Different Autologous Products in The Treatment of Intrabony Defects
Condition: Periodontal Pocket
MeSH terms: Periodontal Pocket
Study type: Interventional

Summary: 
      The aim of this study is to evaluate and compare the efficiencies of platelet-rich fibrin
      (PRF), concentrated growth factor (CGF) and autologous bone graft (ABG) in the treatment of
      patients who have intrabony pockets clinically and to assess the alveolar bone gain (AB gain)
      radiographically ((Panoramic X-ray and cone-beam computed tomography (CBCT) X-ray)).
    

Detailed description: 
      Periodontitis is a complex multifactorial inflammatory disorder of periodontium, which occurs
      due to accumulations of microorganism that lead to gradual damage of periodontal tissues
      resulting in the creation of periodontal defects and recession of gingiva. This leads to the
      initiation of bone resorption forming bone defect known as periodontal pocket (PP). PP could
      be treated by surgical and non-surgical procedures. Non-surgical treatment or initial
      periodontal treatment (IPT) aims to remove irritant factors of periodontal disease. Surgical
      procedure has to be applied if inflammation persists after non-surgical procedures. One of
      the most common surgical procedures used for treatment of PP is an open flap debridement
      (OFD) which aims to remove infection and inflamed tissue, and to establish the appropriate
      biological situations essential for periodontal regeneration. However, the regeneration of
      tissues damaged by periodontitis could not be accomplished by OFD alone. Some autologous
      products that can be used in regenerative periodontal treatment include: ABG, autologous soft
      tissue graft and autologous platelet concentrates (APC).

      ABGs consist of live osteoblasts, osteoprogenitor stem cells and all the three components for
      tissue engineering, i.e, scaffold, cells, and signaling molecules. Among the several
      available regeneration substances, only ABG involves osteoconductive, osteoinductive, and
      osteogenic properties. Due to their favorable characteristics, ABGs have been regarded as the
      "gold standard", and the most successful material that can be used in periodontal
      regeneration surgery. Despite being quite effective, ABGs have some drawbacks, including
      limited donor locations, insufficient bone amount, another site surgery, the possibility of
      some unexpected bone resorption and donor site morbidity, which includes pain, infection,
      sensory loss, and bleeding. Because of these shortcomings, the use of other autologous
      products such as autologous platelet concentrates (APC ; PRF, CGF) has become needed.

      PRF is a second-generation autologous platelet concentrate as it is a natural concentrate
      prepared directly by taking blood from the patient without adding any anticoagulant. PRFs
      were firstly introduced in 2001 with the aim of simplifying the platelet-rich plasma (PRP)
      preparation protocol and overcoming its drawbacks. It is inexpensive, time saving, and it
      does not require chemical alteration in collected blood. Literature showed that the PRF
      membrane could stay intact and release continuously large quantities of growth factors slowly
      for at least 1 week, due to its fiber network scaffold. PRF shows effective outcomes in the
      surgical management of periodontal intra-bony and furcation defects which lead to noticeable
      improvement of PD and CAL. Some other dental applications are socket preservation after
      extraction, root covering procedure, third-molar surgery, alveolar ridge preservation, guided
      tissue regeneration and sinus elevation. Furthermore, PRF has the ability to enhance
      osseointegration of implants and can be used with grafting materials as natural resorbable
      membrane as an alternative to collagen membrane in managing periodontal and peri-implant
      defects. Nevertheless, the PRF membrane has fast biodegradability (up to 14 days). However,
      PRF has some limitation, as it required to be used as quickly as possible after preparation.
      Recently, researchers developed new products of the PRF that aim to improve the properties of
      PRF and obtain a better autogenous biological material by changing the centrifuge time and
      speed (Injectable-PRF, Advanced-PRF and CGF).

      CGF is an advanced second-generation platelet concentrate, which consists of diverse growth
      factors that stimulate and accelerate bone formation and soft and hard tissue healing. CGF
      can also improve the quality of the produced new bone. CGF was firstly introduced by Sacco in
      2006 as a recent improved formulation of PRF which contains high amount of growth factors and
      can be used successfully in regenerative treatments. It has a different preparation protocol
      by alternating and controlling centrifugation speeds manually or by using a special
      centrifuge machine, which permits the formation of a considerably larger and firmer fibrin
      matrix which is more abundant in growth factors compared to those observed in PRP and classic
      PRF. He et al26 reported that the three-dimensional fiber network scaffold of CGF could help
      in releasing growth factors gradually for a period between 7-10 days.

      So, according to recent findings in the literature, the hypothesis of this study was that the
      treatment of periodontal intrabony defects by using OFD in combination with autologous
      products (PRF, CGF and ABG) would lead to effective outcomes compared to OFD alone. Therefore
      the aim of this randomized controlled clinical study was to evaluate the effects of different
      autologous products (PRF, CGF and ABG) on the treatment of periodontitis patients who have
      intrabony pockets and to compare between their efficiency clinically and radiographically.
    

Intervention name(s): autologous products
Intervention type(s): Procedure
Intervention description(s): After the operation area was washed thoroughly with saline, autologous products were placed inside defects according to the related group. For the control group, the defects were left without adding any products.
Allocation: Randomized
Intervention model: Crossover Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Autologous bone graft; concentrated growth factor; platelet-rich fibrin