The Effectiveness of the Influence of the Second Generation Platelet-rich Fibrin in the Treatment of Localized Individual Miller I and II Gingival Recessions (Case Report)

Abstract

BACKGROUND: The mucogingival surgical modality subepithelial connective tissue graft (SCTG) and the coronally positioned flap (CAF) in the treatment of Miller I and II gingival recessions are considered “gold standard,” that is, a technique for predictable and complete gingival root coverage defects, with long-term clinical stability of the obtained results. The counterpart of this type of technique is the relatively young platelet-rich fibrin (PRF) +CAF operational mode, due to the biological characteristics of this autologous platelet concentrate-PRF (angiogenesis, mitogenesis, osteopromotion, immunomodulation, and the capture of stem cells). The aim of this paper is to evaluate the clinical efficacy of the CAF+PRF combined technique, in the treatment of localized individual gingival recessions Miller I and II, through the comparison of the values of periodontal clinical parameters, measured preoperatively and 1 month postoperatively, as well as through the obtained immunohistochemical and histomorphometric analyzes of the taken biopsy material from the recipient site (the area of the grafted gingival defect), 1 month postoperatively. CASE REPORT: A 37-year-old man was admitted to the Clinic for Oral Surgery at JZU USKC “St. Panteleimon”- Skopje for surgical treatment of  localized maxillary gingival recession Miller II at tooth 31. Periodontal clinical parameters were measured preoperatively: Vertical dimension of gingival recession (RD/VGR), periodontal pocket depth (PPD/PD), level of keratinized/attached gingiva (CAL), width of keratinized gingiva (KTW/KMW) and thickness of gingiva (GT), all measured in mm, as well as gingival biotype. A CAF+PRF therapy modality was used for the treatment of the gingival defect. One month postoperatively, repeated measurements of the values of the clinical periodontal indices were performed and they were compared with the measurements obtained preoperatively. CONCLUSION: A significant decrease in the values of RD, PPD, and CAL was determined at the 1-month measurements postoperatively. A non-significant gain in KTW and GT values was noted 1 month post-operative. There were no changes in the gingival biotype before and after surgery. PRF as second-generation autologous concentrates is not only an adjuvant and/or replacement of SCTG – the “gold standard” in the treatment of Miller I and II recessions but it is also a superior alternative in the surgical treatment of this type of shallow mucogingival defects.