EVALUATION OF CLINICAL AND RADIOLOGICAL EFFECTIVENESS OF PLASMA RICH IN GROWTH FACTORS (PRGF®) IN MANAGEMENT OF PERIODONTAL INTRAOSSEOUS DEFECTS

Background: Plasma Rich in Growth Factors (PRGF) is a mixture of autologous proteins and growth factors, prepared from a certain volume of platelet-rich plasma obtained from a small volume of blood, which does not contain leukocytes. Aim: The aim of the study was to evaluate the clinical and radiological efficacy of Plasma rich in growth factors (PRGF) in adjunct to open flap debridement (OFD) and intra-marrow penetration (IMP) compared to OFD and IMP alone for management of periodontal intra-osseous defects in periodontitis patients. Material and methods: Twenty patients with forty contra-lateral sites presenting with >5mm pocket depth and >3mm of intra-bony defect component were recruited in this double blind, split-mouth randomized controlled trial. The experimental site was surgically treated with PRGF in adjunct to OFD and IMP; and the control sites were treated with OFD and IMP alone. The clinical parameters like site specific plaque index (SSPI), site specific gingival index (SSGI), probing pocket depth (PPD), relative attachment level (RAL), gingival marginal level (GML), site-specific bleeding on probing (SSBOP) were recorded at baseline, 3, 6 and 9 months. The radiological parameters like intra-bony defect depth (IBDD), intra-bony defect area (IBDA) and percentage intra-bony defect area fill (%IBDAF) was recorded at baseline, 6 and 9 months. The patient reported outcomes on swelling, bleeding and level of pain in the area treated were also assessed at day 1 to day7. Results: No significant difference was observed for PI, GI and PPD. A Significant favorable improvement in GML was observed in PRGF treated group at all time points, suggesting continuous vertical creeping of the free gingival margin in the PRGF group at 3, 6 and 9 months. The clinical attachment gain (CAG) was significantly higher in the PRGF group at 3 months (p=0.005) and borderline significance at 6 months (p=0.067). The linear radiographic bone gain, i.e, change in IBDD, was significantly higher in the PRGF treated group at 6 months (p=0.02). At 6 months, the PRGF was significantly superior to the OFD (50% Vs 15%) in the number of sites that achieved CAG by 1.5 mm and linear radiographic bone gain of 1.0 mm. At 9 months, the PRGF was border-line significance than the OFD (83% Vs 50%) in the number of sites that achieved CAG by 1.5 mm and linear radiographic bone gain of 1.0 mm. Conclusion: PRGF was found to beneficial in terms of improved clinical attachment gain and radiographic linear bone gain, when used in adjunct to OFD and IMP for management of periodontal intra-osseous defects.