Comparative evaluation of platelet-rich fibrin versus beta-tri-calcium phosphate in the treatment of Grade II mandibular furcation defects using cone-beam computed tomography

ABSTRACT

Objective: The objective of the study was to evaluate clinically and radiographically the efficacy of platelet-rich fibrin (PRF) versus β-tri-calcium phosphate (β-TCP) in the treatment of Grade II mandibular furcation defects. Materials and Methods: Forty-five Grade II furcation defect in mandibular molars which were assigned to open flap debridement (OFD) with PRF Group I (n = 15), to OFD with β-TCP Group II (n = 15), and to OFD alone Group III (n = 15) were analyzed for clinical parameters (probing pocket depth [PPD], vertical clinical attachment level [VCAL], horizontal clinical attachment level [HCAL], gingival recession, relative vertical height of furcation [r-VHF], and relative horizontal depth of furcation [r-HDF]) and radiographical parameters (horizontal depth of furcation [H-DOF], vertical height of furcation [V-HOF]) using cone-beam computed tomography (CBCT) at 6 months interval. Results: For clinical parameters, reduction in PPD and gain in VCAL and HCAL were higher in Group II as compared to Group I. Change in r-VHF and r-HDF was greater in Group II as compared to Group I. Mean percentage clinical vertical defect fill was higher in Group II as compared to Group I (58.52% ± 11.68% vs. 53.24% ± 13.22%, respectively). On CBCT, mean change at 6 months for all parameters showed nonsignificant difference between the two experimental groups. Mean change in V-HOF was higher in Group I as compared to Group II, but mean change in H-DOF and furcation width was more in Group II as compared to Group I. Conclusion: For both experimental and control groups, there was statistically significant improvement at 6 months follow-up from baseline values.

Key words:

Cone-beam computed tomography - Grade II furcation involvement - periodontal regeneration - platelet-rich fibrin - β-tri-calcium phosphate

• REFERENCES

• 1 Marcaccini AM, Pavanelo A, Nogueira AV, Souza JA, Porciúncula HF, Cirelli JA. Morphometric study of the root anatomy in furcation area of mandibular first molars. J Appl Oral Sci 2012; 20: 76-81
• 2 Jepsen S, Eberhard J, Herrera D, Needleman I. A systematic review of guided tissue regeneration for periodontal furcation defects. What is the effect of guided tissue regeneration compared with surgical debridement in the treatment of furcation defects?. J Clin Periodontol 2002; 29 (Suppl. 03) 103-16
• 3 Yukna RA. Clinical evaluation of HTR polymer bone replacement grafts in human mandibular Class II molar furcations. J Periodontol 1994; 65: 342-9
• 4 Saini N, Sikri P, Gupta H. Evaluation of the relative efficacy of autologous platelet rich plasma in combination with β-TCP alloplast versus an alloplast alone in the treatment of human periodontal intrabony defects. A clinical and radiological study. Indian J Dent Res 2011; 22: 107-15
• 5 Döri F, Arweiler NB, Szántó E, Agics A, Gera I, Sculean A. Ten-year results following treatment of intrabony defects with an enamel matrix protein derivative combined with either a natural bone mineral or a ß-tricalcium phosphate. J Periodontol 2013; 84: 749-57
• 6 Das S, Jhingran R, Bains VK, Madan R, Srivastava R, Rizvi I. Socket preservation by beta-tri-calcium phosphate with collagen compared to platelet-rich fibrin: A clinico-radiographic study. Eur J Dent 2016; 10: 264-76
• 7 Park JB, Matsuura M, Han KY, Norderyd O, Lin WL, Genco RJ. et al. Periodontal regeneration in class III furcation defects of beagle dogs using guided tissue regenerative therapy with platelet-derived growth factor. J Periodontol 1995; 66: 462-77
• 8 Walter C, Weiger R, Zitzmann NU. Accuracy of three-dimensional imaging in assessing maxillary molar furcation involvement. J Clin Periodontol 2010; 37: 436-41
• 9 Fuhrmann RA, Bücker A, Diedrich PR. Furcation involvement: Comparison of dental radiographs and HR-CT-slices in human specimens. J Periodontal Res 1997; 32: 409-18
• 10 Misch KA, Yi ES, Sarment DP. Accuracy of cone beam computed tomography for periodontal defect measurements. J Periodontol 2006; 77: 1261-6
• 11 Laky M, Majdalani S, Kapferer I, Frantal S, Gahleitner A, Moritz A. et al. Periodontal probing of dental furcations compared with diagnosis by low-dose computed tomography: A case series. J Periodontol 2013; 84: 1740-6
• 12 Jain S, Mohan R, Karthik KM, Janardhana AB. Platelet rich fibrin and β-TCP for the treatment of grade II furcation defects. A case report. J Dent 2014; 1: 20-3
• 13 Parolia A, Gait TC, Porto IC, Mala K. Endo-perio lesion: A dilemma from 19^th until 21^st century. J Interdiscip Dent 2013; 3: 2-11
• 14 Dohan DM, Choukroun J, Diss A, Dohan SL, Dohan AJ, Mouhyi J. et al. Platelet-rich fibrin (PRF): A second-generation platelet concentrate. Part I: Technological concepts and evolution. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006; 101: e37-44
• 15 Agarwal SK, Jhingran R, Bains VK, Srivastava R, Madan R, Rizvi I. Patient-centered evaluation of microsurgical management of gingival recession using coronally advanced flap with platelet-rich fibrin or amnion membrane: A comparative analysis. Eur J Dent 2016; 10: 121-33
• 16 Available from:. http://www.septodont.com.hr/pdf/rtr_apolonia.pdf [Last accessed on 2016 Jul 28]
• 17 Khanna D, Malhotra S, Naidu DV. Treatment of grade II furcation involvement using resorbable guided tissue regeneration membrane: A six-month study. J Indian Soc Periodontol 2012; 16: 404-10
• 18 Chau VB, Saunders TR, Pimsler M, Elfring DR. In-depth disinfection of acrylic resins. J Prosthet Dent 1995; 74: 309-13
• 19 Silness J, Löe H. Periodontal disease in pregnancy 3. Response to local treatment. Acta Odontol Scand 1966; 24: 747-59
• 20 Loe H, Silness J. Periodontal disease in pregnancy. I. Prevalence and severity. Acta Odontol Scand 1963; 21: 533-51
• 21 Asmita. Gupta V, Bains VK, Singh GP, Jhingran R. Clinical and cone beam computed tomography comparison of NovaBone Dental Putty and PerioGlas in the treatment of mandibular class II furcations. Indian J Dent Res 2014; 25: 166-73
• 22 Peres MF, Ribeiro ED, Casarin RC, Ruiz KG, Junior FH, Sallum EA. et al. Hydroxyapatite/ß-tricalcium phosphate and enamel matrix derivative for treatment of proximal class II furcation defects: A randomized clinical trial. J Clin Periodontol 2013; 40: 252-9
• 23 Sharma A, Pradeep AR. Treatment of 3-wall intrabony defects in patients with chronic periodontitis with autologous platelet-rich fibrin: A randomized controlled clinical trial. J Periodontol 2011; 82: 1705-12
• 24 Pepelassi EM, Bissada NF, Greenwell H, Fara CF. Doxycycline-tricalcium phosphate composite graft facilitates osseous healing in advance periodontal furcation defects. J Periodontol 1991; 62: 106-15
• 25 Bajaj P, Pradeep AR, Agarwal E, Rao NS, Naik SB, Priyanka N. et al. Comparative evaluation of autologous platelet-rich fibrin and platelet-rich plasma in the treatment of mandibular degree II furcation defects: A randomized controlled clinical trial. J Periodontal Res 2013; 48: 573-81
• 26 Horwitz J, Machtei EE, Reitmeir P, Holle R, Kim TS, Eickholz P. Radiographic parameters as prognostic indicators for healing of class II furcation defects. J Clin Periodontol 2004; 31: 105-11
• 27 Brkovic BM, Prasad HS, Konandreas G, Milan R, Antunovic D, Sandor GK. et al. Simple preservation of maxillary extraction socket using β-TCP with type I collagen: Preliminary clinical ad histomorphometric observations. J Can Dent Assoc 2008; 74: 513-8
• 28 Ito K, Yoshinuma N, Goke E, Arai Y, Shinoda K. Clinical application of a new compact computed tomography system for evaluating the outcome of regenerative therapy: A case report. J Periodontol 2001; 72: 696-702