International Journal of Research and Review

DOI: https://doi.org/10.52403/ijrr.20210505
Vol.8; Issue: 5; May 2021
Website: www.ijrrjournal.com
Case Report E-ISSN: 2349-9788; P-ISSN: 2454-2237

Platelet Rich Fibrin in the Treatment of Localised

Gingival Recession: A Case Report
Dhawal Mody1, Vrushali Lathiya2
1
Associate Professor, 2Senior Lecturer,
VSPM Dental College & Research Centre, Department of Periodontology,
Digdoh Hills, Hingna Road, Nagpur - 440019
Corresponding Author: Dhawal Mody

ABSTRACT most predictable surgical procedure for

complete coverage in Millers Class I &
Root recession presents a matter of aesthetic Class II gingival recession.[4]
concern in every dental practice. Also it may Obtaining an optimal root coverage
illicit sensitivity and is more prone to caries than and acceptable esthetics is the primary aim
the covered root surfaces. Platelet- rich fibrin is
of mucogingival surgeries. But when
a second generation platelet concentrate. It is
basically autologous leukocyte and platelet-rich selecting the surgical technique care should
fibrin biomaterial. The use of PRF in also be taken regarding patient comfort.
combination with coronally advanced flap in the Several regenerative materials are also
treatment of gingival recession has shown being used in combination with CAF. One
promising results and is gaining immense such regenerative material is autologous
popularity among the dental practitioners. This platelet concentrates.[5] Platelet- rich fibrin
case reports the use of PRF membrane in root (PRF) is a second-generation platelet
coverage on the labial surface of maxillary concentrate and it was first described by
canine. Choukroun et al. [6] It is the latest
development amongst all the platelet
Key words: Coronally advanced flap, platelet
derived products and techniques. Platelet-
rich fibrin, gingival recession, growth factors
rich plasma (PRP) was the first generation
scaffold derived from blood samples of
INTRODUCTION
Gingival recession (GR) is the humans but the clinical applications of PRP
exposure of the root surface due to were limited due to addition of
displacement of the gingival margin apical anticoagulants and bovine serum and double
to the cement-enamel junction (CEJ). [1,2] centrifugation.[7] On the contrary no
The etiologic factors associated with the anticoagulants, thrombin or calcium
gingival recession include mechanical chloride are required in the preparation of
trauma, improper tooth brushing, PRF. PRF is rich in fibronectin and releases
orthodontic appliances, periodontal various growth factors that promote
diseases, occlusal trauma, tooth regeneration. It has a great potential for
malpositioning, orthodontic tooth hard tissue and soft tissue regeneration.
movement, etc.[3] Amongst the various root Therefore taking into consideration, the
coverage procedure that have been numerous advantages of platelet rich fibrin,
developed to treat gingival recessions, this case reports the use of PRF membrane
Coronally Advanced Flap (CAF) with in combination with CAF in the treatment of
connective tissue graft (CTG) is usually localised gingival recession.
considered as a gold standard and is the

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 Dhawal Mody et.al. Platelet rich fibrin in gingival recession

CLINICAL PRESENTATION There was an adequate width of

A 23 year old female reported to the attached gingival and slight bleeding on
Dept. of Periodontics, of our institute with a probing. After a thorough clinical
chief complaint of poor esthetics in the examination it was decided to treat the
upper left anterior region since six months. gingival recession by employing a coronally
On clinical examination of the patient, a advanced flap in combination with PRF.
Class I Miller’s gingival recession was The surgical procedure was explained and
found in association with 23. The UNC -15 the informed consent was obtained from the
probe revealed 6 mm of clinical attachment patient. Scaling and Root Planing of the
loss (CAL). The amount of gingival entire dentition was done and oral hygiene
recession (GR) measured as the distance instructions were given. Probing pocket
between the cementoenamel junction (CEJ) depth (PPD), gingival recession and width
and free gingival margin was 4 mm and the of attached gingiva were recorded before
Probing pocket depth (PPD) measured as and after the mucogingival surgical
the distance between the gingival margin to procedure.
the base of the pocket was 2 mm (Fig. 1a).

Fig. 1: Preoperative measurement of clinical parameters.

1a) Vertical measurement of Gingival recession (GR) defect in mm
1b) Horizontal measurement of Probing Pocket depth (PPD) in mm
Treatment Strategy
Preparation of Platelet Concentrate

Fig. 2: Preparation of Platelet Concentrate.

2a) Drawing of blood from the antecubital vein.
2b) Centrifugation of the blood contained in the test tubes.
2c) Preparation of PRF membrane

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 Dhawal Mody et.al. Platelet rich fibrin in gingival recession

Platelet rich fibrin was prepared perpendicular to the interdental papillae

according to Choukroun et al. protocol.[8] 10 which is adjacent to the affected site (Fig.
ml of blood was drawn from each patient 3a). A moderate to deep vestibule is
immediately prior to the surgical procedure essential as it allows coronal displacement
by venipuncture of the antecubital vein and of flap without tension. A full-thickness flap
collected in a sterile glass test tube without was reflected till the mucogingival junction
any anticoagulant (Fig.2a) Because of the and was further released by sharp
absence of an anticoagulant, the blood was dissection. (Fig. 3b) The mesiodistal length
quickly collected, and the tubes were of the incision was extended to the nearest
immediately centrifuged for 12 minutes at distal line angle of the most mesial and
2,700 rpm (Fig. 2b). The topmost layer distal teeth involved. Releasing incisions
consisted of acellular platelet-poor plasma across the MGJ were avoided during the
(PPP), a PRF clot in the middle, red blood initial phase of the surgical procedure to
cells (RBCs) were formed at the base. PRF reduce postoperative swelling and pain. At
clot was procured in the form of a the same time, the papilla over which the
membrane by compressing out the fluids CAF was to be placed was de-epithelised to
from the PRF clot and placed in a sterile create a connective tissue bed. The PRF
petri dish.[9] (Fig.2c) membrane was then placed over the
denuded root surface at the recipient site
Preparation of the Recipient Site and then stabilized with the help of (5-0)
Surgical field was properly isolated; bio-absorbable sling suture (Ethicon, St.-
the operative sites were anaesthetized using Stevens-Woluwe, Belgium). The flap was
2% per cent xylocaine hydrochloride with then coronally advanced to completely
adrenaline (1:200000). The surgical cover the membrane and sutured over the
procedure was done as described by Allen graft with sling sutures (Mersilk 4-0) (Fig.
and Miller in 1989. [10] The coronally 3c). Vertical incisions were also closed with
repositioned flap procedure was performed. 4-0 silk sutures. Finally, it was covered with
On the buccal aspect of the maxillary periodontal dressing and mild pressure was
canine, intrasulcular incision was given applied for 5 min to minimize dead space.
followed by horizontal incisions

Fig. 3: Surgical procedure.

3a) Horizontal and sulcular incision placement on the buccal aspect of 23
3b) Flap reflection beyond the mucogingival junction
3c) Placement of sutures

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 Dhawal Mody et.al. Platelet rich fibrin in gingival recession

Post-Operative care removed 10 days after the surgery. There

The patient was advised to use 0.2% was almost 100% root coverage at the time
chlorhexidine digluconate mouthrinse, twice of suture removal. (Fig. 4a) The patient was
daily for two weeks. Systemic analgesics revaluated after 6 months. The results
were prescribed and advised to follow persisted even at the end of 6 months and
routine post-operative periodontal there was a significant increase in the width
instructions. The dressings and sutures were of attached gingiva. (Fig. 4b)

Fig. 4: Postoperative clinical photographs.

4a) Clinical photograph 10 days after surgery
4b) 6 months post surgery

DISCUSSION are a reservoir of many growth factors that

An increasing awareness regarding are known to play a crucial role in hard and
aesthetics in the general population has soft tissue repair and regeneration
substantially risen the demand for mechanisms.[12,13] These include platelet-
periodontal plastic and esthetic procedures. derived growth factors (PDGFs),
The selection of an ideal site is an extremely transforming growth factor-beta (TGF-beta),
crucial factor when it comes to determining vascular endothelial growth factor (VEGF),
the prognosis of root coverage procedures. epidermal growth factor (EGF), and insulin-
Millers Class I and Class II gingival like growth factor-1 (IGF-1). These growth
recession are considered as ideal candidates factors enhance the chemotatic and mitotic
for root coverage wherein one can expect activity and stimulate the migration and
almost 100% of recession coverage. In the proliferation of connective tissue.
present case report we treated a Class I The above case report showed an
gingival recession present on the buccal increase in the width of attached gingiva.
aspect of 23 with PRF in combination with These findings are in accordance with the
CAF. The need for donor site procurement study done by Kuka S. et al. who evaluated
of connective tissue and unnecessary trauma coronally advanced flap with or without
to the patient was avoided in our case report platelet-rich fibrin for the treatment of
by using PRF membrane. Choukroun's PRF multiple gingival recessions and concluded
has proven to be a method that comes close that the use of PRF membranes increased
to the ideal concept of guided (“smart”) the width of attached gingiva
[14]
tissue engineering over the last few years. significantly.
As previously shown, this form of PRF In yet another study, Del Corso M et
contains various growth factors and can al. found significant improvement during
contribute to tissue regeneration in terms of the early periodontal healing phases with a
osteoblast, prekeratinocyte, and gingival thick and stable, final remodelled
fibroblast differentiation and promoting gingiva.[15] Aroca et al., reported that
neoangeogenesis. [11] Platelet alpha-granules addition of a PRF membrane positioned

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 Dhawal Mody et.al. Platelet rich fibrin in gingival recession

under the Modified Coronally Advanced Source of Funding: None

Flap provided excellent results when used to
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14. Kuka S, Ipci SD, Cakar G, Yılmaz S. How to cite this article: Mody D, Lathiya V.
Clinical evaluation of coronally advanced Platelet rich fibrin in the treatment of localised
flap with or without platelet-rich fibrin for gingival recession: a case report. International
the treatment of multiple gingival Journal of Research and Review. 2021; 8(5):
recessions. Clin Oral Investig. 2018 Apr; 22 24-29. DOI: https://doi.org/10.52403/ijrr.
(3):1551-1558. 20210505

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