Platelet rich fibrin and alloplast in the treatment of intrabony defect
The present case report is about a 29-year-old man who was referred to Department of Periodontics, Saveetha Dental College, India, with a complaint of pain in relation to the left lower tooth. On examination, the patient was systemically healthy and had not taken any long-term anti-inflammatory medications or antibiotics.\nOn periodontal examination and radiographic evaluation, the patient presented with an intrabony defect extending up to apical third of the mesial root [] of left mandibular first molar (#36) with a probing depth of 8 mm using William's periodontal probe []. The patient also presented with pain in relation to #36 tooth and had pain on percussion. There was a lingering type of pain when subjected to heat test using a heated gutta-percha point. The diagnosis was made to be primary chronic periodontitis with secondary endodontic involvement in relation to left mandibular first molar (#36).\nInitial therapy consisted of oral hygiene instructions, which were repeated until the patient achieved an O’Leary plaque score of 20% or below.[] Scaling and root planning of the teeth were performed. Patient was referred to Department of conservative dentistry and endodontics for root canal therapy in relation to #35 and #36 teeth (which were symptomatic to the heat test).\nAt 4 weeks following phase 1 therapy, a periodontal re-evaluation was performed to confirm the suitability of #36 tooth for this periodontal surgical procedure. Clinical measurements were made using William's periodontal probe with graduation to a precision of 1 mm.\nBlood sample was taken on the day of the surgery according to the PRF protocol with a REMI 3000 centrifuge and collection kits. Briefly, 6 ml blood sample was taken from the patient without an anti-coagulant in 10 ml glass test tubes and immediately centrifuged at 3000 rpm for 12 min. A fibrin clot was formed in the middle of the tube, whereas the upper part contained acellular plasma and the bottom part contained red corpuscles. The fibrin clot was easily separated from the lower part of the centrifuged blood. The PRF clot was gently pressed between two sterile dry gauges to obtain a membrane, which was later minced and added to the graft material (OSSIFI™) [].\nAn intrasulcular incision was made on buccal and lingual aspect of the tooth of left mandibular teeth (#35, 36 and 37) along with a vertical incision, extending to the muco gingival junction in relation to the distal aspect of #35. A full thickness triangular flap was raised and inner surface of the flap was curetted to remove the granulation tissue. Root surfaces were thoroughly planned using hand instruments and ultrasonic scalers. The left mandibular first molar demonstrated mesial intrabony defect. After removing granulation tissue thoroughly, mesial intrabony defect was found to extend in buccal and apical aspect [].\nBriefly, alloplast (OSSIFI™) and was applied to the defect walls and root surfaces [Figures , and ]. The alloplast with PRF was then condensed using amalgam condensers. The flap were repositioned to their pre-surgical levels and sutured with silk utilizing an interrupted technique [].\nAfter the operation, the patient was prescribed systemic antibiotics (amoxicillin 500 mg tid, 3 days), non-steroidal anti-inflammatory drug (combiflam tid, 3 days) and 0.12% chlorhexidine rinse (twice a day for 4 weeks). Sutures were removed after 7 days. Clinical healing was normal with neither infectious episodes nor untoward clinical symptoms. The patient was seen at 1st week, 2nd week, 1st month, 3rd and 6th month.\nPeriapical intraoral radiographs were obtained from the periodontal defect site at baseline, 3 months and 6 months after surgery []. The radiographs were obtained with paralleling technique using film holders. To standardize, putty index was made and patient was asked to bite on it along with that of the holder.\nIn this case report, the greater reduction in pocket depth and gain in clinical attachment were found after 6 months of the follow-up []. These are the important clinical outcomes for any periodontal regenerative procedures. Radiographs revealed significant bone fill in the intrabony defect compared with measurements at baseline [].