Clinical Oral Investigations

, Volume 22, Issue 3, pp 1345–1354 | Cite as

Effectiveness and predictability of titanium-prepared platelet-rich fibrin for the management of multiple gingival recessions

  • Bilge Cansu Uzun
  • Esra Ercan
  • Mustafa Tunalı
Original Article



Titanium-prepared platelet-rich fibrin (T-PRF) is activated with titanium, which results in a more mature and aggregated form than PRF. In our previous studies, we established that the fibrin carpet formed with titanium had a firmer network structure, and longer resorption time in the tissue than the fibrin carpet formed with glass. The purpose of this randomized controlled clinical trial is to compare the effects of autogenous T-PRF and connective tissue graft (CTG).

Materials and methods

A total of 114 Miller Class I/II gingival recessions with abrasion defects were treated either T-PRF (63 teeth) or CTG (51 teeth) using a modified tunnel technique. Clinical periodontal indexes, keratinized tissue (KTW), gingival thickness, and recession depth were recorded before surgery and at 6- and 12-month follow-up examinations. The visual analog scale and healing index scores were assessed.


The mean root coverages were 93.29 and 93.22% in the T-PRF and CTG groups, respectively, at 12 months post-operatively. CTG resulted in greater gingival thickness than T-PRF at 6 and 12 months post-surgery compared to baseline. Furthermore, the mean amounts of KTW increased by 1.97 and 0.75 mm in the T-PRF and CTG groups, respectively.


Within the limits of this study, the results demonstrated that T-PRF is safe and effective for treatment of multiple Miller Class I/II gingival recession defects.

Clinical relevance

T-PRF can serve as a good autogenous alternative to CTG, which is the gold standard for root coverage.


Gingival recession T-PRF Connective tissue graft Histoconduction Root coverage 



The work is self-funding.

Compliance with ethical standards

Conflict of interest

Dr. Mustafa Tunalı hold intellectual property releated to T-PRF. The other authors declare 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.

Informed consent

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

We thank to Prof. Dr. Binnaz Leblebicioğlu for her precious opinions and Dr. Serdar Karakullukçu for his contribution for statistical analysis.

The study protocol record can be reached at, and the ID is NCT0312187.


  1. 1.
    Marini MG, Greghi SL, Passanezi E et al (2004) Gingival recession: prevalence, extension and severity in adults. J Appl Oral Sci 12:250–255CrossRefPubMedGoogle Scholar
  2. 2.
    Susin C, Haas AN, Oppermann RV et al (2004) Gingival recession: epidemiology and risk indicators in a representative urban Brazilian population. J Periodontol 75:1377–1386CrossRefPubMedGoogle Scholar
  3. 3.
    Sarfati A, Bourgeois D, Katsahian S et al (2010) Risk assessment for buccal gingival recession defects in an adult population. J Periodontol 81:1419–1425CrossRefPubMedGoogle Scholar
  4. 4.
    Maroso FB, Gaio EJ, Rösing CK et al (2015) Correlation between gingival thickness and gingival recession in humans. Acta Odontol Latinoam 28(2):162–166PubMedGoogle Scholar
  5. 5.
    Roccuzzo M, Bunino M, Needleman I et al (2002) Periodontal plastic surgery for treatment of localized gingival recessions: a systematic review. J Clin Periodontol 29(Suppl 3):178–194CrossRefPubMedGoogle Scholar
  6. 6.
    Chambrone L, Chambrone D, Pustiglioni FE et al (2008) Can subepithelial connective tissue grafts be considered the gold standard procedure in the treatment of Miller Class I and II recession-type defects? J Dent 36:659–671CrossRefPubMedGoogle Scholar
  7. 7.
    Wennstrom JL, Zucchelli G (1996) Increased gingival dimensions. A significant factor for successful outcome of root coverage procedures? A 2-year prospective clinical study. J Clin Periodontol 23:770–777CrossRefPubMedGoogle Scholar
  8. 8.
    Muller HP, Eger T, Schorb A (1998) Gingival dimensions after root coverage with free connective tissue grafts. J Clin Periodontol 25:424–430CrossRefPubMedGoogle Scholar
  9. 9.
    Rebele SF, Zuhr O, Schneider D et al (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 41:593–603CrossRefPubMedGoogle Scholar
  10. 10.
    Zucchelli G, Mounssif I, Mazzotti C et al (2014) Coronally advanced flap with and without connective tissue graft for the treatment of multiple gingival recessions: a comparative short- and long-term controlled randomized clinical trial. J Clin Periodontol 41:396–403CrossRefPubMedGoogle Scholar
  11. 11.
    Harris RJ, Miller R, Miller LH et al (2005) Complications with surgical procedures utilizing connective tissue grafts: a follow-up of 500 consecutively treated cases. Int J Periodontics Restorative Dent 25(5):449–459PubMedGoogle Scholar
  12. 12.
    Zucchelli G, Mele M, Stefanini M et al (2010) Patient morbidity and root coverage outcome after subepithelial connective tissue and de-epithelialized grafts: a comparative randomized-controlled clinical trial. J Clin Periodontol 37:728–738PubMedGoogle Scholar
  13. 13.
    Zucchelli G, Mounssif I, Mazzotti C et al (2014) Does the dimension of the graft influence patient morbidity and root coverage outcomes? A randomized controlled clinical trial. J Clin Periodontol 41(7):708–716CrossRefPubMedGoogle Scholar
  14. 14.
    Tatakis DN, Chambrone L, Allen EP et al (2015) Periodontal soft tissue root coverage procedures: a consensus report from the AAP Regeneration Workshop. J Periodontol 86(2 Suppl):52–55CrossRefGoogle Scholar
  15. 15.
    Petrungaro PS (2001) Using platelet-rich plasma to accelerate soft tissue maturation in esthetic periodontal surgery. Compend Contin Educ Dent 22(9):729–732PubMedGoogle Scholar
  16. 16.
    Choukroun J, Adda F, Schoeffler C, Vervelle A (2001) Une opportunité en paro-implantologie: le PRF. Implantodontie 42:55–62Google Scholar
  17. 17.
    Dohan Ehrenfest DM, Rasmusson L, Albrektsson T (2009) Classification of platelet concentrates: from pure platelet-rich plasma (P-PRP) to leucocyte- and platelet-rich fibrin (L-PRF). Trends Biotechnol 27:158–167CrossRefPubMedGoogle Scholar
  18. 18.
    Aroca S, Keglevich T, Barbieri B et al (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 80:244–252CrossRefPubMedGoogle Scholar
  19. 19.
    Del Corso M, Sammartino G, Dohan Ehrenfest DM (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(11):1694–1697 author reply 1697-9CrossRefPubMedGoogle Scholar
  20. 20.
    Jankovic S, Aleksic Z, Milinkovic I et al (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(3):260–273PubMedGoogle Scholar
  21. 21.
    Jankovic S, Aleksic Z, Klokkevold P et al (2012) Use of platelet-rich fibrin membrane following treatment of gingival recession: a randomized clinical trial. Int J Periodontics Restorative Dent 32(2):41–50Google Scholar
  22. 22.
    Eren G, Atilla G (2014) Platelet-rich fibrin in the treatment of localized gingival recessions: a split-mouth randomized clinical trial. Clin Oral Investig 18(8):1941–1948CrossRefPubMedGoogle Scholar
  23. 23.
    Gupta S, Banthia R, Singh P et al (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(2):153–160CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Keceli HG, Kamak G, Erdemir EO et al (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(11):1221–1230CrossRefPubMedGoogle Scholar
  25. 25.
    Tunalı M, Özdemir H, Arabacı T et al (2015) Clinical evaluation of autologous platelet-rich fibrin (L-PRF) in the treatment of multiple adjacent gingival recession defects: a 12-month study. Int J Periodontics Restorative Dent 35(1):105–114CrossRefGoogle Scholar
  26. 26.
    Uraz A, Sezgin Y, Yalim M et al (2015) Comparative evaluation of platelet-rich fibrin membrane and connective tissue graft in the treatment of multiple adjacent recession defects: a clinical study. Journal of Dental Sciences 10(1):36–45CrossRefGoogle Scholar
  27. 27.
    Castro AB, Meschi N, Temmerman A et al (2017) 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 44(1):67–82CrossRefPubMedGoogle Scholar
  28. 28.
    Öncü E, Bayram B, Kantarci A et al (2016) Positive effect of platelet rich fibrin on osseointegration. Med Oral Patol Oral Cir Bucal. Sep 1 21(5):e601–e607PubMedPubMedCentralGoogle Scholar
  29. 29.
    Choukroun J, Diss A, Simonpieri A et al (2006) Plateletrich fibrin (PRF): a second-generation platelet concentrate. Part IV: clinical effects on tissue healing. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 101:56–60CrossRefGoogle Scholar
  30. 30.
    O’Connell SM (2007) Safety issues associated with platelet-rich fibrin method. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 103:587(author reply):587–593CrossRefGoogle Scholar
  31. 31.
    Tunali M, Ozdemir H, Kucukodacı Z et al (2013) In vivo evaluation of titanium-prepared plateletrich fibrin (T-PRF): a new platelet concentrate. Br J Oral Maxillofac Surg 51:438–443CrossRefPubMedGoogle Scholar
  32. 32.
    Tunali M, Ozdemir H, Kucukodacı Z, et al. (2014) A novel platelet concentrate: titanium-prepared platelet-rich fibrin. BioMed Research International Article ID 209548Google Scholar
  33. 33.
    Tunali M, Ozdemir H, Kucukodacı Z et al (2015) A novel platelet concentrate for guided bone regeneration: Titanium Prepared Platelet-Rich Fibrin (T-PRF). Gulhane Med J 57:102–106CrossRefGoogle Scholar
  34. 34.
    Loe H, Silness J (1963) Periodontal disease in pregnancy. I. Prevalence and severity. Acta Odontol Scand 21:533–551CrossRefPubMedGoogle Scholar
  35. 35.
    Silness J, Loe H (1964) Periodontal disease in pregnancy. II. Correlation between oral hygiene and periodontal condtion. Acta Odontol Scand 22:121–135CrossRefPubMedGoogle Scholar
  36. 36.
    Huang LH, Neiva RE, Wang HL (2005) Factors affecting the outcomes of coronally advanced flap root coverage procedure. J Periodontol 76:1729–1734CrossRefPubMedGoogle Scholar
  37. 37.
    Kassab MM, Cohen RE, Andreana S et al (2006) The effect of EDTA in attachment gain and root coverage. Compend Contin Educ Dent 27(6):353–360PubMedGoogle Scholar
  38. 38.
    Cortellini P, Tonetti MS (2001) Microsurgical approach to periodontal regeneration. Initial evaluation in a case cohort. J Periodontol 72:559–569CrossRefPubMedGoogle Scholar
  39. 39.
    Miron RJ, Zucchelli G, Pikos MA et al (2017) Use of platelet-rich fibrin in regenerative dentistry: a systematic review. Clin Oral Invest 21(6):1913–1927CrossRefGoogle Scholar
  40. 40.
    Moraschini V, Barboza Edos S (2016) Use of platelet-rich fibrin membrane in the treatment of gingival recession: a systematic review and meta-analysis. J Periodontol 87:281–290CrossRefPubMedGoogle Scholar
  41. 41.
    Ustaoglu G, Ercan E, Tunali M (2016) The role of titanium-prepared platelet-rich fibrin in palatal mucosal wound healing and histoconduction. Acta Odontol Scand 74(7):558–564CrossRefPubMedGoogle Scholar
  42. 42.
    Öncü E (2017) The use of platelet-rich fibrin versus subepithelial connective tissue graft in treatment of multiple gingival recessions: a randomized clinical trail. Int J Periodontics Restorative Dent 37(2):1–9CrossRefGoogle Scholar
  43. 43.
    Eren G, Kantarcı A, Sculean A et al (2016) Vascularization after treatment of gingival recession defects with platelet-rich fibrin or connective tissue graft. Clin Oral Invest 20(8):2045–2053CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  • Bilge Cansu Uzun
    • 1
  • Esra Ercan
    • 1
  • Mustafa Tunalı
    • 2
  1. 1.Periodontology DepartmentKaradeniz Technical UniversityTrabzonTurkey
  2. 2.Periodontology DepartmentBezmialem Vakıf UniversityIstanbulTurkey

Personalised recommendations