Clinical and radiographic effects of ascorbic acid-augmented platelet-rich fibrin versus platelet-rich fibrin alone in intra-osseous defects of stage-III periodontitis patients: a randomized controlled clinical trial

Abstract

Aim To assess platelet-rich fibrin (PRF) with ascorbic acid (AA) versus PRF in intra-osseous defects of stage-III periodontitis patients. Methodology Twenty stage-III/grade C periodontitis patients, with ≥ 3 mm intra-osseous defects, were randomized into test (open flap debridement (OFD)+AA/PRF; n = 10) and control (OFD+PRF; n = 10). Clinical attachment level (CAL; primary outcome), probing pocket depth (PPD), gingival recession depth (RD), full-mouth bleeding scores (FMBS), full-mouth plaque scores (FMPS), radiographic linear defect depth (RLDD) and radiographic defect bone density (RDBD) (secondary-outcomes) were examined at baseline, 3 and 6 months post-surgically. Results OFD+AA/PRF and OFD+PRF demonstrated significant intragroup CAL gain and PPD reduction at 3 and 6 months (p < 0.001). OFD+AA/PRF and OFD+PRF showed no differences regarding FMBS or FMPS (p > 0.05). OFD+AA/PRF demonstrated significant RD reduction of 0.90 ± 0.50 mm and 0.80 ± 0.71 mm at 3 and 6 months, while OFD+PRF showed RD reduction of 0.10 ± 0.77 mm at 3 months, with an RD-increase of 0.20 ± 0.82 mm at 6 months (p < 0.05). OFD+AA/PRF and OFD+PRF demonstrated significant RLDD reduction (2.29 ± 0.61 mm and 1.63 ± 0.46 mm; p < 0.05) and RDBD-increase (14.61 ± 5.39% and 12.58 ± 5.03%; p > 0.05). Stepwise linear regression analysis showed that baseline RLDD and FMBS at 6 months were significant predictors of CAL reduction (p < 0.001). Conclusions OFD+PRF with/without AA significantly improved periodontal parameters 6 months post-surgically. Augmenting PRF with AA additionally enhanced gingival tissue gain and radiographic defect fill. Clinical relevance PRF, with or without AA, could significantly improve periodontal parameters. Supplementing PRF with AA could additionally augment radiographic linear defect fill and reduce gingival recession depth.

Ascorbic Acid/Retinol and/or Inflammatory Stimuli’s Effect on Proliferation/Differentiation Properties and Transcriptomics of Gingival Stem/Progenitor Cells

“…Clinically, these primary events occur under inflamed periodontal micro-environmental conditions, with inflammatory cytokines stage-managing the path of events [ 2 , 37 , 38 ]. Apart from their important roles in periodontal repair/regeneration [ 13 , 14 , 39 , 40 ], AA and retinol exert anti-oxidative effects against periodontitis-induced tissue damages [ 41 , 42 ], demonstrate immunomodulatory capabilities on stem/progenitor cells, dendritic cells, macrophages, T- and B-cells, and markedly downregulate IL-1α, IL-1β, IL-6, TNF-β, and nitric oxide release [ 43 , 44 , 45 , 46 ]. Most importantly, AA and retinol at specific concentrations, which were employed in the current investigation, could drive cellular reprogramming/de-differentiation and pluripotency [ 19 , 20 , 47 ].…”

Clinical and radiographic evaluation of low-speed platelet-rich fibrin (PRF) for the treatment of intra-osseous defects of stage-III periodontitis patients: a randomized controlled clinical trial

“…Future research is required to explore possible advancements in blood collection tube compositions and their influence on the obtained low-speed PRF volume and quality [ 32 , 47 ]. Horizontal centrifugal procedures, which are postulated to enhance PRF inclusion and uniform distribution of platelets and leucocyte [ 57 , 58 ], should be further investigated with various centrifugal speed and force settings, with special emphasis on optimization of the regenerative and antibiotics/biological delivery potential of low-speed PRF ( 30 , 59 ). Finally, further studies with longer follow-up periods are needed to confirm the reported effects, especially in comparison to different PRF preparation schemes (e.g., L-PRF) or in combination with periodontal biomaterials (bone grafts or biological agents).…”

“…Films were scanned (Xios Scan, Dentsply Sirona, PA, USA) and transferred into an image processing software (Planmeca Romexis, V.6, all-in-one dental imaging software, Helsinki, Finland). The baseline radiographic defect angle was measured as the angle formed by the bony wall of the defect with the long axis of the tooth, and the linear radiographic defect depth (RLDD) was determined from the base of radiographic bone defect to the alveolar crest, which was measured as reported previously [ 30 , 34 ] at baseline and 6 and 9 months. Radiographic bone fill in millimeters was calculated by subtracting follow-up values from baseline, and percentages were expressed as proportion of bone fill of the baseline RLDD.…”

“…Participants' recruitment, operation, and follow-up were carried out between September 2019 and May 2021 at the Department of Periodontology, Faculty of Dentistry, Cairo University, Egypt. Included participants were 18 years in age or older, did not have any previous surgical periodontal therapy at the treatment site, diagnosed with stage-III periodontitis with CAL ≥ 5 mm, PD ≥ 6 mm, which persisted 6-8 weeks following non-surgical periodontal therapy [12], with two or three-walled intra-osseous defect, and FMBS [27] and FMPS [28] less than 20% [29,30]. Exclusion criteria were the presence of tooth mobility, intra-osseous defects extending to the furcation area, smokers, presence of systemic condition that could affect periodontal healing (e.g., diabetes or hyperthyroidism), history of radiotherapy, chemotherapy or bisphosphonate intake, active orthodontic therapy, and pregnant or lactating females [30,31].…”

Arthroscopic Meniscal Repair With Second-Generation Platelet-Rich Fibrin Clot Augmentation

“…Unlike PRP, PRF has the unique property of progressive release of cytokines and growth factors during fibrin matrix remodeling over a period of up to 4 weeks, thereby enhancing healing. [19][20][21] In addition, PRF does not have any negative influence of the chemicals added during PRP preparation. We describe a reproducible and simple way to harvest PRF and create and use a PRF clot, along with detailed instructions on how to integrate the clot with a meniscal repair arthroscopically.…”