Growth Factors in the Localized Gingival Recessions Treatment
Condition: Localized Gingival Recession
MeSH terms: Gingival Recession
Study type: Interventional

Summary: 
      The purpose of this study was to evaluate the clinical efficacy of concentrated-growth-factor
      (CGF) in combination with coronally-advanced-flap (CAF) compared with platelet-rich-fibrin
      (PRF)+CAF for the treatment of localized gingival-recessions (GRs)
    

Detailed description: 
      Gingival recession (GR) is a common mucogingival deformity. The root surface (RS) exposed by
      GR is treated with various surgical techniques.Traditionally, if GT and height of the
      keratinized gingiva (KG) are sufficient, the coronally advanced flap (CAF) technique is
      commonly used to close the exposed RS.Platelets contain various growth factors (GFs) to
      initiate healing process or regeneration of tissue.The second generation of platelet
      concentrates is platelet-rich fibrin (PRF) that are obtained from the centrifugation of blood
      (2700/3000rpm for 12 min) without anticoagulant or bovine trombin.And, the third generation
      of platelets concentrates is concentrated growth factor (CGF) as a new approach to produce
      PRF.It stated that the modified speed during centrifugation contribute the dense fibrin
      matrix in which includes larger, more intensive, more GFs than PRF.CGF is considered to be a
      biomaterial that is better than PRF in bone regeneration, but there is no study compare the
      clinical effects of CGF and PRF in the treatment of localized GRs. Our study hypothesized
      that if CGF has better regenerative capacity than PRF, the use of CGF in the treatment of GRs
      as a natural biomaterial may enhace the percentage of RC or healing of soft tissue compared
      with PRF. Therefore, the purpose of this study was to compare clinical effects of CGF and PRF
      in the treatment of localized GRs.

      The patients of this randomized, split-mouth and controlled clinical trial study protocol
      were selected from individuals referred to the Department of Periodontology, at the Faculty
      of Dentistry, Bulent Ecevit University, for either dentin hypersensitivity or aesthetic
      complaints between April 2015 and June 2017.

      The subjects were enrolled to this study based on the following inclusion criteria: (1) age >
      18 years, (2) systemically and periodontally healthy, (3) non-smokers, (4) presence of ≥2
      buccal adjacent Miller Class I or II GR with ≥2 mm GR depth (RD), probing depth (PD) <3 mm
      and gingival thickness (GT) ≥1 mm on both sides of the maxillary arch, (5) width of
      keratinized gingiva (KGW) ≥2 mm, (6) presence of identiﬁable cemento-enamel junction CEJ, (7)
      central, lateral canine and premolar teeth with GRs in the maxilla (8) full-mouth plaque
      control record (PCR) ≤20% (O'Leary et al. 1972) and gingival index (GI) scores = 0 (Loe,
      1967) and presence of tooth vitality and absence of caries, restorations and furcation
      involvement in the treated area.

      All the subjects received oral hygiene instructions and full-mouth scaling were performed 1
      month before surgery. They were instructed to perform a non-traumatic brushing technique
      (Roll) using an ultra-soft toothbrush. In eighteen patients (mean age 39.67₊10.25 age; 8
      females, 10 males), one side of the jaw received PRF+ CAF (37 defects), the opposite site
      received CGF + CAF (39 defects).

      Application of PRF membrane to the control region: The patient's venous blood was taken into
      the 10-ml test tubes and placed quickly in the Electro-Mag centrifuge (M 815 P, İstanbul,
      Turkey) without shaking. The device was operated at 2700 rpm for 12 minutes to obtain PRF.
      Application of CGF membrane to the test region: The intravenous blood of the patient was
      taken into 10-ml glaas-coated test tubes without anticoagulant solutions and rapidly
      centrifuged with a CGF centrifuge machine (Medifuge, Silfradent, S. Sofia, Italy). The
      instrument's CGF program was selected and operated at speeds and angles ranging from 2700 to
      3000 rpm. After approximately 13 minutes of rotation, CGF was obtained. CGF is characterized
      by 4 phases: (1) serum in the top layer, (2) the second buffy coat layer, (3) the third GF
      and unipotent stem cell layer (CGF), (4) the lower red blood cell layer (RBC). The CGFand PRF
      clot was removed from the tube and separated from the RBC by using microsurgical scissors.
      The CGF was squeezed in a special box that produces membranes at a constant thickness of 1
      mm.All surgeries were performed by the same expert periodontist during a single surgical
      session Gingival recession sites were randomly determined as either test or control site by
      tossing a coin immediately before the surgical procedure.

      Sutures were removed after 10 days and plaque control was maintained by CHX for additional 2
      weeks. The patients started brush the tooth at the end of the 3rd week and they were again
      instructed in mechanical tooth cleaning of the treated tooth using an ultra soft toothbrush
      and roll technique. Oral hygiene instructions were provided at each postoperative visit.
    

Intervention name(s): Concentrated Growth Factor Membrane; Platelet Rich Fibrin
Intervention type(s): Procedure; Procedure
Intervention description(s): Concentrated growth factor is produced by the centrifugation of venous blood and platelets are concentrated in a gel layer containing fibrin matrix; Platelet Rich Fibrinis produced by the centrifugation of venous blood and platelets are concentrated in a gel layer containing fibrin matrix
Other intervention name(s): An agent of platelet concentrates; An agent of platelet concentrates
Intervention MeSH terms: Mitogens
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: localized gingival recession; Platelet rich fibrin; concentrated growth factor; coronally advanced flap