The present study aimed to compare the clinical efficacy of autologous A-PRF and CTG in the management of Miller’s Class I and Class II maxillary gingival recession defects in conjunction with CAF. A-PRF has high concentration of growth factors, which are released slowly and gradually. A-PRF has a membrane-like structure, that can be used as a grafting material without any second surgery. For these reasons we compare the clinical outcomes of A-PRF and CTG, in order to know if A-PRF can be an alternative for CTG in the near future.
The clinical parameters were tested at the baseline for both groups, there was no significant differences, which decrease the risk for bias later on.
After 3 and 6 months, the clinical parameters were evaluated again, this period of time as a reference is sufficient for the assessment of clinical outcomes according to Oncu et al.[10] Intra-group analysis showed a significant reduction in RH, RW from baseline to 6 months in both groups respectively (p ≤ 0.05). Many studies were done to assess the RC% for CAF + A-PRF, it ranged from 58–80%, these results are in accordance with our study (67.2%).[11],[12],[13],[14],[15] Other studies assess the RC% when using CAF + CTG, it was ranged from 77–96.9%, and these results are also similar to our study (86.6%).[16],[17]
Keratinized tissue width around natural teeth is crucial for maintaining oral hygiene and aesthetics.[18] In our study significantly greater KTH was noted among group II (CAF + CTG) as compared to group I (CAF + A-PRF) at the end of 3 & 6 months, this might be attributed to the inherent characteristics of the connective tissue graft having the ability of genetic determinants for the overlying epithelium.
For RH, RW, WAG, CAL, and KTH significant improvements were seen in both groups at 3 and 6 months.
These results were in accordance with other clinical trials.[19],[20],[21] However, group II (CAF + CTG) showed better improvement in these parameters as compared with group I (CAF + A-PRF), and this is in accordance with results obtained by Aldana et al.[22] While, few studies showed no significant difference between them.[23]
Optimal aesthetic integration of tissues is also critical for success. Hence, the present study followed RES for esthetic evaluation given by Cairo et al.[24] The mean RES scores at the end of 6 months were 8.27 ± 1.43 and 9.40 ± 1.24 in group I and II respectively, concluding that CAF + CTG group had a significantly greater value and further VAS-E scores reported by the study participants followed a similar trend. Pairwise analysis showed a statistically significant difference in VAS-E scores between group I & II. The addition of biomaterials beneath coronally advanced flaps might have influenced the patient’s perception.
Addition of a bio-healing material like CTG or A-PRF may improve the long-term stability of treated sites. In the current study, group II (CAF + CTG) sites showed significantly greater improvement in recession parameters than group I (CAF + A-PRF) (p < 0.05), therefore, CTG is considered the gold standard for achieving high-level root coverage and shows a great degree of predictability.[4] However, the procurement of CTG, is technique sensitive and involves an additional surgical site which may cause patient morbidity. In a study, comparing CTG and A-PRF in the treatment of gingival recession, it was concluded that the A-PRF group exhibited early vascularization in wounds.[25] Literature shows that A-PRF is an ideal bio-healing material with a positive wound healing response in gingival recession management. Limitations in the current study include; discrepancy in biotype distribution at baseline, which could be attributed to the randomization technique being followed, which further would have influenced the outcome. Short-term follow-up and lower sample size were the other potential drawbacks of the present study.