Contingent Analysis of Open Flap Debridement, Leukocyte-Rich Platelet-Rich Fibrin and Titanium Platelet-Rich Fibrin in the Treatment of Three-Walled Intra-Bony Defects in Chronic Periodontitis: A Randomized Controlled Clinical Study
Background: Periodontal regeneration, a multifactorial and complex procedure relates to the reconstruction of the periodontal tissues to maintain a clinically healthful state. Attaining a complete periodontal regeneration with the current regenerative procedures offer a limited success. Platelet Ric...
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| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer Medknow Publications
2025-01-01
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| Series: | Journal of International Clinical Dental Research Organization |
| Subjects: | |
| Online Access: | https://journals.lww.com/10.4103/jicdro.jicdro_91_24 |
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| Summary: | Background:
Periodontal regeneration, a multifactorial and complex procedure relates to the reconstruction of the periodontal tissues to maintain a clinically healthful state. Attaining a complete periodontal regeneration with the current regenerative procedures offer a limited success. Platelet Rich Fibrin is a polymerized fibrin matrix having a simple strategy of enhancing healing capacity of natural blood clot by supplementing the natural blood clot with growth factors. This unique structure acts as a vehicle for growth factor delivery system and also carry cells that are essential for tissue regeneration. The potential limitations of PRF include cross-contamination with silica, a lack of rigidity, and fast degradation. To overcome these limitations, the third generation of platelet concentrate Titanium PRF was introduced by Tunali et al 2013 by using biocompatible material titanium, where the fibrin network has a longer absorption time, increased capacity for osseointegration, better hemocompatibility, greater cellular support, and it promotes periodontal regeneration. Aims and Objectives: The aim and objectives of this controlled clinical trial is to compare the clinical and Radiographic effectiveness of Leukocyte Rich Platelet rich fibrin [L-PRF] with open flap debridement, Titanium -Platelet Rich Fibrin[T-PRF] and Open Flap Debridement [OFD] in the management of 3 walled intrabony periodontal defects.
Materials and Methods:
This Randomized controlled clinical trial was conducted in the Department of Periodontics, Rural Dental College, Loni .25 patients with 3 walled intrabony defects at three sites were treated with OFD and L-PRF (experimental group), OFD and T-PRF (experimental group), OFD alone (control group). Evaluation of change in probing pocket depth, Gain in clinical attachment level was done at 9 Months, and defect fill and alveolar crestal bone resorption were evaluated at 6 and 9 Months after surgery by Analysis of Variance (ANOVA) with Post hoc Tukey’s test. Probing Pocket depth was measured from the gingival margin to the base of the pocket, Clinical attachment Level was measured from the cementoenamel junction of each tooth to the soft tissue base of the pocket by using a stent. Prior to surgery a standardized digital periapical radiograph was made using the customized bite-plate and the paralleling technique. Radiographic measurements was done as (1) distance from the Cemento Enamel Junction [CEJ] to the deepest point of the vertical bone defect (BD), (2) distance from the CEJ to the alveolar crest (AC). Measurements were obtained utilizing a millimetre grid. The differences between 6, 9 months and baseline values of CEJ-BD indicated the amount of bone fill. The differences between CEJ-AC will be identified as the amount of crestal bone resorption respectively.
Results:
The Change in Plaque Scores from Baseline to 9 Months at different time intervals depicted that the difference in mean PI Scores from Baseline to 1 Month, Baseline to 3 Months, Baseline to 6 Months and Baseline to 9 Months was statistically significant in all the patients. For the clinical parameters, the comparison of Change of PPD and gain in CAL (Baseline-9 Months) between OFD, L-PRF & T-PRF depicted that the mean change was highest for T-PRF, followed by L-PRF, followed by OFD. Radiographic Parameters which included defect fill demonstrated that for the T-PRF group the bone formation was more followed by L-PRF followed by OFD where bone formation was least at 6 and 9 Months. When the crestal bone resorption was assessed from baseline to 9 Months the mean distance in OFD Group was observed to be increased whereas in L-PRF there was no change and in T-PRF the mean distance from CEJ to AC was observed to be decreased (depicting bone formation only in T-PRF Group).
Conclusion:
With in the limitations of this study it can be concluded that the application of Titanium Platelet-rich fibrin presents new possibilities for enhanced healing and functional recovery in the treatment of IBDs with greater reduction in Pocket Depth, more Clinical Attachment gain and could produce more new bone in less time when compared to L-PRF and OFD. |
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| ISSN: | 2231-0754 2231-5357 |