Evaluation of Platelet Rich Fibrin Matrix(PRFM) as a Regenerative Material in Surgical Management of Human Periodontal Intraosseous Defects:A Randomized Controlled Trial

Periodontitis is a chronic inflammatory disease caused by bacterial Plaque, the onset and progression of which is modulated by a variety of risk factors such as systemic conditions and smoking. It causes pathological alterations of the periodontium, resulting in loss of connective tissue attachment to the tooth, apical migration of the junctional epithelium along the root surface and loss of supporting alveolar bone. If left untreated, cases of periodontal disease can lead to premature tooth loss. However, the complex structure of periodontium, which consist of soft connective tissue of gingiva and periodontal ligament, as well as the mineralized tissues, cementum and bone, makes periodontal wound healing a unique process.

Although, all the tissues of the periodontium get affected, the crux of the problem of chronic periodontal diseases lies in the changes that occur in the bone resulting in intraosseous defects of various architecture, the persistence of which even after completion of active periodontal treatment may increase the site-specific risk of progression of periodontitis.

The two primary components of periodontal therapy involves, the elimination of the periodontal infection by eliminating the pathogenic periodontal microflora which induces favourable clinical changes in the periodontium and substantial efforts should be made to alter the anatomic defect resulting from active periodontitis.

The resective surgical approach and mucogingival surgeries (MGS) were the major periodontal therapies until the 1970s. However, problems with esthetics, root sensitivity and root caries resulting from resective therapy for severe periodontitis were eventually pointed out. Also resective procedure was admitted to be a "Repair" and not "Regeneration" which has long been the goal of periodontal therapy. The past two decades has seen a radical change in periodontal surgery with a shift from resective periodontal surgery to regenerative therapies. Also the concept of treatment has changed towards regeneration with a goal of regaining natural periodontal apparatus.

Conventional surgical approaches (e.g., flap debridement) continue to offer time-tested and reliable methods to access root surfaces, reduce periodontal pockets and attain improved periodontal form/architecture. However, these techniques offer only limited potential to recover tissues, destroyed during earlier disease phases.