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.
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
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
Parallel
open flap debridement with I-prf and xenogeneic graft
Procedure/SurgeryDuring the surgical phase of treatment, patients will undergo open flap debridement surgery. Infiltrative local anesthesia will first be administered to the involved teeth. The gingiva will be incised within the gingival sulcus using a scalpel, and a full-thickness flap will be carefully elevated with a periosteal elevator. Granulation tissue and dental calculus will be completely removed using Gracey curettes (American Eagle, USA) and an ultrasonic scaler. Subsequently, a xenogeneic bone graft mixed with injectable platelet-rich fibrin (i-PRF) will be applied. The flap will then be sutured using 4-0 polypropylene sutures.
open flap debridement with saline and xenogenic graft
Procedure/SurgeryDuring the surgical phase of treatment, patients will undergo open flap debridement surgery. Infiltrative local anesthesia will first be administered to the involved teeth. The gingiva will be incised within the gingival sulcus using a scalpel, and a full-thickness flap will be carefully elevated with a periosteal elevator. Granulation tissue and dental calculus will be thoroughly removed using Gracey curettes (American Eagle, USA) and an ultrasonic scaler. A xenogeneic bone graft mixed with physiological saline will then be applied. Finally, the flap will be sutured using 4-0 polypropylene sutures.
Intrabony Defect Fill
The change in the defect size will be evaluated using computed tomography. Slices with a thickness of 1.0 mm will be acquired in the sagittal plane. The defect base, alveolar bone crest, and cementoenamel junction (CEJ) will be identified on the images, and the distances between these anatomical landmarks will be measured in millimeters. The distance between the defect base and the alveolar bone crest will be used to determine the depth of the intraosseous defect.
Clinical Attachment Level
It represents the value obtained by measuring the distance between the pocket base and the cementoenamel junction (CEJ) using a standard periodontal probe with a diameter of 0.4-0.5 mm, rounded to the nearest millimeter. The changes in clinical attachment level will be measured at baseline, as well as at the 3- and 6-month follow-up visits.
Probing Pocket Depth
Probing pocket depth, defined as the distance between the base of the periodontal pocket and the free gingival margin, is one of the important clinical parameters used to monitor tissue healing after periodontal treatments. It will be measured in mm from the six surfaces of the involved tooth (buccal mesial, buccal middle, buccal distal, palatal/lingual mesial, palatal/lingual middle, and palatal/lingual distal) using a Williams or UNC-15 periodontal probe. Changes in probing pocket depth will be recorded at baseline, as well as at the 3- and 6-month follow-up visits.
Plaque Index
Patients' plaque indices will be recorded according to the Silness \& Löe Index. After the teeth are air-dried, the amount of plaque near the gingival margin of each tooth will be examined with an inspection and a periodontal probe. Index values ranging from 0 to 3 are assigned based on the amount of plaque on the tooth surface. Based on this index: 0: No plaque 1. A thin layer of plaque is observed along the gingival margin. This thin layer can be detected with a periodontal probe. 2. A moderate layer of plaque is observed along the gingival margin. This plaque can be visually detected. 3. A considerable layer of plaque is observed at the gingival margin. The interdental spaces appear to be full of plaque.
Gingival Index
This index was developed by Löe \& Silness. This system evaluates bleeding, the most fundamental sign of inflammation. The mesial, distal, vestibular, and lingual gingiva of the teeth are evaluated. They are scored from 0 to 3. These values are then summed and divided by four. This calculates the gingival index. Dividing the total by the number of teeth yields the individual score. According to this index: 0: Healthy gingiva, no inflammation. 1. Mild gingival inflammation, discoloration, and mild edema. No bleeding on probing. 2. Moderate gingival inflammation, redness, and edema. Bleeding on probing. 3. Severe gingival inflammation, redness, and edema. Spontaneous bleeding occurs.
Pain Assasment
The Visual Analog Scale (VAS) is the most commonly used scale for both measuring pain intensity and monitoring the degree of pain relief. The VAS consists of a 10-cm line with endpoints of "no pain" and "worst possible pain." The patient marks the line that best describes their pain intensity. The average of the obtained values is calculated for each patient. The patient's pain, inability to chew, and procedural stress will be assessed with the VAS at two weeks postoperatively.
Click on the lead sponsor to view all of their trials.
