Comparative evaluation of platelet-rich fibrin versus beta-tri-calcium phosphate in the treatment of Grade II mandibular furcation defects using cone-beam computed tomography

Efficacy of Platelet-rich Fibrin for the Treatment of Grade II Furcation Defects in Mandibular Molars

Aim:

To evaluate the efficacy of platelet-rich fibrin (PRF) in the treatment of grade II furcation mandibular molars.

Materials and Methods:

We enrolled 12 patients with 24 mandibular class II furcation defects in this randomized clinical trial with a split-mouth design. These defects were treated with either open flap debridement (OFD) in conjunction with PRF (test group) or only OFD (control group). We recorded and assessed clinical parameters (probing pocket depth [PPD], gingival recession [GR], and vertical and horizontal clinical attachment level [VCAL and HCAL, respectively]), radiographic parameters (bone defect fill [%BF]), and microbiological parameters at baseline and 6 months after treatment.

Results:

After treatment, PPD, VCAL, HCAL, BF, and microbiological parameters were significantly reduced in both groups. All clinical and radiographic parameters showed significant improvement at the sites that had been treated with PRF and OFD compared with those that had been treated with OFD alone. Among 24 furcation defects in both groups, 10 showed a significantly improved clinical condition and 14 remained at the initial grade. There were no more severe conditions recorded after treatment.

Conclusion:

Within the limitation of this article, we have demonstrated the effectiveness of PRF in the regenerative treatment of grade II furcation defects.

Periodontal regeneration using platelet-rich fibrin. Furcation defects: A systematic review with meta-analysis

The objective of the study was to compare the treatment outcomes of periodontal furcation defects by using platelet-rich fibrin (PRF) with other commonly utilized modalities. The eligibility criteria comprised randomized controlled trials (RCTs) comparing the clinical outcomes of PRF with those of other modalities for the treatment of furcation defects. Studies were classified into 11 categories in 3 different groups as follows: Group I (addition of PRF): (1) open flap debridement (OFD) alone versus OFD/PRF, (2) OFD/bone graft (OFD/BG) versus OFD/BG/PRF; Group II (comparative studies to PRF): (3) OFD/BG versus OFD/PRF, (4) OFD/collagen membrane versus OFD/PRF, (5) OFD/PRP versus OFD/PRF, (6) OFD/rhBMP2 versus OFD/PRF; and Group III (addition of biomaterial/biomolecule to PRF): OFD/PRF versus … (7) OFD/PRF/BG, (8) OFD/PRF/amniotic membrane (AM), (9) OFD/PRF/metformin, (10) OFD/PRF/bisphosphonates, (11) OFD/PRF/statins. Weighted means and forest plots were calculated for the reduction of probing pocket depth (PPD), gain of vertical and horizontal clinical attachment levels (VCAL and HCAL), gain in vertical and horizontal bone levels (VBL, HBL), and radiographic bone fill (RBF). From 45 articles identified, 21 RCTs reporting on class II furcations were included. The use of OFD/PRF and OFD/BG/PRF statistically significantly reduced PPD and improved VCAL and HCAL when compared to OFD or OFD/BG, respectively. The comparison between OFD/PRF alone versus OFD/BG, OFD/CM, OFD/PRP, or OFD/rhBMP2 led to similar outcomes for all investigated parameters, including a reduction in PPD, VCAL/HCAL gain, and RBF. The additional incorporation of a BG to OFD/PRF only mildly improved outcomes, whereas the addition of AM improved clinical outcomes. The addition of small biomolecules such as metformin, bisphosphonates, or statins all led to significant improvements in PPD, VCAL, and HCAL when compared to OFD/PRF alone. Noteworthy, a very high heterogeneity was found in the investigated studies. The use of PRF significantly improved clinical outcomes in class II furcation defects when compared to OFD alone, with similar levels being observed between OFD/PRF and/or OFD/BG, OFD/CM, OFD/PRP, or OFD/rhBMP2. Future research geared toward better understanding potential ways to enhance the regenerative properties of PRF with various small biomolecules may prove valuable for future clinical applications. Future histological research investigating PRF in human furcation defects is largely needed. The use of PRF in conjunction with OFD statistically significantly improved PPD, VCAL, and HCAL values, yielding comparable outcomes to commonly used biomaterials. The combination of PRF to bone grafts or the addition of small biomolecules may offer additional clinical benefits, thus warranting future investigation.

Effect of Injectable Platelet-Rich Fibrin with a Nano-Hydroxyapatite Bone Graft on the Treatment of a Grade II Furcation Defect

Background: Periodontal diseases lead to bone loss, crestal defects and even loss of the tooth, which also further makes it difficult to replace the tooth. Autogenous bone grafts are considered the gold standard in bone regenerative procedures. This study aimed to compare and evaluate the bone regenerative effects of i-PRF (Injectable- Platelet-rich fibrin) with a bone graft and a bone graft alone in mandibular grade II furcation defects over a period of 9 months. Method: This was a comparative study of 12 participants, who were randomly selected and grouped into two groups: test and control. Following phase I therapy, both groups were subjected to open flap debridement. In the test group, after debridement, a nano-hydroxyapatite bone graft mixed with i-PRF was inserted, whereas in the control group only a nano-hydroxyapatite bone graft was inserted. The clinical parameters such as plaque index (PI), gingival index (GI), pocket probing depth (PPD), clinical attachment level (CAL), horizontal probing depth (HPD) and vertical probing depth (VPD) were recorded at baseline, 3 months, 6 months and 9 months following the surgery. The bone area fill (BAF) was assessed using intraoral periapical radiographs (IOPARs) taken at baseline and 9 months after surgery. Results: At the baseline, there was no statistically significant difference between the tested parameters. After 9 months all the clinical parameters, PI, GI, PPD, CAL, HPD and VPD as well as radiographic bone fill showed a significant increase in both the groups (p < 0.05) (PI-TGr; CGr−VPD—3.5 ± 0.54 to 0.66 ± 0.51; 3.3 ± 0.81 to 2 ± 0.63/BAF—2.9 ± 0.88 to 5.6 ± 1.10; 3.4 ± 1.39 to 3.9 ± 1.4). On comparison the test group showed better results for each clinical parameter. Conclusion: The results showed increased improvement in clinical conditions in both groups, although better results were seen in the group where i-PRF with a nano-HA bone graft was used in the furcation defect.

Overview of the Effect of Different Regenerative Materials in Class II Furcation Defects in Periodontal Patients

The aim of this review was to give an overview of the outcomes of the use of different regenerative materials to treat molars with class II furcation defects in patients with periodontitis in comparison with open flap debridement (OFD). A search of five databases (PubMed-Medline, Embase, Cochrane, Scopus and Web of Science) was conducted up to and including January 2022. According to the PICOS guidelines, only randomized control trials (S) considering periodontal patients with at least one molar with a class II furcation involvement (P) treated with regenerative materials (I) in comparison to OFD as control treatment (C) and a minimum follow-up period of 6 months were included. Vertical clinical attachment level (VCAL) was considered as the primary outcome (O), while horizontal clinical attachment level (HCAL), horizontal probing depth (HPD) and vertical probing depth (VPD) were considered as secondary outcomes. The search through the databases initially identified 1315 articles. Only 25 of them met the eligibility criteria and were included. The studies were grouped in four macro-categories according to the material used: absorbable and non-absorbable membranes, blood derivatives and a combination of different materials. The greater part of the included studies reported a statistically significant difference in using regenerative materials when compared to OFD. The blood derivatives groups reported a range of mean changes in VCAL of 0.86-4.6 mm, absorbable membrane groups reported -0.6-3.75 mm, non-absorbable membranes groups reported -2.47-4.1 mm, multiple materials groups reported -1.5-4.87 mm and enamel matrix derivatives reported a mean change in VCAL of 1.45 mm. OFD showed a range of mean VCAL changes of -1.86-2.81 mm. Although no statistical analysis was performed, the use of regenerative materials may be considered moderately beneficial in the treatment of molars with grade II furcation involvement. However, the substantial heterogeneity in the protocols' design does not allow us to draw definitive conclusions. In addition, low levels of evidence for morbidity and patient-centered outcomes were reported.

The Adjunctive Use of Leucocyte- and Platelet-Rich Fibrin in Periodontal Endosseous and Furcation Defects: A Systematic Review and Meta-Analysis

The aim of this systematic review of randomized controlled trials was to evaluate the adjunctive use of leucocyte- and platelet-rich fibrin (L-PRF) in periodontal endosseous and furcation defects, as compared without L-PRF. The endosseous defect group was subclassified into: L-PRF/open flap debridement (L-PRF/OFD) versus OFD, L-PRF/osseous graft (L-PRF/OG) versus OG, L-PRF/Emdogain (L-PRF/EMD) versus EMD, and L-PRF/guided tissue regeneration (L-PRF/GTR) versus GTR. The furcation defect group was subclassified into L-PRF/OFD versus OFD, and L-PRF/OG versus OG. Mean difference, 95% confidence intervals and forest plots were calculated for probing pocket depth (PPD), clinical attachment level (CAL) and radiographic defect depth (DD). Nineteen studies concerning systemically healthy non-smokers were included. The results of this systematic review and meta-analysis showed in two- and/or three-wall endosseous defects that the adjunctive use of L-PRF to OFD or OG was significantly beneficial for PPD reduction, CAL gain and DD reduction, as compared without L-PRF. Furthermore, the data showed that for two- and/or three-wall endosseous defects, the adjunctive use of L-PRF to GTR was significantly beneficial for CAL and DD improvement, whereas adding L-PRF to EMD had no significant effect, and that for class II furcation defects, the addition of L-PRF to OFD was significantly beneficial for PPD, CAL and DD improvement, whereas the addition of L-PRF to OG was significantly clinically beneficial. In conclusion, this systematic review and meta-analysis found that there was significant clinical and radiographic additive effectiveness of L-PRF to OFD and to OG in two- and/or three-wall periodontal endosseous defects of systemically healthy non-smokers, as compared without L-PRF.

The added benefit of L-PRF to autogenous bone grafts in the treatment of degree II furcation involvement in mandibular molars

BACKGROUND

Tissue regeneration within the periodontally involved furcation area is one of the most challenging aspects of periodontal surgery. The aim of this study was to evaluate the additional benefit of leukocyte and platelet-rich fibrin (L-PRF) to autogenous bone grafts (ABGs) in the treatment of mandibular molar degree II furcation involvement, comparing the clinical outcomes with those from open flap debridement (OFD)+ABG and OFD alone treatments.

METHODS

Fifty-four patients, exhibiting one buccal or lingual mandibular molar furcation defect, were randomly assigned to three treatment groups: OFD+ABG+L-PRF(n = 18); OFD+ABG (n = 18); and OFD (n = 18). Clinical [probing pocket depth (PPD), horizontal clinical attachment level (HCAL), vertical clinical attachment level (VCAL), gingival recession (GR)] and radiographic [vertical bone level (VBL)] parameters were evaluated at baseline and 6 months after treatment. HCAL change was the primary outcome.

RESULTS

No significant differences within each group were reported for GR changes, but statistically significant improvements in HCAL, VCAL, PPD and VBL were observed in all groups, except for VBL in the OFD group. At 6 months, the mean HCAL gain was 2.29±0.18 mm in the OFD+ABG+L-PRF group, which was significantly greater than that in the OFD+ABG (1.61±0.18 mm) and OFD (0.86±0.18 mm) groups. Both OFD+ABG+L-PRF and OFD+ABG therapies produced a significantly greater clinical and radiographic improvement than OFD.

CONCLUSION

The addition of L-PRF to ABG produces a significantly greater HCAL gain and PPD reduction as compared to OFD+ABG treatment in mandibular degree II furcation involvements. This article is protected by copyright. All rights reserved.

Analysis of geometrical tomographic parameters of furcation lesions in periodontitis patients

Objectives

This study was aimed to investigate the relationship between geometric parameters of furcation lesions - maximum area of lesion opening (MALO), angle formed between the roots (ABR), lesion volume (LV) and presence and height of infra-osseous defects (IOD) - and the success of therapy with enamel matrix derivative proteins (EMD) in patients with grade C periodontitis, using cone-beam computed tomography (CBCT).

Methods

The study consisted of two groups of patients with grade C periodontitis: control (surgery) (n = 17) and test (surgery + EMD) (n = 17). Images parameters on CBCT were recorded using OnDemand3D and ITK-SNAP software.

Results

Pearson's correlation coefficient demonstrated that only IOD was statistically significant in the probing depth PD (P = 0.01), with a moderate positive correlation (R = 0.59). MALO was found to be statistically significant (P = 0.03) in the test group (surgery + EMD), with moderate negative correlation (R = -0.5).

Conclusion

The presence of infra-osseous defects and height were relevant in relation to the success of the type of treatment addressed in this study.

Use of Platelet-Rich Fibrin in the Treatment of Grade 2 Furcation Defects: Systematic Review and Meta-Analysis

In periodontitis patients, furcation defects are crucial sites to regenerate due to their complex anatomy. Various modern surgical techniques and use of biomaterials have been suggested in the literature. Among all, platelet-rich fibrin (PRF) has potential in tissue regeneration thanks to its role in the release of growth factors. Therefore, the purpose of this study was to evaluate the beneficial effect of the addition of PRF to open flap debridement (OFD) or as an adjuvant to other biomaterials such as bone grafts in the treatment of grade 2 mandibular furcation defects. Systematic research was carried out on the databases Medline, Scopus, Embase, and Cochrane Library and registered on PROSPERO (CRD42020167662). According to the PICO guidelines by Cochrane, randomized trials and prospective non-randomized trials were evaluated, with a minimum follow-up period of 6 months. The inclusion criteria were the absence of systemic diseases, non-smoking patients, and a population aged from 18 to 65 years. Vertical pocket probing depth (PPD), vertical clinical attachment level (VCAL), and gingival recession (REC) were the primary outcomes. Vertical furcation depth (VFD), and the percentage of bone defect fill (%v-BDF) were considered as secondary outcomes. A meta-analysis of the primary and secondary outcomes was performed. Publication bias was assessed through a funnel plot. Eighty-four articles were initially extracted. Eight randomized clinical trials were analyzed according to the exclusion and inclusion criteria. The Quality assessment instrument (QAI) revealed four articles at low risk of bias, one at moderate, and three at high risk of bias. The metanalysis showed significant data regarding PPD, VCAL, VFD and %v-BDF in the comparison between PRF + OFD vs. OFD alone. The adjunct of PRF to a bone graft showed a significant difference for VCAL and a not statistically significant result for the other involved parameters. In conclusion, the adjunctive use of PRF to OFD seems to enhance the periodontal regeneration in the treatment of grade 2 furcation defects. The combination of PRF and bone graft did not show better clinical results, except for VCAL, although the amount of literature with low risk of bias is scarce. Further well-designed studies to evaluate the combination of these two materials are therefore needed.

[Accuracy of cone beam computed tomography in assessing maxillary molar furcation involvement]

OBJECTIVE

This study aimed to assess the accuracy of cone beam computed tomography (CBCT) in detecting furcation involvement (FI) in maxillary molars.

METHODS

Thirty-one maxillary molars of 15 patients with generalized chronic periodontitis considered for furcation surgery were assessed. Clinical examination and CBCT were performed, and the FI degree was evaluated. Clinical and CBCT-based FI assessments were compared with intrasurgical data.

RESULTS

The agreement between clinical and intrasurgical assessments was weak in all sites, with a kappa of less than 0.4; the complete, overestimated, and underestimated agreement percentages were 42.0%, 24.7%, and 33.3%, respectively. The agreement between the CBCT and intrasurgical assessments was strong, with a ka ppa of 0.831; the complete, overestimated, and underestimated agreement percentages were 88.2%, 3.2%, and 8.6%, respectively. The agreement between both assessments was the highest in the buccal furcation entrance (κ=0.896), followed by that in the distopalatal (κ=0.822) and mesiopalatal (κ=0.767) furcation entrances.

CONCLUSIONS

CBCT images demonstrated high accuracy in assessing the horizontal bone loss of FI in maxillary molars.

Platelet-Rich Fibrin in Coverage of Gingival Recession: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis sought to evaluate the efficacy of platelet-rich fibrin (PRF) membranes versus subepithelial connective tissue grafts (SCTGs) in the coverage of Miller class I and II gingival recessions. After the inclusion and exclusion criteria were applied, the quality of seven articles (Cohen's Kappa = 0.9) was evaluated using the Jadad scale. The MEDLINE/PubMed, Cochrane, and Web of Science databases were consulted, and manual searches were performed in the most popular periodontics journals. The studies included considered a total of 122 patients, 203 surgical fields on which SCTGs were used, and 205 surgical fields on which PRF was used. The parameters analyzed were probing depth, clinical attachment level, gingival recession, and keratinized mucosa. The minimum follow-up period accepted was 6 months. A statistically significant difference between the SCTG and PRF groups was found only in the case of keratinized mucosa. However, gingival recession, clinical attachment level, and probing depth parameters in the PRF group were found to be statistically equal to those of the SCTG group (the gold standard) (p ≥0.05). PRF membranes were determined to be a promising alternative to autogenous gingival grafts in the treatment of Miller class I and II gingival recessions.

Role of Cone-Beam Computed Tomography in the Management of Periodontal Disease

The goal of this paper was to review the current literature surrounding the use of cone beam computed tomography (CBCT) related to the diagnosis, prognostic determination, and treatment of periodontal diseases. A literature review was completed to identify peer-reviewed articles related to CBCT and periodontics. The results were filtered to pool only articles specific to CBCT and periodontal diagnosis, prognosis, and treatment/outcomes. The articles were reviewed and findings summarized. Author’s commentary on technological advances and additional potential uses of CBCT in the field of periodontics were included. There is evidence to suggest that CBCT imaging can be more accurate in diagnosing specific periodontal defects (intrabony and furcation defects), and therefore be helpful in the prognostic determination and treatment planning. However, at this time, CBCT cannot be recommended as the standard of care. It is up to the individual clinician to use one’s own judgment as to when the additional information provided by CBCT may be beneficial, while applying the As Low As Reasonably Achievable (ALARA) principle. With continued technological advances in CBCT imaging (higher resolution, reduced imaging artifacts, lower exposure, etc.) the author’s believe that CBCT usage will become more prominent in diagnosis and treatment of periodontal diseases.

Autologous Platelet Concentrates in Treatment of Furcation Defects-A Systematic Review and Meta-Analysis

Background: The aim of this review was to evaluate the adjunctive effect of autologous platelet concentrates (APCs) for the treatment of furcation defects, in terms of scientific quality of the clinical trials and regeneration parameters assessment. Methods: A systematic search was carried out in the electronic databases MEDLINE, SCOPUS, CENTRAL (Cochrane Central Register of Controlled Trials), and EMBASE, together with hand searching of relevant journals. Two independent reviewers screened the articles yielded in the initial search and retrieved the full-text version of potentially eligible studies. Relevant data and outcomes were extracted from the included studies. Risk of bias assessment was also carried out. The outcome variables, relative to baseline and post-operative defect characteristics (probing pocket depth (PPD), horizontal and vertical clinical attachment loss (HCAL, VCAL), horizontal and vertical furcation depth (HFD, VFD) were considered for meta-analysis. Results: Ten randomized trials were included in this review. Only one study was judged at high risk of bias, while seven had a low risk, testifying to the good level of the evidence of this review. The meta-analysis showed a favorable effect regarding all outcome variables, for APCs used in adjunct to open flap debridement (p < 0.001). Regarding APCs in adjunct to bone grafting, a significant advantage was found only for HCAL (p < 0.001, mean difference 0.74, 95% CI 0.54, 0.94). The sub-group analysis showed that both platelet-rich fibrin and platelet-rich plasma in adjunct with open flap debridement, yielded significantly favorable results. No meta-analysis was performed for APCs in combination with guided tissue regeneration (GTR) as only one study was found. Conclusion: For the treatment of furcation defects APCs may be beneficial as an adjunct to open flap debridement alone and bone grafting, while limited evidence of an effect of APCs when used in combination with GTR was found.

[Study on the bone regeneration induced by advanced-platelet-rich fibrin and β- tricalcium phosphate composite]

Objective

To explore the osteogenesis effect of advanced-platelet-rich fibrin (A-PRF) and β-tricalcium phosphate (β-TCP) composite.

Methods

Thirty-two healthy female New Zealand rabbits were randomly selected. A-PRF was prepared by collecting blood from middle auricular artery. Rabbits were randomly divided into 6 groups: groups A, B, C, D, and E (6 rabbits in each group) and group F (2 rabbits). Bone defects (6 mm in diameter, 8 mm in depth) were drilled into femur condyle of each rabbit's both back legs. Then A-PRF and β-TCP composites manufactured by different proportion were planted into bone defects of group A (1∶1), group B (2∶1), group C (4∶1), group D (1∶2) and group E (1∶4) ( V/ V). The bone defect was not repaired in group F. The specimens were collected at 8 and at 12 weeks after operation. Then gross observation, X-ray examination, Micro-CT examination, and biomechanical test were performed. The bone volume/total volume (BV/TV), trabecular number (Tb.N), trabecular thickness (Tb.Th), and trabecular spacing (Tb.Sp), compressive strength, and modulus of elasticity were calculated.

Results

The gross observation and X-ray examination showed that the osteogenesis effect at 12 weeks was better than that at 8 weeks. At the same time point, the repair of bone defect and the formation of new bone in group B were better than those in other groups. Micro-CT examination showed that the trabeculae of new bone in group B were the most and the trabeculae arranged closely at 8 and 12 weeks. Besides there were significant differences in BV/TV, Tb.N, and Tb.Sp between group B and the other groups ( P<0.05). There were significant differences in Tb.N and Tb.Th in group B, BV/TV and Tb.Sp in group C, Tb.Sp in group D between 8 weeks and 12 weeks ( P<0.05). Biomechanical tests showed that the compression strength and elastic modulus of group B were the highest, and the compression strength and elastic modulus of group C were the lowest at 8 and at 12 weeks, showing significant differences ( P<0.05). There were significant differences in compression strength and elastic modulus of each group between 8 weeks and 12 weeks ( P<0.05).

Conclusion

The A-PRF and β-TCP composite can repair femoral condylar defects in rabbits, and the osteogenesis is better in proportion of 2∶1.

3D cone beam computed tomography reconstruction images in diagnosis of ameloblastomas of lower jaw: A case report and mini review

Cone beam computed tomography (CBCT) has obvious advantages over regular radiography in diagnosis of complex diseases. Objective of this study is to report a case of a mandibular jaw ameloblastoma recurring cyst, which represents a benign tumor of odontogenic epithelium, using CBCT imaging technology. CBCT examination of the patient suffering with recurrent lower jaw cyst (relapsing four years after surgery) showed a decrease in irregular bone density and appearance of a honeycomb pattern (3.5 cm×2.5 cm×1.8 cm) in the right lower jaw. This suggests that the lesion is more likely to be an ameloblastoma. Preoperative tissue biopsy and pathological examination of surgical sample confirmed the diagnosis. Surgical resection of the diseased tissue and autogenous bone grafting in the mandible was performed. Postoperative CBCT examination showed that the bone defect healed well, without recurrence of the tumor 22 months postoperatively. In conclusion, the rotated 3D CBCT images clearly displays the exact size, location, borders and internal changes of the tumor in the jaw cyst itself and the adjacent tissues. Thus, the dental CBCT allows clinicians to better evaluate lesions, leading to better treatment outcomes.

Patient-centered Microsurgical Management of Gingival Recession using Coronally Advanced Flap with Either Platelet-rich Fibrin or Connective Tissue Graft: A Comparative Analysis

Purpose:

To evaluate autologous platelet-rich fibrin (PRF) and autogenous connective tissue graft (CTG) in gingival recession defects in conjunction with coronally advanced flap (CAF) using a microsurgical technique.

Materials and Methods:

Forty-five Class I and II recession defects were randomly equally (n = 15) divided into three groups: Group I sites treated with CAF with PRF, Group II sites treated with CAF with CTG, and Group III sites treated with CAF alone using microsurgical approach. Parameters recorded were vertical gingival recession (VGR) and horizontal gingival recession (HGR), % complete root coverage (CRC), patient comfort score (PCS), patient esthetic score (PES), and hypersensitivity score (HS) at 10 days, 3 months, and 6 months.

Results:

CAF surgery alone and in combination with PRF or CTG are effective procedures to cover denuded roots with mean VGR values of 1.26 ± 0.70 mm (74.4%), 1.26 ± 0.59 mm (58%), and 1.06 ± 0.79 mm (53.3%) for Groups I, II, and III, respectively. In terms of CRC achieved at 6 months, results showed that 100% CRC was obtained in 60% sites of Group I, 20% sites of Group II, and 27% sites of Group III. Patient response and acceptance for surgical treatment modality in terms of PCS and PES were highest for Group I (PRF and CAF) followed by Group III and Group II, and there was decrease in HS for Group I (PRF and CAF) while no significant changes in HS were observed for Group II and Group III. At the end of 6 months follow-up, there was a significant increase in gingival thickness measurements using transgingival probing in Group II, whereas nonsignificant changes were observed in Group I and Group III.

Conclusions:

A long-term multicenter randomized controlled clinical study may be necessary to evaluate the clinical outcome for autologous PRF in comparison to CTG and CAF alone.