Minimally Invasive Non-Surgical Periodontal Therapy Alone vs. Minimally Invasive Non-Surgical Periodontal Therapy With I-PRF With or Without Chlorhexidine on Stage III Periodontitis Patients

Impact of I-PRF With or Without Chlorhexidine on Minimally Invasive Non-Surgical Periodontal Therapy in Stage III Periodontitis: A Randomized Clinical Trial

This study aims to assess the effect of chlorhexidine augmented I-PRF together with MINST and I-PRF alone with MINST versus MINST alone in the treatment of stage III periodontitis patients.

The microbial profile shift that occurs during the transition from periodontal health to gingivitis or periodontitis makes it clear that the initiation and progression of periodontal diseases depend totally upon the presence of a dental biofilm. This microbial shift provides the rationale for the main objective of periodontal therapy, which aims to convert the biofilm from being associated with disease to being associated with health. Accordingly, the most effective therapies depend on relatively nonspecific approaches that physically disrupt the biofilm and decrease the oral bacterial load (Craig, 2016).

Using modified PRF with anti-bacterial properties can be highly important as a topical surgical tool that promotes tissue healing and prevents local infection (Polak, Clemer-Shamai and Shapira, 2019; El-Sayed et al., 2026). Moreover, such application may reduce the need for systemic antibiotic regimens (Polak, Clemer-Shamai and Shapira, 2019).

More recently, a novel protocol termed minimally invasive nonsurgical therapy (MINST) has been proposed for the treatment of isolated deep pockets associated with intrabony defects. Treatment of deep periodontal pockets by means of MINST consists of careful scaling and root debridement using special ultrasonic devices with delicate tips and operating microscope under local anesthesia (Nibali et al., 2019).

Since the incorporation of antiseptics into I-PRF hasn't been tested clinically yet, this study intends to evaluate the clinical and radiographic effects of using Chorhexidine augmented injrctable-platelet-rich fibrin together minimally invasive non-surgical periodontal therapy in the treatment stage III periodontitis patients.

Inclusion Criteria:

• Patient-related criteria:

  • Patient consulting in the outpatient clinic.
  • Age ≥ 18 years old.
  • Able to tolerate the study procedures.
  • Patient ready to perform oral hygiene instructions.
  • Compliance with the maintenance program.
  • Provide informed consent.
  • Accepts the 6 months follow-up period.

Teeth related criteria:

• Presence of at least one radiographic intrabony defect depth ≥3 mm.
• Patients with at least 10 teeth per arch.
• Presence at least of two teeth with PD ≥ 6 mm per quadrant.
• Isolated inter-proximal defect on a single-rooted tooth or mandibular molar, not extending to the furcation area.
• Untreated patients diagnosed with stage III with slow/moderate rate of progression grade (A/B) Periodontitis.

Exclusion Criteria:

• Patient-related criteria:

  • Medically compromised patients.
  • Pregnant or nursing women.
  • Uncooperative patients.
  • Smokers (> 10 cigarettes/day).

Teeth related criteria:

• Furcation involvement.
• Mobility ≥ degree 1
• Acute periodontal or endodontic abscesses
• Third molars
• Non-surgical periodontal treatment in the past 6 months, or surgical periodontal treatment in the past 12 months.
• Antibiotic treatment or anti-inflammatory treatment within 6 months prior to periodontal therapy.
• Previous periodontal surgery.