Platelet-rich Fibrin and Connective Tissue Graft in Recession Treatment

Study Overview
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Brief Summary
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The aim of the trial is to evaluate the effectiveness of coronally advanced flap (CAF)+connective tissue graft(CTG)+platelet-rich fibrin(PRF) combination in Miller I and II recession treatment by comparing with CAF+CTG. 40 patients were surgically treated either with CAF+CTG+PRF (test group) or CAF+CTG (control group). Clinical parameters of plaque index (PI), gingival index (GI), vertical recession (VR), probing depth (PD), attachment level (AL), keratinized tissue width (KTW), horizontal recession (HR), MGJ localization (L-MGJ), tissue thickness (TT) were recorded at baseline, 3 months (PS1) and 6 months (PS2) post-surgery. Root coverage (RC), complete RC (CRC), attachment gain (AG), and keratinized tissue change (KTC) were also calculated.

Detailed Description
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Given the encouraging effects of platelet-rich fibrin (PRF) in healing and regeneration, it has been hypothesized that PRF might develop the outcomes obtained with coronally advanced flap (CAF)+connective tissue graft(CTG). Therefore, it was aimed to evaluate the effectiveness of CAF + CTG + PRF in Miller Class I and II recession defect treatment by comparing the outcomes with CAF + CTG in a preliminary, controlled, randomized clinical trial (RCT) with a 6-month follow-up. The study was conducted with 40 patients randomly grouped in half shares into indicated study groups. After phase I therapy, clinical variables including plaque index (PI), gingival index (GI), vertical recession (VR), probing depth (PD), attachment level (AL), keratinized tissue width (KTW), horizontal recession (HR), MGJ localization (L-MGJ), tissue thickness (TT) were recorded. The surgical sites were prepared by using sulcular and adjacent vertical incisions and CTGs were harvested from the palatal regions. Different from CAF+CTG group, PRF was prepared by obtaining 10 ml venous blood, centrifugation and extraction of the gel containing highly concentrated platelet cells in CAF+CTG+PRF patients. Then the gel was placed over the exposed root surface in the same group. The CAF was primarily closed and postoperative instructions were given. After suture removal at second postoperative week, the patients were followed-up by monthly recall visits. Same periodontal clinical variables were recorded 3 and 6 months after surgery.

Official Title
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The Adjunctive Effect of Platelet Rich Fibrin to Connective Tissue Graft in the Treatment of Buccal Recession Defects. Results of a Randomized Parallel Group Controlled Trial

Conditions
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Gingival Recession

Intervention / Treatment
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* Biological: platelet-rich fibrin
* Procedure: connective tissue graft
* Procedure: coronally advanced flap


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Systemically healthy Single Miller type I or II recession defect ≥ 3 mm localized to anterior/premolar area No alveolar bone loss Identifiable cemento-enamel junction Probing depth ≤3mm Exclusion Criteria: Smoking Pregnancy History of periodontal surgery in last two years Mobility Excessive occlusal contacts Caries Loss of vitality
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: PRF+CAF+CTG<br>platelet-rich fibrin + coronally advanced flap + connective tissue graft | Biological: platelet-rich fibrin<br>* autologous platelet-rich fibrin was isolated from venous blood of each patient by defined centrifugation methods<br>Procedure: connective tissue graft<br>* connective tissue graft was harvested from the palatal region of each patient by single incision method<br>Procedure: coronally advanced flap<br>* buccal gingival flap was raised by sharp-blunt-sharp dissection and positioned coronally to cover connective tissue graft (and platelet-rich fibrin gel)<br>|
| Active Comparator: CAF+CTG<br>coronally advanced flap + connective tissue graft | Procedure: connective tissue graft<br>* connective tissue graft was harvested from the palatal region of each patient by single incision method<br>Procedure: coronally advanced flap<br>* buccal gingival flap was raised by sharp-blunt-sharp dissection and positioned coronally to cover connective tissue graft (and platelet-rich fibrin gel)<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Vertical Recession | Measured from cementoenamel junction to margin of the gingiva by periodontal probe | Baseline, 6 weeks and 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Horizontal Recession | measured horizontally between two borders of the recession at the line tangential to cementoenamel junction by periodontal probe | Baseline, 6 weeks and 6 months | 
| Probing Depth | measured from margin of the gingiva to gingival sulcus base by periodontal probe | Baseline, 6 weeks and 6 months | 
| Attachment Level | measured from cementoenamel junction to gingival sulcus base by periodontal probe | Baseline, 6 weeks and 6 months | 
| Keratinized Tissue Width | measured from margin of the gingiva to mucogingival junction by periodontal probe | Baseline, 6 weeks and 6 months | 
| Tissue Thickness | under local anesthesia, measured from 1.5 mm below the margin of the gingiva with a spreader and its stopper silicon disc. Then, distance of the marked point was measured by using a standardized caliper to the closest 0.1 mm by periodontal probe | Baseline, 6 weeks and 6 months |