Title

Platelet-rich Fibrin and Connective Tissue Graft in Recession Treatment
The Adjunctive Effect of Platelet Rich Fibrin to Connective Tissue Graft in the Treatment of Buccal Recession Defects. Results of a Randomized Parallel Group Controlled Trial
  • Phase

    N/A
  • Study Type

    Interventional
  • Intervention/Treatment

    platelet rich fibrin ...
  • Study Participants

    40
The aim of the trial is to evaluate the effectiveness of coronally advanced flap (CAF)+connective tissue graft(CTG)+platelet-rich fibrin(PRF) combination in Miller I and II recession treatment by comparing with CAF+CTG. 40 patients were surgically treated either with CAF+CTG+PRF (test group) or CAF+CTG (control group). Clinical parameters of plaque index (PI), gingival index (GI), vertical recession (VR), probing depth (PD), attachment level (AL), keratinized tissue width (KTW), horizontal recession (HR), MGJ localization (L-MGJ), tissue thickness (TT) were recorded at baseline, 3 months (PS1) and 6 months (PS2) post-surgery. Root coverage (RC), complete RC (CRC), attachment gain (AG), and keratinized tissue change (KTC) were also calculated.
Given the encouraging effects of platelet-rich fibrin (PRF) in healing and regeneration, it has been hypothesized that PRF might develop the outcomes obtained with coronally advanced flap (CAF)+connective tissue graft(CTG). Therefore, it was aimed to evaluate the effectiveness of CAF + CTG + PRF in Miller Class I and II recession defect treatment by comparing the outcomes with CAF + CTG in a preliminary, controlled, randomized clinical trial (RCT) with a 6-month follow-up. The study was conducted with 40 patients randomly grouped in half shares into indicated study groups. After phase I therapy, clinical variables including plaque index (PI), gingival index (GI), vertical recession (VR), probing depth (PD), attachment level (AL), keratinized tissue width (KTW), horizontal recession (HR), MGJ localization (L-MGJ), tissue thickness (TT) were recorded. The surgical sites were prepared by using sulcular and adjacent vertical incisions and CTGs were harvested from the palatal regions. Different from CAF+CTG group, PRF was prepared by obtaining 10 ml venous blood, centrifugation and extraction of the gel containing highly concentrated platelet cells in CAF+CTG+PRF patients. Then the gel was placed over the exposed root surface in the same group. The CAF was primarily closed and postoperative instructions were given. After suture removal at second postoperative week, the patients were followed-up by monthly recall visits. Same periodontal clinical variables were recorded 3 and 6 months after surgery.
Study Started
Feb 28
2013
Primary Completion
Dec 31
2013
Study Completion
May 31
2014
Results Posted
May 01
2018
Last Update
Oct 26
2018

Biological platelet-rich fibrin

autologous platelet-rich fibrin was isolated from venous blood of each patient by defined centrifugation methods

Procedure connective tissue graft

connective tissue graft was harvested from the palatal region of each patient by single incision method

Procedure coronally advanced flap

buccal gingival flap was raised by sharp-blunt-sharp dissection and positioned coronally to cover connective tissue graft (and platelet-rich fibrin gel)

PRF+CAF+CTG Experimental

platelet-rich fibrin + coronally advanced flap + connective tissue graft

CAF+CTG Active Comparator

coronally advanced flap + connective tissue graft

Criteria

Inclusion Criteria:

Systemically healthy
Single Miller type I or II recession defect ≥ 3 mm localized to anterior/premolar area
No alveolar bone loss
Identifiable cemento-enamel junction
Probing depth ≤3mm

Exclusion Criteria:

Smoking
Pregnancy
History of periodontal surgery in last two years
Mobility
Excessive occlusal contacts
Caries
Loss of vitality

Summary

PRF+CAF+CTG

CAF+CTG

All Events

Event Type Organ System Event Term

Vertical Recession

Measured from cementoenamel junction to margin of the gingiva by periodontal probe

PRF+CAF+CTG

6 months

0.35
mm (Mean)
Standard Deviation: 0.52

6 weeks

0.38
mm (Mean)
Standard Deviation: 0.54

Baseline

3.35
mm (Mean)
Standard Deviation: 0.43

CAF+CTG

6 months

0.65
mm (Mean)
Standard Deviation: 0.59

6 weeks

0.65
mm (Mean)
Standard Deviation: 0.59

Baseline

3.2
mm (Mean)
Standard Deviation: 0.34

Horizontal Recession

measured horizontally between two borders of the recession at the line tangential to cementoenamel junction by periodontal probe

CAF+CTG+PRF

6 months

6 weeks

Baseline

3.8
mm (Median)
Inter-Quartile Range: 2.0 to 5.0

CAF+CTG

6 months

1.0
mm (Median)
Inter-Quartile Range: 0.0 to 2.0

6 weeks

1.0
mm (Median)
Inter-Quartile Range: 0.0 to 3.0

Baseline

3.0
mm (Median)
Inter-Quartile Range: 2.0 to 5.0

Probing Depth

measured from margin of the gingiva to gingival sulcus base by periodontal probe

CAF+CTG+PRF

6 months

1.0
mm (Median)
Inter-Quartile Range: 1.0 to 1.0

6 weeks

1.0
mm (Median)
Inter-Quartile Range: 1.0 to 1.0

Baseline

1.0
mm (Median)
Inter-Quartile Range: 1.0 to 2.0

CAF+CTG

6 months

1.0
mm (Median)
Inter-Quartile Range: 1.0 to 2.0

6 weeks

1.0
mm (Median)
Inter-Quartile Range: 1.0 to 2.0

Baseline

1.0
mm (Median)
Inter-Quartile Range: 1.0 to 2.0

Attachment Level

measured from cementoenamel junction to gingival sulcus base by periodontal probe

CAF+CTG+PRF

6 months

1.0
mm (Median)
Inter-Quartile Range: 1.0 to 3.0

6 weeks

1.0
mm (Median)
Inter-Quartile Range: 1.0 to 3.0

Baseline

4.5
mm (Median)
Inter-Quartile Range: 3.0 to 5.5

CAF+CTG

6 months

1.8
mm (Median)
Inter-Quartile Range: 1.0 to 3.0

6 weeks

2.0
mm (Median)
Inter-Quartile Range: 1.0 to 3.0

Baseline

4.0
mm (Median)
Inter-Quartile Range: 3.0 to 5.0

Keratinized Tissue Width

measured from margin of the gingiva to mucogingival junction by periodontal probe

CAF+CTG+PRF

6 months

4.0
mm (Median)
Inter-Quartile Range: 2.0 to 7.5

6 weeks

4.0
mm (Median)
Inter-Quartile Range: 2.0 to 7.5

Baseline

3.0
mm (Median)
Inter-Quartile Range: 2.0 to 6.0

CAF+CTG

6 months

3.8
mm (Median)
Inter-Quartile Range: 2.0 to 7.0

6 weeks

3.5
mm (Median)
Inter-Quartile Range: 1.5 to 7.0

Baseline

2.8
mm (Median)
Inter-Quartile Range: 2.0 to 6.0

Tissue Thickness

under local anesthesia, measured from 1.5 mm below the margin of the gingiva with a spreader and its stopper silicon disc. Then, distance of the marked point was measured by using a standardized caliper to the closest 0.1 mm by periodontal probe

CAF+CTG+PRF

6 months

1.9
mm (Median)
Inter-Quartile Range: 1.4 to 2.6

6 weeks

1.9
mm (Median)
Inter-Quartile Range: 1.4 to 2.6

Baseline

0.9
mm (Median)
Inter-Quartile Range: 0.4 to 1.6

CAF+CTG

6 months

1.5
mm (Median)
Inter-Quartile Range: 1.0 to 2.2

6 weeks

1.6
mm (Median)
Inter-Quartile Range: 0.9 to 2.6

Baseline

0.9
mm (Median)
Inter-Quartile Range: 0.4 to 1.6

Total

40
Participants

Age, Continuous

40.72
years (Mean)
Standard Deviation: 7.18

Age, Categorical

Region of Enrollment

Sex: Female, Male

Overall Study

CAF+CTG+PRF

CAF+CTG