Journal of Periodontology; Copyright 2012 DOI: 10.1902/jop.2012.

110722

Platelet-Rich Fibrin Combined with a Porous Hydroxyapatite Graft

for the Treatment of Three-Wall Intrabony Defects in Chronic
Periodontitis: A Randomized Controlled Clinical Trial.
1. Dr. A R Pradeep* MDS, 2. Dr. Pavan Bajaj* BDS, (MDS), 3. Dr. Nishanth S. Rao* BDS,
(MDS), 4. Dr. Esha Agarwal* BDS, (MDS), 5. Savitha B. Naik MDS†
*
Dept of Periodontics, Govt. Dental College & Research Institute, Bangalore 560002.
†
Department of Conservative Dentistry and Endodontics Government Dental College and
Research Institute Fort, Bangalore, Karnataka, India.
Background: Porous hydroxyapatite (HA) bone grafting material has been used to fill periodontal
intrabony defects, which has resulted in clinically acceptable responses. Platelet-rich fibrin (PRF) is a leukocyte
and platelet preparation that concentrates various polypeptide growth factors and therefore has the potential to
be used as regenerative treatment for periodontal defects. The present study aimed to explore the clinical and
radiographical effectiveness of autologous PRF Vs PRF+HA in treatment of intrabony defects in chronic
periodontitis subjects.
Material and Methods: 90 intrabony defects were treated either with autologous PRF with open flap
debridement (OFD) or PRF+HA with OFD or OFD alone. Clinical and radiological parameters such as probing
depth (PD), clinical attachment level (CAL), intrabony defect depth and % defect fill were recorded at baseline
and 9 months postoperatively.
Results: Mean PD reduction was greater in PRF (3.90 + 1.09 mm) and PRF+HA (4.27 + 0.98mm)
groups than control group (2.97 + 0.93 mm) while mean CAL gain was also found to be greater in PRF (3.03 +
1.16 mm) and PRF+HA (3.67 + 1.03 mm) compared to controls (2.67 + 1.09 mm). Furthermore, significantly
greater percentage of mean bone fill was found in the PRF (56.46 + 9.26 %) and PRF+HA (63.39 + 16.52 %)
compared to control (15.96 + 13.91% ).
Conclusions: Treatment of intrabony defects with PRF results in significant improvements of Clinical
parameters compared with baseline. HA when added to PRF increases the regenerative effects observed with
PRF in the treatment of human three wall intrabony defects.

KEY WORDS:
Periodontal regeneration, Periodontal surgery, Periodontitis, hydroxyapatite/therapeutic use,
Clinical trial(s).
The primary goal of periodontal treatment is the maintenance of the natural dentition in
health and comfortable function. Periodontal regeneration can be defined as the complete
restoration of the lost tissues to their original architecture and function by recapitulating the
crucial wound healing events associated with their development.1,2 There are a broad range of
treatment options available, but only a few may be regarded as truly regenerative procedures.
To be considered a regenerative modality, a material or technique must histologically
demonstrate that bone, cementum and a functional periodontal ligament (a new attachment
apparatus) can be formed on a previously diseased root surface.3 A recent review stated that
the current evidence is that regenerative periodontal therapies to date can only restore a
fraction of the original tissue volume in extent. Thus, complete periodontal restoration may
still be regarded as an illusion.4 Various biomaterials,5-11 based on endogenous regenerative
technology (ERT), have been in used for periodontal tissue regeneration in addition to
autogenous12,13 and allogenic bone grafts,14,15 but till date no graft material has been proven
as a gold standard in the treatment of intrabony defects.
For many years, research has attempted to use biologically active molecules to achieve
periodontal regeneration. Among these molecules are: extracellular matrix proteins and cell-
attachment factors; mediators of cell metabolism and activity; and growth ⁄ differentiation

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Journal of Periodontology; Copyright 2012 DOI: 10.1902/jop.2012.110722

factors. Numerous growth factors, alone or in combination, have been tested for periodontal
regeneration in animal experiments. Among these are insulin-like growth factors, fibroblast
growth factors, epidermal growth factor, platelet-derived growth factors (PDGF), vascular
endothelial growth factor, parathyroid hormone, transforming growth factor-β (TGF-β) and
bone morphogenetic proteins.4
Platelet-rich fibrin (PRF) described by Choukroun et al.16 is a second generation platelet
concentrate which allows one to obtain fibrin membranes enriched with platelets and growth
factors, after starting from an anticoagulant-free blood harvest.17,18 PRF looks like a fibrin
network and leads to more efficient cell migration and proliferation, and thus cicatrization.19
This unique structure may act as a vehicle for carrying cells that are essential for tissue
regeneration. Many growth factors, such as platelet-derived growth factor (PDGF) and TGF-
β, are released from PRF.17,18,20 A recent, study has demonstrated that the PRF membrane has
a very significant slow sustained release of key growth factors for at least one week and up to
28 days,21 which means that the membrane stimulates its environment for a significant time
during wound healing. Beneficial effects of PRF have been studied in various procedures,
such as facial plastic surgery,22 a sinus-lift procedure as a sole osteoconductive filling
material,23 and multiple gingival recessions case treated with a coronally advanced flap.24
PRF has been shown to act as suitable scaffold for breeding human periosteal cells in vitro,
which may be suitable for bone tissue engineering applications.25
Porous hydroxyapatite (HA) bone grafting material has been used to fill periodontal
intrabony defects, which has resulted in clinically acceptable responses.26 It has been shown
that porous HA bone grafts have excellent bone conductive properties which permit
outgrowth of osteogenic cells from existing bone surfaces into the adjacent bone material.27
Since there are no organic components contained in HA, this bone graft material does not
induce any allergic reaction and is clinically very well tolerated.28 However true periodontal
regeneration is not achieved because healing which occurs is a connective tissue
encapsulation of the graft with a long junctional epithelium.29
The use of PRF and HA in combination for periodontal regenerative therapy offers an
interesting and potentially clinically useful modality to the clinician in treating periodontal
osseous defects. However, it is yet unknown whether a combination of these materials may
further enhance the outcome of periodontal regenerative therapy. Thus the purpose of the
present study was to investigate the efficacy of autologous PRF or PRF and HA bone graft
with open flap debridement (OFD) in the treatment of three wall intrabony defects in
comparison to OFD alone.

MATERIALS AND METHODS

Subject Selection
In this 9-month follow-up, randomized, double blinded, controlled clinical trial , a total of 62
systemically healthy subjects (34 males and 28 females; mean age: 39.7 years) undergoing
periodontal therapy at the Department of Periodontics, Government Dental College and
Research Institute, Bangalore, India, were selected. The study was conducted from November
2010 to November 2011. The research protocol was initially submitted to the Institutional
Ethical Committee and Review Board of the Government Dental College and Research
Institute, Bangalore. After ethical approval, all subjects were verbally informed and written
informed consent was collected for participation in the study.
The subjects were classified as chronic periodontitis and subjects with aggressive
periodontitis were excluded based on the 1999 consensus classification of periodontal

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Journal of Periodontology; Copyright 2012 DOI: 10.1902/jop.2012.110722

diseases.30 The inclusion criteria were the presence of intrabony defects (IBD) ≥ 3 mm deep
(distance between alveolar crest and base of the defect on intraoral periapical radiograph
[IOPA]) along with an interproximal probing depth (PD) ≥ 5 mm following phase I therapy
(scaling and root planing [SRP)]) in asymptomatic tooth. Osseous defects needed to have
three walls. Two and one-wall defects and interdental craters were excluded from the study.
Patients, with aggressive periodontitis, with known systemic illness and taking any
medications known to affect the outcomes of periodontal therapy, insufficient platelet count
(< 200,000/mm3), pregnancy / lactation and use of any form of tobacco were excluded, from
the study. Those having unacceptable oral hygiene (if plaque index [PI]31 >1.5) after the
reevaluation of phase I therapy were also excluded from the study. In addition, teeth with
furcation defects, non-vital and/or mobility of tooth ≥ Grade II were also excluded.32

Presurgical Therapy
Prior to the surgery, each patient was given careful instructions on proper oral hygiene
measures. A full-mouth supra- and subgingival SRP procedure was performed under local
anesthesia. Six to eight weeks following phase I therapy, periodontal evaluation was
performed to confirm the desired sites for the study. The selected sites were divided
randomly (computer generated tables) into the control and test groups (PRF or PRF+HA).
The control group consisted of the sites treated with OFD i.e. conventional flap surgery,
whereas the test group sites were treated with OFD (conventional flap surgery) with
autologous PRF or PRF+HA.
One operator (PB) performed all the surgeries while another operator (ARP) performed
all the clinical and radiographic measurements without knowledge of the groups. Patients
were blinded for allocation to particular group and treatment.

Clinical and Radiographic Measurements

The clinical parameters recorded before surgical procedures included site-specific PI, sulcus
bleeding index33 (mSBI), PD from the gingival margin, clinical attachment level (CAL) along
with gingival marginal level (GML) from the apical level of customized acrylic stents with
grooves to ensure a reproducible placement of the University of North Carolina (UNC) no. 15
periodontal probe†.
All IBD were evaluated at baseline and 9 months postoperatively. For the measurement of
bone defect, distance from the crest of the alveolar bone to the base of the defect was
considered. Individually customized bite blocks and parallel angle technique were used to
obtain standardized radiographs. For assessment, radiographs were scanned with a scanner‡
of 6400 DPI by an evaluator (ARP) who was blinded to surgical procedure performed in
subjects. The radiographic IBD depth was measured by computer aided software program§ as
used previously.34

PRF Preparation
The PRF was prepared following the protocol developed by Choukroun et al16 and used in
our previous study.34 Just prior to surgery, intravenous blood (by venipuncturing of the
antecubital vein) was collected in three 10-ml sterile tubes without anticoagulant and
immediately centrifuged in centrifugation machine║ at 3,000 revolutions (approximately 400
g) per minute for 10 minutes. Blood centrifugation immediately after collection allows the
composition of a structured fibrin clot in the middle of the tube, just between the red
corpuscles at the bottom and acellular plasma (Platelet-poor plasma [PPP]) at the top. PRF
was easily separated from red corpuscles base [preserving a small red blood cell (RBC) layer]

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Journal of Periodontology; Copyright 2012 DOI: 10.1902/jop.2012.110722

using a sterile tweezers and scissors just after removal of PPP and then transferred onto a
sterile compress. A stable fibrin membrane was obtained by squeezing serum out of the PRF
clot.

Surgical Procedure
Intra-oral antisepsis was performed with 0.12% chlorhexidine digluconate rinse and iodine
solution was used to carry out extraoral antisepsis. Following administration of local
anaesthesia, buccal and lingual sulcular incisions were made and mucoperiosteal flaps were
reflected. Care was taken to preserve as much inter-proximal soft tissue as possible.
Meticulous defect debridement and root planing were carried out using ultrasonic
instruments¶ and area specific curettes #. No osseous recontouring was carried out.
In the PRF+HA group, HA** granules with particle sizes of 600-700 microns were mixed
with PRF at a proportion of 1:1 (v/v). The PRF– HA mixture was delivered to the defect.
Care was taken not to overfill defects. A membrane of compressed PRF was trimmed and
adapted over the grafted defect.
In PRF group one PRF of the required size was placed into the intrabony defect and the
other was used to prepare the membrane which covered the defect as a membrane. The
mucoperiosteal flaps were repositioned and secured in place using 3-0 non-absorbable silk
surgical suture††. Interrupted or sling sutures were placed and the surgical area was protected
and covered with periodontal dressing‡‡.

Postoperative Care
Suitable antibiotics and analgesics (amoxicillin 500 mg four times per day for 5 days and
ibuprofen 800 mg three times per day) were prescribed, along with chlorhexidine digluconate
rinses (0.12%) twice daily for 2 weeks. Periodontal dressing and sutures were removed 2
weeks post-operatively. Surgical wounds were gently cleansed with 0.12% of chlorhexidine
digluconate and subjects were instructed for gentle brushing with a soft toothbrush. Each
patient was re-instructed for proper oral hygiene measures at 8 weeks post-operatively and
examined weekly up to 1 month after surgery and then at 3 and 9 months. No subgingival
instrumentation was attempted at any of these appointments.

Post-Surgical Measurements
Soft and hard tissue evaluation was performed 9 months after surgery. Soft tissue
measurements were repeated with previously used acrylic stents. For hard tissue re-
evaluation, second IOPA of the same study site was carried out and IBD measurement was
reassessed at 9 months.

Primary and Secondary Outcome Measures

The primary outcome of the study was bone defect fill evaluated radiographically. The
secondary outcomes included PD, CAL, mSBI and PI.

Statistical Analysis
The data were analyzed using statistical software§§. Power calculations were performed
before the study was initiated. To achieve 90% power and detect mean differences of the
clinical parameters between groups, 25 sites per group were required. The results were
averaged (mean standard deviation) for each clinical and radiographical parameter at baseline
and 9 months. mSBI and PI were expressed as absolute and relative counts and comparison
was performed using Chi-square test. Normality assumption of the data was tested using

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Journal of Periodontology; Copyright 2012 DOI: 10.1902/jop.2012.110722

Shapiro-Wilk's W test. The difference between each pair of measurement was then calculated
(Baseline – 9 months). The paired t-test was applied to assess the statistical significance
between time points within each group for clinical and radiographic parameters. ANOVA and
post hoc scheff’s test was applied to assess the statistical significance between time points
between the groups for clinical and radiographic parameters. The mean intra-examiner
standard deviation of differences in repeated PD measurements and CAL measurements were
obtained using single passes of measurements with a UNC- 15 probe† (correlation
coefficients between duplicate measurements; r = 0.95).

RESULTS
57 subjects (90 sites) out of 62 subjects completed the study, hence only 90 sites were
subjected to statistical analysis (Figure 1). Out of the 90 sites 37 sites were from upper and
lower single rooted teeth and the remaining 53 sites from upper and lower multi-rooted teeth.
All treated cases showed uneventful wound healing. A statistically significant reduction in
the PI and mSBI was observed in all the three groups at 9 months postoperatively (p<0.001).
(Table 1).
Mean values for clinical and radiological parameters at baseline and 9 months are
reported in Table 2 while mean changes in the parameters are reported in Table 3. Both PRF
and PRF+HA sites presented with a significantly greater PD reduction (3.90 + 1.09 and 4.27
+ 0.98 mm respectively) than control sites (2.97 + 0.93 mm) at 9 months postoperatively
(p<0.05). CAL gain was also greater in the PRF (3.03 + 1.16 mm) and PRF+HA (3.67 + 1.03
mm) sites as compared to control sites (2.67 + 1.09), and a statistically significant difference
was found between PRF+HA and control site (Table 3). PRF (56.46 + 9.26 %) and PRF+HA
(63.39 + 16.52 %) presented with a significantly greater IBD fill than the control sites (15.96
+ 13.91 %) at 9 months (p<0.001) (Table 3).

DISCUSSION
The present study was aimed to evaluate the clinical effectiveness of autologous PRF or PRF
and HA in the treatment of three wall intrabony defects in chronic periodontitis patients.
Subject age, gender, and teeth with osseous defects treated were similar in all groups at
baseline. Each subject demonstrated excellent oral hygiene and a generally healthy gingival
condition throughout the study.
The uneventful healing in the patients is in agreement with our previous studies,5,34 thus
supporting the excellent properties of autologous PRF to enhance periodontal wound healing.
Plaque, infection and smoking are the important factors that have been shown to significantly
influence the outcomes of regenerative periodontal surgery.35 Because the current study has
excluded smokers and included only those subjects who were able to maintain acceptable oral
hygiene, it may be assumed that careful patient selection was also responsible for the positive
outcomes obtained in all three groups.
Reduction in PD, IBD and gain in CAL are the major clinical outcomes measured to
determine the success of any periodontal treatment. In the present study, a significant
reduction in PD and CAL gain were found in all three groups when compared with baseline
and 9 months. However, there was more PD reduction (3.90 + 1.09) in the PRF-treated and
PRF+HA treated groups (4.27 + 0.98) compared with the subjects treated with conventional
periodontal flap surgery alone. The present study also reflects the percentage of IBD fill in
the PRF group (56.46 + 9.26 %) and PRF+HA group (63.39 + 16.52 %) is higher than the
conventionally treated subjects, supporting the significance and advantage of various growth
factors present in the PRF may accelerate the soft and hard tissue healing.16,36 The PD

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Journal of Periodontology; Copyright 2012 DOI: 10.1902/jop.2012.110722

reduction, CAL gain, GML change, IBD depth reduction and percentage IBD fill found in the
current study are similar to the mean changes found in our previous studies on PRF in
intrabony defects.37,38
In a recent study to examine the suitability of autologous PRF as regenerative treatment
for periodontal intrabony defects in humans and to examine the ability of bovine porous bone
mineral (BPBM) to augment the regenerative effects exerted by PRF, Lekovic et al.39
reported a significantly greater reduction in pocket depth in the PRF–BPBM group (4.47 ±
0.78 mm on buccal and 4.29 ± 0.82 mm on lingual sites) when compared with the PRF group
(3.35 ± 0.68 mm on buccal and 3.24 ± 0.73 mm on lingual sites). The PRF–BPBM group
presented with significantly greater attachment gain (3.82 ± 0.78 mm on buccal and 3.71 ±
0.75 mm on lingual sites) than the PRF group (2.24 ± 0.73 mm on buccal and 2.12 ± 0.68 mm
on lingual sites). Defect fill was also greater in the PRF–BPBM group (4.06 ± 0.87 mm on
buccal and 3.94 ± 0.73 mm on lingual sites) than in the PRF group (2.21 ± 0.68 mm on
buccal and 2.06 ± 0.64 mm on lingual sites). The results of the current study are similar to the
findings of Lekovic et al.39 though no significant difference could be found between PRF and
PRF + HA groups.
PRF consists of a fibrin matrix polymerized in a tetramolecular structure, the
incorporation of platelets, leukocyte, and cytokines, and circulating stem cells.17 PRF would
be able to progressively release cytokines during fibrin matrix remodeling; such a mechanism
might explain the clinically observed healing properties of PRF.40 It is also found that PRF
organized as a dense fibrin scaffold with a high number of leukocytes concentrated in one
part of the clot,41 with a specific slow release of growth factors (such as TGF-β, PDGF-AB,
and vascular endothelial growth factor) and glycoproteins (such as thrombospondin-1) during
≥7 days.20 So leukocytes seem to have a strong influence on growth factor release,20 immune
regulation, anti-infectious activities,42 and matrix remodeling during healing. Overall, PRF
has physical and biochemical attributes that make it attractive for application in periodontal
wound healing, and for these reasons it was investigated as a potential regenerative agent for
intrabony periodontal defects.
It has been reported that the combination of a mineralized, rigid graft material, with a
semi-fluid, nonrigid agent, such as enamel matrix proteins,43 significantly enhanced the
clinical outcome of intrabony defects treated without the addition of rigid graft material. For
this reason, we chose HA, hypothesizing that it could enhance the effects of PRF by
maintaining the space for tissue regeneration to occur, as well as by exerting an
osteoconductive effect in the intrabony defect area. Combining HA with PRF resulted in
greater pocket depth reduction, gain in clinical attachment and defect fill than PRF used
alone.
In the present study, once defects were filled, they were covered by a PRF membrane.
The intended role of the PRF membrane was to contain the HA and/or PRF in the intrabony
defect in the early phase of healing, also as PRF membranes are inhomogeneous because
leukocytes and platelet aggregates are concentrated within one end of the membrane,41 PRF
membrane (with RBC end of the membranes facing towards defect) were used to cover IBD
defect like GTR for providing core material homogeneity.
In the current study the primary outcome was bone defect fill as radiographic evaluation
is a noninvasive examination for bony defects repair. The possible errors in measuring the
IBD fill on radiographs, such as those due to exposure settings, geometric error (e.g.,
radiographic techniques), and the development of films, were minimized. Another factor that
may have caused an error was the use of conventional film rather than digital
images.However, Borg et al.44 assessed the marginal bone level around implants placed in

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Journal of Periodontology; Copyright 2012 DOI: 10.1902/jop.2012.110722

dogs and found no difference in accuracy and precision between digital and conventional
films. Also, bone fill data derived from surgical re-entry are important to substantiate routine
postoperative measurement data obtained radiographically.
In conclusion, the data from this study suggests, firstly, that treatment of intrabony
defects with PRF results in significant improvements of PD, CAL and IBD fill compared
with baseline and, secondly, that HA increases the clinical effects observed with PRF in the
treatment of human three wall intrabony defects. However, long term, multicenter
randomized, controlled clinical trial will be required to know clinical and radiographical
effect over bone regeneration also the long term results associated with both modalities of
therapy, as well as the histological nature of newly formed tissues by either treatment,
remains to be elucidated.

CONFLICT OF INTEREST AND SOURCE OF FUNDING:

The authors declare that they have no conflict of interests. Authors declare no financial support or relationships
that may pose conflict of interest.

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bony defects: a controlled clinical trial. J Clin Periodontol 2011; 38:925-932.
39. Lekovic V, Milinkovic I, Aleksic Z et al. Platelet-rich fibrin and bovine porous bone mineral vs. platelet-
rich fibrin in the treatment of intrabony periodontal defects. J Periodont Res 2011 doi: 10.1111/j.1600-
0765.2011.01446.x. [Epub ahead of print]
40. Dohan DM, Choukroun J, Diss A et al. Platelet-rich fibrin (PRF): A second-generation platelet concentrate.
Part II: Platelet-related biologic features. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006; 101:
E45-50.
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Choukroun’s PRF (platelet-rich fibrin) on human gingival fibroblasts, dermal prekeratinocytes,
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Radiol Endod 2009; 108: 341-352.
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Staphylococcus aureus. J Orthop Res 2008; 26: 404-410
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matrix proteins used alone or in combination with bovine porous bone mineral in the treatment of intrabony
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Corresponding Author: Dr. A R Pradeep, Professor and Head, Dept of Periodontics, Govt.
Dental College & Research Institute, Bangalore 560002, India, Ph: +919845081190, E-mail:
periodontics_gdc@yahoo.co.in, Fax: 08026703176
Submitted December 8, 2011; accepted for publication January 23, 2012.

Figure 1:
STUDY FLOW CHART

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Journal of Periodontology; Copyright 2012 DOI: 10.1902/jop.2012.110722

Table 1: Bleeding and Plaque Index in PRF, PRF + HA and Control Groups at Baseline

and 9 Months

Group Visit mSBI Score PI Score

0-0.5 0.6-1.0 1.1-1.5 p- 0-0.5 0.6-1.0 1.1-1.5 p-

value value

PRF Baseline 0 11 19 0 14 16
n (%) (0) (36.67) (63.33) (0) (46.67) (53.33)
<0.001 <0.001
9 21 9 0 22 8 0
months (70) (30) (0) (73.33) (26.67) (0)
PRF + Baseline 0 12 18 0 12 18
HA n (0) (40) (60) (0) (40) (60)
(%) <0.001 <0.001

9 24 6 0 24 6 0
months (80) (20) (0) (80) (20) (0)
Control Baseline 0 11 19 0 13 17
n (%) (0) (36.67) (63.33) (0) (43.33) (56.67)
<0.001 <0.001
9 7 23 0 23 7 0
months (23.33) (76.67) (0) (76.66) (23.33) (0)
*denotes significant difference

PI: Plaque score, mSBI: modified sulcus bleeding index

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 Journal of Periodontology; Copyright 2012 DOI: 10.1902/jop.2012.110722

Table 2: Clinical and Radiographic Parameters in Test and Control Groups at

Baseline and 9 Months

Parameters Visits PRF PRF + HA Control

Mean + p-value Mean + p-value Mean + p-value
S.D. S.D. S.D.
PD (mm) Baseline 8.17±1.26 8.37±1.19 8.03±1.13
<0.001* <0.001* <0.001*
9 months 4.27±0.69 4.10±0.85 5.07±0.74
CAL (mm) Baseline 6.40 ±1.33 6.63±1.10 6.57±1.17
<0.001* <0.001* <0.001*
9 months 3.37±0.56 2.97±0.93 3.90±0.76
GML (mm) Baseline 1.63±0.49 1.77±0.43 1.77±0.43
0.002* <0.001* 0.09
9 months 1.17±0.46 1.10±0.31 1.93±0.25
IBD depth Baseline 5.63±1.16 6.03±1.16 5.80±0.81
<0.001* <0.001* <0.001*
(mm) 9 months 2.43±0.68 2.17±0.99 4.87±1.04
*denotes significant difference

PD: Probing depth, CAL: Clinical attachment level, GML: Gingival marginal level, IBD

depth: Intra bony defect depth

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 Journal of Periodontology; Copyright 2012 DOI: 10.1902/jop.2012.110722

Table 3: Mean changes in the clinical and radiographic parameters over 9 months

period between the groups

Parameters PRF PRF+ HA OFD p-value

Mean PD 3.90 + 1.09 4.27 + 0.98 2.97 + 0.93 PRF Vs PRF+ HA 0.371
change
(mm) PRF Vs OFD 0.002*

PRF+ HA Vs OFD <0.001*

Mean CAL 3.03 + 1.16 3.67 + 1.03 2.67 + 1.09 PRF Vs PRF+ HA 0.087
gain (mm)
PRF Vs OFD 0.435

PRF+ HA Vs OFD 0.003*

Mean GML 0.47 + 0.73 0.67 + 0.55 -0.17 + 0.53 PRF Vs PRF+ HA 0.449
change
(mm) PRF Vs OFD 0.001*

PRF+ HA Vs OFD <0.001*

Mean IBD 3.20 + 0.89 3.87 + 1.33 0.93 + 0.83 PRF Vs PRF+ HA 0.05*
depth
reduction PRF Vs OFD <0.001*

PRF+ HA Vs OFD <0.001*

Percentage 56.46 + 9.26 63.39 + 15.96 + PRF Vs PRF+ HA 0.147

of Bone 16.52 13.91
defect fill PRF Vs OFD <0.001*
(%)
PRF+ HA Vs OFD <0.001*

*denotes significant difference

12
Journal of Periodontology; Copyright 2012 DOI: 10.1902/jop.2012.110722

†
Hu- Friedy, Chicago, IL, USA.
‡
Epson Perfection V700, Bangalore, INDIA.
§
Scion image Corporation, Frederick, MD, USA.
║
R-4C, REMI, Mumbai, INDIA.
¶
EMS V-Dent, Shantou, Guangdong, CHINA.
#
Gracey, Hu- Friedy, Chicago, IL, USA.
**
Sybograf, Eucare Pharmaceuticals Private Limited, Chennai, India.
††
Ethicon, Johnson and Johnson Ltd., Somerville, NJ, USA
‡‡
Coe-Pak, GC America Inc., Chicago, IL, USA.
§§
SPSS version 10.5, SPSS, Chicago, USA.
†
Hu- Friedy, Chicago, IL, USA.

13
Figure 1: STUDY FLOW CHART

Assessed for Eligibility

(n= 82)

3 wall Interproximal
intrabony defects (IBD) ≥ 3
mm deep along with an
interproximal probing depth
(PD) ≥ 5 mm

N=62
(34 males and 28 females)
104 sites

PRF group PRF+HA group Control group

N= 21 (35 sites) N= 21(35 sites) N= 20 (34 sites)

Failed to follow-up Failed to follow-up Failed to follow-up

N=2 (6 sites) N=1 (3 sites) N=2 (5 sites)

Analyzed Analyzed Analyzed

N=19 (30) N=20 (30) N=18 (30)