Comparative Clinical Evaluation of Modified Coronally Advanced Flap with and without Platelet Rich Fibrin in the Treatment of Multiple Adjacent Miller's Class I and Class II Gingival Recession Defects: A Randomized Clinical Trial

Document Type : Original Article

Authors

1 Department of Periodontics, Rapti Academy of Health of Sciences, Lumbini, Nepal

2 Department of Periodontics, Dental Teaching Hospital, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal

3 Department of Periodontology, College of Dental Surgery, B. P. Koirala Institute of Health Sciences, Dharan, Nepal

4 Department of Periodontics, Western Regional Hospital, Pokhara, Nepal

5 World Health Organization, Bagmati, Nepal

Abstract

Background and aim: Coronally advanced flaps, along with their modifications, are the simplest and most predictable procedures for root coverage. The addition of an inter-positional material is considered to achieve better outcomes. Therefore, this study aimed to assess the potential benefits of adding platelet-rich fibrin (PRF) membrane to the modified coronally advanced flap (MCAF) procedure in terms of change in vertical recession depth (VRD) and mean root coverage percentage ( MRC%).
Materials and methods: A total of twelve systemically healthy subjects with thirty-four Miller's class I and II gingival recession defects were randomly assigned to a control (MCAF) or test (MCAF + PRF) group with seventeen defects in each. Vertical recession depth, gingival thickness (GTH), width of keratinized gingiva (WKG), probing depth (PD), and clinical attachment level (CAL) were recorded at baseline, one month and three months, mean root coverage percentage (MRC%) at one month and three months and VAS score for pain at ten days post-operative.
Results: MRC% was 75.96±21.01 and 83.23±18.28 % in the control and test groups at three months with no statistically significant difference (p>0.05). However, a statistically significant difference (p<0.05) was obtained concerning GTH gain at one and three months and decreased VAS score for pain at ten days in the test group compared to the control group.
Conclusions: Increase in GTH appears to justify using PRF and MCAF for treating multiple adjacent Miller's class I and II gingival recession defects. PRF membrane might be an alternative to different grafting materials in root coverage procedures.

Keywords

Main Subjects


[1]  Wiebe CB, Putnins EE. The periodontal disease classification system of the American Academy of Periodontology-an update. Journal-canadian dental association. 2000;66(11):594-9.
[2]  Löe H, Ånerud Å, Boysen H. The natural history of periodontal disease in man: prevalence, severity, and extent of gingival recession. Journal of periodontology. 1992;63(6):489-95. https://doi.org/10.1902/jop.1992.63.6.489.
[3]  Govindasamy BR, Naik VK, Balasundaram A. Comparison of coronally advanced versus semilunar coronally repositioned flap in the management of maxillary gingival recessions. The Saudi Dental Journal. 2021;33(7):642-9. https://doi.org/10.1016/j.sdentj.2020.05.005.
[4]  Zucchelli GD, De Sanctis M. Treatment of multiple recession‐type defects in patients with esthetic demands. Journal of periodontology. 2000;71(9):1506-14. https://doi.org/10.1902/jop.2000.71.9.1506.
[5]  Shkreta M, Atanasovska-Stojanovska A, Dollaku B, Belazelkoska Z. Exploring the gingival recession surgical treatment modalities: A literature review. Open access Macedonian journal of medical sciences. 2018;6(4):698-708. https://doi.org/10.3889%2Foamjms.2018.185.
[6]  Graziani F, Gennai S, Roldan S, Discepoli N, Buti J, Madianos P, Herrera D. Efficacy of periodontal plastic procedures in the treatment of multiple gingival recessions. Journal of clinical periodontology. 2014;41:S63-76. https://doi.org/10.1111/jcpe.12172.
[7]  Chambrone L, Faggion Jr CM, Pannuti CM, Chambrone LA. Evidence‐based periodontal plastic surgery: An assessment of quality of systematic reviews in the treatment of recession‐type defects. Journal of Clinical Periodontology. 2010;37(12):1110-8. https://doi.org/10.1111/j.1600-051X.2010.01634.x.
[8]  Culhaoglu R, Taner L, Guler B. Evaluation of the effect of dose-dependent platelet-rich fibrin membrane on treatment of gingival recession: a randomized, controlled clinical trial. Journal of Applied Oral Science. 2018;26. https://doi.org/10.1590/1678-7757-2017-0278.
[9]  Fernandes GV, Santos NB, De Siqueira RA, Wang HL, Blanco-Carrion J, Fernandes JC. Autologous Platelet Concentrate of 2nd and 3rd generations efficacy in the surgical treatment of gingival recession: An overview of systematic reviews. Journal of Indian Society of Periodontology. 2021;25(6):463-79. https://doi.org/10.4103%2Fjisp.jisp_515_20.
[10] Choukroun J, Diss A, Simonpieri A, Girard MO, Schoeffler C, Dohan SL, Dohan AJ, Mouhyi J, Dohan DM. Platelet-rich fibrin (PRF): a second-generation platelet concentrate. Part IV: clinical effects on tissue healing. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. 2006;101(3):e56-60. https://doi.org/10.1016/j.tripleo.2005.07.011.
[11] Anilkumar K, Geetha A, Ramakrishnan T, Vijayalakshmi R, Pameela E. Platelet-rich-fibrin: A novel root coverage approach. Journal of Indian Society of Periodontology. 2009;13(1):50-4. https://doi.org/10.4103%2F0972-124X.51897.
[12] Aroca S, Keglevich T, Barbieri B, Gera I, Etienne D. Clinical evaluation of a modified coronally advanced flap alone or in combination with a platelet‐rich fibrin membrane for the treatment of adjacent multiple gingival recessions: A 6‐month study. Journal of periodontology. 2009;80(2):244-52. https://doi.org/10.1902/jop.2009.080253.
[13] Dohan DM, Choukroun J, Diss A, Dohan SL, Dohan AJ, Mouhyi J, Gogly B. Platelet-rich fibrin (PRF): a second-generation platelet concentrate. Part II: platelet-related biologic features. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. 2006;101(3):e45-50. https://doi.org/10.1016/j.tripleo.2005.07.009.
[14] Padma R, Shilpa A, Kumar PA, Nagasri M, Kumar C, Sreedhar A. A split mouth randomized controlled study to evaluate the adjunctive effect of platelet-rich fibrin to coronally advanced flap in Miller's class-I and II recession defects. Journal of Indian Society of Periodontology. 2013;17(5):631-6. https://doi.org/10.4103%2F0972-124X.119281.
[15] Thamaraiselvan M, Elavarasu S, Thangakumaran S, Gadagi JS, Arthie T. Comparative clinical evaluation of coronally advanced flap with or without platelet rich fibrin membrane in the treatment of isolated gingival recession. Journal of Indian Society of Periodontology. 2015;19(1):66-71. https://doi.org/10.4103%2F0972-124X.145790.
[16] Gupta S, Banthia R, Singh P, Banthia P, Raje S, Aggarwal N. Clinical evaluation and comparison of the efficacy of coronally advanced flap alone and in combination with platelet rich fibrin membrane in the treatment of Miller Class I and II gingival recessions. Contemporary clinical dentistry. 2015;6(2):153-60. https://doi.org/10.4103%2F0976-237X.156034.
[17] Dohan Ehrenfest DM, Del Corso M, Diss A, Mouhyi J, Charrier JB. Three‐dimensional architecture and cell composition of a Choukroun's platelet‐rich fibrin clot and membrane. Journal of periodontology. 2010;81(4):546-55. https://doi.org/10.1902/jop.2009.090531.
[18] Hwang D, Wang HL. Flap thickness as a predictor of root coverage: a systematic review. Journal of periodontology. 2006;77(10):1625-34. https://doi.org/10.1902/jop.2006.060107.
[19] Kuka S, Ipci SD, Cakar G, Yılmaz S. Clinical evaluation of coronally advanced flap with or without platelet-rich fibrin for the treatment of multiple gingival recessions. Clinical Oral Investigations. 2018;22(3):1551-8. https://doi.org/10.1007/s00784-017-2225-9.
[20] Del Corso M. Del Corso M, Sammartino G, Dohan Ehrenfest DM. Clinical evaluation of a modified coronally advanced flap alone or in combination with a platelet-rich fibrin membrane for the treatment of adjacent multiple gingival recessions: a 6-month study. J Periodontol. 2009;80(11):1694-7. doi:10.1902/jop.2009.090253
[21] Kochar D, Narula S, Sharma RK, Tewari S, Chopra D. Creeping attachment in Miller class III recessions: A report of five cases. Clinical Advances in Periodontics. 2012;2(4):217-22. https://doi.org/10.1902/cap.2012.110082.
[22] Anjcamo A, Bergenholtz A, Hugoson A, Ainamo J. Location of the mucogingival junction 18 years after apically repositioned flap surgery. Journal of clinical periodontology. 1992;19(1):49-52. https://doi.org/10.1111/j.1600-051X.1992.tb01148.x.
[23] Gürgan CA, Oruç AM, Akkaya M. Alterations in location of the mucogingival junction 5 years after coronally repositioned flap surgery. Journal of periodontology. 2004;75(6):893-901. https://doi.org/10.1902/jop.2004.75.6.893.
[24] Cheng YF, Chen JW, Lin SJ, Lu HK. Is coronally positioned flap procedure adjunct with enamel matrix derivative or root conditioning a relevant predictor for achieving root coverage? A systemic review. Journal of Periodontal Research. 2007;42(5):474-85. https://doi.org/10.1111/j.1600-0765.2007.00971.x.
 
Volume 4, Issue 3
September 2022
Pages 110-118
  • Receive Date: 01 July 2022
  • Revise Date: 16 August 2022
  • Accept Date: 29 August 2022
  • First Publish Date: 01 September 2022