Comparative evaluation of second generation plateletrich fibrin (PRF) and connective tissue graft (CTG) in the management of localized miller class I and II gingival recessions: a case series

The mucogingival surgical modality SCTG + CAF (subepithelial connective tissue graft (SCTG) + coronally advanced flap (CAF)) in the treatment of Miller Class I and II gingival recessions is considered the “gold standard” technique for predictable and complete root coverage of gingival defects, with long-term clinical stability of the achieved results. The aim of this study is to evaluate the clinical efficacy of the CAF + PRF combined technique in the treatment of localized single Miller Class I and II gingival recessions in 10 patients, by comparing periodontal clinical parameters measured preoperatively and one month postoperatively, versus results obtained with the CAF + CTG (SCTG) modality in another 10 patients with the same type of recession, over the same time period. Material and method: Ten patients were admitted to the Clinic “St. Panteleimon” – Skopje, Department of Oral Surgery, for surgical treatment of localized single Miller Class I and II gingival recessions. Half of the patients were treated with the CAF + PRF technique, while the other half were treated with the CAF + CTG (SCTG) modality. One day preoperatively, periodontal clinical parameters were measured, including vertical gingival recession (RD/VGR), probing pocket depth (PPD/PD), clinical attachment level (CAL), keratinized gingival width (KTW/KMW), and gingival thickness (GT), all measured in millimeters, as well as gingival biotype in all 10 patients. Following mucogingival surgical procedures (CAF + PRF in five patients and CAF + CTG/SCTG in five patients), the same periodontal clinical parameters were recorded one month postoperatively in all patients. These values were then compared with the preoperative measurements both between the groups and within each group over time.
Results: An insignificant reduction in PPD and CAL, as well as a slight, clinically minor increase in KTW, was observed when comparing measurements taken one day preoperatively and one month postoperatively between the two groups. Similarly, no statistically significant changes in these parameters were observed within the same group over the same time periods. A statistically significant increase in the RD/VR parameter (Z = 1.984; p = 0.0472) was observed in the SCTG + CAF group one month postoperatively compared with the PRF + CAF group, while other comparisons of this parameter between and within groups were not statistically significant. Regarding the GT parameter, a statistically significant change (Z = 2.507; p = 0.0122) was observed in the PRF + CAF group when comparing baseline and one-month postoperative values within the same group. However, no statistically significant differences in GT were observed between the two groups at either time point. Changes in gingival biotype from thin to thick were observed only in the PRF + CAF group one month postoperatively in 2 patients (40%). Conclusion: Therefore, PRF as a second generation of autologous concentrate is not only an adjuvant and/or replacement of the SCTG- "gold standard" in the treatment of Miller I and II, but is also a superior alternative in the surgical treatment of this type of superficial mucogingival defects.

Keywords: PRF, platelet concentrates, CAF, Miller I and II, gingival recessions, mucogingival surgery.