Evaluation of the Effect of a Hydroxyapatite-Beta Tricalcium Phosphate (βTCP) graft with Platelet Rich Fibrin Occlusive Membrane on Intrabony Defects Accessed With a Single Flap Approach –A Randomized Controlled Clinical trial

Abstract

The aim of this study was to evaluate and compare the clinical and radiographic outcomes of intrabony defects accessed with a Single Flap Approach, with an occlusive Platelet Rich Fibrin membrane, that did or did not receive an additional Hydroxyapatite -Beta Tri Calcium Phosphate composite bone graft. The study comprised 30 patients presenting with intra-bony defects who were randomly treated using Single Flap Approach with Platelet Rich Fibrin and with or without additional bone graft (Hydroxyapatite + β Tri Calcium Phosphate composite graft). Patients were recalled at 12 and 36 months to assess and compare the Full Mouth Plaque scores (FMPS%), Full mouth bleeding scores (FMBS%),Probing Pocket Depth (PPD), Relative Clinical Attachment Level (R-CAL),position of Gingival Margin at surgical site (GM), and Radiographic assessment of crestal bone level with Radiovisiography - RVG (mm). The results revealed a significant reduction in the mean FMPS%, FMBS%, & PPD within the groups (p≤0.0001),but did not reveal any statistical significance when compared between the test and the control groups at various time points (12 and 36 months). Both test and control groups showed statistically significant gain in the mean Relative Clinical Attachment Levels (R-CAL) at 12 months (p≤0.0001). The position of the gingival margin (GM) had a minimal gradual apical shift (gingival recession) till 12 months with a mild statistical significance of (p≤ 0.048) in the control group. The test group initially had a coronal shift at 12 months’ time point and then shifted apically later and became comparable at 36 months between the control and the test group but with no statistical significance(p≤0.784).RVG values revealed a statistically significant radiographic bone fill (p≤0.0001) in both, test group and the control groupat 12 months’ time point. This Bone fill significantly improved in both the groups when measured at 36 months, and the test group had a better bone fill compared to the control group with statistical significance (p≤0.023).The results of this study indicate that the sites which received PRF alone and PRF + HA -βTCP in the treatment of periodontal intraosseous defects accessed with Single Flap A were clinically effective with a substantial probing pocket depth reduction and clinical attachment gain. Although the adjunctive use of HA -βTCP graft shows a significant bone fill radiographically under the experimental conditions it offers no significant adjunctive effects on the surrogate markers.