journal club Mandibular Degree II Furcation Defects Treatment With Platelet-Rich Fibrin and 1% Alendronate Gel Combination: A Randomized Controlled Clinical Trial

1. Mandibular Degree II Furcation Defects Treatment With
Platelet-Rich Fibrin and 1% Alendronate Gel
Combination: A Randomized Controlled Clinical Trial
Dharmendra at el , J Periodontol , March 2017

2. Introduction
Platelet-rich fibrin (PRF) is a pool of growth-promoting factors and cytokines that
pro- mote bone regeneration and maturation of soft tissue.
Alendronate (ALN), an influential member of the bis-phosphonate group, is
known to enhance osteo-blastogenesis and inhibit osteoclastic bone resorption,
thus promoting tissue regeneration.

3. AIM
To assess effectiveness of PRF and 1% ALN gel combination in mandibular degree
II furcation defect treatment in comparison with PRF and access therapy alone.

4. MATERIALS AND METHODS
Patients Selection
Total of 72 systemically healthy patients
36 males and
36 females
Aged 30 to 50 years
Mean age: 38 years
Inclusion criteria
Presence of degree II furcation defects buccally in vital, asymptomatic mandibular first
and second molars with a radiolucent furcation area on an intraoral periapical
radiograph with vertical probing depth (PD) >5 mm and horizontal probing depth >3
mm after an etiotropic phase, i.e., scaling and root planing (SRP).
No history of periodontal therapy or antibiotic treatment in previous 6 months.

5. Exclusion criteria
Presence of systemic conditions known to affect periodontal status
Use of medications known to affect periodontal therapy outcomes
Blood disorders and inadequate platelet count (<200,000/mm3)
Pregnancy/lactation
Smoking and tobacco use
Immunodeficiency
Teeth with extensive gingival recession
Poor oral hygiene (plaque index [PI] >1.5) after etiotropic phase reevaluation

6. Pre-surgical Therapy
Using ultrasonic and hand instrumentation, a full-mouth SRP was done using local
anaesthetic solution.
Periodontal examination was performed 6 to 8 weeks after etiotropic phase treatment
to obtain confirmation of desired sites for the study.

7. These patients divided into three groups
Group 1 consisted of 26 sites treated with access therapy, i.e., open-flap debridement
.
Group 2 consisted of 26 sites treated with access therapy with autologous PRF.
Group 3 included 26 sites treated with access therapy and autologous PRF + 1%
ALN gel.

8. Clinical and Radiographic Measurements
Clinical parameters
PI (site specific),
modified sulcus bleeding index (mSBI),
PD
Relative vertical attachment level ( RVAL )
Relative Horizontal attachment level ( RHAL).

9. Customised acrylic stents with grooves were used to ensure a reproducible
placement of a probe for vertical measurement and a probe for horizontal
measurement.
All furcation defects were assessed at baseline and at 9 months postoperatively.
For obtaining standardised radiographs, single customised bite blocks and the
paralleling technique was used.

10. Preparation of PRF
The method was described for the first time by Dohan et al.
1% ALN Gel Preparation
ALN gel was formulated as proposed by Reddy et al.

11. Surgical Procedure
Povidone iodine solution was used for extraoral antisepsis, and 0.12% chlorhexidine
digluconate was used for pre-surgical mouth-rinsing.
After achieving adequate local anesthetic effect, intracrevicular in-cisions were
performed on both sides (buccal and lingual).
After this, a mucoperiosteal flap was reflected. Maximum interproximal soft tissue
was preserved.

12. Statistical Analyses
Statistical software was used for data analyses.
x2 test was used for comparison.
Shapiro–Wilk test was used for testing the normality assumption of data.
Analysis of variance (for simultaneous comparisons among three groups) and
post hoc Scheffe test

13. Greater PD reduction was found in group 2 and group 3 sites than control sites
(group 1) at 9 months postoperatively (P < 0.05).
Reduction in PD was greater in group 3 (4.4 – 0.57 mm) when compared with group
2 (3.69 – 0.76 mm) and group 1 (2.41 – 0.77 mm).
Group 2 and 3 sites presented with greater RVAL and RHAL gain as compared with
group 1, with a statistically significant difference found (P <0.05).
Result

14. RVAL and RHAL gain was greater in group 3 (4.12 – 0.6 mm and 3.64 – 0.90 mm) when
compared with group 2 (3.39 – 0.49 mm and 2.86 – 0.062 mm) and group 1 (2.33 – 0.48
mm and 2.04 – 0.35 mm).
Greater IBD depth reduction was found in group 2 and 3 sites than group 1 sites at 9 months
(P <0.05).
Group 3 showed greater percentage of bone fill (56.01% – 2.64%) as opposed to group 2
(49.43% – 3.70%) and group 1 (10.25% – 3.66%)

15. Results of the present trial showed that furcation defect sites treated with PRF +
1% ALN (group 3) resulted in marked reduction of PD (4.4 – 0.57 mm) and gain
in RVAL and RHAL (4.12 – 0.6 and 3.64 – 0.90 mm, respectively) with greater
reduction in defect depth (2.92 – 0.25 mm) and bone defect fill percentage
(56.01% – 2.64%).
The difference was statistically significant when compared with PRF alone (group
2), where reduction in PD (3.69 – 0.76 mm), RVAL and RHAL gain (3.39 – 0.49
and 2.86 – 0.062 mm, respectively), reduction in defect depth (2.59 – 0.32 mm),
and bone defect fill percentage (49.43% – 3.70%) were found.
Discussion

16. Groups 2 and 3 showed statistically significant improvements in primary and
secondary outcomes in comparison with group 1, which showed only %10% of
bone defect fill.
The remarkable reduction in PD and gain in clinical attachment seen in group 3
revealed the intensified combined efficacy of growth-promoting factors delivered
by PRF and bone synthetic activity of ALN.
The present trial also shows the greater percentage of IBD depth reduction (i.e.,
bone defect fill) in group 2 (49.43% – 3.70%) and group 3 (56.01% – 2.64%)
which is higher than in group 1(10.25% – 3.66%), exemplifying the beneficial
effects of growth-promoting factors in regeneration .

17. The present study deals with a combined approach therapy using PRF and potent
bone stimulator pharmacologic medium ALN in furcation defect treatment.
There was greater reduction in PD, more RVAL and RHAL gain, and significant
bone defect fill with PRF + 1% ALN in degree II furcation defect treatment.
Conclusion

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