Mandibular Degree II Furcation Defects Treatment With Platelet-Rich Fibrin and 1% Alendronate Gel Combination: A Randomized Controlled Clinical Trial

• Autores: Dharmendra Kanoriya, A.R. Pradeep, Vibhuti Garg, Sandeep Singhal
• Localización: Journal of periodontology, ISSN 0022-3492, Vol. 88, Nº. 3, 2017, págs. 250-258
• Idioma: inglés
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• Resumen

  • Background: Different materials have been investigated for renewal of lost supporting periodontal structures and tested for furcation defect treatment. Platelet-rich fibrin (PRF) is a pool of growth-promoting factors and cytokines that promote bone regeneration and maturation of soft tissue. Alendronate (ALN), an influential member of the bisphosphonate group, is known to enhance osteoblastogenesis and inhibit osteoclastic bone resorption, thus promoting tissue regeneration. This randomized trial was done to assess effectiveness of PRF and 1% ALN gel combination in mandibular degree II furcation defect treatment in comparison with PRF and access therapy alone.

    Methods: Seventy-two mandibular molar furcation defects were treated with either access therapy alone (group 1), access therapy with PRF (group 2), or access therapy with PRF and 1% ALN (group 3). Plaque index, modified sulcus bleeding index, probing depth (PD), relative vertical attachment level (RVAL) and relative horizontal attachment level (RHAL), and intrabony defect depth were recorded at baseline and 9 months postoperatively. Radiographically, defect fill, assessed in percentage, was evaluated at baseline, before surgery, and 9 months post-therapy.

    Results: Group 3 showed greater PD reduction and RVAL and RHAL gain when compared with groups 1 and 2 postoperatively. Moreover, group 3 sites showed a significantly greater percentage of radiographic defect fill (56.01% ± 2.64%) when compared with group 2 (49.43% ± 3.70%) and group 1 (10.25% ± 3.66%) at 9 months.

    Conclusions: Furcation defect treatment with autologous PRF combined with 1% ALN gel results in significant therapeutic outcomes when compared with PRF and access therapy alone. Combining ALN with PRF has potential for regeneration of furcation defects without any adverse effect on healing process.

    Inflammatory disease of supporting structures of teeth (i.e., periodontitis) leads to periodontal pocket formation by initiating supporting periodontal ligament and alveolar bone loss around the teeth.1 Periodontal disease causes periodontal breakdown at a higher rate in molars with furcation involvement and, in comparison with furcations of uninvolved molars or single-rooted teeth, periodontal therapy response is less favorable.2 Teeth with furcation involvement offer unique challenges to successful periodontal therapy and affect treatment outcomes.3 Prevention of periodontal disease progression along with lost periodontal tissue regeneration forms the main goal of periodontal treatment.4 To resolve furcation defects, various approaches have been used, such as bovine-derived xenografts,5-8 demineralized freeze-dried bone allografts,5-7,9 autografts,10,11 barrier membranes,4,12-14 and membranes and bone grafts in combination.15,16 Apart from these regenerative modalities that are still used presently, biomimetic agents, such as bone morphogenetic proteins,17 platelet-derived growth factor (PDGF),18 enamel matrix derivatives,19 and platelet rich plasma20 have given better results in furcation resolution.

    Choukroun et al.21 described platelet-rich fibrin (PRF) as a second-generation platelet concentrate that incorporates platelets and growth factors within fibrin membranes. The original PRF was finally described and classified as leukocyte and PRF (L-PRF), and the acronym L-PRF is now commonly used to refer to the original PRF.22 Platelets and growth factors get concentrated within the natural fibrin matrix component obtained from blood harvest and serves as a healing matrix component.21 PRF has proved beneficial in various regenerative soft tissue and bone procedures such as facial plastic surgery23 and as an osteoconductive filling substance in sinus lift procedures,24 as well as in regeneration of periodontal tissue in intrabony defect (IBD) treatment25 and mandibular degree II furcation defect resolution.26 Bisphosphonates (BPs), which are pyrophosphate analogs chemically, are a group of bone metabolism mediators that inhibit osteoclastic bone resorption.27 BPs promote osteoblastogenesis by initiating formation of osteoblast precursors and mineralized nodules and inducing secretion of inhibitors of osteoclast-mediated resorption by osteoblasts.28,29 They have been used effectively in Paget disease and osteoporosis by reducing bone loss.30,31 Alendronate (ALN), a nitrogen-containing BP, is widely used for treating many conditions associated with bone loss.31 ALN prevents bone resorption by causing alteration of osteoclast cytoskeleton, thus inhibiting its interaction with bone matrix. It also causes apoptosis of these cells.32 ALN may significantly prevent bone resorption without affecting mineralization or bone quality32 and also has antimicrobial properties.33 Previous studies have demonstrated that 1% ALN gel, locally delivered into periodontal pockets for intrabony and furcation defects, is highly effective as an adjuvant to mechanotherapy in treatment of periodontitis.34-36 Recently, it has been found that topical use of ALN in experimental periodontitis decreases localized inflammation, helps with tissue reparation, and increases bone formation in furcations.37 However, its systemic administration for treatment of periodontitis is associated with risk of onset of osteonecrosis of the jaw.38 Combined application of PRF and 1% ALN gel with access therapy in mandibular degree II furcation defect treatment has not been evaluated, to the best of the author’s knowledge, until now. Considering the aforementioned fact that combined application of PRF with 1% ALN may yield synergistic effects, this study is planned as a single-center, randomized trial to assess efficacy of PRF and 1% ALN gel with access therapy in mandibular degree II furcation defect resolution.