"Comparison of the effectiveness of demineralized freeze dried bone allograft and titanium-prepared platelet rich fibrin in treating intra-bonydefects under surgical operating microscope A Randomized split mouth study"

Periodontitis is an infectious disease of the supporting structures of the teeth

in which changes occurring within the alveolar bone are very crucial because

the destruction of the bone is responsible for mobility and tooth loss. The

resorption process of bone is usually interfered by various factors such as

severe gingival inflammation, changes within the bacterial plaque composition,

continuous or repeated trauma to the tooth by occlusal discrepancies and

systemic diseases.

One way of determining whether an inflammatory gingival lesion has

spread into the underlying periodontal structures is by radiographic evidence

of crestal alveolar bone loss and associated pocket formation. It is often

characterized by formation of intra-bony defects and the treatment of these

defects still remains a challenge to the clinician. Several regenerative

procedures have been described in the literature.

Graft material used for periodontal regeneration are categorized as autografts,

allografts, xenografts. Autografts and DFDBA have histologic evidence of pdl

regeneration in humans. Harvesting intraoral autogenous bone for pdl grafting is

often an unattractive option due to the limited quantity of bone available as well

as potential need for second surgical site. where as Decalcified freeze-dried

bone allograft (DFDBA) contains bone morphogenetic proteins (BMPs) that aid

in mesenchymal cell migration, attachment and osteogenesis have both

osteoinductive as well as osteoconductive activity and the ability to create and

maintain the space. DFDBA has been proposed as an effective regenerative

material for osseous defects.

Later on, research efforts shifted toward platelet concentrates because of the

acceleration of wound healing and stimulation of adjacent cells for the

restoration of the lost periodontium.

Platelet concentrates are way ahead of other biomaterials due to constant

release of growth factors over a time period, which are crucial for stimulation

of adjacent progenitor cells, leading to periodontal regeneration and tissue

healing.5 These platelet concentrates also have leucocytes, vitronectin,

fibronectin, bone morphogenetic proteins (BMPs), and cytokines that

contribute to different stages of the wound healing process.6 Initially, platelet-

rich plasma (PRP) was used alone or with bone graft in the treatment of intra-

bony defects. Although the results were reasonable, due to the risk of

antigenicity as a result of the addition of bovine anti-thrombin, leucocyte-

platelet-rich fibrin (L-PRF) was introduced, which does not require any kind of

anticoagulant.