Efficiency of PRP on Acellular Dermal Matrix Application in the Treatment of Multiple Adjacent Gingival Recessions
Condition: Gingival Recession, Generalized
MeSH terms: Gingival Recession
Study type: Interventional

Summary: 
      The aim of this study was to evaluate the effectiveness of platelet rich plasma (PRP)
      combined with coronally advanced flap plus acellular dermal matrix application (CAF+ADM) in
      the treatment of multiple adjacent gingival recessions (MAGRs).

      12 patients with 84 Miller Class I or II recession defects were participated. Sites were
      randomly assigned into CAF+ADM+PRP or CAF+ADM groups. Gingival recession depth (GRD),
      recession width (GRW), width of keratinized tissue (WKT), creeping attachment (CRA), root
      coverage (RC) as well as plaque index, gingival index, probing depth (PD), and clinical
      attachment level (CAL) were recorded at baseline and 3rd,6th and 12th months postoperatively.
      The data were analyzed statistically.
    

Detailed description: 
      Several methods have been demonstrated for the treatment of gingival recession defects with
      the use of PRP. In an 8-month randomized controlled trial, it was reported that there was no
      significant difference between PRP and CTG treated groups in terms of root coverage of Miller
      Class 1 or II buccal recession defects. However, in the same study contour and texture of
      soft tissue showed valuable enhancement in PRP group. The use of PRP together with ADM in the
      treatment of MAGRs may alleviate the need for autogenous donor tissue. Shepherd et al.
      compared coronally positioned tunnel technique and ADM application with and without PRP for
      the treatment of single gingival recession defects and reported no statistically significant
      root coverage difference between groups.

      Although there are numerous root coverage procedures to treat the conditions, predictable
      coverage of multiple adjacent gingival recessions still remains a challenge for the
      clinician. The aim of this randomized, controlled, clinical trial was to compare the CAF plus
      ADM application together with and without PRP to determine whether the PRP provided an
      advantage in terms of gaining coverage of deep and wide recession defects in the treatment of
      MAGRs.

      In the present study, using a controlled blinded split-mouth design, 14 patients with
      multiple Miller Class I or II adjacent recession defects ≥ 3mm deep on bilateral operation
      sites were randomly operated either with CAF+ADM+PRP or only CAF+ADM as test and control
      groups respectively. Two patients who failed to return for all postoperative visits were
      exited from the study.

      Finally12 patients who had adjacent Miller Class 1 or II (Miller) recession defects ≥ 3mm
      deep on non-molar teeth in the same dental arch at least two bilateral site, underwent
      through root coverage surgery and were followed for 12 months. The study sample consisted of
      84 teeth associated with total of 12 patients; seven patients each showing a pair of three
      teeth, four patients each showing a pair of four teeth, and one patient showing a pair of
      five teeth with adjacent multiple recessions deep on the buccal aspect of each tooth. The
      treated teeth were 26 incisors, 24 canines and 34 first premolars. Standardized radiographs
      were taken to evaluate the interproximal alveolar bone level. At baseline, 3, 6 and 12 months
      after the surgeries; Miller classification of the recession defect (Miller, 1985), plaque
      index (PI) (Silness and Loe, 1964), gingival index (GI) (Loe, 1967) probing depth (PD),
      clinical attachment level(CAL), Probing depth(PD), gingival margin (GM), Gingival recession
      width (GRW) were recorded. The pre-surgical evaluation included an analysis of the patient's
      tooth brushing technique and habits. At the teeth showing gingival recessions, a coronally
      directed roll technique using a soft toothbrush was indicated to minimize the tooth brushing
      trauma to the gingival margin. Pre-surgical therapy included scaling, root planning,
      polishing and general oral hygiene instruction. All surgical procedures were performed with
      Coronally Advanced Flap technique.
    

Intervention name(s): CAF+ADM+PRP; CAF+ADM
Intervention type(s): Procedure; Procedure
Intervention description(s): CAF+ADM+PRP group treated with coronally advanced flap technique including ADM placement, In CAF+ADM+PRP group, ADM was hydrated in the platelet-poor plasma (PPP) and the PRP was applied to surgical sites prior to final suturing.; CAF+ADM group treated with coronally advanced flap technique including ADM placement without PRP application
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: multiple adjacent gingival recessions; platelet rich plasma; acellular dermal matrix; coronally advanced flap; gingival recession; root coverage; clinical attachment level