Vitamins A‐ and C‐augmented platelet‐rich fibrin in periodontal intraosseous defects: A randomized clinical trial

Abstract

BACKGROUND: Vitamins A and C (VitA+C) are pivotal biomolecules, with synergistic effects, especially in conjoint presence, on cellular pluripotency and regenerative capabilities. This randomized trial aimed to evaluate (VitA+C)-augmented injectable platelet-rich fibrin (i-PRF) versus i-PRF alone with a modified minimally invasive surgical technique (M-MIST) in periodontal intraosseous defects in patients with stage III periodontitis. METHODS: This parallel group, two-arm, triple-blinded, randomized controlled trial included patients with stage III grade B periodontitis (n = 28) randomly allocated to the test (VitA+C/i-PRF+M-MIST; n = 14) or the control (i-PRF+M-MIST; n = 14) group. The changes in radiographic linear defect depth (RLDD) (primary outcome), radiographic bone fill (RBF), and radiographic bone density (RBD) were recorded at baseline, 6, and 9 months. Clinical attachment level (CAL), probing depth (PD), gingival margin level (GML), plaque index (PI), and gingival index (GI; secondary outcomes) were recorded at baseline, 3 6, and 9 months. The in vitro release kinetics of VitA and VitC from the i-PRF were characterized over 7 days using high-performance liquid chromatography (HLPC). RESULTS: VitA+C/i-PRF+M-MIST demonstrated a significantly higher RLDD-reduction at 6 months and a higher RBF percentage at 6 and 9 months compared with i-PRF+M-MIST (p < 0.05), with no intergroup differences regarding RBD. Both groups independently demonstrated significant improvements in CAL, PD, GML, RLDD, and BDA over time (p < 0.05). Significantly higher CAL-gain and PD-reduction were evident in the VitA+C/i-PRF+M-MIST group at 9 months (p < 0.05). CONCLUSIONS: I-PRF with M-MIST significantly enhance periodontal clinical and radiographic parameters over time. Conjoint vitamin A/C augmentation of i-PRF at the described concentration results in significantly greater improvement in radiographic and clinical parameters of intraosseous defects compared with i-PRF alone. CLINICAL TRIAL REGISTRATION: This study was registered in the US National Institutes of Health Clinical Trials Registry (NCT05499598; https://www. CLINICALTRIALS: gov/).