World Journal of Dentistry

Register      Login

VOLUME 14 , ISSUE 12 ( December, 2023 ) > List of Articles


A Clinical Evaluation of Advanced Platelet-rich Fibrin and Bioresorbable Collagen Membrane for Root Coverage Using Vestibular Incision Subperiosteal Tunnel Access Technique: A Comparative Study

Surabhi Durgapal, Mamatha Shetty

Keywords : Advanced platelet-rich fibrin, Collagen membrane, Gingival recession, Vestibular incision subperiosteal tunnel access

Citation Information : Durgapal S, Shetty M. A Clinical Evaluation of Advanced Platelet-rich Fibrin and Bioresorbable Collagen Membrane for Root Coverage Using Vestibular Incision Subperiosteal Tunnel Access Technique: A Comparative Study. World J Dent 2023; 14 (12):1056-1062.

DOI: 10.5005/jp-journals-10015-2343

License: CC BY-NC 4.0

Published Online: 31-01-2024

Copyright Statement:  Copyright © 2023; The Author(s).


Aim: The present study aims to compare and evaluate the effectiveness of a bioresorbable collagen membrane (CM) (bioguide) and an advanced platelet-rich fibrin (A-PRF) when combined with the vestibular incision subperiosteal tunnel access (VISTA) technique to treat Cairo's root type 1 (RT1) and RT2 gingival recession abnormalities. Materials and methods: The clinical trial was a split-mouth randomized clinical trial that included 44 sites within the age-group 18–50 years with the bilateral Cairo RT1 or RT2 gingival recession defect. Recession defects at antagonist sites in each patient were categorized into group I (VISTA + bioresorbable CM) and group II (VISTA + A-PRF) and comparative evaluations were made. Gingival index (GI), the width of keratinized gingiva (WKG), pocket probing depth (PPD), recession height (RH), mean clinical attachment level (CAL), gingival thickness (GT), and mean root coverage (MRC) were recorded and statistically analyzed at baseline and 6 months posttreatment. Results: A statistically significant difference in MRC was detected during the follow-up period of 6 months with 76.95 ± 17.11 in group I and 86.09 ± 17.11 in group II. Analysis of GT demonstrated improvement in both groups (72.4% in group I and 76.6% in group II) from baseline to 6 months posttreatment. Conclusion: The VISTA along with A-PRF and CM has resulted in better outcomes with more promising results observed in the A-PRF group. Clinical significance: The ultimate goal of the root coverage procedure is to reduce sensitivity, improve esthetics, protect the root surfaces, promote periodontal health, and enhance oral function. The use of VISTA with A-PRF and CM provides reduced trauma and better healing properties negating the use of two surgical sites.

  1. Abbas F, Wennström J, Van der Weijden F, et al. Surgical treatment of gingival recessions using emdogain gel: clinical procedure and case reports. Int J Periodont Restor Dent 2003;23(6):607–613.
  2. Lang NP, Lindhe J. Clinical periodontology and implant dentistry John Wiley & Sons; 2015.
  3. Valderhaug J. Periodontal conditions and carious lesions following the insertion of fixed prostheses: a 10-year follow-up study. Int Dent J 1980;30(4):296–304.
  4. Tugnait A, Clerehugh V. Gingival recession—its significance and management. J Dent 2001;29(6):381–394. DOI: 10.1016/s0300-5712(01)00035-5
  5. Chambrone L, Tatakis DN. Periodontal soft tissue root coverage procedures: a systematic review from the AAP Regeneration Workshop. J Periodontol 2015;8(2 suppl):S8–51. DOI: 10.1902/jop.2015.130674
  6. Miller PD Jr. A classification of marginal tissue recession. Int Periodontol Rest Dent 1985;5(2):9–13.
  7. Cairo F, Nieri M, Cincinelli S, et al. The interproximal clinical attachment level to classify gingival recessions and predict root coverage outcomes: an explorative and reliability study. J Clin Periodontol 2011;38(7):661–666. DOI: 10.1111/j.1600-051X.2011.01732
  8. McGuire MK, Nunn ME. Evaluation of the safety and efficacy of periodontal applications of a living tissue-engineered human fibroblast-derived dermal substitute. I. Comparison to the gingival autograft: a randomized controlled pilot study. J Periodontol 2005;76(6):867–880. DOI: 10.1902/jop.2005.76.6.867
  9. Rosetti EP, Marcantonio RA, Rossa Jr C, et al. Treatment of gingival recession: comparative study between subepithelial connective tissue graft and guided tissue regeneration. J Periodontol 2000;71(9):1441–1447. DOI: 10.1902/jop.2000.71.9.1441
  10. Tinti C, Vincenzi G, Cocchetto R. Guided tissue regeneration in mucogingival surgery. J Periodontol 1993;64:1184–1191. DOI: 10.1902/jop.1993.64.11s.1184
  11. Harris RJ. A comparison of 2 root coverage techniques: Guided tissue regeneration with a bioabsorbable matrix style membrane versus a connective tissue graft combined with a coronally positioned pedicle graft without vertical incisions. Results of a series of consecutive cases. J Periodontol 1998;69(12):1426–1434. DOI: 10.1902/jop.1998.69.12.1426
  12. Harris RJ, Harris AW. The coronally positioned pedicle graft with inlaid margins: a predictable method of obtaining root coverage of shallow defects. Int J Periodont Restorat Dent 1994;14(3):228–241.
  13. Dohan DM, Choukroun J, Diss A, et al. Platelet-rich fibrin (PRF): a second-generation platelet concentrate. Part II: platelet-related biologic features. Oral Surg Oral Med Oral Pathol Oral Radiol Endodontol 2006;101(3):e45–e50. DOI: 10.1016/j.tripleo.2005.07.009
  14. Choukroun J, Ghanaati S. Reduction of relative centrifugation force within injectable platelet-rich-fibrin (PRF) concentrates advances patients’ own inflammatory cells, platelets and growth factors: the first introduction to the low speed centrifugation concept. Eur J Trauma Emerg Surg 2018;44(1):87–95. DOI: 10.1007/s00068-017-0767-9
  15. Zadeh HH. Minimally invasive treatment of maxillary anterior gingival recession defects by vestibular incision subperiosteal tunnel access and platelet-derived growth factor BB. Int J Periodont Restorat Dent 2011;31(6):653–660.
  16. Mansouri SS, Moghaddas O, Torabi N, et al. Vestibular incisional subperiosteal tunnel access versus coronally advanced flap with connective tissue graft for root coverage of Miller's class I and II gingival recession: a randomized clinical trial. J Adv Periodontol Implant Dent 2019;11(1):12–20. DOI: 10.15171/japid.2019.003
  17. Gil A, Bakhshalian N, Min S, et al. Treatment of multiple recession defects with vestibular incision subperiosteal tunnel access (VISTA): a retrospective pilot study utilizing digital analysis. J Esthet Restorat Dent 2018;30(6):572–579. DOI: 10.1111/jerd.12434
  18. Richardson CR, Allen EP, Chambrone L, et al. Periodontal soft tissue root coverage procedures: practical applications from the AAP regeneration workshop. Clin Advanc Periodont 2015;5(1):2–10. DOI: 10.1902/cap.2015.140059
  19. Agarwal M, Dhruvakumar D. Coronally repositioned flap with bioresorbable collagen membrane for Miller's class I and II recession defects: a case series. Med Princ Pract 2019;28(5):477–480. DOI: 10.1159/000500308
  20. Steinberg AD, LeBreton G, Willey R, et al. Extravascular clot formation and platelet activation on variously treated root surfaces. J Periodontol 1986;57(8):516–522. DOI: 10.1902/jop.1986.57.8.516
  21. Shieh AT, Wang HL, O'Neal R, et al. Development and clinical evaluation of a root coverage procedure using a collagen barrier membrane. J Periodontol 1997;68(8):770–778. DOI: 10.1902/jop.1997.68.8.770
  22. Lee EJ, Meraw SJ, Oh TJ, et al. Comparative histologic analysis of coronally advanced flap with and without collagen membrane for root coverage. J Periodontol 2002;73(7):779–788. DOI: 10.1902/jop.2002.73.7.779
  23. Huang LH, Neiva RE, Soehren SE, et al. The effect of platelet-rich plasma on the coronally advanced flap root coverage procedure: a pilot human trial. J Periodontol 2005;76(10):1768–1777. DOI: 10.1902/jop.2005.76.10.1768
  24. Chekurthi S, Tadepalli A, Parthasarathy H, et al. Evaluation of clinical efficacy of advanced platelet-rich fibrin in the management of gingival recession defects: case series. Clin Adv Periodont 2022;12(2):88–93. DOI: 10.1002/cap.10160
  25. Sameera S, Nagasri M, Kumar PA, et al. Comparison of two surgical techniques in the treatment of multiple gingival recessions sandwiched with a combination of A-PRF and LPRF. Saudi Dent J 2018;30(3):183–189. DOI: 10.1016/j.sdentj.2018.03.002
  26. Tuttle D, Kurtzman GM, Froum SH. Platelet-rich fibrin minimally invasive root recession soft-tissue grafting. Int J Growth Factor Stem Cell Dent 2018;1:32–37.
  27. Jain KS, Vaish S, Gupta SJ, et al. Minimally invasive treatment of gingival recession by vestibular incision subperiosteal tunnel access technique with collagen membrane and advanced platelet-rich fibrin: a 6-month comparative clinical study. J Indian Soc Periodontol 2021;25(6):496–503. DOI: 10.4103/jisp.jisp_590_20
  28. Kim DM, Bassir SH, Nguyen TT. Effect of gingival phenotype on the maintenance of periodontal health: an American Academy of Periodontology best evidence review. J Periodontol 2020;91(3):311–338. DOI: 10.1002/JPER.19-0337
  29. Barootchi S, Tavelli L, Zucchelli G, et al. Gingival phenotype modification therapies on natural teeth: a network meta-analysis. J Periodontol 2020;91(11):1386–1399. DOI: 10.1002/JPER.19-0715
  30. Hwang D, Wang HL. Flap thickness as a predictor of root coverage: a systematic review. J Periodontol 2006;77(10):1625–1634. DOI: 10.1902/jop.2006.060107
  31. Agudio G, Chambrone L, Pini Prato G. Biologic remodeling of periodontal dimensions of areas treated with gingival augmentation procedure: a 25-year follow-up observation. J Periodontol 2017;88(7):634–642. DOI: 10.1902/jop.2017.170010
  32. de Resende DRB, Greghi SLA, Siqueira AF, et al. Acellular dermal matrix allograft versus free gingival graft: a histological evaluation and split-mouth randomized clinical trial. Clin Oral Investig 2019;23(2):539–550. DOI: 10.1007/s00784-018-2470-6
  33. Pietruska M, Skurska A, Podlewski L, et al. Clinical evaluation of Miller class I and II recessions treatment with the use of modified coronally advanced tunnel technique with either collagen matrix or subepithelial connective tissue graft: a randomized clinical study. J Clin Periodontol 2019;46(1):86–95. DOI: 10.1111/jcpe.13031
  34. Dohan DM, Choukroun J, Diss A, et al. Platelet-rich fibrin (PRF): a second-generation platelet concentrate. Part I: technological concepts and evolution. Oral Surg Oral Med Oral Pathol Oral Radiol Endodont 2006;101(3):e37–e44. DOI: 10.1016/j.tripleo.2005.07.008
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.