RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE

KARNATAKA

ANNEXURE –II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. NAME OF THE CANDIDATE

AND ADDRESS (IN BLOCK

LETTERS)

Dr.ANILKUMAR RATHODPOST GRADUATE STUDENT,

DEPT. OF PERIODONTICS & ORAL IMPLANTOLOGY

A.M.E’S DENTAL COLLEGE AND HOSPITAL

BIJENGERE ROAD, RAICHUR- 584103.

2. NAME OF THE

INSTITUTION

A.M.E’s DENTAL COLLEGE AND HOSPITAL

AND RESEARCH CENTRE,

BIJENGERE ROAD, RAICHUR- 584103,

KARNATAKA.

3. COURSE OF STUDY AND

SUBJECT

MASTER OF DENTAL SURGERY IN

PERIODONTICS AND ORAL IMPLANTOLOGY

4. DATE OF ADMISSION TO

COURSE

27/05/2011

5. TITLE OF THE TOPIC EVALUATION OF EFFECT OF PLATELET

RICH FIBRIN ON CORONALLY ADVANCED

FLAPS. –A CLINICAL STUDY

BRIEF RESUME OF THE INTENDED WORK :

6.1 Need for the study :

Periodontal disease is recognized as major public health problem throughout the world and is

the most common cause of tooth loss.

Gingival recession can cause major functional and esthetic problems. It has been related

clinically to a higher incidence of root caries, attachment loss, hypersensitivity and smile related

concerns.

Gingival recession should be viewed as both soft and hard tissue defect. The surgical

techniques used for root coverage are based on tissue displacement, whether by translation (i.e.

pedicle flap procedures) or by grafting (i.e. free gingival or connective tissue graft procedures).

Review of literature has shown that better results were obtained by using connective tissue graft

rather than guided tissue regeneration. The studies have shown that the chemical treatment of the

root surface does not have any added benefit over the conventional procedure alone. The

subepithelial connective tissue graft maintains high esthetics but disadvantage of this procedure

includes the need for an additional donor site and its technical difficulty.

Platelet rich fibrin (PRF) is a novel treatment option available for various mucogingival

defects. The best part of platelet rich fibrin is acquirement of optimal esthetic results with

excellent soft tissue contour and texture.

Platelet rich fibrin is an enhanced concentrate of platelets derived from centrifuged blood. It

affects cellular activities at genetic and cellular levels.

It contains platelet derived growth factors (PDGF)-A and (PDGF)-B are major mitogens for

human periodontal ligament cells. The transforming growth factor (TGF)-1 has a significant role

in mitogenic and immune response.

Advantages of using PRF are-

The need for donor site is eliminated, making the technique less invasive.

Lessens postsurgical discomfort.

Promotes rapid soft tissue healing with less edema compared to connective tissue graft

and enamel matrix derivative technique.

It is easy to prepare and lacks biochemical handling of blood, which makes this

preparation strictly autologous.

6.2 Review of literature:

A clinical study was conducted to evaluate the effect of platelet rich fibrin in gingival

recession. A 44 year old patient reported with a chief complaint of hypersensitivity in lower

anterior tooth region and a 19 year old patient with chief complaint of gingival recession in lower

anterior tooth region. Surgical procedure was done to elevate a full thickness mucoperiosteal flap

and treated with platelet rich fibrin. Postoperative review revealed clinical attachment gain and a

reduction in probing depth with restoration of physiological gingival contour. Postoperative

review after 1 month in both cases revealed a good colour match and gain in clinical attachment

levels with almost 96% root coverage.1

A clinical study was conducted to evaluate clinical effectiveness of activated platelet rich

fibrin membrane in treatment of gingival recession. 19 gingival recessions, Miller’s class I or

class II were treated with coronally advanced flap and platelet rich fibrin (PRF) membrane.

Clinical recordings were made before and 12 months after mucogingival surgical treatment.

Clinical evaluation of healing events was estimated with recordings of the healing index (HI),

which is performed in 1st, 2nd and 3rd week postsurgically. Results of this study confirmed that both

the procedures were effective with equivalence of clinical results in solving gingival recession

problems. The utilization of PRF resulted in a decreased postoperative discomfort and advanced

tissue healing.2

A clinical study was conducted for the treatment of gingival recession. The PRF

membrane was used for root coverage on labial surfaces of the mandibular anterior teeth. This

was accomplished using laterally displaced flap technique with PRF membrane at the recipient

site. A 19 year male patient was evaluated for recession in relation to the mandibular left incisor.

Root coverage procedure was done and postoperative follow up was done for a period of 1 month.

There was no postoperative complication and the healing was satisfactory. The patients did not

have any postoperative morbidity. Complete coverage was achieved 6 months after the procedure,

with excellent tissue contour and colour.3

A clinical study was conducted to evaluate the clinical effectiveness of PRF

membrane used in combination with a coronally advanced flap and to compare it with the use of

an enamel matrix derivative in combination with a coronally advanced flap in gingival recession

treatment. 20 split mouth cases of maxillary anterior teeth or bicuspids with Miller’s class I or

class II gingival recession were treated with a coronally advanced flap combined with a PRF

membrane group or with enamel matrix derivative group placed under a coronally advanced flap.

The results of the study demonstrated that the PRF group showed 65% of the root coverage,

compared to the enamel matrix derivative group which showed only 60% of the root coverage.

The difference observed between the two groups at 12 months was statistically significant with

average root coverage of 70.5% in enamel matrix derivative group and 72.1% in the PRF group.4

A clinical study was conducted to determine whether the addition of an autologous platelet

rich fibrin clot to a modified coronally advanced flap (MCAF-test group) would improve the

clinical outcome compared to an MCAF alone (control group) for the treatment of multiple

gingival recessions. 20 subjects with three adjacent Miller’s class I or class II multiple gingival

recessions of similar extent on both sides of the mouth were enrolled in the study. Root coverage

procedure was performed. Gingival recession was measured at base line and at 1, 3 and 6 months

post surgery. Based on the results of the study it was concluded that the MCAF is a predictable

treatment for multiple adjacent Miller’s class I or class II recession type defects. The addition of

PRF membrane positioned under the MCAF provided inferior root coverage but an additional

gain in gingival/mucosal thickness at 6 months compared to conventional therapy.5

6.3 Objectives of the study :

To evaluate efficacy of coronally advanced flap on root coverage in gingival

recession.

To evaluate efficacy of coronally advanced flap with platelet rich fibrin on root

coverage in gingival recession.

To compare efficacy of coronally advanced flap alone and coronally advanced flap

with platelet rich fibrin in treatment of gingival recession.

7 MATERIALS AND METHODS :

7.1 Source of data :

Patients of this study would be selected from the outpatient department (OPD) of

Periodontics and Oral Implantology, AME’S Dental College and Hospital, Raichur, Karnataka.

7.2. Method of Collection of Data (including sampling procedure, if any) :

Sample Size :

16 patients with Miller’s class I or class II gingival recession will be included in this study.

Study period:

The duration of this clinical study will be for 6 month period.

Selection criteria:

Inclusion criteria:

1. Teeth with Miller’s class I or class II gingival recession.

2. More than 18 years of age.

3. Willing to comply with the study related procedures.

Exclusion criteria:

1. Previous surgical attempts to correct the gingival recession.

2. Long term (more than 2 weeks) use of antibiotics in past 3 months.

3. Patients who are unable to perform routine oral hygiene procedures or not complying

with the oral hygiene instructions.

4. Mucosal disorders like high frenal attachments and ulcers.

5. Mal-aligned teeth.

6. Smokers or patients with tobacco chewing habits.

7. Medically compromised patients.

8. Pregnant.

Clinical parameters:

Clinical parameters will be assessed at different time intervals (at baseline, 1, 3 and 6 months) in

both experimental and control group. Following clinical parameters will be recorded.

1. Probing depth.

2. Recession width.

3. Clinical attachment level.

4. Keratinized gingival width.

5. Gingival/mucosal thickness

Investigations:

1. Blood investigations.

2. Intraoral periapical radiographs (IOPA)

Study design:

Patients will be divided randomly into the following groups.

1. Experimental group- Treatment of Miller’s class I or class II gingival recession with platelet

rich fibrin and coronally advanced flap procedure.

2. Control group- Treatment of Miller’s class I or class II gingival recession with coronally

advanced flap alone.

The patients with Miller’s class I or class II recession will be treated with the platelet

rich fibrin and coronally advanced flap on experimental group and only coronally advanced flap

alone on control group. All clinical parameters will be assessed at baseline and at 1, 3 and 6

months postsurgery.

.

Statistical analysis:

Results will be subjected for statistical analysis by following test.

Paired t test- Intra group comparison.

Unpaired t test- Inter group comparison.

8

7.3 Does the study require any investigations or interventions to be conducted on patients or other humans or animals? If so, please describe briefly.

Yes, this study involves collection of blood sample from experimental group patients for

preparation of platelet rich fibrin for the treatment of gingival recessions.

7.4 Has ethical clearance been obtained from your institution in case of 7.3?

Yes.

References:

1. Kumar A P, Fernandes B, Surya C. Platelet rich fibrin: A promising approach for root

coverage. Journal of Interdisciplinary Dentistry 2011; 1(2): 115-118.

2. Aleksic Z, Jankovic S, Dimitrijevic B, Diynic-Resnik T, Milinkovic I, Lekovic V. The use of

platelet rich fibrin membrane in gingival recession treatment. Srp Arh Celok Lek 2010;

138(1-2): 11-8.

3. Anilkumar K, Geetha A, Umasudhakar, Ramakrishna T, Vijayalakshmi R and Pameela E.

Platelet rich fibrin: A novel root coverage approach. Journal of Indian Society of

Periodontology 2009; 13(1): 50-54.

4. Jankovic S, Aleksic T, Milinkovic S, Dimitrijevic B. The coronally advanced flap in

combination with platelet rich fibrin and enamel matrix derivative in the treatment of gingival

recession: A comparative study. Eur J Esthet Dent 2010; 5(3): 260-73.

5. Aroca S, Keglevich T, Barbieri B, Istvan G, and Etienne D. Clinical evaluation of a modified

coronally advanced flap alone or in combination with a platelet rich fibrin membrane for the

treatment of adjacent multiple gingival recession: A 6 month study. Journal of Periodontology

2009; 80(2): 244-252.