Bioactive Glass and Platelet Rich Fibrin in Intrabony Defects
Condition: Periodontal Diseases; Bone Resorption
MeSH terms: Bone Resorption; Periodontal Diseases
Study type: Interventional
Phase: Phase 3

Summary: 
      Background: Platelet-rich fibrin (PRF) and bioactive glass putty has been shown to be
      effective in promoting reduction in probing depth, gain in clinical attachment, and defect
      fill in intrabony periodontal defects. The individual role played by bioactive glass putty in
      combination with PRF is yet to be elucidated.

      AIM: To compare the clinical effectiveness of the combination of Plaltelet Rich Fibrin and
      Bioactive Glass Putty and Bioactive glass putty regenerative techniques for intrabony defects
      in humans.

      Material and methods: Ten pairs of intrabony defects were surgically treated with PRF and
      Bioactive glass putty (Test group) on one side or bioactive glass putty (Control group) on
      other side. The primary outcomes of the study included changes in probing depth, attachment
      level and bone fill of Osseous defect. The clinical parameters were recorded at baseline, 3,
      6, and 9 months. Radiographic assessment was done using standardized intra oral periapical
      radiographs. Comparisions were made within each group between baseline, 3 months, 6 months
      and 9 months using the ANOVA test followed by Bonferroni test.
    

Detailed description: 
      INTRODUCTION

      Periodontitis is an infectious disease that causes destruction of the attachment
      apparatus.[1].The mainstay aim of periodontal treatment is the regeneration of the lost
      attachment apparatus of the teeth. Variety of treatment modalities are available for
      periodontal regenerative therapy including bone grafts, bone substitutes, Guided Tissue
      Regeneration, growth factors, application of tissue engineering or the combination of two or
      more of the above listed approaches. [2] Alloplasts, may be an effective alternative to
      allograft and xenografts as there is no risk of disease transmission and the supply is
      unlimited.[3] The Bioactive glass promotes osteogenesis by adsorption and concentrations of
      protein utilized by osteoblast to form a mineralized extracellular matrix. [4] The advantage
      of the putty form of bioactive glass is the glycerine and polyethylene glycol which makes the
      glass particle coherent and thus enhancing handling characteristics and minimal migration of
      graft particles from the defect site. [5] Histological evaluation of material has shown that
      the particulate tends to retard the down growth of epithelial tissue. [6,7,8,9] Growth
      factors play a pivotal role in periodontal regeneration. Platelet Rich Fibrin is believed to
      release polypeptide growth factors, such as transforming growth factors-ß, platelet derived
      growth factors, vascular endothelial growth factors and matrix glycoproteins (such as
      thrombospondin -1) into the surgical wound in a sustained fashion for at least 7 days as
      shown in vitro. [10] Thus, given the unique graft with osteoconductive, osteoinductive and
      osteostimulative properties and properties of autologous PRF, application of combination
      approach was attempted for the assessment of their additional benefits to the healing
      mechanisms and periodontal regeneration in intrabony defects.

      Materials and methods Patient Selection This randomized control trial was carried out in the
      Department of Periodontics and Oral Implantology, Santosh Dental College and Hospital,
      Santosh University, Ghaziabad. Ten patients suffering chronic localized periodontitis aged
      between 20 -50 years (7 males and 3 females) with 10 pairs of contalateral intraosseous
      defects (n=20) comprised the study population. A total of 20 bone defects (10 pairs) were
      decided by the statisticion to be of statistical strength. Convenient sampling design was
      used for the enrolment of study patients. Ethical approval was taken from the institutional
      ethical committee The patients were explained in detail about the procedure and a written
      informed consent was taken. The intrabony defects were diagnosed clinically with moderate to
      deep periodontal pockets > or = 5mm and with clinical and radiographic evidence of
      vertical/angular osseous defects. [3] Patients with systemic diseases, on anticoagulants,
      those with habit of smoking and alcohol, with known history of allergy to graft material and
      who have undergone periodontal surgical treatment for chronic periodontitis within twelve
      months for the same defects were excluded from the study.

      PRESURGICAL THERAPY Patients underwent phase I therapy. The selected defects were evaluated
      after 2 weeks, and persistent pockets > or = 5mm and patients with clinical radiographic
      evidence of angular osseous defects were scheduled for surgery.

      Clinical Parameters :

      Oral hygiene status was recorded using the gingival index of Loe & Sillness,[11];

      with score 0 indicating absence of inflammation and score 3 indicating severe

      inflammation and plaque index of Silness & Loe. [12]

      Probing pocket depth and Clinical attachment level were recorded at baseline on the

      day of surgery, 3, 6 and 9 months intervals using UNC-15 probe and customized

      acrylic occlusal stents grooved in the area of defect to provide reproducible insertion

      axis-

      The following measurements were recorded with customized

      acrylic stent:

        -  Fixed reference point (FRP) to the base of pocket (BP)

        -  Fixed reference point (FRP) to the cemento-enamel junction (CEJ)

        -  Fixed reference point (FRP) to the gingival margin (GM)

      PPD and CAL were calculated from these probing measurements as:

        -  PPD = (FRP to BP) - (FRP to GM)

        -  CAL= (FRP to BP) - (FRP to CEJ)

      Radiographic measurements: Standardized intra-oral periapical radiographs of the defects were
      taken using a paralleling technique.[13]

      Amount of defect fill: Defects were measured from the fixed reference point (distance between
      the cemento-enamel junction to the radiographic base of the bone defect ) with the help of
      1.1 mm grid and the following radiographic features were recorded on the day of surgery, 3, 6
      and 9 months intervals.
    

Intervention name(s): Platelet rich fibrin; Bioactive Glass
Intervention type(s): Drug; Drug
Intervention description(s): In the test site the graft was then carefully compacted from the base of the defect coronally. PRF membrane was placed in the test site; The control site were packed with the bioactive glass graft alone
Other intervention name(s): PRF; Novabone
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary purpose: Treatment
Keywords: Periodontal disease; Platelet rich fibrin