Comparative evaluation of i-prf with micro-needling and low-level laser application on post operative healing associated with open flap debridement in the treatment of stage iii periodontitis: A split mouth study

Periodontitis is a chronic inflammatory disease affecting the supporting structures of the teeth, including the gingiva, periodontal ligament, and alveolar bone. It is primarily initiated by a dysbiotic bacterial biofilm but perpetuated by an exaggerated host immune response, leading to progressive tissue destruction and eventual tooth loss if untreated. The management of periodontitis aims to eliminate the microbial etiology, reduce inflammation, halt disease progression, and restore periodontal health. Initial therapy typically involves non-surgical approaches such as scaling and root planing combined with improved oral hygiene practices. In cases with persistent deep pockets or advanced disease, surgical interventions like open flap debridement, regenerative procedures, and use of biologics (such as platelet concentrates or growth factors) are employed to gain better access for debridement, facilitate tissue regeneration, and improve long-term outcomes. Injectable platelet-rich fibrin (i-PRF) is a concentrated autologous preparation rich in growth factors that promotes tissue regeneration and healing. When combined with micro-needling on the inner aspect of the flap (the connective tissue side), it enhances penetration and release of growth factors into the surgical site. This approach may accelerate soft-tissue healing, reduce post-operative inflammation, and improve clinical outcomes such as pocket depth reduction and attachment gain compared to flap surgery alone. Low-level laser therapy (LLLT) applied to the inner aspect of the flap during periodontal surgery enhances bio-stimulation, promoting faster and better-quality healing. By stimulating fibroblast activity, collagen production, angiogenesis, and reducing inflammation, LLLT improves tissue regeneration and reattachment to root surfaces.