Modified minimally invasive surgical technique with clindamycin‐augmented or non‐augmented platelet‐rich fibrin in periodontal regeneration: A randomized clinical trial

Abstract

AbstractAimInjectable platelet‐rich fibrin (I‐PRF), a second‐generation platelet concentrate, is widely used to enhance soft and hard tissue healing alone or in combination with biomaterials, relying on its harboring of various pivotal growth/differentiation factors. This randomized trial assessed the effect of clindamycin (CLN) augmented injectable platelet‐rich fibrin (I‐PRF) with modified minimally invasive surgical technique (M‐MIST) versus I‐PRF alone with M‐MIST on the clinical and radiographic parameters in the management of periodontal intra‐bony defects in patients with stage‐III grade B periodontitis.MethodsThis is a 9‐month parallel‐grouped, two arm, double‐blinded, randomized controlled trial (RCT) that included 28 patients (n = 28) with stage‐III grade B periodontitis, who were allocated randomly to test‐ (CLN/I‐PRF + M‐MIST, 50 μL of CLN per 1 mL of I‐PRF; n = 14) or control‐group (I‐PRF + M‐MIST; n = 14). Clinical attachment level (CAL; primary outcome), probing depth (PD), gingival margin level (GML), plaque index (PI), and gingival index (GI) were recorded at baseline, 3, 6, and 9 months, whereas radiographic parameters radiographic linear defect depth (RLDD), and radiographic defect area (RDA) were recorded at baseline, 6, and 9 months. The CLN release kinetics from the I‐PRF were further characterized.ResultsCompared to baseline, both groups independently demonstrated significant improvements in CAL, PD, GML, GI, PI, RLDD and BDA at 3, 6 and 9 months (p < .05). A significant reduction in CAL measurements was noticeable in the CLN/I‐PRF + M‐MIST and I‐PRF + M‐MIST group independently over time (p < .05). CLN/I‐PRF + M‐MIST showed significantly lower CAL than PRF + M‐MIST group at baseline, after three as well as 9 months (p < .05). Intergroup comparisons at 9 months demonstrated that CAL‐gain was non‐significant between groups (p > .05), GI significantly lower in CLN/I‐PRF + M‐MIST, whereas PD‐reduction significantly higher I‐PRF + M‐MIST group (p < .05). CLN was steadily released for the I‐PRF for up to 48 h, with a peak concentration at 24 h, which then gradually declined till the seventh day.ConclusionsI‐PRF with M‐MIST provided significant clinical and radiographic improvement up to 9 months postoperatively in stage‐III grade B periodontitis. CLN, at the applied concentration and release duration, does not appear to further positively impact these observed I‐PRF effects.