Treatment of Multiple Adjacent Gingival Recessions Using Leucocyte- and Platelet-rich Fibrin with Coronally Advanced Flap: a 12-month Split-mouth Controlled Randomized Clinical Trial

Overview

Journal Clin Oral Investig

Specialty Dentistry

Date 2024 May 1

PMID 38691209

Authors

Atacan Yavuz

Hatice Selin Gungormek

Leyla Kuru

Basak Dogan

Affiliations

Soon will be listed here.

Abstract

Objective: This split-mouth randomized study aimed to assess efficacy of leucocyte-platelet-rich fibrin (L-PRF) versus connective tissue graft (CTG) in achieving root coverage (RC) for multiple adjacent gingival recessions (MAGRs) throughout 12-month period.

Materials And Methods: The study enrolled 59 teeth from 12 patients with Miller Class I MAGRs ≥ 2 mm on bilateral or contralateral sides. Patients were randomly assigned to receive coronally advanced flap (CAF) with either CTG (control) or L-PRF (test) treatment. Various parameters, including plaque and gingival index, clinical attachment level, recession depth, probing depth, recession width (RW), papilla width (PW), keratinized tissue width (KTW), gingival thickness (GT), percentage of RC, complete root coverage (CRC), and location of the relative gingival margin concerning the cemento-enamel junctions (GMCEJ) after CAF, were recorded at baseline, 3-, 6-, and 12-months post-surgery. On June 29, 2021 the study was registred to ClinicalTrials.gov (NCT04942821).

Results: Except KTW and GT gain, all clinical parameters, RC, and CRC were similar between the groups at all follow-up periods (p > 0.05). The higher GT and KTW gains were detected in the control group compared to test group at 12 months (p < 0.05). Both RC and CRC were positively associated with initial PW and GMCEJ, but negatively with initial RW (p < 0.05).

Conclusions: The current study concludes that L-PRF were equally effective as CTG in treating MAGRs in terms of RC and CRC. Additionally, RC and CRC outcomes appeared to be influenced by GMCEJ, PW, and RW.

Clinical Relevance: L-PRF could represent a feasible substitute for CTG in treating MAGRs.

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References

Harris R, Miller R, Miller L, Harris C . Complications with surgical procedures utilizing connective tissue grafts: a follow-up of 500 consecutively treated cases. Int J Periodontics Restorative Dent. 2005; 25(5):449-59. View

Choukroun J, Diss A, Simonpieri A, Girard M, Schoeffler C, Dohan S . Platelet-rich fibrin (PRF): a second-generation platelet concentrate. Part V: histologic evaluations of PRF effects on bone allograft maturation in sinus lift. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006; 101(3):299-303. DOI: 10.1016/j.tripleo.2005.07.012. View

Chambrone L, Botelho J, Machado V, Mascarenhas P, Mendes J, Avila-Ortiz G . Does the subepithelial connective tissue graft in conjunction with a coronally advanced flap remain as the gold standard therapy for the treatment of single gingival recession defects? A systematic review and network meta-analysis. J Periodontol. 2022; 93(9):1336-1352. DOI: 10.1002/JPER.22-0167. View

Mancini L, Tarallo F, Quinzi V, Fratini A, Mummolo S, Marchetti E . Platelet-Rich Fibrin in Single and Multiple Coronally Advanced Flap for Type 1 Recession: An Updated Systematic Review and Meta-Analysis. Medicina (Kaunas). 2021; 57(2). PMC: 7915928. DOI: 10.3390/medicina57020144. View

Karring T, Lang N, Loe H . The role of gingival connective tissue in determining epithelial differentiation. J Periodontal Res. 1975; 10(1):1-11. DOI: 10.1111/j.1600-0765.1975.tb00001.x. View

Stefanini M, Zucchelli G, Marzadori M, de Sanctis M . Coronally Advanced Flap with Site-Specific Application of Connective Tissue Graft for the Treatment of Multiple Adjacent Gingival Recessions: A 3-Year Follow-Up Case Series. Int J Periodontics Restorative Dent. 2017; 38(1):25-33. DOI: 10.11607/prd.3438. View

Zuhr O, Baumer D, Hurzeler M . The addition of soft tissue replacement grafts in plastic periodontal and implant surgery: critical elements in design and execution. J Clin Periodontol. 2014; 41 Suppl 15:S123-42. DOI: 10.1111/jcpe.12185. View

Kumar A, Bains V, Jhingran R, Srivastava R, Madan R, Rizvi I . Patient-centered Microsurgical Management of Gingival Recession using Coronally Advanced Flap with Either Platelet-rich Fibrin or Connective Tissue Graft: A Comparative Analysis. Contemp Clin Dent. 2017; 8(2):293-304. PMC: 5551337. DOI: 10.4103/ccd.ccd_70_17. View

Tunali M, Ozdemir H, Arabaci T, Gurbuzer B, Pikdoken L, Firatli E . Clinical evaluation of autologous platelet-rich fibrin in the treatment of multiple adjacent gingival recession defects: a 12-month study. Int J Periodontics Restorative Dent. 2015; 35(1):105-14. DOI: 10.11607/prd.1826. View

10.

Skurska A, Dolinska E, Sulewska M, Milewski R, Pietruski J, Sobaniec S . The assessment of the influence of vertical incisions on the aesthetic outcome of the Miller class I and II recession treatment: a split-mouth study. J Clin Periodontol. 2015; 42(8):756-763. DOI: 10.1111/jcpe.12440. View

11.

Tonnesen M, Feng X, Clark R . Angiogenesis in wound healing. J Investig Dermatol Symp Proc. 2001; 5(1):40-6. DOI: 10.1046/j.1087-0024.2000.00014.x. View

12.

Mufti S, Dadawala S, Patel P, Shah M, Dave D . Comparative Evaluation of Platelet-Rich Fibrin with Connective Tissue Grafts in the Treatment of Miller's Class I Gingival Recessions. Contemp Clin Dent. 2018; 8(4):531-537. PMC: 5754972. DOI: 10.4103/ccd.ccd_325_17. View

13.

Choukroun J, Diss A, Simonpieri A, Girard M, Schoeffler C, Dohan S . Platelet-rich fibrin (PRF): a second-generation platelet concentrate. Part IV: clinical effects on tissue healing. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006; 101(3):e56-60. DOI: 10.1016/j.tripleo.2005.07.011. View

14.

Cairo F, Cortellini P, Pilloni A, Nieri M, Cincinelli S, Amunni F . Clinical efficacy of coronally advanced flap with or without connective tissue graft for the treatment of multiple adjacent gingival recessions in the aesthetic area: a randomized controlled clinical trial. J Clin Periodontol. 2016; 43(10):849-56. DOI: 10.1111/jcpe.12590. View

15.

Dohan Ehrenfest D, Del Corso M, Diss A, Mouhyi J, Charrier J . Three-dimensional architecture and cell composition of a Choukroun's platelet-rich fibrin clot and membrane. J Periodontol. 2010; 81(4):546-55. DOI: 10.1902/jop.2009.090531. View

16.

Pini Prato G, Tinti C, Vincenzi G, Magnani C, Cortellini P, Clauser C . Guided tissue regeneration versus mucogingival surgery in the treatment of human buccal gingival recession. J Periodontol. 1992; 63(11):919-28. DOI: 10.1902/jop.1992.63.11.919. View

17.

Ozkan Sen D, Oncu E . Splith mouth randomized control trial comparison of T-PRF and subepithelial connective tissue graft in the treatment of maxillar multiple gingival recessions. J Esthet Restor Dent. 2022; 35(3):449-456. DOI: 10.1111/jerd.12986. View

18.

Miller Jr P . A classification of marginal tissue recession. Int J Periodontics Restorative Dent. 1985; 5(2):8-13. View

19.

Dohan Ehrenfest D, Rasmusson L, Albrektsson T . Classification of platelet concentrates: from pure platelet-rich plasma (P-PRP) to leucocyte- and platelet-rich fibrin (L-PRF). Trends Biotechnol. 2009; 27(3):158-67. DOI: 10.1016/j.tibtech.2008.11.009. View

20.

Loe H, SILNESS J . PERIODONTAL DISEASE IN PREGNANCY. I. PREVALENCE AND SEVERITY. Acta Odontol Scand. 1963; 21:533-51. DOI: 10.3109/00016356309011240. View