrabony defects

Introduction: Periodontal regeneration aims to regenerate the lost periodontium, and platelet concentrates are frequently used in the medical fields to improve the healing and promote tissue regeneration. Objective: The aim of the study was to evaluate the efficacy of injectable platelet-rich fibrin (i-PRF) (sticky bone) in comparison to platelet-rich fibrin (PRF) in the treatment of intrabony defects. Materials and Methods: A total of 54 sites treated were divided into three groups (Group I – open flap debridement [OFD alone], Group II – OFD with i-PRF [sticky bone], and Group III – OFD with PRF) in moderate-to-severe periodontitis. The clinical parameters assessed were plaque index, gingival index, probing pocket depth (PPD), relative attachment level, and defect depth reduction at baseline, 3, 6 and 9 months. Results: Nine months postoperatively, a significant improvement in clinical and radiographic parameters was observed from baseline in all three groups. However, Group II and Group III showed better results in all the parameters compared to Group I. Nine months postoperatively, the defect depth reduction was: OFD - 41.59%, i-PRF - 72.75%. and PRF - 62.11%. Conclusion: PC (i-PRF [sticky bone] and PRF) have shown better clinical and radiographic outcomes than OFD in the treatment of intrabony defects in chronic periodontitis.

Clinical and radiographic evaluation of platelet-rich fibrin as an adjunct to bone grafting demineralized freeze-dried bone allograft in intrabony defects.

Background:Several bone graft materials are popularized in the treatment of intrabony defects. Demineralized freeze-dried bone allograft (DFDBA) is widely used in the treatment of intrabony defects. Platelet-rich fibrin (PRF) is autologous blood preparation which helps in wound healing and regeneration. Hence, this study focuses on evaluation of PRF, DFDBA, and their combination in the regeneration of intrabony defects.Materials and Methods:A total of 39 sites with intrabony defects were randomly assigned into three groups: (Group I - Open flap debridement, Group II - DFDBA alone, and Group III- DFDBA + PRF). Parameters such as probing pocket depth (PPD), relative attachment level (RAL), and radiographic bone fill were measured at baseline, 3 months, and 6 months. Intragroup comparison at various study intervals was made using one-way ANOVA test. Intergroup comparison was made using Tukey's multiple post hoc test.Results:Reduction in the PPD and greater difference in RAL was observed over the study period in all the three groups with greater reduction in DFDBA + PRF group. Reduction in the radiographic defect depths was observed over the study period in all the three groups with the greatest reduction of 38.99% in the DFDBA + PRF group. However, no statistically significant difference was reported by DFDBA versus DFDBA + PRF group.Conclusion:Combination of DFDBA and PRF improved the clinical and radiographic parameters compared to PRF and DFDBA alone. PRF was combined with DFDBA to produce a synergistic effect for treating intrabony defects in chronic periodontitis patients.

Comparison of Bioactive Glass Bone Graft (Putty) with Autologous Platelet-rich Fibrin in the Treatment of Intrabony Defects

Comparison of Bioactive Glass Bone Graft (Putty) with Autologous Platelet-rich Fibrin in the Treatment of Intrabony Defects

Comparison of Regenerative Potential of Platelet-rich Fibrin Alone and in Combination with Bovine Bone Graft in Intraosseous Defect by Single Flap Approach: A Clinical and Radiographic Study.

ABSTRACTAim:To compare the regenerative potential of platelet-rich fibrin alone and in combination with bovine bone graft in intraosseous defect by the single flap approach.Materials and Methods:A total of 32 sites of intrabony defects were selected and were treated with platelet-rich fibrin (PRF) alone or in combination with bovine bone graft. Clinical parameters [Gingival index (GI), probing depth (PD), clinical attachment level (CAL), Gingival recession, and radiographic parameters (defect fill, alveolar crest level, and defect depth)] were recorded at baseline, 3 months, and 6 months.Results:Statistical analysis was done by independent and paired t-test. There were statistically significant changes in GI, PD reduction, CAL gain, defect fill, alveolar crest level changes, and defect depth resolution from baseline, 3 months, and 6 months in both the groups (P < 0.001). On intergroup comparison, Group II showed statistically significant changes in a reduction in pocket depth and defect depth resolution at P < 0.001.Conclusion:PRF in combination with bovine bone graft was more effective in the treatment of intrabony defects.

Different Regenerative Responses of Two Platelet Concentrates in the Treatment of Human Periodontal Infrabony Defects: A Clinico-Radiographic Study.

Background:Platelet concentrates usage in the treatment of intrabony defects has been improved due to advancement of research. Many generation of platelet concentrates were used, but research regarding advanced platelet-rich fibrin (A-PRF) regarding periodontal treatment is scanty.Aim:The purpose of the study was to evaluate and compare PRF and A-PRF in the treatment of human periodontal infrabony defects (IBDs) both clinically and radiographically.Materials and Methods:Twenty-eight patients having IBDs were divided into Group A (PRF) and Group B (A-PRF). Clinical parameters such as plaque index, gingival index, probing pocket depth (PPD), and clinical attachment level (CAL) were recorded at baseline and 3 and 6 months and radiographic examination at baseline and 6 months were also recorded to evaluate defect fill, resolution, and change in the alveolar crest height. Then, all the data were tabulated in a Microsoft Excel sheet and subjected to statistical analysis. Mean and standard deviations of the clinical and radiographic parameters were calculated, and unpaired t-test was performed to assess intergroup comparison at different time intervals.Results:Intragroup comparison showed statistically significant improvement in PPD and CAL at 3 and 6 months while statistically significant improvement was observed in mean defect fill and resolution in Group B.Conclusion:Individually, both the materials have shown promising results. However, statistically, PRF group (Group A) showed better treatment outcome in terms of bone fill and A-PRF group (Group B) in terms of soft tissue healing.

Treatment of Intrabony Defects Using Equine-derived Bone Granules and Collagen Membranes: A Retrospective Study with a 13-year Follow-up

The aim of this study is to investigate the effectiveness of a combination of an equine-derived, enzyme-treated bone graft and an equine collagen membrane to treat intrabony defects caused by periodontitis. About 22 patients with a single 1-, 2-, or 3-wall intrabony defect and a probing pocket depth (PPD) of ≥5 mm, who were treated using an enzyme-deantigenated equine bone graft in addition to a collagen membrane and were followed up for at least 10 years, were retrospectively assessed. The plaque index (PI), the sulcus bleeding index (SBI), PPD, and the clinical attachment level (CAL) at each follow-up visit were compared to baseline. The mean PI, SBI, PPD, and CAL were 0.22 ± 0.41, 1.86 ± 0.78, 7.86 ± 1.39 mm, and 8.84 ± 1.86 mm, respectively, at baseline, and 0.25 ± 0.44, 0.12 ± 0.32, 2.59 ± 0.50, and 4.04 ± 0.77 mm, respectively, at the last follow-up. The difference was significant for all parameters (p < 0.001) except PI (p = 0.83). The final CAL gain was 4.8 mm (49.8%). The SBI, PPD, and CAL still significantly improved at the 12-month follow-up visit but not at the 24-month follow-up visit. There were no correlations between either the number of defect walls or smoking and outcomes. In one case, a surgical re-entry at 5 years allowed a clinical evaluation, showing that intrabony defect was repaired with the newly formed bone of the patient. Equine bone granules in addition to an equine collagen membrane effectively and safely treated intrabony defects caused by periodontitis providing long-term results. Equine-derived bone grafts have been in the market for more than 20 years. However, to the author's knowledge, no studies have reported long-term results for the use of this type of bone graft in periodontal surgery. The equine-derived bone granules used in the present study appears a promising option for treating intrabony defects due to moderate to severe periodontitis.

Evaluation of titanium-prepared platelet-rich fibrin and leucocyte platelet-rich fibrin in the treatment of intra-bony defects: A randomized clinical trial.

Background. Various treatment modalities, such as leucocyte platelet-rich fibrin (L-PRF), bone grafts, and membranes, have been used for the restoration of lost periodontal tissues. Titanium-prepared platelet-rich fibrin (T-PRF) has attracted attention for its proper haemocompatibility, thick fibrin meshwork, and long resorption time. The present study aimed to evaluate the effectiveness of T-PRF and L-PRF in the management of intra-bony defects based on clinical and radiographic criteria. Methods. Twenty-six subjects with 34 intra-bony 3- walled defects were divided into two groups (n=17) and treated with T-PRF or L-PRF. Clinical and radiographic measurements were recorded at baseline and 6- , 3- and 9- month intervals and tabulated on Microsoft Excel spreadsheets. For intra- and intergroup comparisons, paired and unpaired t-tests were performed. P<0.05 was set as statistically significant Results. Intra-group comparisons revealed statistically significant differences (P<0.05) from baseline in both groups regarding clinical measurements. On intergroup comparison, the T-PRF group exhibited a significantly higher defect fill compared to the L-PRF group (P<0.05). Conclusion. Within the limits of the present study, T-PRF seems to be a better alternative to L-PRF in the treatment of intra-bony defects.

Comparison of GTR, T-PRF and open-flap debridement in the treatment of intrabony defects with endo-perio lesions: a randomized controlled trial.

Background Titanium- prepared platelet rich fibrin (T-PRF) is an autologous hemo-component with a high concentration of platelets that also incorporates leukocytes, and growth factors into the dense fibrin matrix and can be used as a healing biomaterial. This study assesses the adjunctive use of T-PRF in intrabony defects (IBDs) with open flap debridement (OFD) in comparison with guided tissue regeneration (GTR) as a gold standard and OFD alone as a control. Material and Methods A total of 45 patients (15 per group) were randomized as either T-PRF (test group), GTR (test group), or OFD alone (control group) sites. Probing depth (PD), clinical attachment level (CAL), and IBD were recorded. The radiographic depth of IBD was also measured. Primary outcomes assessed were changes in PD, CAL, and radiographic IBD that were assessed at the beginning and nine months later. Results The PRF and GTR group showed significant improvement in clinical parameters compared with the OFD alone (control group) at nine months. While there were no significant differences in PD and CAL between test groups (T-PRF and GTR groups), the significant difference was found in radiographic IBD depth. Conclusions T-PRF may give similar successful results as GTR in the treatment of IBDs with endo-perio lesions. Key words:Flap surgery, guided tissue regeneration, intrabony defects, periodontitis, root canal therapy.

Expression of gingival crevicular fluid markers during early and late healing of intrabony defects after surgical treatment: a systematic review

BackgroundSurgical treatments such as guided tissue regeneration (GTR) and access flap surgery are widely employed for the treatment of intrabony defects. However, little is known regarding the postoperative expression of gingival crevicular fluid (GCF) markers.ObjectiveThe aim of this systematic review was to compare the expression of GCF markers following treatment of periodontal intrabony defects with guided tissue regeneration or access surgery. The association of the markers’ expression with the clinical outcome was also assessed.MethodsAn electronic literature search was conducted in MEDLINE, EMBASE, OpenGrey, LILACS and Cochrane Library up to December 2018 complemented by a manual search. Human, prospective clinical studies were identified. The changes from baseline up to 30 days (early healing) and 3 months (late healing) were assessed.ResultsA total of 164 publications were identified and reviewed for eligibility. Of these, 10 publications fulfilled the inclusion criteria. The included studies evaluated 15 different GCF markers with a follow-up time between 21 and 360 days postoperatively. PDGF, VEGF and TIMP-1 changes were often investigated in the included studies; however, contrasting results were reported. Two studies agreed that both GTR and OFD lead to similar OPG level changes. TGF-β1 is increased early postoperatively, irrespective of the surgical technique employed.ConclusionThere is limited evidence available on the expression of GCF markers after surgical interventions of intrabony periodontal defects. However, OPG and TGF-β1 tend to increase early post-operatively, irrespective of the surgical technique employed, irrespective of the surgical technique employed.Clinical relevanceMore well-designed, powered studies with sampling periods reflecting the regenerative process are needed, and future research should focus on employing standardised protocols for collecting, storing and analysing GCF markers.

Application of Platelet Rich Fibrin in the Regeneration of Intra Oral Defects: A Systematic Review

Objective: To systematically review the randomized clinical trials (RCTs) on the effect of Platelet Rich Fibrin (PRF) concentrate on the tissue regeneration of intra-oral defects.&#x0D; Methods: An electronic search was performed in PubMed/Medline and Cochrane Library using relevant keywords until June 2018. RCTs which used PRF concentrate for treatment of intrabony defects, sinus augmentation, furcation involvement, endo-periodontal lesions, gingival recession, and ridge preservation were included in the present review.&#x0D; Results: In total, 79 studies that were used PRF either solely or mixed in human trials were included and divided based on the defect type. Most of the studies used PRF to treat intra-bony defects showed that it would improve treatment outcomes. In case of furcation involvement, the application of L-PRF in addition to open flap debridement improved the bone regeneration in grade II mandibular furcation involvement. In case of ridge preservation and sinus floor augmentation, the results were controversial.&#x0D; Conclusions: The result of the current systematic review implied that the treatment outcome of PRF application for periodontal and soft tissue repair depends on the treatment strategies and type of the defect. It was shown to PRF application is a practical approach to accelerate and enhance new bone formation in human studies in intrabony defects and furcation involvements. However, further clinical trials for evaluation of other types of intra-oral defects are required.

Treatment of intrabony defects with modified perforated membranes in aggressive periodontitis: a 4-year follow-up of a randomized controlled trial

Objective(1) To assess long-term outcomes 4 years following guided tissue regeneration (GTR) of intrabony defects in patients diagnosed with aggressive periodontitis (AgP) and (2) to identify predictors of clinical attachment level (CAL) gain and bone/graft density gain.Materials and methodsIn 15 patients, two deep intrabony defects were randomly treated with xenogenic graft plus modified perforated membranes (MPM, tests) or xenogenic graft plus standard collagen membranes (CM, controls). After 4 years, clinical and radiographic outcomes were evaluated and compared with outcomes at baseline and after 1 year.ResultsAfter 4 years, 14 test sites and 13 control sites were available for analysis. One tooth was lost as a result of root fracture. There were significant improvements in all evaluated parameters after 1 and 4 years in relation to baseline, but no differences were observed between tests and controls. However, some non-significant changes were found between 1 and 4 years. Regression analyses showed that recurrence of periodontitis was a significant predictor for CAL gain (p = 0.001) and bone/graft density gain (p = 0.024) from 1 to 4 years.ConclusionsGTR of intrabony defects in AgP with either standard or modified CM yielded similarly successful and maintainable clinical benefits for compromised teeth 4 years following the surgery. The use of MPM showed no additional benefit.Clinical relevanceThis study demonstrates that most of the positive outcomes of GTR in AgP may be preserved over 4 years. Periodontitis recurrence might influence long-term outcomes.

Effects of topical application of 1% sodium alendronate gel in the surgical treatment of periodontal intrabony defects: A 6-month randomized controlled clinical trial.

Sodium alendronate (ALN) is an aminobisphosphonate and potent inhibitor of bone resorption. It has been suggested that ALN might be a promising carrier of biomolecules for periodontal bone repair. The aim of this randomized split-mouth clinical trial was to evaluate the effects of the topical application of 1% ALN gel in intrabony defects during the surgical treatment of patients with periodontitis. Sixty-four intrabony defects from 32 patients with periodontitis were randomly treated with either 1% ALN gel or placebo gel during periodontal surgeries. Full-mouth periodontal examination was performed at baseline and at 3 and 6 months after surgical treatment. Clinical attachment level (CAL), probing depth (PD), and bleeding on probing (BOP) were recorded as the clinical outcomes. Bone defects were evaluated by digital subtraction radiography (DSR) at baseline and 6 months post-treatment. Analyses were performed through Fisher, Kruskal-Wallis, and ANOVA tests and a generalized estimation equations method. Both ALN and placebo groups showed significant improvements in BOP, PD, and CAL after periodontal surgical procedures (P<0.001). Intergroup analysis showed significantly better outcomes in the ALN group with higher PD reduction and clinical attachment gain. DSR showed positive effects on periodontal bone repair strongly associated in the ALN group (P<0.001). Topical application of 1% ALN may be a promising and beneficial adjuvant for the treatment of intrabony defects during surgical periodontal therapy.

A Comparative Study of The Effect of Demineralized Bone Matrix with and Without Low Level Laser Therapy on The Treatment of Periodontal Infra-Bony Defects (Randomized Clinical Trial)

Objective: This study aimed at comparing clinically and radiographically the therapeutic effect of low level laser therapy and demineralized bone matrix, used in management of periodontal intrabony defect. Subjects and methods: Thirty two non-smoking patients aged between 28-51 years with severe chronic periodontitis participated in this randomized clinical study. Patients were randomly assigned into one of 2 groups (16 patients each): demineralized bone grafting alone of the intrabony defect, control group (Group I), demineralized bone grafting and the application of low level laser therapy (LLLT) (Group II). Clinical and radiographic parameters including plaque index, bleeding index, probing depth, clinical attachment level (CAL) and intrabony defect depth were reassessed at 6 months after surgery. Results: Specifically, LLLT treated sites (Group II) showed statistically significant differences regarding pocket depth and CAL compared with Group I. Intrabony defect depth was significantly reduced for LLLT group compared to that of Group I control. Conclusion: The use of LLLT as an adjunct with demineralized bone matrix (DBM) in the treatment of intrabony defects was more significant in improving the probing depth, CAL and intrabony defect depth than using DBM alone.

Evaluation of the Effect of Local Melatonin Gel Application in the Treatment of Intrabony Defects in Chronic Periodontitis Patients:

Evaluation of the Effect of Local Melatonin Gel Application in the Treatment of Intrabony Defects in Chronic Periodontitis Patients:

Additive effectiveness of autologous platelet-rich fibrin in the treatment of intrabony defects: A PRISMA-compliant meta-analysis.

Background:This meta-analysis was performed to determine the additive effectiveness of autologous platelet-rich fibrin in the treatment of intrabony defects in chronic periodontitis patients.Methods:Pertinent studies were identified by a search in Medline, EMBASE, the Web of Science, and the Cochrane Library. The trials searched were evaluated for eligibility. Cochrane Collaboration's Review Manager software was used to perform the meta-analyses.Results:Twelve eligible clinical trials were included. Pooled data found that adjunctive platelet-rich fibrin exactly yielded a significantly superior probing depth reduction compared with open flap debridement alone (weighted mean difference, 1.01; 95% confidence interval 0.95–1.08; P < .00001). The clinical attachment level (CAL) gain after treatment for 9 months was higher in patients treated with platelet-rich fibrin plus open flap debridement group than in open flap debridement-treated patients (weighted mean difference, 1.29; 95% confidence interval 0.96– 1.61; P < .00001). Similarly, the meta-analysis demonstrated that platelet-rich fibrin was superior to single open flap debridement with respect to gingival marginal level change (weighted mean difference, 0.45; 95% confidence interval 0.31–0.58; P < .00001). Regarding the hard tissue radiographic parameters, including defect depth reduction and percentage of fill defects in bone, adjunctive platelet-rich fibrin yielded significantly superior results compared with open flap debridement alone.Conclusion:Adjunctive use of platelet-rich fibrin with open flap debridement significantly improves fill defects when compared to open flap debridement alone. However, additional powered studies with much larger sample sizes are needed to obtain a more concrete conclusion.