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Clinical evaluation of coronally advanced flap with or without platelet-rich fibrin for the treatment of multiple gingival recessions

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Abstract

Objectives

The aim of this randomized, controlled study was to assess the clinical effect of platelet-rich fibrin (PRF) in combination with coronally advanced flap (CAF) on root coverage, esthetics, and patient satisfaction when compared to CAF alone for the treatment of multiple Miller class I recessions.

Materials and methods

A total of 24 patients with 52 Miller class I multiple recessions ≥ 3 mm were included and divided into CAF + PRF and CAF groups. At baseline and 12 months after surgery, recession height (RH), keratinized tissue height, gingival thickness (GT), and mean and complete defect coverage were evaluated. Patient satisfaction and root coverage esthetic scores were also assessed.

Results

Baseline RH in CAF + PRF and CAF groups was 3.15 ± 0.24 and 3.36 ± 0.34 mm, respectively. Intragroup comparisons revealed significant differences at 12 months for all parameters (p < 0.05). RH reduction was 2.75 ± 0.33 and 2.51 ± 0.33 mm (mean root coverage of 88.36 and 74.63%) in the CAF + PRF and CAF groups, respectively. Intergroup differences were found to be significant for GT gain (p < 0.05).

Conclusions

The additional use of PRF membrane did not provide additional benefits in terms of root coverage outcomes compared with CAF alone. The use of PRF membranes increased tissue thickness significantly.

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Notes

  1. Stainless steel digital caliper 75 mm, Shan, China

  2. Vacuette 10-ml blood collection tube no additive, Greiner Bio-one, NC, USA

  3. Hettich EBA 20 centrifuge, Tutlingen, Germany

  4. Coated Vicryl 5-0 sutures, Ethicon, Johnson & Johnson, NJ, USA

  5. Prolene 5-0 sutures, Ethicon, Johnson & Johnson, NJ, USA

  6. Augmentin BID, GlaxoSmithKline Pharmaceuticals, Turkey

  7. Apranax Forte, Abdi Ibrahim, Turkey

  8. Klorhex Oral Rinse; Drogsan Pharmaceuticals, Turkey

  9. IBM SPSS Statistics 22, NY, USA

References

  1. Graziani F, Gennai S, Roldan S, Discepoli N, Buti J, Madianos P, Herrera D (2014) Efficacy of periodontal plastic procedures in the treatment of multiple gingival recessions. J Clin Periodontol 41:63–76

    Article  Google Scholar 

  2. Tatakis DN, Chambrone L, Allen EP, Langer B, McGuire MK, Richardson CR, Zabalegui I, Zadeh HH (2015) Periodontal soft tissue root coverage procedures: a consensus report from the AAP regeneration workshop. J Periodontol 86:S52–S55

    Article  PubMed  Google Scholar 

  3. De Sanctis M, Zucchelli G (2007) Coronally advanced flap: a modified surgical approach for isolated recession-type defects: three-year results. J Clin Periodontol 34:262–268

    Article  PubMed  Google Scholar 

  4. Cairo F, Pagliaro U, Butti J, Baccini M, Graziani F, Tonelli P, Pagavino G, Tonetti MS (2016) Root coverage procedures improve patient aesthetics. A systematic review and Bayesian network meta-analysis. J Clin Periodontol 43:965–975

    Article  PubMed  Google Scholar 

  5. Cordaro L, di Torresanto VM, Torsello F (2012) Split-mouth comparsion of a coronally advanced flap with or without enamel matrix derivative for coverage of multiple gingival recession defects: 6- and 24-month follow-up. Int J Periodontics Restorative Dent 32:e10–e20

    PubMed  Google Scholar 

  6. Ahmedbeyli C, Ipçi SD, Cakar G, Kuru BE, Yılmaz S (2014) Clinical evaluation of coronally advanced flap with or without acellular dermal matrix graft on complete defect coverage for the treatment of multiple gingival recessions with thin tissue biotype. J Clin Periodontol 41:303–310

    Article  PubMed  Google Scholar 

  7. Cardaropoli D, Tamagnone L, Roffredo A, Gaveglio L (2014) Coronally advanced flap with and without a xenogenic collagen matrix in the treatment of multiple recessions: a randomized controlled clinical study. Int J Periodontics Restorative Dent 34:97–102

    Article  Google Scholar 

  8. Aroca S, Keglevich T, Barbieri B, Gera I, Etienne D (2009) 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 80:244–252

    Article  PubMed  Google Scholar 

  9. Padma R, Shilpa A, Kumar PA, Nagasri M, Kumar C, Sreedhar A (2013) 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. J Indian Soc Periodontol 17:631–636

    Article  PubMed  PubMed Central  Google Scholar 

  10. Thamaraiselvan M, Elavarasu S, Thangakumaran S, Gadagi JS, Arthie T (2015) Comparative clinical evaluation of coronally advanced flap with or without platelet-rich fibrin membrane in the treatment of isolated gingival recession. J Indian Soc Periodontol 19:66–71

    Article  PubMed  PubMed Central  Google Scholar 

  11. Gupta S, Banthia R, Singh P, Banthia P, Raje S, Aggarwal N (2015) 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. Contemp Clin Dent 6:153–160

    Article  PubMed  PubMed Central  Google Scholar 

  12. Aleksic Z, Jankovic S, Dimitrijevic B, Divnic-Resnik T, Milinkovic I, Lekovic V (2010) The use of platelet-rich fibrin membrane in gingival recession treatment. Srp Arh Celok Lek 138:11–18

    Article  PubMed  Google Scholar 

  13. Jankovic S, Aleksic Z, Milinkovic I, Dimitrijevic B (2010) The coronally advanced flap in combination with platelet-rich fibrin (PRF) and enamel matrix derivative in the treatment of gingival recession: a comparative study. Eur J Esthet Dent 5:260–273

    PubMed  Google Scholar 

  14. Jankovic S, Aleksic Z, Klokkevold P, Lekovic V, Dimitrijevic B, Kenney EB, Camargo P (2012) Use of platelet-rich fibrin membrane following treatment of gingival recession: a randomized clinical trial. Int J Periodontics Restorative Dent 32:41–50

    Google Scholar 

  15. Eren G, Atilla G (2013) Platelet-rich fibrin in the treatment of localized gingival recessions: a split-mouth randomized clinical trial. Clin Oral Investig 18:1941–1948

    Article  PubMed  Google Scholar 

  16. Uraz A, Sezgin Y, Yalim M, Taner IL, Cetiner D (2015) 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 10:36–45

    Article  Google Scholar 

  17. Keceli HG, Kamak G, Erdemir EO, Evginer MS, Dolgun A (2015) The adjunctive effect of platelet-rich fibrin to connective tissue graft in the treatment of buccal recession defects. Results of a randomized parallel group controlled trial. J Periodontol 86:1221–1230

    Article  PubMed  Google Scholar 

  18. Choukroun J, Adda F, Schoeffler C, Vervelle A (2001) Une opportunite en paro implantologie: le PRF. Implantodontie 42:55–62

    Google Scholar 

  19. Dohan DM, Choukroun J, Diss A, Dohan SL, Doha AJJ, Mouhyi J, Gogly B (2006) Platelet rich fibrin (PRF): a second-generation platelet concentrate. Part II: platelet-related biologic features. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 101:E45–E50

    Article  PubMed  Google Scholar 

  20. Choukroun J, Diss A, Simonpieri A, Girard MO, Schoeffler C, Dohan SL, Dohan AJJ, Mouhyi J, Dohan DM (2006) 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 101:E56–E60

    Article  PubMed  Google Scholar 

  21. Dohan Ehrenfest DM, de Peppo GM, Doglioli P, Sammartino G (2009) Slow release of growth factors and thrombospondin-1 in Choukroun’s plateletrich fibrin (PRF): a gold standard to achieve for all surgical platelet concentrates technologies. Growth Factors 27:63–69

    Article  PubMed  Google Scholar 

  22. Dohan Ehrenfest DM, Bielecki T, Jimbo R, Barbe G, Del Corso M, Inchingolo F, Gilberto S (2012) Do the fibrin architecture and leucocyte content influence the growth factor release of platelet concentrates? An evidence-based answer comparing a pure platelet-rich plasma (P-PRP) gel and a leucocyte- and platelet-rich fibrin (L-PRF). Curr Pharm Biotechnol 13:1145–1152

    Article  PubMed  Google Scholar 

  23. Dohan Ehrenfest DM, Diss A, Odin G, Doglioli P, Hippolyte MP, Charrier JB (2009) In vitro effects of Choukroun’s PRF (platelet rich fibrin) on human gingival fibroblasts, dermal prekeratinocytes, preadipocytes, and maxillofacial osteoblasts in primary cultures. Oral Surg Oral Med Oral Pathol Oral Radiol End 108:341–352

    Article  Google Scholar 

  24. Ozenci I, Dirikan Ipci S, Cakar G, Yılmaz S (2015) Tunnel technique versus coronally advanced flap with acellular dermal matrix graft in the treatment of multiple gingival recessions. J Clin Periodontol 42:1135–1142

    Article  PubMed  Google Scholar 

  25. Zucchelli G, Testori T, De Sanctis M (2006) Clinical and anatomical factors limiting treatment outcomes of gingival recession: a new method to predetermine the line of root coverage. J Periodontol 77:714–721

    Article  PubMed  Google Scholar 

  26. Silness J, Löe H (1964) Periodontal disease in pregnancy. II. Correlation between oral hygiene and periodontal condition. Acta Odontol Scand 22:121–135

    Article  PubMed  Google Scholar 

  27. Löe H, Silness J (1963) Periodontal disease in pregnancy. I. Prevalence and severity. Acta Odontol Scand 21:533–551

    Article  PubMed  Google Scholar 

  28. Ainamo J, Bay I (1975) Problems and proposals for recording gingivitis and plaque. Int Dent J 25:229–235

    PubMed  Google Scholar 

  29. Mahajan A, Dixit J, Verma UP (2007) A patient-centered clinical evaluation of acellular dermal matrix graft in the treatment of gingival recession defects. J Periodontol 78:2348–2355

    Article  PubMed  Google Scholar 

  30. Cairo F, Rotundo R, Miller PD, Pini Prato GP (2009) Root coverage esthetic score: a system to evaluate the esthetic outcome of the treatment of gingival recession through evaluation of clinical cases. J Periodontol 80:705–710

    Article  PubMed  Google Scholar 

  31. Zucchelli G, Mounssif I (2015) Periodontal plastic surgery. Periodontol 68:333–368

    Article  Google Scholar 

  32. Cheng YF, Chen JW, Lin SJ, Lu HK (2007) Is coronally positioned flap procedure adjunct with enamel matrix derivative or root conditioning a relevant predictor for achieving root coverage? A systemic review. J Periodont Res 42:474–485

    Article  PubMed  Google Scholar 

  33. Kumar RV, Shubhashini N (2013) Platelet rich fibrin: a new paradigm in periodontal regeneration. Cell Tissue Bank 14:453–463

    Article  PubMed  Google Scholar 

  34. Dohan Ehrenfest DM, Pinto NR, Pereda A, Jimenez P, Corso MD, Kang BS, Nally M, Lanata N, Wang HL, Quirynen M (2017) The impact of centrifuge characteristics and centrifugation protocols on the cells, growth factors, and fibrin architecture of a leukocyte- and platelet-rich fibrin (L-PRF) clot and membrane. Platelets 24:1–14

  35. Castro AB, Meschi N, Temmerman A, Pinto N, Lambrechts P, Teughels W, Quirynen M (2016) Regenerative potential of leucocyte- and platelet-rich fibrin. Part A: intra-bony defects, furcation defects and periodontal plastic surgery. A systematic review and meta-analysis. J Clin Periodontol. https://doi.org/10.1111/jcpe.12643

  36. Sanz M, Simion M, Working Group 3 of the European Workshop on Periodontology (2014) Surgical techniques on periodontal plastic surgery and soft tissue regeneration: consensus report of Group 3 of the 10th European Workshop on Periodontology. J Clin Periodontol 41:S92–S97

    Article  PubMed  Google Scholar 

  37. Zucchelli G, Mele M, Mazzotti C, Marzadori M, Montebugnoli L, De Sanctis M (2009) Coronally advanced flap with and without vertical releasing incisions for the treatment of multiple gingival recessions: a comparative controlled randomized clinical trial. J Periodontol 80:1083–1094

    Article  PubMed  Google Scholar 

  38. Baldi C, Pini-Prato G, Pagliaro U, Nieri M, Saletta D, Muzzi L, Cortellini P (1999) Coronally advanced flap procedure for root coverage. Is flap thickness a relevant predictor to achieve root coverage? A 19-case series. J Periodontol 70:1077–1084

    Article  PubMed  Google Scholar 

  39. Hwang D, Wang HL (2006) Flap thickness as a predictor of root coverage: a systematic review. J Periodontol 77:1625–1634

    Article  PubMed  Google Scholar 

  40. Rebele SF, Zuhr O, Schneider D, Jung RE, Hürzeler MB (2014) Tunnel technique with connective tissue graft versus coronally advanced flap with enamel matrix derivative for root coverage: a RCT using 3D digital measuring methods. Part II. Volumetric studies on healing dynamics and gingival dimensions. J Clin Periodontol 41:593–603

    Article  PubMed  Google Scholar 

  41. Woodyard JG, Greenwell H, Hill M, Drisko C, Iasella JM, Scheetz J (2004) The clinical effect of acellular dermal matrix on gingival thickness and root coverage compared to coronally positioned flap alone. J Periodontol 75:44–56

    Article  PubMed  Google Scholar 

  42. Cortes AQ, Martins AG, Nociti FH, Sallum AW, Casati MZ, Sallum EA (2004) Coronally positioned flap with or without acellular dermal matrix graft in the treatment of class I gingival recessions: a randomized controlled clinical study. J Periodontol 75:1137–1144

    Article  Google Scholar 

  43. Da Silva RC, Joly JC, de Lima AF, Tatakis DN (2004) Root coverage using the coronally positioned flap with or without a subepithelial connective tissue graft. J Periodontol 75:413–419

    Article  PubMed  Google Scholar 

  44. Lima JA, Santos VR, Feres M, De Figueiredo LC, Duarte PM (2011) Changes in the subgingival biofilm composition after coronally positioned flap. J Appl Oral Sci 19:68–73

    Article  PubMed  PubMed Central  Google Scholar 

  45. Ehrenfest D, Del Corso M, Diss A, Mouhyi J, Charrier J-B (2010) Three-dimensional architecture and cell composition of a choukroun’s platelet rich fibrin clot and membrane. J Periodontol 81:546–555

    Article  Google Scholar 

  46. Pini-Prato G, Cairo F, Nieri M, Rotundo R, Franceschi D (2011) Esthetic evaluation of root coverage outcomes: a case series study. Int J Periodontics Restorative Dent 31:603–610

    PubMed  Google Scholar 

  47. Ozcelik O, Haytac M, Seydaoglu G (2011) Treatment of multiple gingival recessions using a coronally advanced flap procedure combined with button application. J Clin Periodontol 38:572–580

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Private Practice, Acıbadem, Istanbul, Turkey

    Samed Kuka

  2. Faculty of Dentistry, Department of Periodontology, Altınbaş University, Kartaltepe Mah. İncirli cad. No:11 Bakırköy, Istanbul, Turkey

    Sebnem Dirikan Ipci & Gokser Cakar

  3. Private Practice, Taksim, Istanbul, Turkey

    Selcuk Yılmaz

Authors
  1. Samed Kuka
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  2. Sebnem Dirikan Ipci
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  3. Gokser Cakar
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  4. Selcuk Yılmaz
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Corresponding author

Correspondence to Gokser Cakar.

Ethics declarations

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This clinical study adheres to the ethics and principles as per Helsinki Declaration (2008). The guidelines, consent forms, and all other related items were approved by the Insititutional Review Board of Yeditepe University in Istanbul, Turkey.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Clinical relevance

Scientific rationale for the study: Platelet-rich fibrin (PRF) is a fibrin matrix in which cytokines, growth factors, and cells are trapped and may serve as a resorbable membrane releasing these biological substances. Literature reveals diversified results related to its application in the treatment of multiple gingival recessions.

Principal findings: Although there was an increase in gingival thickness with PRF application, both CAF + PRF and CAF approaches presented similar successful clinical results.

Practical implications: The use of the PRF membranes significantly increased tissue thickness. Further studies will be valuable in getting more insight about how tissue thickness affects root coverage stability with greater follow-up times.

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Kuka, S., Ipci, S.D., Cakar, G. et al. Clinical evaluation of coronally advanced flap with or without platelet-rich fibrin for the treatment of multiple gingival recessions. Clin Oral Invest 22, 1551–1558 (2018). https://doi.org/10.1007/s00784-017-2225-9

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  • DOI: https://doi.org/10.1007/s00784-017-2225-9

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