Treatment of Intrabony Defects With Injectable Platelet-Rich Fibrin and Xenogenic Grafts

Evaluation of the Effect of Injectable Platelet-Rich Fibrin in the Treatment of Periodontal Intrabony Defects With Xenogenic Grafts: a Randomized Controlled Clinical Trial

The use of injectable platelet-rich fibrin (i-PRF) in both surgical and non-surgical dental treatments has become increasingly widespread. Hard tissue grafts can produce "sticky bone," and bone gain can have a positive effect on intrabony defects frequently seen in periodontal disease, compared to grafts alone. This study aims to clinically and radiographically evaluate the effectiveness of using bovine-derived xenogenic bone grafts in combination with i-PRF and bovine-derived xenogeneic bone grafts alone in patients with intrabony defects and stage III periodontitis.

Intrabony defects are frequently observed in periodontitis patients. Bovine-derived xenogenic grafts are widely used in their treatment. To date, the graft has been mixed with various materials to increase its regenerative efficacy. In recent years, studies have explored its use in combination with PRF derivatives. Furthermore, with the introduction of i-PRF in regenerative treatments, its application with various biomaterials has been attempted. Applications have been made with materials such as demineralized freeze-dried bone allografts, hydroxyapatite bone grafts, and nanohydroxyapatite, with successful results. However, no studies have been conducted to date on the application of i-PRF with bovine-derived xenogeneic grafts in intrabony periodontal defects. This study aims to demonstrate that bovine-derived xenogeneic graft materials, which are frequently preferred by patients, achieve more successful results in various clinical and radiographic parameters in the treatment of intrabony defects, thanks to the contribution of i-PRF. The aims are to reduce clinical parameters that favor the treatment, increase bone fill, and minimize the defect area. It is thought that the use of I-PRF, a tissue-friendly biological material, will contribute to positive results in these parameters.

Inclusion Criteria:

• Male and female patients aged 18-65 years
• Patients with Stage III Periodontitis according to the AAP-EFP 2017 Periodontal Disease Classification
• PPD≥5 mm (if persistent 6 weeks after initial periodontal treatment)
• Intrabony defects in the interproximal region with 2 or 3 walls and a depth of at least ≥3 mm
• Non-smokers (those who smoke up to 10 per day may be included)

Exclusion Criteria:

• Patients under 18 years of age or older than 65 years of age
• Patients unable to consent
• Systemic diseases that could affect the success of surgery, such as uncontrolled diabetes
• Single-walled intrabony defects
• Those who have taken antibiotics, anti-inflammatory or immunosuppressive drugs, or birth control pills within the three months prior to the study
• Those who have received active periodontal treatment within the last six months and periodontal surgery within the last year
• Smoking more than 10 cigarettes per day
• Pregnancy or breastfeeding
• Those taking medications that affect the gums (e.g., calcium channel blockers, phenytoin or cyclosporine)
• Teeth with furcation defects
• Those undergoing active orthodontic treatment
• Those who are allergic to the biomaterials used in the study or prescribed medications