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

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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.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00784-021-03929-1.

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Most cited references 75

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Staging and grading of periodontitis: Framework and proposal of a new classification and case definition

Kenneth S Kornman, Henry Greenwell, Maurizio Tonetti (2018)

Authors were assigned the task to develop case definitions for periodontitis in the context of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. The aim of this manuscript is to review evidence and rationale for a revision of the current classification, to provide a framework for case definition that fully implicates state-of-the-art knowledge and can be adapted as new evidence emerges, and to suggest a case definition system that can be implemented in clinical practice, research and epidemiologic surveillance.

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Periodontitis: Consensus report of workgroup 2 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions: Classification and case definitions for periodontitis

Panos Papapanou, Mariano Sanz, Nurcan Buduneli … (2018)

A new periodontitis classification scheme has been adopted, in which forms of the disease previously recognized as "chronic" or "aggressive" are now grouped under a single category ("periodontitis") and are further characterized based on a multi-dimensional staging and grading system. Staging is largely dependent upon the severity of disease at presentation as well as on the complexity of disease management, while grading provides supplemental information about biological features of the disease including a history-based analysis of the rate of periodontitis progression; assessment of the risk for further progression; analysis of possible poor outcomes of treatment; and assessment of the risk that the disease or its treatment may negatively affect the general health of the patient. Necrotizing periodontal diseases, whose characteristic clinical phenotype includes typical features (papilla necrosis, bleeding, and pain) and are associated with host immune response impairments, remain a distinct periodontitis category. Endodontic-periodontal lesions, defined by a pathological communication between the pulpal and periodontal tissues at a given tooth, occur in either an acute or a chronic form, and are classified according to signs and symptoms that have direct impact on their prognosis and treatment. Periodontal abscesses are defined as acute lesions characterized by localized accumulation of pus within the gingival wall of the periodontal pocket/sulcus, rapid tissue destruction and are associated with risk for systemic dissemination.

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Treatment of stage I–III periodontitis—The EFP S3 level clinical practice guideline

Mariano Sanz, David Herrera, Moritz Kebschull … (2020)

Abstract Background The recently introduced 2017 World Workshop on the classification of periodontitis, incorporating stages and grades of disease, aims to link disease classification with approaches to prevention and treatment, as it describes not only disease severity and extent but also the degree of complexity and an individual's risk. There is, therefore, a need for evidence‐based clinical guidelines providing recommendations to treat periodontitis. Aim The objective of the current project was to develop a S3 Level Clinical Practice Guideline (CPG) for the treatment of Stage I–III periodontitis. Material and Methods This S3 CPG was developed under the auspices of the European Federation of Periodontology (EFP), following the methodological guidance of the Association of Scientific Medical Societies in Germany and the Grading of Recommendations Assessment, Development and Evaluation (GRADE). The rigorous and transparent process included synthesis of relevant research in 15 specifically commissioned systematic reviews, evaluation of the quality and strength of evidence, the formulation of specific recommendations and consensus, on those recommendations, by leading experts and a broad base of stakeholders. Results The S3 CPG approaches the treatment of periodontitis (stages I, II and III) using a pre‐established stepwise approach to therapy that, depending on the disease stage, should be incremental, each including different interventions. Consensus was achieved on recommendations covering different interventions, aimed at (a) behavioural changes, supragingival biofilm, gingival inflammation and risk factor control; (b) supra‐ and sub‐gingival instrumentation, with and without adjunctive therapies; (c) different types of periodontal surgical interventions; and (d) the necessary supportive periodontal care to extend benefits over time. Conclusion This S3 guideline informs clinical practice, health systems, policymakers and, indirectly, the public on the available and most effective modalities to treat periodontitis and to maintain a healthy dentition for a lifetime, according to the available evidence at the time of publication.

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Author and article information

Contributors

Karim Fawzy El-Sayed:

ORCID: http://orcid.org/0000-0002-6261-3609

karim.fawzy@gmail.com

Journal

Journal ID (nlm-ta): Clin Oral Investig

Journal ID (iso-abbrev): Clin Oral Investig

Title: Clinical Oral Investigations

Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )

ISSN (Print): 1432-6981

ISSN (Electronic): 1436-3771

Publication date (Electronic): 12 April 2021

Publication date PMC-release: 12 April 2021

Publication date (Print): 2021

Volume: 25

Issue: 11

Pages: 6309-6319

Affiliations

[1 ]GRID grid.7776.1, ISNI 0000 0004 0639 9286, Oral Medicine and Periodontology Department, Faculty of Dentistry, , Cairo University, ; Al Saraya Str. 11, Manial, Cairo, Egypt

[2 ]GRID grid.7776.1, ISNI 0000 0004 0639 9286, Oral and Maxillofacial Radiology Department, Faculty of Dentistry, , Cairo University, ; Giza, Egypt

[3 ]GRID grid.9764.c, ISNI 0000 0001 2153 9986, Clinic for Conservative Dentistry and Periodontology, School of Dental Medicine, , Christian Albrechts University, ; Kiel, Germany

Author information

Karim Fawzy El-Sayed http://orcid.org/0000-0002-6261-3609

Article

Publisher ID: 3929

DOI: 10.1007/s00784-021-03929-1

PMC ID: 8531044

PubMed ID: 33842996

SO-VID: f5c5ff75-0a61-4ffa-9d0b-11880e7f77e9

License:

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 9 March 2021

Date accepted : 29 March 2021

Funding

Funded by: Christian-Albrechts-Universität zu Kiel (3094)

Open Access :

Open Access funding enabled and organized by Projekt DEAL.

Custom metadata

ScienceOpen disciplines: Dentistry

Keywords: vitamin c,ascorbic acid,platelet-rich fibrin,periodontal regeneration,periodontitis,intra-osseous defects

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ScienceOpen disciplines: Dentistry

Keywords: vitamin c, ascorbic acid, platelet-rich fibrin, periodontal regeneration, periodontitis, intra-osseous defects

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

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Arab Journal of Forensic Sciences & Forensic Medicine (AJFSFM)

Most cited references 75

Staging and grading of periodontitis: Framework and proposal of a new classification and case definition

Periodontitis: Consensus report of workgroup 2 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions: Classification and case definitions for periodontitis

Treatment of stage I–III periodontitis—The EFP S3 level clinical practice guideline

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