The Effectiveness of the Influence of the Second Generation Platelet-rich Fibrin in the Treatment of Localized Individual Miller I and II Gingival Recessions (Case Report)
Article Sidebar
Main Article Content
Abstract
BACKGROUND: The mucogingival surgical modality subepithelial connective tissue graft (SCTG) and the coronally positioned flap (CAF) in the treatment of Miller I and II gingival recessions are considered “gold standard,” that is, a technique for predictable and complete gingival root coverage defects, with long-term clinical stability of the obtained results. The counterpart of this type of technique is the relatively young platelet-rich fibrin (PRF) +CAF operational mode, due to the biological characteristics of this autologous platelet concentrate-PRF (angiogenesis, mitogenesis, osteopromotion, immunomodulation, and the capture of stem cells). The aim of this paper is to evaluate the clinical efficacy of the CAF+PRF combined technique, in the treatment of localized individual gingival recessions Miller I and II, through the comparison of the values of periodontal clinical parameters, measured preoperatively and 1 month postoperatively, as well as through the obtained immunohistochemical and histomorphometric analyzes of the taken biopsy material from the recipient site (the area of the grafted gingival defect), 1 month postoperatively.
CASE REPORT: A 37-year-old man was admitted to the Clinic for Oral Surgery at JZU USKC “St. Panteleimon”- Skopje for surgical treatment of localized maxillary gingival recession Miller II at tooth 31. Periodontal clinical parameters were measured preoperatively: Vertical dimension of gingival recession (RD/VGR), periodontal pocket depth (PPD/PD), level of keratinized/attached gingiva (CAL), width of keratinized gingiva (KTW/KMW) and thickness of gingiva (GT), all measured in mm, as well as gingival biotype. A CAF+PRF therapy modality was used for the treatment of the gingival defect. One month postoperatively, repeated measurements of the values of the clinical periodontal indices were performed and they were compared with the measurements obtained preoperatively.
CONCLUSION: A significant decrease in the values of RD, PPD, and CAL was determined at the 1-month measurements postoperatively. A non-significant gain in KTW and GT values was noted 1 month post-operative. There were no changes in the gingival biotype before and after surgery. PRF as second-generation autologous concentrates is not only an adjuvant and/or replacement of SCTG – the “gold standard” in the treatment of Miller I and II recessions but it is also a superior alternative in the surgical treatment of this type of shallow mucogingival defects.
Downloads
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
References
Raetzke PB. Covering localized areas of root exposure employing the “envelope” technique. J Periodontol. 1985;56(7):397-402. http://doi.org/10.1902/jop.1985.56.7.397 PMid:3894614
Takei H, Azzi R, Han T. Periodontal plastic and esthetic surgery. In: Caranzza FA, editor. Clinical Periodontology. 10th ed. St. Louis: Elsevier; 2009. p. 1005-30.
Rodas MA, Paula BL, Pazmiño VF, Lot Vieira FF, Junior JF, Silveira EM. Platelet-rich fibrin in coverage of gingival recession: A systematic review and meta-analysis. Eur J Dent. 2020;14(2):315-26. http://doi.org/10.1055/s-0040-1701907 PMid:32221958
Harris RJ. Human histologic evaluation of root coverage obtained with a connective tissue with partial thickness double pedicle graft. A case report. J Periodontal. 1999;70(7):813-21. https://doi.org/10.1902/jop.1999.70.7.813 PMid:10440645
Uraz A, Sezgin Y, Yalim M, Taner IL, Cetiner D. Comparative evaluation of platelet-rich fibrin membrane and connective tissue graft in the treatment of multiple adjacent recession defects: A clinical study. J Dent Sci. 2013;10(1):36-45. https://doi.org/10.1016/j.jds.2012.10.010
Gebistorf M, Mijuskovic M, Pandis N, Fudalej PS, Katsaros C. Gingival recessionin orthodontic patients 10 to 15 years posttreatment: A retrospective cohort study. Am J Orthod Dentofacial Orthop. 2020;25: 645-655.
Garzon HS, Alfonso C, Vega FJ, García A, Muñoz A, Jaimes G, et al. Treatment of Miller I mandibular gingival recessions using PRF vs. Connective graft. Int J Dent. 2021;2021:6616688. http://doi.org/10.1155/2021/6616688 PMid:33927763
Loe H. Modified gingival index J Periodontol. 1963;38(6):610-6.
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. J Periodontol. 2010;81(4):546-55. https://doi.org/10.1902/jop.2009.090531 PMid:20373539
Mijiritsky E, Assaf HD, Peleg O, Shacham M, Cerroni L, Mangani L. Use of PRP, PRF and CGF in periodontal regeneration and facial rejuvenation-a narrative review. Biology (Basel). 2021;10(4):317. http://doi.org/10.3390/biology10040317 PMid:33920204
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(3):e37-44. https://doi.org/10.1016/j.tripleo.2005.07.008 PMid:16504849
Shah R, Triveni MG, Thomas R, Mehta DS. An update of the protocols and biologic actions of Platelet rich fibrin in Dentistry. Eur J Prosthodont Restor Dent. 2017;25(2):64-72. https://doi.org/10.1922/EJPRD_01690Shah09 PMid:28590091
Dohan DM, Choukroun J, Diss A, Dohan SL, Dohan AJ, Mouhyi J, et al. Platelet-rich fibrin (PRF): A second-generation platelet concentrate. Part II: Platelet-related biologic features. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;101(3):e45-50. https://doi.org/10.1016/j.tripleo.2005.07.009 PMid:16504850
Miron RJ, Moraschini V, Fabbro DM, Piattelli A, Fujioka- Kobayashi M, Zhang Y, et al. Use of platelet-rich fibrin for the treatment of gingival recessions: A systematic review and meta- analysis. Clin Oral Investig. 2020;24(8):2543-57. https://doi.org/10.1007/s00784-020-03400-7
Fujioka-Kobayashi M, Miron RJ, Hernandez M, Kandalam U, Zhang Y, Choukroun J. Optimized platelet-rich fibrin with the low-speed concept: Growth factor release, biocompatibility, and cellular response. J Periodontol. 2017;88(1):112-21. https://doi.org/10.1902/jop.2016.160443 PMid:27587367
Takahashi A, Tsujino T, Yamaguchi S, Isobe K, Watanabe T, Kitamura Y, et al. Distribution of platelets, transforming growth factor-beta 1, plateled-derived growth factor-BB, vascular endothelial growth factor and matrix metalloprotease-9 in advanced platelet-rich fibrin and concentrated growth factor matrices. J Investig Clin Dent. 2019;10(4):e12458. https://doi.org/10.1111/jicd.12458 PMid:31461225
Sohn DS, Huang B, Kim J, Park WE, Park CC. Utilization of autologous concentrated growth factors (CGF) enriched bone graft matrix (sticky bone) and CGF-enriched fibrin membrane in implant dentistry. J Implant Adv Clin Dent. 2015;7:11-8.
Ehrenfest DM, Piatelli A, Sammartino G, Wang HL. New biomaterials and regenerative medicine strategies in periodontology, oral surgery, esthetic and implant dentistry 2016. Biomed Res Int. 2017;2017:8209507. https://doi.org/10.1155/2017/8209507 PMid:28210625
Kang YH, Yeon SH, Park JY, Chung JH, Choung YH, Choung HW, et al. Platelet-rich fibrin is a Bioscaffold and reservoir of growth factors for tissue regeneration. Tissue Eng Part A. 2011;17(3-4):349-59. https://doi.org/10.1089/ten.TEA.2010.0327 PMid:20799908
de Sanctis M, Zucchelli G. Coronally advanced flap: A modified surgical approach for isolated recession-type defects: Three- year results. J Clin Periodontol. 2007;34(3):262-8. https://doi.org/10.1111/j.1600-051X.2006.01039.x PMid:17309597
Kumar A, Bains VK, 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. https://doi.org/10.4103/ ccd.ccd_70_17 PMid:28839418
Kim BS, Kim YK, Yun PY, Yi YJ, Lee HJ, Kim SG, et al. Evaluation of peri-implant tissue response according to the presence of keratinized mucosa. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;107(3):e24-8. https://doi.org/10.1016/j.tripleo.2008.12.010 PMid:19217009
Wennstrom JL. Mucogingival therapy. Ann Periodontal. 1966;1(1):671-701. https://doi.org/10.1092/annals.1996.1.1.671 PMid:9118276
Trombelli L. Periodontal regeneration in gingival recession defects. Periodontal 2000. 1999;19:138-50. https://doi.org/10.1111/j.1600-0757.1999.tb00152.x PMid:10321221
Eren G, Atilla G. Platelet-rich fibrin in the treatment of localized gingival recessions: A split-mouth randomized clinical trial. Clin Oral Investig. 2014;18(8):1941-8. https://doi.org/10.1007/ s00784-013-1170-5 PMid:24362634
Choukroun J, Diss A, Simonpieri A, Girard MO, Schoeffler C, Dohan SL, et al. 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. https://doi.org/10.1016/j.tripleo.2005.07.011 PMid:16504852
Toffler M, Toscano N, Holtzlaw D, Del Corso M, Ehrenfest D. Introducing Choukroun’s platelet-rich fibrin to the reconstructive
surgery milieu. J Implant Adv Clin Dent. 2009;1(6):21-32.
McGuire MK, Cochran DL. Evaluation of human recession defects treated with coronally advanced flap and either enamel matrix derivative or connective tissue. Part 2: Histological evaluation. J Periodontol. 2003;74(8):1126-35. https://doi.org/10.1902/jop.2003.74.8.1126 PMid:14514225
Tsujino T, Masuki H, Nakamura M, Isobe K, Kawabata H, Aizawa H, et al. Striking differences in platelet distribution between advanced-platelet-rich fibrin and concentrated growth factors: Effects of silica-containing plastic tubes. J Funct Biomater. 2019;10(3):43. https://doi.org/10.3390/jfb10030043 PMid:31533279
Masuki H, Isobe K, Kawabata H, Tsujino T, Yamaguchi S, Watanabe T, et al. Acyte cytotoxic effects of silica microparticles used for coating of plastic blood-collection tubes on human periosteal cells. Odontology. 2020;108(4):545-52. https://doi.org/10.1007/sl0266-020-00486-z PMid:31997225
Al Jasser R, AlKudamani H, Andreana S. Platelet-rich fibrin as a new approach in treating gingival recession: Systematic review and meta-analysis. J Dent Oral Disord Ther. 2017;5(2):1-12.
Eren G, Kantarcı A, Sculean A, Atilla G. Vascularization after treatment of gingival recession defects with platelet-rich fibrin or connective tissue graft. Clin Oral Investig. 2015;9. https://doi.org/10.1007/s00784-015-1697-8
Madi M, Elakel AM. The clinical implication of platelet-rich fibrin on parodontal regeneration: A systematic review. Saudi Dent J. 2021;33:55-62. https://doi.org/10.1016/j.sdentj.2020.12.002 PMid:33551617
Panda S, Satpathy A, Chandra Das A, Kumar M, Mishra L, Gupta S, et al. Additive effect of platelet rich fibrin with coronally advanced flap procedure in root coverage of miller’s Class I and II recession defects-A PRISMA compliant systematic review and meta-analysis. Materials (Basel). 2020;13(19):4314. https://doi.org/10.3390/ma13194314 PMid:32992613
Moraschini V, Edos SB. Use of platelet-rich fibrin in the treatment of gingival recessions: A systematic review and meta-analysis. J. Periodontol. 2016;87(3):281-90. https://doi.org/10.1902/jop.2015.150420 PMid:26561997
Miron RJ, Zucchelli G, Pikos MA, Salama M, Lee S, Guillemette V, et al. Use of platelet-rich fibrin in regenerative dentistry: A systematic review. Clin Oral Investig. 2017;21(6):1913-27. https://doi.org/10.1007/s00784-017-2133-z PMid:28551729
Eren G, Atilla G. Platelet-rich fibrin in the treatment of bilateral gingival recessions. Clin Adv Periodontics. 2011;2(3)110074. https://doi.org/10.1902/cap.2012.110074
Öncü E. The use of platelet-rich fibrin versus subepithelial connective tissue graft in treatment of multiple gingival recessions: A randomized clinical trial. Int J Periodontics Restorative Dent. 2017;37(2):265-71. https://doi.org/10.11607/prd.2741 PMid:28196169
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):144. https://doi.org/10.3390/medicina57020144 PMid:33562581
Shivakumar MA, Gopal SV, Govindaraju P, Ramayya S, Bennadi D, Mruthyuenjaya RK. Evaluation of treatment for isolated bilateral miller’s Class I or II gingival recession with platelet-rich fibrin membrane-A comparative study. J Young Pharm. 2016;8(3):1-10.