Effectiveness of Injectable Platelet Rich Fibrin, Oxygen Releasing Gel and Hyaluronic Acid Gel as Local Drug Delivery Agents in the Treatment of Chronic Periodontitis: A Clinico-Microbiologic Study
DOI:
https://doi.org/10.15517/dafg0q85Keywords:
Dental scaling; Hyaluronic acid; Periodontal pocket; Periodontitis, Platelet-rich fibrin; Root planning.Abstract
This study clinically and microbiologically evaluated the efficacy of liquid i-PRF, oxygen-releasing gel, and hyaluronic acid (HA) gel as local drug delivery (LDD) agents adjunctive to scaling and root planing (SRP) for treating periodontal pockets. A split-mouth randomized controlled trial involved 12 patients with 80 periodontal pockets (3-6 mm depth). Pockets were randomly assigned to four groups: Control (SRP alone), Experimental Group I (i-PRF + SRP), Group II (oxygen-releasing gel + SRP), and Group III (HA gel + SRP). Plaque samples were analyzed for spirochetes using dark-field microscopy at baseline, 1- and 3-months post-treatment. Other primary outcome assessed were Plaque Index (PI), Gingival Index (GI), Probing Pocket Depth (PPD), Clinical Attachment Level (CAL), and Gingival Recession (GR)—were measured using a UNC-15 probe. The statistical tests used were the Bonferroni test for intragroup comparison, the paired t test, the repeated measure analysis of variance test (ANOVA), and the unpaired t test for intergroup comparison between different groups. Intragroup analysis showed significant improvements in PI, GI, PPD, CAL, and GR across all groups (p<0.05). Intergroup comparisons revealed no significant differences. Microbiologically, i-PRF significantly reduced spirochetes (p<0.05), while oxygen-releasing gel showed superior clinical outcomes (p<0.05). All LDD agents have shown significant therapeutic potential. Oxygen-releasing gel excelled clinically, while i-PRF was microbiologically superior, indicating its therapeutic potential for periodontal pocket treatment.
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Hinrichs J.E., Kotsakis G., Naik D.G., Uppoor A. Classification of disease and conditions affecting the periodontium. In: Newman M. G.,Takie H.H., Klokkevold. P.R., Carranza F. A., editors. Carranza’s Clinical Periodontology 12th edition, Saunders Elsevier Publication, 2016.p.p.57-72.
Glickman I., Smulow J.B. Periodontal disease: Clinical, radiographic, and histopathologic features. Saunders: Philadelphia; 1974.
Graziani F., Karapetsa D., Alonso B., Herrera D. Nonsurgical and surgical treatment of periodontitis: How many options for one disease? Periodontol. 2000; 2017: 152-88.
Teles R.P., Haffajee A.D., Socransky S.S. Microbiological goals of periodontal therapy. Periodontol. 2000;2006: 42: 180-218.
Lindhe J., Westfelt E., Nyman S., Socransky S.S., Heijl L., Bratthall G. Healing following surgical/non-surgical treatment of periodontal disease. A clinical study. J Clin Periodontol 1982; 9: 115-28.
Antczak-Bouckoms A., Joshipura K., Burdick E., Tulloch J.F. Meta-analysis of surgical versus non-surgical methods of treatment for periodontal disease. J Clin Periodontol. 1993 Apr; 20: 4: 259-68.
Shah S.A., Vijayakar H.N., Rodrigues S.V., Mehta C.J., Mitra D.K., Shah R.A. To compare the effect of the local delivery of hyaluronan as an adjunct to scaling and root planing versus scaling and root planing alone in the treatment of chronic periodontitis. J Indian Soc Periodontol. 2016 ; 20: 549-56.
Ghanaati S., Booms P., Orlowska A., Kubesch A., Lorenz J., Rutkowski J. et al. Advanced platelet- rich fibrin: A new concept for cell-based tissue engineering by means of inflammatory cells. J Oral Implantol 2014; 40: 679-89.
Vuckovic M., Nikolic N., Milasin J., Đorđević V., Milinkovic I., Asotic J. et al. The effect of injectable platelet rich fibrin use in the initial treatment of chronic periodontitis. Srp Arh Celok Lek. 2020; 148: 280-5.
Dalton S.J., Whiting C.V., Bailey J.R., Mitchell D.C., Tarlton J.F. Mechanism of chronic skin ulceration linking lactate, transforming growth factor-beta, vascular endothelial growth factor, collagen remodeling, collagen stability, and defective angiogenesis. J Invest Dermatol. 2007; 127: 958-68
Mesa F.L., Aneiros J., Cabrera A. Antiproliferative effect of topical hyaluronic acid gel. Studies in gingival biopsies of patients with periodontal disease. Histol. Histopathol. 2002; 17: 747-53.
Laxman V.K., Khatri M., Devaraj C.G. Evaluation of new furcation stent as a fixed reference point for class II furcation measurements. J Contem Dent Pra.c 2009; 10: 1-11.
Silness J., Loe H. Periodontal disease in pregnancy II. Correlation between oral hygiene and periodontal condition. Acta odontol Scand 1964; 21: 533-51
Loe H., Silness J Periodontal diseases in pregnancy. I. Prevalence and severity Acta odontol Scand 1963; 21: 533-51
Roman -Torres C.V.G., Bryington M.S., Kussaba S.T., Pimentel A.C., Jimbo R., Cortelli J.R. et al. Comparison Of Full-Mouth Scaling and Quadrant-Wise Scaling in the Treatment of Adult Chronic Periodontitis. Braz Dent J. 2018; 29: 296-300.
Soni R., Priya A., Yadav H., Mishra N., Kumar L. Bone augmentation with sticky boneand platelet- rich fibrin by ridge- split technique and nasal floor engagement for immediate loading of dental implant after extracting impacted. Natl J Maxillofac Surg 2019; 10: 98-101.
Fotani S., Shiggaon L.B., Waghmare A., Kulkarni G., Agrawal A., Tekwani R. Effect of injectable platelet rich fibrin (i-PRF) on thin gingival biotype: A clinical trial Journal of Appl. Dent Med Sci.2019; 5: 9-16.
Cunha E.J., Auersvald C.M., Deliberador T.M., Gonzaga C.C., Esteban Florez F.L., Correr G.M., Storrer C.L.M. Effects of Active Oxygen Toothpaste in Supragingival Biofilm Reduction: A Randomized Controlled Clinical Trial. Int J Dent. 2019 Jul 1; 2019: 3938214.
Koul A., Kabra R., Chopra R., Sharma N., Sekhar V. Comparative evaluation of oxygen releasing formula (blue m® gel) and chlorhexidine as an adjunct with scaling and root planing in the management of patients with chronic periodontitis- A clinicmicrobiological study. J Dent Specialities. 2019; 7: 111-7.
Asha A., Prabhuji M.L.V., Rashmi P., Roja Y., Bhavikatti S.K. Pocket reduction with high concentrated oxygen oral gel: A Preliminary Case Report Research Journal of pharmacy and technology2022; 15 (10): 4367-1.
Johannsen A., Tellefsen M., Wikesjö U., Johannsen G. Local delivery of hyaluronan as an adjunct to scaling and root planing in the treatment of chronic periodontitis. J Periodontol. 2009 Sep; 80 (9): 1493-7.
Lang N.P. Focus on intrabony defects-conservative therapy. Periodontol 2000 2000; 22: 51-8.
Lindhe, J., Nyman, S., & Karring, T. (1982). Scaling and root planing in shallow pockets. Journal of Clinical Periodontology, 9 (5), 415-418.
Badersten A., Nilveus R., Egelberg J. Effect of nonsurgical periodontal therapy. III. Single versus repeated instrumentation. J Clin Periodontol. 1984; 11: 114-24.
Miron R.J., Zhang Y., Ghanaati S., Choukroun J., Hernandez M., Kandalam U. et al. Injectable platelet rich fibrin (i-PRF): Oppurtunities in regenerative dentistry. Clin Oral Investig 2017, 21: 2619-27.
Pullishery F., Hussein Alattas M., Roshdy Abdelrasoul M., Fouad Hassan A., Abdelhamid Ahmed Derbala D., Hashir S. Effectiveness of i-PRF in periodontal regeneration - A systematic review and meta-analysis. Saudi Dent J. 2024 Feb; 36 (2): 214-221.
Niveda R. and Kaarthikeyan G. Effect of oxygen releasing oral gel compared to chlorhexidine gel in the Treatment of Periodontitis. Int. J. Pharm. Res. 2020; 32: 75-82.
Deliberador T.M., Weiss S.G., Rychuv F., Cordeiro G., Cate M.C.L.T., Leonardi L. et al. Comparative analysisin vitro of the application of blue M® oral gel versus chlorhexidine on porphyromonas gingivalis. A Pilot Study Advances in Microbiology 2020; 10: 194-201.
Agarwal R., Kamble P.S., Mangalekar S.B., Nayak Y., Sawant P., Chatterjee A. A comparative evaluation of efficacy of oxygen releasing formula gel, chlorhexidine gel and scaling and root planing alone in the management of chronic periodontitis– A clinico-microbiological study. Eur. Chem. Bull. 2023; 12: 4520-4536.
Dohan D.M., Choukroun J., Diss A. Platelet-rich fibrin (PRF): A second-generation platelet concentrate. Part II: Platelet-related biologic features. Oral Surg Oral Med Oral Pathol Oral RadiolEndod. 2006; 101: 45-50.
Serafini G., Lopreiato M., Lollobrigida M., Lamazza L., Mazzucchi G., Fortunato L. et al. Platelet Rich Fibrin (PRF) and Its Related Products: Biomolecular Characterization of the Liquid Fibrinogen. J Clin. Med. 2020; 9: 1099.
Zhou X., Wang J., Liu W., Huang, X., Song, Y., Wang, Z.et al..Periodontal Status and Microbiologic Pathogens in Patients with Chronic Obstructive Pulmonary Disease and Periodontitis: A Case-Control Study. Int J Chron Obstruct Pulmon Dis. 2020; 15: 2071-2079.
Choukroun J., Ghanaati S. Reduction of relative centrifugation force within injectable platelet- rich-fibrin (PRF) concentrates advances patients' own inflammatory cells, platelets and growth factors: The first introduction to the low speed centrifugation concept. Eur J Trauma EmergSurg 2018; 44: 87-95.
Karde P.A., Sethi K.S., Mahale S.A., Khedkar S.U., Patil A.G., Joshi C.P. Comparative evaluation of platelet count and antimicrobial efficacy of injectable platelet-rich fibrin with other platelet concentrates: An in vitro study. J Indian Soc Periodontal 2017; 21: 97-101.
Xu, Y., Höfling, K., Fimmers, R., Frentzen, M., & Jervøe-Storm, P. M. Clinical and Microbiological Effects of Topical Subgingival Application of Hyaluronic Acid Gel Adjunctive to Scaling and Root Planing in the Treatment of Chronic Periodontitis. Journal of Periodontology, 2004; 75 (8): 1114-1118.
Gontiya, G.; Galgali, S.R. Effect of hyaluronan on periodontitis: A clinical and histological study. J. Indian Soc. Periodontol. 2012, 16: 184-192.
Eick S., Renatus A., Heinicke M., Pfister W., Stratul S.I., Jentsch H. Hyaluronic Acid as an adjunct after scaling and root planing: a prospective randomized clinical trial. J Periodontol 2013 Jul; 84 (7): 941-949.
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