Gingival Graft vs T-PRF in Papilla Defects

Overview

Objective: Titanium-prepared platelet-rich fibrin (T-PRF) has emerged as a promising biomaterial in periodontal regenerative procedures. The aim of this study will be to compare the clinical effectiveness of de-epithelialized gingival grafts (DGG) and T-PRF in the reconstruction of deficient interdental papillae using the tunnel technique. Methods: A total of 34 patients presenting with 115 Class I and II interdental papilla defects will be enrolled in this study. Interdental papilla reconstruction will be performed using the tunnel technique in combination with either DGG or T-PRF. Demographic characteristics (age and sex), dentogingival variables (tooth shape, papilla location, jaw type, and papilla loss classification), and clinical parameters will be recorded. Clinical assessments will include probing depth (PD), gingival index (GI), plaque index (PI), gingival thickness (GT), keratinized tissue height (KTH), black triangle width (BTW), black triangle height (BTH), papilla fill percentage (%PF), and black triangle area (BTA). All clinical parameters will be assessed at baseline and at 1, 3, and 6 months following surgery.

This randomized controlled clinical trial aims to evaluate the clinical efficacy of two autogenous grafting materials, de-epithelialized gingival graft (DGG) and titanium-prepared platelet-rich fibrin (T-PRF), when used in combination with the tunnel technique for interdental papilla reconstruction (IPR). Interdental papilla defects may cause esthetic concerns, food impaction, and phonetic difficulties. Several surgical and non-surgical methods have been proposed for IPR. Connective tissue grafts (CTG) are considered the gold standard in many periodontal procedures; however, they require a second surgical site and are associated with increased patient discomfort. As alternatives, several types of PRF have been developed; however, T-PRF demonstrates superior properties, including improved biocompatibility and prolonged growth factor release. The study is designed as a parallel-group randomized controlled trial. Thirty-four participants with Class I or II interdental papilla defects were included and randomly assigned to one of two groups: Control Group: tunnel technique combined with DGG Test Group: tunnel technique combined with T-PRF membrane Surgical procedures were performed by the same operator, while measurements were obtained by a blinded examiner. Clinical parameters will be evaluated preoperatively and at 1, 3, and 6 months postoperatively. Inclusion criteria include participants aged 25-70 years with papilla loss in the anterior maxilla or mandible, systemically healthy, non-smokers, and with no previous surgery in the target area. Exclusion criteria include smoking, systemic diseases, pregnancy or breastfeeding, and poor compliance with follow-up visits. Prior to the surgical procedure, all participants received Phase I periodontal therapy, including comprehensive oral hygiene instructions. Participants were re-evaluated during follow-up visits, and those meeting the inclusion criteria were subsequently enrolled in the surgical phase. Surgical Procedure The surgical procedure involves papilla reconstruction using the tunnel technique. Sulcular and horizontal incisions are made to create a half-thickness tunnel flap. De-epithelialized gingival grafts or T-PRF membranes are prepared according to standardized protocols and placed into the prepared papillary voids. Grafts are stabilized using guiding sutures, and tension-free closure of the flap is achieved. Postoperative care includes pain management, antimicrobial therapy, and oral hygiene instructions. Measurement of Demographic, Dentogingival, and Clinical Parameters Demographic and dentogingival data, including age, gender, crown shape, papilla classification, jaw type, and papilla area, will be recorded. Clinical parameters assessed preoperatively and at follow-up include probing depth, gingival index, plaque index, gingival thickness, keratinized tissue height, black triangle height and width, papilla fill percentage, and black triangle area. Standardized measurement techniques and calibrated instruments will be used to ensure accuracy and reproducibility. Statistical Analysis Data will be analyzed using Statistical Package for the Social Sciences and Jamovi software application. Normality will be assessed using Shapiro-Wilk and Kolmogorov-Smirnov tests. Between-group comparisons will use Mann-Whitney U test, and categorical data will be evaluated using Fisher's Exact Test or Yates correction. Repeated measures will be analyzed using Robust ANOVA. Statistical significance will be set at p \< 0.05.