Comparative Evaluation of DFDBA versus PRF with DFDBA in Treatment of Grade-II Furcation Defects – A Clinical Trial

ABSTRACT

Background:

In order to determine whether a method is more successful for treating a grade-II furcation deficiency, this randomized trial will compare demineralized freeze-dried bone allograft (DFDBA) to platelet-rich fibrin with DFDBA

Materials and Methods:

Twenty systematically healthy patients between the ages of 30 and 60 with a grade-II furcation were evaluated pre and postoperatively for changes in the modified plaque index, probing depth, relative vertical and horizontal clinical attachment level, gingival marginal level, and radiographic bone defect.

Results:

The test group significantly outperformed the control group on all clinical and radiological measures

Conclusion:

The experimental group improved at both clinical attachment levels and had a higher decrease in probing depth than the control group did.

INTRODUCTION

In periodontitis, damage to the gums and supporting bone around the teeth is caused by the body’s abnormal immune reaction to a normally harmless substance, such as biofilm bacteria.[1] The inaccessible furcation region of the molar causes a greater incidence of periodontal deterioration and a less positive response to periodontal treatment. New bone, cementum, and periodontal ligament growth is what regenerative therapy is all about.[2] The usage of demineralized freeze-dried bone allograft (DFDBA) for periodontal regeneration has increased in recent years. There are bone morphogenetic proteins in DFDBA, which aid in the movement of mesenchymal cells, their connection to other cells, and the formation of bone.[3,4] Regenerative medicine is built on the foundation of growth factors and their role in promoting wound repair. In addition to their essential function in hemostasis, platelets serve as an autologous supply of growth factors.[5,6,7,8,9,10] So, this membrane creates a wound-healing environment.[11]

MATERIALS AND METHODS

The Periodontics division of the Goenka Research Institute of Dental Science in Piplaj, Gandhinagar, Gujarat, conducted a comparative clinical investigation. Twenty otherwise healthy individuals aged 30–60 years were found to have matched pairs with contralateral grade-II furcation and will be randomly selected as a test (DFDBA + platelet-rich fibrin [PRF]) and control (DFDBA) groups. The patient will be checked for grade-II furcation defect with Naber’s probe and confirmed with a radiograph. Proper phase-1 therapy will be done. Impression will be taken to make the cast and stent. Patients were considered eligible if they matched the following criteria: Patients in this study were between the ages of 30 and 60 years, they had chronic periodontitis, a paired contralateral mandibular grade-II furcation defect, and radiolucency in the furcation region of their molars after scaling and root planing (phase-I treatment) but were otherwise asymptomatic. No systemic illnesses were detected in any group.[12,13] Sites scheduled to receive surgery were reevaluated 8 weeks following phase-I treatment to determine their eligibility for surgical operation.

RESULTS

At 3 and 6 months post-baseline, the test group was compared to itself using Student’s paired t-test. Both groups (test and control) were compared using the independent t-test. Twenty patients were split into two groups, each having 40 furcation sites (sites were randomly assigned to each group). All patients were followed up with at 3 months and 6 months after surgery. There was no initial statistical difference between the experimental and control groups. Patients reported feeling okay after surgery, and all incisions had healed properly. The experimental group showed statistically and clinically significant greater improvement over the control group at every time point examined, like probing depth (PD), residual horizontal clinical attachment level (RHCAL), and residual vertical clinical attachment level (RVCAL). From the beginning to the completion of the research period, there was no statistically significant difference in the mean gingival marginal level (GML) of the test group [Table 1]. Between baseline and 6 months, the mean depth of bone abnormalities reduced in both groups [Table 2].

Table 1.

Intergroup comparison of gingival marginal level at various time periods

Time period	Group	n	Mean	Standard deviation	t	P	S or NS
Baseline	Test	20	6.4	1.46	0.21	0.82	NS
	Control	20	6.3	1.41
3 months	Test	20	5.9	1.43	−1.9	0.06	NS
	Control	20	6.8	1.53
6 months	Test	20	5.9	1.41	−2.7	0.01*	S
	Control	20	7.2	1.6

*Indicates statistical significance at P≤0.05. S=Significant, NS=Not statistically significant

Table 2.

Intergroup comparison of bone defect depth at various time periods

Time period	Group	n	Mean	Standard deviation	t	P	S or NS
Amount of bone gain	Test	20	1.42	0.55	4.8	0.001*	S
	Control	20	0.73	0.32
Baseline	Test	20	2.75	0.48	0.66	0.50	NS
	Control	20	2.64	0.54
6 months	Test	20	1.26	0.57	−3.73	0.001*	S
	Control	20	1.90	0.51

S=Significant, NS=Not statistically significant

DISCUSSION

Globally, periodontal disease is the most common form of gum disease. Research demonstrated that demineralizing a cortical bone graft induced new bone growth and significantly increased its osteogenic capacity.[14] Prathap S et al.[15] in their research, radiovisiography (RVG) was used as a supplementary approach to compare the pre and postoperative states of the area containing the mandibular molar with grade-II furcation. RVG with grid was also used in this research to assist in postoperative monitoring of bone defect depth. After 6 months of observation, the mean bone defect depth in the experimental sites decreased to 1.26 ± 0.57 compared to 1.90 ± 0.51 in the control sites (radiographic parameters). Recovery of both soft and hard tissues may be sped up because of the growth factors included in PRF (Choukroun et al., 2001; Dohan et al., 2007).[6,8] Simon et al.[11] also found that PRF and PRF with membrane-treated sites exhibited significant osseous fill-in sockets after 3 weeks. Mazor and coworkers.[9] Using PRF in combination with a sinus lift has been shown by radiographic and histologic analysis to stabilize a significant amount of spontaneously regenerated bone in the subsinus cavity.

CONCLUSION

Both groups had reductions in PD, RVCAL, RHCAL, and bone defect depth. In the control group, no change in gingival margin level was seen after surgery. The proportion of PD and the percentage of increase in clinical attachment levels and radiographic examination of bone defect depth were found to be lower and greater, respectively, in the experimental group compared to the control group. In conclusion, when PRF was added to DFDBA, clinical metrics improved much more than when DFDBA was used alone.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.