The use of platelet-rich fibrin membrane in gingival recession treatment

Abstract

Introduction. Fibrin, fibronectin, platelet derived growth factor, and transforming growth factors from platelet concetrate are crucial for tissue reparation and regeneration. Objective. This study was designed to evaluate clinical effectiveness of activated platelet-rich fibrin (PRF) membrane in treatment of gingival recession. Methods. 19 gingival recessions Miller class I or II were treated with a coronally advanced flap and the PRF membrane (PRF group). Following the elevation of the flap, bone and root surfaces were covered with the PRF membrane. After suturing, the PRF membrane was covered with a coronally advanced flap. In the same patients, 19 other gingival recessions were treated with CTG in combination with the coronally advanced flap (the CTG group). Clinical recordings were made of vertical recession depth (VRD), probing depth (PD), clinical attachment level (CAL) and keratinized tissue width (KTW) before and 12 months after mucogingival surgical treatment. Clinical evaluation of healing events was estimated with recordings of the healing index (HI). Recordings of HI were performed in the 1st, 2nd and 3rd week post-surgically. Results. Mean root coverage was significant in both groups (the PRF group 79.94% and the CTG group 88.56% %; p lt 0.01). The difference between the two tested groups was not statistically significant. Results of the keratinized tissue width showed significant increase (p lt 0.05) 12 months after the surgery in both, the PRF and CTG groups. Results of KTW showed statistical significance of recorded differences obtained in the two evaluated groups (p lt 0.05). There was no statistical significance in reduction of PD and CAL recorded in the PRF and CTG groups. The values of HI recorded in the 1st and 2nd week postoperatively were significantly enhanced in the PRF group (p lt 0.05). Conclusion. Results of this study confirm both procedures as effective with equivalence of clinical results in solving gingival recession problems. The utilization of the PRF resulted in a decreased postoperative discomfort and advanced tissue healing.

Uvod. Fibrin, fibronektin, faktor rasta poreklom iz trombocita i transformišući faktor rasta imaju presudnu ulogu u regeneraciji i reparaciji tkiva. Cilj rada. Ispitati i utvrditi značaj primene membrane od fibrina bogatog trombocitima (engl. plateletrich fibrin - PRF) u lečenju recesija gingive. Metode rada. Devetnaest obostranih gingivalnih recesija klase I ili II po Mileru lečeno je sa dva različita terapijska modaliteta. U eksperimentalnoj grupi recesija je, nakon odizanja mukoperiostnog režnja, preko izložene alveolarne kosti i korena zuba postavljena PRF membrana kao augmentacioni materijal, koja je zatim pokrivena koronarno pomerenim režnjem. U kontrolnoj grupi su izložena alveolarna kost i koren zuba prekriveni transplantatom vezivnog tkiva (TVT) uz koronarno pomereni režanj. Kod obe grupe recesija posmatrani su sledeći parametri: veličina recesije gingive, širina keratinizovane gingive, nivo pripojnog epitela i dubina sondiranja. Parametri su mereni neposredno pre hirurškog zahvata i 12 meseci kasnije. Zabeležen je i indeks zarastanja rane tokom prve tri nedelje posle operacije. Rezultati. Kod obe grupe recesija postignuto je značajno prekrivanje ogoljenog korena zuba (PRF membrana 79,94% i TVT 88,56%; p lt 0,01), dok između dve ispitivane grupe nije uočena statistički značajna razlika. Rezultati ispitivanja širine keratinizovane gingive su pokazali značajno povećanje u obe ispitivane grupe dvanaest meseci nakon hirurškog lečenja (p lt 0,05). Takođe je uočena statistički značajna razlika između posmatranih grupa (p lt 0,05) kod parametra širina keratinizovane gingive. Statističke značajnosti kada je reč o smanjenju nivoa pripojnog epitela i dubine sondiranja, kako u okviru grupa, tako i između obe ispitivane grupe (p>0,05), nije bilo. Merenjem indeksa zarastanja rane uočeni su značajno bolji rezultati u eksperimentalnoj grupi nakon prve i druge nedelje nego u kontrolnoj (p lt 0,05). Zaključak. Oba postupka pokazala su se adekvatnim u lečenju gingivalnih recesija. U kontrolnoj grupi bili su bolji rezultati u dobitku keratinizovanog tkiva, dok se eksperimentalna procedura pokazala jednostavnijom i komfornijom za samog bolesnika, uz značajno bolji postoperacioni tok.