International Journal of Clinical Case Reports 2016, Vol.6, No.22, 1-8
1
Case Report Open Access
Surgical Management of Endo-Perio Lesion with Demineralised Bone Matrix in
Combination with Platelet Rich Fibrin: A Case Report
Pradnya Kale
1
, Kamlesh Talesara
2
, Kaustubh P. Patil
3
, Abhishek Singh Nayyar
4
1 Department of Conservative Dentistry & Endodontics, Dr.D.Y.Patil Dental College & Hospital, Pune, Maharashtra, India
2 Department of Periodontics and Oral Implantology, Dr.D.Y.Patil Dental School, Lohegaon, Pune, Maharashtra, India
3 Department of Periodontics and Oral Implantology, Dr.D.Y.Patil Dental College & Hospital, Pune, Maharashtra, India
4 Department of Oral Medicine and Radiology, Saraswati-Dhanwantari Dental College and Hospital and Post-Graduate Research Institute, Parbhani,
Maharashtra, India
Corresponding author email
International Journal of Clinical Case Reports 2016, Vol.6, No.22 doi
Received: 13 May, 2016
Accepted: 19 Aug., 2016
Published: 22 Aug., 2016
Copyright © 2016 Pradnya et al., This is an open access article published under the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Preferred citation for this article:
Pradnya K., Kamlesh T., Kaustubh P.P., and Abhishek S.N., 2016, Surgical management of Endo-Perio lesion with demineralised bone matrix in
combination with platelet rich fibrin: A Case Report, International Journal of Clinical Case Reports, 6(22): 1-8 (doi
Abstract:
Periodontal disease is a chronic inflammatory disease process that eventually leads to loss of periodontal attachment and
an eventual, bone destruction. The objective of periodontal therapy is to regenerate the lost periodontal tissues. Platelets are rich in
growth factors that may contribute to an accelerated process of tissue regeneration. Demineralised bone matrix, (DMBM) xenograft
is a bone inductive, sterile, bioresorbable, graft composed of Type I collagen. Given the unique properties of autologous platelet rich
fibrin (PRF) and already demonstrated regenerative capacity of commercially available bone grafts, application of a combination
approach was attempted. We herewith present a case report of a combined endo-perio lesion that was treated by a combination of
autologous PRF and bovine derived xenograft, assessed clinically and radiographically.
Keywords
Periodontal disease; Periodontal therapy; Demineralised bone matrix; Xenograft; Platelet rich fibrin; Bone grafts
1 Introduction
Periodontal disease is a chronic inflammatory disease process that eventually leads to loss of periodontal
attachment and an eventual, bone destruction. The objective of periodontal therapy is to regenerate the lost
periodontal tissues. However, periodontal regeneration requires a sequence of biological events including cell
adhesion, migration, proliferation and differentiation (Giannobile, 1996). A combination of growth factors may
more effectively stimulate formation of mineralized as well as non-mineralized tissues (Lynch, 1994). Platelets
are rich in growth factors that may contribute to an accelerated process of tissue regeneration. During the early
stages of wound healing, platelets released growth factors, including platelet derived growth factor, insulin like
growth factor-1 and transforming growth factor-β, initiate a cascade of cellular and molecular events that result in
wound healing in a highly regulated and coordinated manner (Lynch, 1994). The application of these growth
factors to bone and periodontal regeneration has been investigated using numerous in-vitro and in-vivo models
with promising results (Pierce et al., 1991; Hollinger et al., 2008; Kaigler et al., 2011; Kao and Fiorellini, 2012).
Xenografts used in the treatment of infra-bony defects can be both bovine bone and natural coral; these, also,
being referred to as anorganic bone graft materials, since they are suggested to remove all cells and proteinaceous
material leaving behind an inert, bioresorbable, bone scaffolding, upon which re-vascularization, osteoblast
migration and woven bone formation supposedly occur (Sowmya et al., 2009). Demineralised bone matrix
(DMBM) xenograft is a bone inductive, sterile, bioresorbable, xenograft composed of Type I collagen, prepared
from bovine cortical samples, resulting in non-immunogenic, flowable particles, of approximately 250μm
dimensions, that are completely replaced by host bone in around 4-24 weeks (Blumenthal et al., 1986).
Platelet-rich fibrin (PRF) described by Choukroun et al is a second-generation platelet concentrate which allows
one to obtain fibrin membranes enriched with platelets and growth factors after starting from an
anti-coagulant-free blood harvest without any artificial biochemical modification (Choukroun et al., 2000). The
PRF clot forms a strong natural fibrin matrix that concentrates almost all the platelets and growth factors of the
