PERIO - Periodontal Practice Today 5 (2008), No. 4 4. June 2009
PERIO - Periodontal Practice Today 4 (2007), No. 1 (09.03.2007)
The use of platelet-rich plasma in combination with connective tissue grafts following treatment of gingival recessions
Jankovic, Sasha M / Zoran, Aleksic M / Vojislav, Lekovic M / Bozidar, Dimitrijevic S / Kenney, Barry E
Background: The biologic mediators from platelet-rich plasma (PRP) modulate cell proliferation and differentiation in a cell type-specific manner, leading to enhanced tissue reparation and regeneration. It is conceivable that concentrated growth factors within PRP up-regulates cellular activity and subsequently promotes periodontal regeneration in vivo. This study was designed to evaluate and compare clinical effectiveness of activated PRP in the standard treatment of gingival recessions with connective tissue graft (CTG).
Methods: Basic surgical technique was based on the use of CTG and coronally advanced flap procedure. Fifteen gingival recessions Miller class I or II were treated with CTG and PRP (group CTG+PRP). After elevation of the flap, bone and root surfaces were smeared with activated PRP gel. The CTG was also irrigated with PRP gel before placement over the exposed root surface. After suturing, the CTG was covered with a coronally advanced flap. In the same patients, 15 other gingival recessions were treated with CTG in combination with a coronally advanced flap (group CTG). Clinical recordings were made of vertical recession depth (VRD), probing depth (PD), clinical attachment level (CAL) and keratinised tissue width (KTW) before and 6 months after mucogingival surgical treatment. Clinical evaluation of healing events was estimated with recordings of the healing index (HI). Recordings of HI were performed on the 1st, 2nd and 3rd week post-surgery.
Results: Mean values of VRD were significantly decreased from 3.61 ± 0.70 mm to 0.30 ± 0.45 mm (p < 0.01) in the group CTG+PRP (91.68%) and from 3.45 ± 0.84 mm to 0.38 ± 0.48 mm (p < 0.01) in the group CTG (mean root coverage 88.96 %). The difference between the two tested groups was not statistically significant. Results of the KTW showed significant increase from 1.32 ± 0.66 mm presurgery to 3.20 ± 0.54 mm (p < 0.01) 6 months after in group CTG+PRP, and from 1.41 ± 0.58 mm to 2.55 ± 0.45 mm in group CTG (p < 0.01). Results of KTW showed statistical significance of recorded differences obtained in the two evaluated groups (p < 0.05). There was no statistical significance in reduction of PD and CAL recorded in CTG+PRP and CTG group. The values of HI recorded on the 1st and 2nd week post-operatively were significantly enhanced in the CTG+PRP group (3.11 ± 0.32 and 4.20 ± 0.27) in reference with HI values recorded in control group (2.25 ± 0.54 and 3.05 ± 0.38).
Conclusions: The results of this study confirm both procedures as effective and highly predictable surgical techniques in solving gingival recession problems. The addition of PRP resulted in an increased width of keratinised tissue and advanced tissue healing.
Keywords: gingival recessions, growth factors, PRP, regeneration