The Evaluation Clinical Results of Coronally Advanced Flap With Platelet Rich Fibrin

Study Overview
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Brief Summary
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The aim of this study was to evaluate the clinical outcomes of platelet- rich fibrin and coronally advanced flap technique in the treatment of multiple gingival recessions in comparison with connective tissue graft technique.

Detailed Description
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Aim of this study was to evaluate the clinical outcomes of platelet rich fibrin (PRF)+coronally advanced flap (CAF) technique in the treatment of multiple gingival recessions in comparison with connective tissue graft (CTG)+CAF technique.12 patients with bilateral Miller Class I multiple gingival recessions were treated with PRF+CAF (test group) and CTG+CAF (control group) technique in a split-mouth study design. Probing depth, recession depth (RD), clinical attachment level (CAL), recession width, position of gingival margin, papilla width, keratinized tissue height (KTH), keratinized tissue thickness (KTT) were measured at baseline and 3, 6 and 12 months after surgery. Root coverage (RC) and complete root coverage (CRC) ratios were evaluated post-operatively.

Official Title
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Treatment of Multiple Adjacent Gingival Recessions With Coronally Advanced Flap in Combination With Platelet-Rich Fibrin: A Split-Mouth Study

Conditions
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Root Coverage

Intervention / Treatment
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* Procedure: Platelet rich fibrin and coronally advanced flap
* Procedure: Connective tissue graft and coronally advanced flap


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients had at two quadrants, adjacent Miller Class I and at least 2 mm or deeper recessions Full mouth plaque score 20% and Full mouth bleeding on probing 10% no active periodontal disease, involving incisors, canines and premolars, age ≥ 18 years Exclusion Criteria: Patients with general diseases which could affect healing process, smokers Patients had undergone periodontal surgery during the pervious 24 months on the involved sites, pregnant or breastfeeding women endodontic lesions or non-detectable cemento-enamel junctions at experimental teeth

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Platelet rich fibrin and coronally advanced flap<br>Coronally advanced flap and platelet rich fibrin were used in treatment arms. | Procedure: Platelet rich fibrin and coronally advanced flap<br>* CAF were used in treatment arms. Root planning was performed on the exposed part of roots to provide more biocompatible surface for re-attachment. Two 10 cc tubes with clot activator were used to collect blood from the patient; blood was centrifuged at 2700 rpm for 12 min. PRF box was used to form fibrin clots into membranes. PRF was positioned at the level of the cemento-enamel junction (CEJ), and sutured on the periosteum bed with 6/0 absorbable sutures. Gingival margins on the flap were placed at least 1 mm coronally of the CEJ and sutured with 5/0 absorbable sutures. Sutures were removed at 2nd week.<br>|
| Active Comparator: Connective tissue graft and coronally advanced flap<br>Coronally advanced flap and connective tissue graft were used in treatment arms. | Procedure: Connective tissue graft and coronally advanced flap<br>* Control sites were treated by coronally advanced flap (CAF) combined with connective tissue graft (CTG). CAF were used in both treatment arms. Root planning was performed on the exposed part of roots to provide more biocompatible surface for re-attachment. CTG was obtained with single incision method. CTG was positioned at the level of the cemento-enamel junction (CEJ), and sutured on the periosteum bed with 6/0 absorbable sutures. Gingival margins on the flap were placed at least 1 mm coronally of the CEJ and sutured with 5/0 absorbable sutures. Sutures were removed at 2nd week.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Percentage of Root Coverage | The percentage of root coverage was calculated according to the preoperative recession depth to postoperative recession depth. | 12 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Complete Root Coverage | Complete root coverage was calculated according to measurement of the pre and post operative gingival margin which was above the enamel-sement junction. | 12 months | 
| Change from Baseline Keratinized Tissue Width at 3 months | Width of keratinized tissue at mid-buccal point measured from free gingival margin to mucogingival junction | 3 months | 
| Change from Baseline Keratinized Tissue Width at 6 months | Width of keratinized tissue at mid-buccal point measured from free gingival margin to mucogingival junction | 6 months | 
| Change from Baseline Keratinized Tissue Width at 12 months | Width of keratinized tissue at mid-buccal point measured from free gingival margin to mucogingival junction | 12 months | 
| Change from Baseline Gingival Thickness at 3 months | Gingival thickness at mid-buccal aspect measured at the center of keratinized tissue. | 3 months | 
| Change from Baseline Gingival Thickness at 6 months | Gingival thickness at mid-buccal aspect measured at the center of keratinized tissue. | 6 months | 
| Change from Baseline Gingival Thickness at 12 months | Gingival thickness at mid-buccal aspect measured at the center of keratinized tissue. | 12 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Gingival recession, Plastic surgery, Platelet rich fibrin, Connective tissue graft, Coronally advanced flap