Clinical and Radiographic Evaluation of the Efficacy of Platelet-Rich Fibrin as an Adjunct to Minimally Invasive Non-Surgical Treatment in Individuals With Advanced Periodontitis

Periodontitis is a chronic multifactorial inflammatory disease associated with dysbiotic dental biofilm and progressive destruction of the tooth-supporting tissues. In advanced periodontitis, vertical alveolar bone loss may result in periodontal intrabony defects. These defects are clinically important because they are commonly associated with deep periodontal pockets, clinical attachment loss, bleeding on probing, and increased risk of further periodontal breakdown if not adequately treated.

The management of periodontal intrabony defects traditionally includes non-surgical periodontal therapy as the initial treatment approach. However, in advanced cases, residual deep pockets and persistent inflammation may remain after conventional non-surgical therapy. Minimally invasive non-surgical treatment (MINST) has been proposed as a tissue-preserving approach for the management of intrabony periodontal defects. MINST aims to remove subgingival biofilm and calculus through careful instrumentation while minimizing trauma to the periodontal tissues. The technique emphasizes the preservation of the interdental papilla and marginal gingiva, limited tissue manipulation, avoidance of aggressive root planing and gingival curettage, and support of stable blood clot formation within the defect.

In this study, MINST is performed using fine periodontal instruments and thin ultrasonic tips without flap elevation. The objective of this approach is to achieve effective subgingival debridement while preserving soft tissue architecture and supporting periodontal wound healing. The minimally invasive nature of the procedure may be particularly relevant for patients with advanced periodontitis, where maintaining gingival tissue stability and reducing postoperative morbidity are important clinical goals.

Platelet-rich fibrin (PRF) is an autologous platelet concentrate obtained from the patient's own blood. PRF contains platelets, leukocytes, fibrin, and growth factors that may contribute to wound healing, angiogenesis, tissue repair, and periodontal regeneration. Concentrated platelet-rich fibrin (C-PRF) is a liquid PRF formulation prepared by collecting the cell-rich fraction from the buffy coat layer after centrifugation. Compared with liquid PRF protocols, C-PRF is designed to provide a higher concentration of platelets and leukocytes in a small volume, potentially increasing its biological activity at the application site.

Although several studies have evaluated different adjunctive biomaterials with minimally invasive periodontal therapy, evidence regarding the use of C-PRF together with MINST in advanced periodontitis remains limited. Therefore, this study is designed to evaluate whether the adjunctive application of C-PRF may provide additional clinical and radiographic benefits when combined with MINST in patients with stage III-IV periodontitis and periodontal intrabony defects.