Comparative Evaluation Of Microneedling vs Injectable Platelet Rich Fibrin In Thin Periodontal Phenotype: A Randomised Split Mouth Clinical Trial

INTRODUCTION The gingival phenotype and different parts of the masticatory mucosa have become the subject of considerable interest in Periodontics, especially from an aesthetic and therapeutic perspective. The periodontal phenotype has been defined as the combination of gingival phenotype and buccal bone plate thickness (bone morphotype). Gingival phenotype refers to gingival thickness (GT) and keratinized tissue width (KTW).

Gingival phenotypes can be classified as scalloped and thin or flat and thick gingiva. A gingival thickness of ≥1 mm is defined as thick phenotype and a gingival thickness of ≤1 mm as thin phenotype1. Thin gingival phenotype are very friable and might be prone to recede in response to traumatic insults, such as plaque-related inflammation and traumatic toothbrushing. Gingival recession is usually observed in the presence of trauma and inflammation in individuals with thin phenotypes, whereas pocket formation has been reported in individuals with thick phenotypes.

Soft tissue grafting in areas of thin phenotypes can enhance the quality of the gingival tissue. The best way to convert a thin soft tissue to a thick phenotype is through subepithelial connective tissue grafting Various other soft tissue augmentation procedures include: - modified roll technique and use of acellular dermal matrix. There were many drawback of these techniques such as were not cost effective, complications, second surgical site creation, healing and time consuming, etc.

Therefore marked transformation in the field of periodontics has led to the development of newer, less invasive therapeutic approaches, which allows proper management of surrounding tissues to provide best outcome of periodontal therapy. Minimally invasive treatment approaches help to achieve satisfactory therapeutic results with minimum trauma to tissues. Recent study has shown i-PRF (injectable Platelet Rich Fibrin) and Microneedling procedures to be effective in increasing gingival tissue thickness.

I-PRF prepared according to low-speed centrifugation concept can provide a significant advantage for the regeneration process, as it is rich in platelets, leucocytes and growth factors. I-PRF clots and forms a gel form after approximately 10-15 min and preserves its content in the tissue for sustained release. Recent studies have shown that in comparison to PRP and the blood clot even though there is slight or no increases in blood cell concentrations and growth factors; i- PRF was capable of inducing higher cell migration and mRNA expression of TGF- β, PDGF, osteocalcin and significant increase in type I collagen gene expression. It has been suggested that i- PRF provides a three- dimensional fibrin clot network embedding platelets, leucocytes, type I collagen, osteocalcin and growth factors acting as a dynamic gel with additional release of growth factors up to 10 days. Hence studies have documented that i-PRF results in increased gingival thickness.