Bilateral multiple recession coverage with platelet-rich fibrin in comparison with amniotic membrane
A 40 year-old male patient reported to the Department of Periodontology with a complaint of hypersensitivity to chilled drinks, in relation to the upper left and right back teeth region. He had no significant medical history. The patient gives a two-year prior orthodontic history. On clinical examination, multiple adjacent recessions were identified on the right and left posterior maxillary teeth. The bilateral recession defects, Miller Class I, were measured by calculating the distance between the cementoenamel junction (CEJ) and the gingival margin. It was recorded as the second premolar of 3 mm and first molar of 3 mm. A hard tissue abrasion defect was also present on these teeth and was measured to be less than 0.5 mm in dimension. Phase 1 therapy was completed with oral hygiene instruction reinforced. The surgical procedure was explained to the patient and informed consent was obtained. The use of an additive membrane was assigned by toss of a coin.\nThe operative site, that is, 15 and 16 was anesthetized using 2% Xylocaine with adrenaline (1:200,000). A coronally positioned flap technique was performed at the surgical site in relation to 15 and 16 []. This was performed by making two horizontal incisions with respect to the distal and mesial interdental papillae of 16 and 15, followed by a crevicular incision, two vertical releasing incisions at the mesial and distal aspects of 16 and 15. A full thickness flap followed by a partial thickness one was reflected []. A horizontal releasing incision was made in the periosteum, at the base of the flap, to facilitate tension-free coronal displacement. The exposed root surfaces were scaled and root planed. Following this, the cervical step at the CEJ was eliminated using an aerator and a diamond bur.\nAfter the recipient site preparation was completed, 5 ml of venous blood was drawn in test tubes without an anticoagulant, and centrifuged immediately. It was centrifuged for 12 minutes at 2700 rpm. The resultant product consisted of the following three layers: The topmost layer consisted of acellular Platelet-Poor Plasma (PPP), a PrF clot in the middle, and red blood cells (RBCs) at the bottom. After centrifugation, the PrF clot was obtained, separated from the RBC base using scissors, and placed in a sterile dappen dish. The PrF membrane was prepared by placing it into a petri dish. At the recipient site, the PRF clot was placed over the denuded root surfaces []. The flap was coronally advanced to cover the membrane as well as the defect and sutured []. A tin foil and periodontal dressing were placed over the surgical area.\nThe patient was advised to use 0.2% chlorhexidine digluconate mouth rinse, twice daily. Systemic analgesics were prescribed and he was advised to follow the routine postoperative instructions. The dressing and sutures were removed 10 days after surgery.\nFollow-up of seven months [].\nA similar surgical procedure was followed for the receipt bed preparation along with reduction of the cervical step in relation to 25and 26, similar to that for the PrF membrane [Figures –]. The commercially available amniotic membrane# was cut into the desired shape and length with scissors and placed onto the recession site []. The flap was coronally advanced and sutured []. A tin foil and periodontal dressing were placed over the surgical area.\nSimilar postoperative instructions were advocated as those for CAF with PrF.\nFollow-up of seven months [].\nPostoperative examination was done for one, three, six, and seven months. At the end of the seventh month, both the treatment procedures showed 100% root coverage and increased gingival biotype. However, the amniotic membrane-treated sites showed more stable results than the PrF-treated sites at the end of the seventh month.