Discussion
bleeding, OFD, bone gain, periodontitis, intrabony periodontal lesions, pain, tooth loss, PD, CM, Periodontitis
BLEEDING, PROLIFERATION, PERIODONTITIS, INFLAMMATION, CHRONIC INFLAMMATORY DISEASE, PERIODONTITIS, REGRESSION
Periodontitis is a chronic inflammatory disease that is a leading cause of tooth loss in adults due to the progressive loss of supporting alveolar bone [The use of autologous platelet concentrates in the treatment of infrabony periodontal lesions have been reported in the literature with favorable results [The contradiction in GF release between in- vitro and clinical studies as well as the reported adsorptive/ release potential of loaded CM arose the hypothesis of the possible benefit of using CM in retaining higher levels of GF from L-PRF harvests within intrabony defects. In the present study, coverage of L-PRF filled intrabony periodontal lesions with CM is investigated clinically and radiographically. In addition, the hypothesis for the local benefit of using CM in preserving PDGF-BB and VEGF concentrations is addressed.The patients enrolled in the current study had stage III periodontitis with interproximal 2 or 3 osseous wall contained defects that are ≥ 3mm in depth. Predictability of regeneration depends not only on the number of remaining osseous walls but also the defect depth; deeper defects with higher number of osseous walls demonstrated higher radiographic bone gain and improved CAL [In the current study, a statistically significant drop in GI and PI within every group was recorded despite the comparison between the tests and control was statistically insignificant. This suggests that oral hygiene measures and local factors debridement had a higher influence over the gingival health than the treatment protocol. Such findings run parallel with Sharma and Pradeep who reported a statistically significant intragroup reduction in PI and bleeding index without statistically significant difference between OFD and PRF in the treatment of furcation defects over a period of 9 months [The mean PD reduction following treatment was ⁠3.8, 3.8 and 3.9 mm for OFD, L-PRF, and L-PRF + CM respectively. Despite L-PRF + CM group highest reduction in PD, there was no statistically significant intergroup difference. Similarly, the CAL mean reductions were 3.1mm, 3 mm and 2.6 mm for the three groups respectively in order with statistically insignificant difference between them despite the statistically significant reduction within all groups between observation intervals. This corresponds with one study which reported the lack of a statistically significant difference between CM and L-PRF in PD and CAL reduction [The radiographic outcomes for the L-PRF + CM group demonstrated a significantly greater reduction in DBF mean distance (2.12 mm) and percentage change (32.6%) in comparison to the OFD (mean reduction: 0.43 mm, % change: 7.25%) and L-PRF group (mean reduction: 0.8 mm, % change: 12.6%). The grounds of this reduction could be the expected synergistic effect of the GTR and the protected L-PRF membranes where the L-PRF expressed its classical potentials as GTR membranes. One clinical trial reported a greater percentage reduction (58.19 ± 13.24%) in defect depth fill when CM was used with PRF in comparison to CM [For the growth factors’ concentrations, having the peak level at the first day following surgical intervention with subsequent regression was consistent with the existing evidence in the literature [One limitation that might have affected the clinical outcomes was the gender variation among the groups. Reviewing the literature, there is a lack in evidence for the influence of gender on the amount of radiographic bone fill following regenerative therapy [On the molecular level, gender differences raise a question for the possible structural and physiologic differences in L-PRF harvests between the groups. The literature demonstrates that the fewer erythrocytic count in female and older patients were associated with larger size PRF membranes. The same study hypothesized that larger membranes might be associated with higher density of cellular elements and signaling molecules [The results of the present study contrasts the possible influence of gender type on the release profile of PDGF and VEGF. This conclusion should be carefully interpreted since we only evaluated two GF. All patients were prescribed Ibuprofen following surgical intervention for the management of pain and inflammation. Therefore, it was considered the drug pharmacodynamics and their possible influence on the secretory profile of GF. Under inflammatory conditions, one study demonstrated statistically significant reduction in endothelial cell viability and proliferation as well as an increase in VEGF production following the administration of Ibuprofen [