Comparative Evaluation of Platelet Rich Fibrin Membrane vs. Collagen Membrane in Combination with Hydroxy-Apatite (HA) for the Treatment of Mandibular Molar Furcation Defects – A Randomized Clinical Control Trial


Affiliations

  • Community Health Centre, Nawacity, Medical officer (Dental), Nagaur, Rajasthan, 341509, India
  • Government Dental College (RUHS-CODS), Jaipur, Department of Periodontology, Rajasthan, 302016, India
  • Government Dental College (RUHS-CODS), Jaipur, Department of Periodontology, Jaipur, Rajasthan, 302016, India

Abstract

Aim: A clinical trial to compare the relative efficacy of hydroxyapatite in combination with either PRF (Platelet rich fibrin) or collagen membrane in treatment of grade II furcation defects of mandibular molars. Methodology: The sample consisted of 35 Grade II mandibular molar furcation defects planed for open flap debridement (OFD) (Group 1, n=12), Platelet-rich fibrin membrane + Hydroxyapatite (HA) with OFD (Group 2, n=12), and Collagen membrane (CM) + HA with OFD (Group 3, n=11). These were recorded at baseline and 9 months postoperatively for plaque index (PI), gingival index (GI), probing depth (PPD), relative vertical and relative horizontal clinical attachment levels (RVCAL and RHCAL), and intrabony defect depth (IBD). Results: PI and GI scores decreased significantly in all three groups at 9 months postoperatively as compared to baseline scores. After 9 months of follow up visits mean PD reduction was greater in Group 2 (3.66 ± 0.98 mm) and Group 3 (3.45 ± 1.5 mm) than Group 1 (2.08 ± 0.90 mm), and mean RVCAL and RHCAL gain were greater in Group 2 (3.25 ± 0.75 mm and 3.92 ± 0.29 mm, respectively) and Group 3 (3.09 ± 0.70 mm and 3.89 ± 0.54 mm) compared with Group 1 (1.33 ± 0.77 mm and 2.25 ± 0.62 mm). A significant reduction in IBD depth was found in Groups 2 (2.16*0.38 mm) and 3 (1.58*0.35 mm) than in Group 1 (0.70*0.15 mm). The differences in PI, GI, PPD, RVCAL, and RHCAL between Groups 2 and 3 at baseline and 9 months were not statistically significant. There was a statistically significant difference in the depth reduction of IBD between Groups 2 and 3 at nine months. Conclusion: Within the scope of this study, it can be stated that the use of HA in conjunction with PRF or CM in the treatment of grade II mandibular furcation abnormalities resulted in a considerable reduction in GI PI, PPD, RVCAL, RHCAL, and IBD depth on follow up visit at 9 months after surgery. However, the combination of HA with PRF membrane exhibited significant improvement in radiographic parameters in comparison to the combination of HA with Collagen membrane.


Keywords

Collagen Membrane, Mandibular Molar Furcation, Open Flap Debridement, Study

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References

Newman MG, Takei HH, Klokkevold PR, Carranza FA. Carranza’s Clinical Periodontology, 12th ed. St. Louis 2011: Elsevier Health Sciences; 2014.

Avila-Ortiz G, De Buitrago JG, Reddy MS. Periodontal regeneration - furcation defects: A systematic review from the AAP regeneration workshop. J Periodontol. 2015; 86(Suppl.):S108-S130. https://doi.org/10.1902/jop.2015.130677. PMid:25644295.

American Academy of Periodontology. Glossary of Periodontal Terms. 4th ed. American Academy of Periodontology; Chicago, LA, USA; 2001. Accessed on 06 September 2021. Available at https://members.perio.org/libraries/glossary.

Basam MK, Steiger J, Neely AL, Shah M, Bhola M. Treatment of class II molar furcation involvement: Metaanalysis of re-entry results. J Periodontol. 2011; 86(3):413-428. https://doi.org/10.1902/jop.2010.100306. PMid:21091347.

Sánchez-Pérez A, Moya-Villaescusa MJ. Periodontal disease affecting tooth furcations. A review of the treatments available. Med Oral Patol Oral Cir Bucal. 2009 Oct 1; 14(10):e554-e557. https://doi.org/10.4317/medoral.14.e554.

Kinaia BM, Steiger J, Neely AL, Shah M, Bhola M. Treatment of class II molar furcation involvement: Meta-Analysis of re-entry results. J Periodontol. 2001; 82:413-428. https://doi.org/10.1902/jop.2010.100306. PMid:21091347.

Reynolds MA, et al. The efficacy of bone replacement grafts in the treatment of periodontal osseous defects: A systematic review. Ann Periodontol. 2003; 8:227-265. https://doi.org/10.1902/annals.2003.8.1.227. PMid:14971256.

Okuda K, et al. Platelet-rich plasma combined with a porous hydroxyapatite graft for the treatment of intrabonyperiodontal Defects in Humans: A comparative controlled clinical study. J Periodontol. 2005; 76:890-898. https://doi.org/10.1902/ jop.2005.76.6.890. PMid:15948682.

Shivashankar VY, Johns DA, Vidyanath S, Sam G. Combination of platelet rich fibrin, hydroxyapatite and PRF membrane in the management of large inflammatory periapical lesion. J Conserv Dent. 2013; 16:261-264. https://doi.org/10.4103/09720707.111329. PMid:23833463 PMCid:PMC3698593.

Gottlow J. Guided tissue regeneration using bioresorbable and non-resorbable devices: Initial healing and long-term results. J Periodontol. 1993; 64(11 Suppl):1157-1165. https://doi.org/10.1902/jop.1993.64.11s.1157.

11. Singh A K. GTR membranes: The barriers for periodontal regeneration. DHR Int J Med Sci (DHR-IJMS). 2013; 4(1):3138.

Choukroun J, Adda F, Schoeffer C, Vervelle A. PRF: An opportunity in perioimplantology (in French). Implantodontie. 2001; 42:55-62.

Kumar RV, Shubhashini N. Platelet rich fibrin: A new paradigm in periodontal regeneration. Cell Tissue Bank. 2013; 14:453-463. https://doi.org/10.1007/s10561-012-9349-6. PMid:23143637.

Miron RJ, Choukroun J. Platelet Rich Fibrin in Regenerative Dentistry: Biological Background and Clinical Indications, 1st ed., Hoboken, John Wiley & Sons Ltd.; 2017. https://doi.org/10.1002/9781119406792.ch1.

Wu CL, Lee SS, Tsai CH, Lu KH, Zhao JH, Chang YC. Platelet-rich fibrin increases cell attachment, proliferation and collagen-related protein expression of human osteoblasts. Aust Dent J. 2012; 57:207-212. https://doi.org/10.1111/j.18347819.2012.01686.x. PMid:22624763.

Badran Z, Abdallah MN, Torres J, Tamimi F. Platelet concentrates for bone regeneration: Current evidence and future challenges. Platelets. 2017; 29:105-112. https://doi.org/10.1080/09537104.2017.1327656. PMid:28649897.

Chang YC, Zhao JH. Effects of platelet-rich fibrin on human periodontal ligament fibroblasts and application for periodontal infrabony defects. Aust Dent J. 2011; 56(4):365371. https://doi.org/10.1111/j.1834-7819.2011.01362.x. PMid:22126345.

Sheikh Z, et al. Collagen based barrier membranes for periodontal guided bone regeneration applications. Odontology. 2017; 105(1):1-12. https://doi.org/10.1007/s10266-016-0267-0. PMid:27613193.

Mattson JS, Gallagher SJ, Jabro MH. The use of 2 bioabsorbable barrier membranes in the treatment of interproximal intrabony periodontal defects. J Periodontol. 1999; 70(5):510-517. https://doi.org/10.1902/jop.1999.70.5.510. PMid:10368055.

World Medical Association. WMA declaration of Helsinkiethical principles for medical research involving human subjects. JAMA. 2013; 10(20):2191-2194. https://doi.org/10.1001/jama.2013.281053. PMid:24141714.

Kothari CR. Research Methodology Methods & Techniques. 2nd ed. New Delhi: New Age International publisher; 2004. p. 184-232.

Vandana KL and Gupta I. Location of cemento enamel junction for CAL measurement: A clinical crisis. J Ind Soc Periodontol. 2009; 13(1):12-15. https://doi.org/10.4103/0972-124X.51888. PMid:20376234 PMCid:PMC2846668.

Choukroun J, Adda F, Schoeffer C, Vervelle A. PRF: An opportunity in perioimplantology (in French). Implantodontie. 2001; 42:55-62.

Gher ME, Vernino AR. Root morphology-Clinical significance in pathogenesis and treatment of periodontal disease. J Am Dent Assoc. 1980; 101:627-633. https://doi.org/10.14219/jada.archive.1980.0372. PMid:7002975.

Reynolds MA, AichelmannReidy ME, BranchMays GL. Regeneration of periodontal tissue: Bone replacement grafts. Dent Clin North Am. 2010; 54:5571. https://doi.org/10.1016/j.cden.2009.09.003. PMid:20103472.

Misch KA, Yi ES, Sarment DP. Accuracy of cone beam computed tomography for periodontal defect measurements. J Periodontol. 2006; 77:1261-1266. https://doi.org/10.1902/ jop.2006.050367. PMid:16805691.

Karthikeyan BV, Sujatha V, Prabhuji ML. Furcation measurements: Realities and limitations. J Int Acad Periodontol. 2015; 17(4):103-115.

Yusof NAM, Erni Noor E, Yusof MYPM. The accuracy of linear measurements in cone beam computed tomography for assessing intrabony and furcation defects: A systematic review and meta-analysis. J Oral Res. 8(6):527-539. https://doi.org/10.17126/joralres.2019.077.

Pradeep AR, Karvekar S, Nagpal K, Patnaik K, Raju A, Singh P. Rosuvastatin 1.2 mg in situ gel combined with 1:1 mixture of autologous platelet-rich fibrin and porous hydroxyapatite bone graft in surgical treatment of mandibular class ii furcation defects: A Randomized clinical control Trial. J Periodontol.

; 87(1):5-13. https://doi.org/10.1902/jop.2015.150131. PMid:26439386.

Asimuddin S, Koduganti RR, Panthula VNR, Jammula SP, Dasari R, Gireddy H. Effect of autologous platelet rich fibrin in human mandibular molar grade II furcation defects-A randomized clinical trial. J Clin Diagn Res. 2017; 11(4):ZC73-ZC77. https://doi.org/10.7860/ JCDR/2017/23277.9694. PMid:28571267 PMCid:PMC 5449923.

Mehta DB, Deshpande NC, Dandekar SA. Comparative evaluation of platelet rich fibrin membrane and collagen membrane along with demineralized freeze-dried bone allograft in Grade II furcation defects: A randomized controlled study. J Indian Soc Periodontol. 2018; 22:322-327. https://doi.org/10.4103/jisp.jisp_310_17. PMid:30131624 PMCid:PMC6077968.

Eberhard J, et al. Full mouth treatment concepts for chronic periodontitis: A systemic review. J Clin Periodontol. 2008; 35:591-604. https://doi.org/10.1111/j.1600-051X.2008.01239.x. PMid: 18498383.

Wang HL, O’Neal RB, Thomas CL, Shyr Y, Mac Neil RL. Evaluation of an absorbable collagen membrane in treating class II furcation defects. J Periodontol. 1994; 65:1029-1036.

https://doi.org/10.1902/jop.1994.65.11.1029. PMid:7853126.

Sharma A, Pradeep AR. Autologous platelet-rich fibrin in the treatment of mandibular degree II furcation defects: A randomized clinical trial. J Periodontol. 2011; 82(10):1396-1403. https://doi.org/10.1902/jop.2011.100731. PMid:21284545.

Reddy MS, et al. Periodontal regeneration - furcation defects: A consensus report from the AAP regeneration workshop. J Periodontol. 2015; 86(2 Suppl):S131-S133. https://doi.org/10.1902/jop.2015.140379. PMid:25644296.

Simonpieri A, Del Corso M, Sammartino G, Dohan, Ehrenfest DM. The relevance of Choukroun’s platelet-rich fibrin and metronidazole during complex maxillary rehabilitations using bone allograft. Part II: Implant surgery, prosthodontics, and survival. Implant Dent. 2009; 18:220-229. https://doi.org/10.1097/ID.0b013e31819b5e3f. PMid:19509532.

Gassling V, Douglas T, Warnke PH, Açil Y, Wiltfang Y, and Becker ST. Plateletrich fibrin membranes as scaffolds for periosteal tissue engineering. Clinical Oral Implants Res. 2010; 21(5):543-549. https://doi.org/10.1111/j.1600-0501.2009.01900.x. PMid:20443805.

Preeja C, Arun S. Platelet-rich fibrin: Its role in periodontal regeneration. Saudi J Dent Res. 2014; 5:117-122. https://doi.org/10.1016/j.ksujds.2013.09.001.

Clipet F, Tricot S, Alno N, Massot M, Solhi H, Cathelineau G, et al. In vitro effects of Choukroun’s platelet-rich fibrin conditioned medium on 3 different cell lines implicated in dental implantology. Implant Dent. 2012; 21:51-56. https://doi.org/10.1097/ID.0b013e31822b9cb4. PMid:21986450.

Simonpieri A, Del Corso M, Sammartino G, Dohan Ehrenfest DM. The relevance of Choukroun’s platelet-rich fibrin and metronidazole during complex maxillary rehabilitations using bone allograft. Part I: A new grafting protocol. Implant Dent. 2009; 18:102-111. https://doi.org/10.1097/ID.0b013e318198cf00. PMid:19359860.


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