Clinical effectiveness of combining platelet rich fibrin with alloplastic bone substitute for the management of combined endodontic periodontal lesion
A 35 year old male patient reported to the Department of Periodontics with a complaint of pain in the upper left front tooth region associated with pus discharge for 2 months (). He also gave history of trauma around 7 years back and noticed discoloration of tooth with time but he took no treatment as the tooth was asymptomatic. On intraoral examination there were no carious teeth. Intraoral periapical X-ray (IOPA) was taken which revealed radiolucency along the distal side of the entire root surface to the apex (). Electric pulp testing was done to check the vitality of the tooth which confirmed that the tooth was non vital and the tooth was tender on percussion. Vertical probing depth was measured which was found to be 8 mm on distal side. Endodontic treatment was taken up first and then periodontal regenerative surgery was planned for treatment of defect.\nOn the day of surgery, PRF was prepared. Exactly 10 mL of whole blood was drawn by venipuncture of the antecubital vein and collected in two 5 mL sterile glass tubes coated with an anticoagulant, acid-citrate-dextrose. Whole blood was initially centrifuged (3,000 rpm for 10 minutes, ).The plasma was then aspirated with a micropipette and subjected to a second centrifugation at 2,000 rpm for 10 minutes, which allowed the precipitation of the platelets (0.8 to 1.2 mL) to fall onto the bottom. Coagulated preparation of 0.3 mL of PRF was obtained by its combination with 0.1 g of calcium chloride (). Then graft material was mixed with the coagulated platelet rich plasma (PRP) preparation.\nThe area selected for surgery was anesthetized using xylocaine with adrenaline 1 : 200,000. A full thickness flap was raised at the labial aspect using intracrevicular incision (). Thorough curettage of the defect area was done and a combination of PRF and bioactive glass was placed in the defect ( and ). Closure of soft tissue flap was done with non resorbable black silk (3-0) suture using interrupted suturing technique. The sutures were removed 10 days after surgery. The patient was scheduled for regular recall intervals at 3, 6, 9 and 12 months. PRF and bone graft resulted in substantial amount of bone fill (), and probing depth was reduced to 2 mm.