International Journal of Clinical Case Reports 2016, Vol.6, No.21, 1-5
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coverage in isolated gingival recession defects (Allen and Miller, 1989; Wennström and Zucchelli, 1996).
Although the bilaminar technique using sub-epithelial connective tissue grafts still holds the most promising
results in root coverage, histological studies show an unpredictable healing. The use of PRF membrane in our case
to attain root coverage may alleviate the need for donor site procurement of connective tissue thereby,
considerably reducing the morbidity which encourages investigations of a more regenerative nature. The scientific
rationale behind the use of platelet preparations lies in the fact that the platelet alpha-granules are a reservoir of
many growth factors that are known to play a crucial role in hard and soft tissue repair and regeneration
mechanisms (Marx et al., 1998; Anitua et al., 2007). These include platelet-derived growth factors (PDGFs),
transforming growth factor-beta (TGF-beta), vascular endothelial growth factor (VEGF), epidermal growth factor
(EGF), and insulin-like growth factor-1 (IGF-1). Platelet-derived growth factors exhibit chemotactic and
mitogenic properties that promote and modulate cellular functions involved in tissue healing and regeneration, as
well as cell proliferation mechanisms (Dohan, 2010). There are many advantages of using PRF, a
second-generation platelet concentrate. PRF does not use bovine thrombin or other exogenous activators in the
preparation process thereby, reducing the chances of rejection by inducing auto-immune responses. It forms a
gel-like matrix that contains high concentrations of non-activated, functional, intact platelets, contained within a
fibrin matrix, that release, a relatively constant concentration of growth factors over a period of 7-days (Carroll et
al., 2005). In the form of a membrane, it can be used as a fibrin bandage serving as a matrix to accelerate the
healing of wound edges (Gabling et al., 2009; Vence et al., 2009). Being autologous in nature, it is relatively
inexpensive, as no additional cost for synthetic membranes is incurred to the patients. Furthermore, the chair-side
preparation of PRF is quite easy and processing is fast and simple. Del Corso M et al evaluated the use of PRF in
the treatment of multiple gingival recession defects with coronally advanced flap procedures and found significant
improvement during the early periodontal healing phases with a thick and stable, final remodelled gingiva (Del
Corso et al., 2009). In the same year, Aroca S et al reported inferior root coverage of about 80.7% at the test site
(CAF+ PRF) as compared to about 91.5% achieved at control site (CAF), but an additional gain in gingival/
mucosal thickness compared to conventional therapy (Aroca et al., 2009). An increase in thickness of the
keratinised tissues reported in both studies may contribute to a long term stable clinical outcome with reduced
probability of recurrence of recession. Pavaluri A K et al also found CAF to be a predictable treatment for isolated
Miller's class I and II recession defects (Pavaluri et al., 2013). The addition of PRF membrane with CAF provides
superior root coverage with additional benefits of gain in CAL and width of keratinized gingiva at 6-months
post-operative follow-up. They stated that the treatment of isolated Miller′s class I and II gingival recession
defects indicated that CAF surgery alone or in combination with PRF provide effective procedures to cover
denuded root surfaces. The data obtained from a combination of CAF+PRF on a 6-months period of follow-up
showed additional benefits along with mean root coverage in the treatment of Miller′s class I and II gingival
recession defects when compared with the CAF technique alone. Thangavelu A et al found CAF and CAF+PRF
treatment techniques resulting in a favourable clinical outcome in terms of root coverage obtained (Thangavelu et
al., 2015). While comparing the two groups, there was no statistically significant difference for any of the clinical
parameters except for an increase in gingival thickness in the CAF+PRF group that was a significant clinical
outcome providing a definite advantage of the technique with a certainly reduced probability of the recurrence of
such defects.
Conclusion
The use of autologous platelet preparations like PRF allows the clinician to optimize tissue remodelling, wound
healing and local angiogenesis by the local delivery of growth factors and proteins. This case report reflects the
success of this biomaterial for coverage of single tooth recession defects. The novel technique described enables
the clinician to gainfully harvest the full regenerative capacity of this autologous biologic material.
