Treatment of multiple gingival recessions, class 1, with coronal advance flap (CAF) with or without Leucocytes -Platelet rich fibrin (L-PRF). Randomized controlled trial
- Autores: Nuno Bernardo Malta Santos
- Directores de la Tesis: Pilar Batalla Vázquez (dir. tes.), Juan Blanco Carrión (tut. tes.)
- Lectura: En la Universidade de Santiago de Compostela ( España ) en 2025
- Idioma: inglés
- Tribunal Calificador de la Tesis: José Vicente Sanz Casado (presid.), Antonio Liñares González (secret.), Fernando Alberto Deométrio Rodrigues Alves Guerra (voc.)
- Programa de doctorado: Programa de Doctorado en Ciencias Odontológicas por la Universidad de Santiago de Compostela
- Materias:
- Enlaces
- Resumen
Background: Gingival recession, characterized by gingival apical migration and subsequent root exposure, poses significant clinical challenges, including aesthetic concerns, hypersensitivity, and potential root caries. The coronally advanced flap (CAF) procedure, with or without the adjunctive use of platelet-rich fibrin (PRF), is used to achieve root coverage and promote periodontal regeneration.
Objective: This study aims to evaluate the clinical outcomes of the treatment of Miller Class I gingival recessions using CAF alone versus CAF combined with leukocyte- and platelet-rich fibrin (L-PRF). The primary outcome measured was the percentage of root coverage (%RC) at six months. Secondary outcomes included mean root coverage (MRC), frequency of achieving 100% root coverage (CRC), keratinized tissue width (KTW), gingival thickness gain, volume gain, recession area reduction, healing quality, pill consumption, and patient-reported outcomes (PROs).
Methods: This randomized clinical trial included 19 patients with a total of 70 Miller Class I gingival recessions. Participants were randomly assigned to two groups: test group (CAF+L-PRF, n=42 sites) and the control group (CAF alone, n=28 sites). Clinical parameters were assessed at baseline and six months post-treatment, including percentage of root coverage (%RC), mean root coverage (MRC), frequency of achieving 100% root coverage (CRC), keratinized tissue width gain (KTW), gingival thickness gain in two different regions of interest (meanGT, maxGT), volume gain, and healing quality (IPR scores). Pain and patient-reported outcomes were evaluated using the Visual Analog Scale (VAS) and standardized questionnaires, respectively. Pills consumption post-surgery was also recorded. All measurements were made using a digital evaluation protocol. Statistical analyses were performed using Mann-Whitney U test, mixed-effects models, and ANOVA to determine differences between groups and over time.
Results: - Root Coverage: The mean percentage of root coverage (%RC) was 89.30% ± 20.33% in the test group and 81.60% ± 27.93% in the control group (p=0.168). The mean root coverage (MRC) was 1.01 ± 0.59 mm in the test group and 0.92 ± 0.68 mm in the control group (p=0.260). The frequency of achieving 100% root coverage (CRC) was 73.81% in the test group and 57.14% in the control group (p=0.193).
- Keratinized Tissue Width gain (KTW): The mean KTW, increased from 2.75 ± 0.84 mm to 3.03 ± 0.91 mm in the test group and from 3.00 ± 1.01 mm to 3.06 ± 0.86 mm in the control group. The difference over time was statistically significant (p=0.042), but not between groups (p=0.474).
- Gingival Thickness: In the first ROI, the mean gingival thickness gain (meanGT) was 0.16 ± 0.11 mm in the test group and 0.11 ± 0.10 mm in the control group (p=0.075). In the second ROI, the maximum gingival thickness gain (maxGT) was 0.58 ± 0.27 mm in the test group and 0.55 ± 0.20 mm in the control group (p=0.857).
- Volume Gain: The mean volume gain was 1.13 ± 1.25 mm³ in the test group and 0.86 ± 0.84 mm³ in the control group (p=0.415).
- Healing Quality (IPR Scores): No statistically significant differences were found between groups in any phase of healing (p>0.05).
- Pills Consumption: The mean number of pills taken post-surgery was 1.70 ± 1.25 in the test group and 3.11 ± 2.57 in the control group (p=0.243).
- Patient-Reported Outcomes (PROMs): No statistically significant differences were found between groups in esthetic satisfaction, willingness to undergo the procedure again, or sensitivity reduction (p>0.05).
Conclusion This study found no statistically significant differences in most clinical outcomes between CAF alone and CAF combined with L-PRF in the treatment of Miller Class I gingival recessions. Both treatment modalities resulted in similar improvements in root coverage, keratinized tissue width, gingival thickness, volume gain, healing quality, and patient-reported outcomes. However, the mean gingival thickness gain in the first region of interest showed a trend towards better results in the test group (p=0.075), despite not being statistically significant. Longer studies with larger sample sizes will be needed to confirm this trend.
