Combined effectiveness of platelet rich fibrin and bone graft in the management of endodontically treated mandibular grade II furcation defects when used with or without diode laser. A Randomized controlled clinical trial

The periodontal disease is a chronic inflammatory process, characterized by microbial etiology and cyclic evolution which  determines a progressive, site-specific destruction of the supporting tissues of the tooth and proceeds from the superficial (gingiva) to the deep periodontium (alveolar bone, periodontal ligament, cementum), resulting in typical pathological lesions (periodontal pockets, gingival recessions, vertical and/or horizontal bone resorption, bi or tri furcation lesions etc) to the loss of the dental element.1 According to American Academy of Periodontology  furcation  lesion is defined as the pathologic resorption of bone in the anatomic area of multirooted tooth/teeth where the roots diverge as cited in the report of  Sanz M et al2 and was further classified as  grades I to IV by Irving Glickman in 1953.

Different regenerative approaches have been proposed for management of furcation involvement: Guided tissue regeneration, enamel matrix derivatives, bone substitutes like autogenous bone graft, alloplast, autograft etc. but the complete closure of furcation defects is unpredictable because of  multiple reasons such as  narrow furcation area, root approximation, cervical enamel projections, ridges, convexities and concavities on root surface that frequently render the defect impossible to  instrument effectively. Therefore, furcation defects represent a formidable problem in the treatment of periodontal diseases.3

Different studies showed variable results as few suggested partial regeneration of grade II furcation defects in vital teeth when treated by  PRF alone3 or in combination with  bone graft4 whereas  reports of Salaria SK et al5,6 in endodontically treated non vital toothshowed complete regeneration when treated with combination  of PRF and bone graft. In spite of different periodontal regenerative approaches, as currently, not a single regenerative material is considered gold standard in the treatment of osseous defects.6

  Currently, Choukroun’s Platelet-rich fibrin(PRF) and Diode laser attracted lot of attention of various researchers because of their distinctive properties. Choukroun’s PRF is enriched with platelets, cytokine and growth factors when used as membrane or as grafting material creates an improved space making effect which, facilitates cell event that are favourable for periodontal regeneration leading to mineralized tissue formation,7 it also  induces the cell proliferation of osteoblasts, periodontal ligament cells, growth factors, but suppress the oral epithelial cell growth,8 thereby improving the soft and hard tissue healing.

Laser have several potential benefits such as antibacterial effect, stimulation of wound healing, haemostasis and delayed epithelial migration which  may facilitate the outcome of  flap surgery.9 To the best of our knowledge, the use of PRF, bone graft with or without  Diode Laser in the management of grade II furcation defects in endodontically treated teeth are scarce in literature. Therefore, the present study was designed to evaluate the combined effectiveness of PRF and bone allograft in the management of  endodontically treated mandibular grade II furcation defect when used with or without Diode Laser.

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