CLINICAL AND RADIOGRAPHIC EVALUATION OF THE EFFICACY OF A PRF BLOCK WITH GTR MEMBRANE IN THE MANGAEMENT OF GRADE II FURCATION DEFECTS - A RANDOMISED CONTROL CONTROLLED STUDY

Periodontitis is a diseasethat is characterized by the destruction of periodontal tissue, if leftuntreated it will lead to different types of bone deformities. One suchdeformity is furcation defect. Various surgical regenerative techniques havebeen proposed in order to treat furcation defects of periodontitis-affectedteeth. The use of autologous platelet concentrates (APCs) is gaining popularityas a source of multiple growth factors in high concentrations, for regenerativetreatments in many clinical applications1. Autologous plateletconcentrates are advantageously used as a cost-effective adjunct to surgicalregenerative therapy, even in combination with bone grafts and barriermembranes2. Several randomized controlled trials have reportedimprovement of post-operative soft and hard tissue healing, and improved bonefill and attachment gain.

Platelet rich fibrin(PRF) is a second-generation autologous platelet concentrate introduced byChoukron et al 2001. Ghanaati et al in 2014 introduced a modification of PRFclots (A-PRF) by using low speed centrifugation concept which significantlyincreases the platelet and leuckocyte number and also releases significantlyhigher concentrations of key growth factors3. Further Miron et al in2015 introduced liquid variety of PRF (i-PRF) which may accelerate the wound-healingprocesses with increased vascularization. The benefits of i-PRF show slow andsustained release of growth factors, by releasing the expression oftransforming growth factor-β and collagen-1 mRNA along with cells migration fortissue regeneration4.

Abdallah et al in 2017introduced a “PRF block†consisting of L-PRF mixed with i- PRF and syntheticbone graft formed into a cohesive block. This block forms a volumetric matrixwhich can be used to fill various osseous defects5. Jayasheela et alused A-PRF block in infrabony defects which showed significant gain in the bonevolume, high defect fill, defect resolution. In A-PRF block, the cut membraneof the A-PRF acts as a biological matrix and promotes migration of osteoprogenitorcells to the centre of the graft6. Therefore, we hypothesize thatformation of cohesive mass obtained from the use of A-PRF block could performbetter compared to bone grafts in management of furcation defects owing to thebetter handling characteristics and sustained delivery of growth factors. Here,we are using demineralized bovine bone matrix (DMBM) which has been found toenhance mesenchymal cells differentiate into giant cells and chondrocytes,cartilage formation and bone formation in the vascularized areas of matrix;which enhances new tissue formation within the period of 30days. DMBM hasosteoconductive and osteoinductive properties due to the inherent bonemorphogenetic protein that remains behind which stimulates the adjacent undifferentiatedcells to form bone7. To the best of our knowledge, there are nostudies where A-PRF block with xenograft was used in the management of Grade Ⅱfurcation defects, so the aim of the presentstudy is to evaluate the clinical and radiographic outcomes ofGrade II furcation defects treated with A-PRF block and GTR membrane.