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Non-incised papillae surgical approach for intrabony defects utilizing advanced platelet-rich fibrin/xenograft
Raksha Kumari1, Triveni M Gowda1, Rucha Shah1
1Department of Periodontics, Bapuji Dental College and Hospital, Davangere, India.
Background:
The present study aimed to assess and evaluate the clinical and radiographic outcomes of the non-incised papilla surgical approach (NIPSA) with advanced platelet-rich fibrin (A-PRF)/xenograft composite to enhance periodontal regeneration in intrabony defects.
Methods:
A total of 10 systemically healthy patients aged 25-55 years with 3- or 2-wall intrabony defects involving the buccal wall and defect depth ≥3 mm were selected. Microsurgical technique NIPSA was employed, and grafting was done using A-PRF/xenograft composite, followed by A-PRF membrane placement. The radiographic cone beam computed tomography measurements of total defect depth and bone density in Hounsfield-Units (HUs) were taken at baseline and at the end of 6 months. Clinical parameters, including probing depth, clinical attachment level, and gingival thickness, were recorded at baseline and at 6 months postoperatively.
Results:
From baseline to 6-month study showed a mean reduction of 2.69 mm in probing depth and a mean gain of 2.68 mm in clinical attachment and 2.81 mm gain in gingival thickness. Radiographically, a mean reduction of 2.80 mm in total defect depth and gain in bone density from 22.20 to 507.10 HUs was observed. All the parameters showed clinical and statistical improvement.
Conclusions:
NIPSA technique, along with the A-PRF/xenograft composite, can be an effective and minimally invasive regenerative procedure for the management of intrabony defects in the maxillary and mandibular anterior region.
Key Points:
To the best of our knowledge, this is the first study to demonstrate the effectiveness of the non-incised papilla surgical approach technique in combination with advanced platelet-rich fibrin (A-PRF)/xenograft composite for the management of 2- and 3- wall intrabony defects. Minimally invasive non-incised papillae preservation approach effectively maintained the integrity of soft tissues and graft stability, both of which are critical factors for successful regenerative outcomes. A harmonious biomaterial A-PRF/xenograft composite graft utilizes the biological activity of PRFs with structural support of the graft material in escalating the regenerative treatment.
Plain Language Summary:
This study assessed a minimally invasive surgical procedure to help restore the bone and supporting tissues around teeth damaged by periodontal disease. Ten healthy adults with specific types of bone defects were treated using this procedure in the anterior region. A biologically active material prepared from the patient's own blood was combined with a bone graft to restore the defect. After 6 months, patients showed significant improvements such as increased gum attachment, gum thickness, and reduced pocket depth. In a three-dimensional scan, bone level and bone density were also increased. These changes indicate that the treated sites healed with stronger and more stable supporting structures. The outcomes suggest that this approach may offer an effective and less traumatic option for managing bone defects in the esthetic region, with encouraging clinical and radiographic outcomes.
