Effectiveness of Platelet-Rich Fibrin in the Treatment of Intrabony Defects with or Without Bone Graft: A Clinical Comparative Study.

BACKGROUND: Periodontal diseases are a group of inflammatory diseases causing alveolar bone loss and eventually leading to loss of teeth. The present study was evaluated the effectiveness of platelet-rich fibrin (PRF) in the treatment of intrabony defects with or without bone graft.
MATERIALS AND METHODS: Thirty subjects with the presence of intrabony defects were enrolled. All subjects were included irrespective of age and gender. A questionnaire was prepared for extracting demographic and personal details of all the patients. William probe and moth mirror-tweezers set was used for carrying out clinical examination of all subjects. Random and unbiased division of all the subjects was done with ten patients in each group as follows: Group I: Subjects in which treatment was carried out using PRF with demineralized bone matrix, Group II: Subjects in which treatment was carried out using PRF alone, and Group III: Subjects in which treatment was carried in the form of open flap debridement (OFD). Pretreatment and posttreatment clinical variables were assessed which included plaque index (PI), gingival index (GI), probing depth (PD), relative attachment level (RAL), and gingival recession (GR) were assessed at baseline and 9 months postoperatively were calculated.
RESULTS: Mean PI among Group 1, Group 2, and Group 3 at baseline was 0.78, 0.8, and 0.84, respectively. Mean PI among Group 1, Group 2, and Group 3 at 9 months follow-up was 0.56, 0.55, and 0.72, respectively. Significant results were obtained while comparing the PI among the three study groups at follow-up. Mean GI among Group 1, Group 2, and Group 3 at baseline was 0.78, 0.8, and 0.84, respectively. Mean GI among Group 1, Group 2, and Group 3 at 9 months follow-up was 0.56, 0.55, and 0.72, respectively. Significant results were obtained while comparing the GI among the three study groups at follow-up. Significant difference was seen in PD, RAL, and GR from baseline to 9 months in all groups (P < 0.05).
CONCLUSION: PRF leads to significantly better improvement in the clinical parameters on follow-up in comparison to OFD alone in patients with the presence of intrabony defects. Copyright:

INTRODUCTION

Periodontal pathologies comprise a spectrum of pathologic entities which are inflammatory in nature and are accompanied by the loss of alveolar bone tissue. These alterations usually finally result in creation of edentulous environment. Periodontitis occurs usually as a cumulative result of conflicting communications in between micro-organism and the Defense system of host (immune response).[1] Simultaneously, at the same time, it also results in degradation of health-related quality of life. For treating such subjects and for confronting the spread of further infections process involving the periodontal tissue, periodontal surgery is usually recommended. With the combination of periodontal surgery and grafting procedures, regenerative procedures are also possible. These are tried mostly in those patients, in which nonsurgical periodontal therapy has failed to show desired results and in inhibiting pathologic activity.[23]

Various procedures have been put forward from time to time for managing patients with advanced periodontal pathologies. These include: flap surgical procedures, osseous respective procedures, guided tissue regeneration and grafting procedures.[4]

Main aim of periodontal surgery is to deliver convenience for ideal confiscation of plaque related subjects along with calculus. It also aims to correct the presence of any bony indiscretions stirring because of bone resorptive processes. Data from different researches have demonstrated that periodontal surgical procedures in patients having severe grade of periodontitis usually cases minimal periodontal breakdown with advancing time period. If in such patients, posttreatment oral hygiene measures are adequately taken; data show that they fully succeed in controlling tooth loss in approximately 85% of subjects.[3]

Numerous biomaterials are getting tried over the past few decades in subjects with the presence of intrabony defects. However, the outcome in such subjects is differential. In the recent past, biological modifiers have established their capability to excite parental cells present in periodontal defects. These lead to proliferative and differential integration process of cells of periodontal ligament tissue. These growth factors are known to arise naturally from platelets.[5] Platelet-rich fibrin (PRF) might be regarded as an enhanced therapeutic choice in comparison to PRP.[56] Hence, we planned the current research for establishing the effectiveness of PRF in treating patients with intrabony defects with or without bone graft.

MATERIALS AND METHODS

The present study was conducted at Department of Periodontology, Hazaribag College of Dental Sciences and Hospital, Hazaribag, Jharkhand. Thirty subjects with the presence of intrabony defects were enrolled. All subjects were included irrespective of age and gender. Before the starting of the surgical procedures, written consent was obtained from all the subjects after telling them research protocol involved in the current study. A questionnaire was prepared for extracting demographic and personal details of all the patients. William probe and moth mirror-tweezers set was used for carrying out clinical examination of all subjects. Random and unbiased division of all the subjects was done with 10 patients in each group as follows:

Group I: Subjects in which treatment was carried out using PRF with demineralized bone matrix (DBM)

Group II: Subjects in which treatment was carried out using PRF alone, and

Group III: Subjects in which treatment was carried in the form of open flap debridement (OFD).

Pretreatment and posttreatment clinical variables were assessed which included plaque index (PI), gingival index (GI), probing depth (PD), relative attachment level (RAL), and gingival recession (GR) were assessed at baseline and 9 months postoperatively were calculated. Analysis of all the results was performed using SPSS software SPSS software version 20.0 (IBM, Armonk, New York). Chi-square test and Mann–Whitney U was used for the evaluation of level of significance.

RESULTS

Table 1 shows the demographic data. Mean age of Group I patients, Group II patients, and Group III patients were 45.8 years, 48.6 years, and 44.7 years, respectively. 60%, 50% and 70% of the patients of Group I, Group II, and Group III were males, while remaining were female, respectively. Table 2 and Graph 1 show the outcome of PI and GI. Mean PI among Group 1, Group 2, and Group 3 at baseline was 0.78, 0.8, and 0.84, respectively. Mean PI among Group 1, Group 2, and Group 3 at 9 months follow-up was 0.56, 0.55, and 0.72, respectively. Significant results were obtained while comparing the PI among the three study groups at follow-up. Mean GI among Group 1, Group 2, and Group 3 at baseline was 0.78, 0.8, and 0.84, respectively. Mean GI among Group 1, Group 2, and Group 3 at 9 months follow-up was 0.56, 0.55, and 0.72, respectively. Significant results were obtained while comparing the GI among the three study groups at follow-up. Table 3 and Graph 2 shows significant difference in PD, RAL and GR from baseline to 9 months in all groups (P < 0.05).

Table 1

Demographic data

Study groups	Mean age (years)	Males (%)
Group I	45.8	60
Group II	48.6	50
Group III	44.7	70

Table 2

Outcome of plaque index and gingival index

Parameters	Duration	Group 1	Group 2	Group 3	P
Plaque index	Baseline	0.78	0.80	0.84	0.01*
	9 months	0.56	0.55	0.72
Gingival index	Baseline	0.76	0.82	0.83	0.00*
	9 months	0.52	0.56	0.66

*Significant

Graph 1

Assessment of plaque index and gingival index

Table 3

Comparison of clinical parameters

Parameters	Duration	Group I	Group II	Group III	P
PD (mm)	Baseline	8.4	8.2	8.3	0.01*
	9 months	4.2	4.0	5.2
RAL (mm)	Baseline	11.5	12.4	11.9	0.03*
	9 months	7.2	8.2	9.2
GR (mm)	Baseline	0.56	0.72	0.52	0.02*
	9 months	0.72	0.90	1.62

*Significant. PD: Probing depth, RAL: Relative attachment level, GR: Gingival recession

Graph 2

Comparison of clinical parameters

DISCUSSION

Over a period of time, Choukroun et al., PRF has become a routinely employed option these days in managing patients with presence of intra bony defects.[7] It represents 2nd generation of PCs. They consist of organically vigorous protein rich components which enhances the healing process drastically. At the same time, in-vitro studies have demonstrated that they stimulate angiogenic processes, repair of tissue components. However, it also results in some amount of inflammatory response.[8] The union and merging of protein components with a forming fibrin mesh or with extracellular matrix probably could generate chemotactic components thereby helping in recruitment process of stem cells. This further propagates cell migration, proliferation, and hence; enhances tissue regeneration and repair process.[910] Hence, we planned the current research for establishing the effectiveness of PRF in treating patients with intrabony defects with or without bone graft.

In the present study, mean age of Group I patients, Group II patients, and Group III patients were 45.8 years, 48.6 years, and 44.7 years, respectively. 60%, 50% and 70% of the patients of Group I, Group II, and Group III were males, while remaining were females respectively. Mean PI among Group 1, Group 2, and Group 3 at baseline was 0.78, 0.8, and 0.84, respectively. Mean PI among Group 1, Group 2, and Group 3 at 9 months follow-up was 0.56, 0.55, and 0.72, respectively. Significant results were obtained while comparing the PI among the three study groups at follow-up. Our results were in concordance with the results obtained by Chandradas et al. who also demonstrated similar findings. In their study, authors analyzed the effectiveness PRF with or without bone graft (DBM graft) in managing patients with intrabony defects. Analysis of 36 patients with the presence of intrabony defects was done. Randomization of all the patients was done into three study groups as follows: Group A-(PRF with DBM), Group B-(PRF alone), and Group C (OFD). They analyzed clinical and periodontal variables on the 9th month of follow-up. They observed that mean reduction in periodontal parameters was significantly higher in Group A, and Group B in comparison to Group C.[11]

In the present study, mean GI among Group 1, Group 2, and Group 3 at baseline was 0.78, 0.8, and 0.84, respectively. Mean GI among Group 1, Group 2, and Group 3 at 9 months follow-up was 0.56, 0.55, and 0.72, respectively. Significant results were obtained while comparing the GI among the three study groups at follow-up. Significant difference was demonstrated in PD, RAL and GR from baseline to 9 months in all groups (P < 0.05). Similar findings were observed in the study conducted by Elkhatat et al. They evaluated effectiveness of GTR on the prognostic outcome of OFD in managing subjects with presence of intrabony defects. Analysis of total 16 patients was done in their study. They also randomized patients in two study groups: Group 1-open flap surgery and GTR group, and Group 2-open flap surgery alone. They results demonstrated significantly better results in the membrane group in comparison to open flap surgery alone group.[12]

CONCLUSION

PRF leads to significantly better improvement in the clinical parameters on follow-up in comparison to OFD alone in patients with the presence of intrabony defects.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.