Injectable platelet rich fibrin effect on laser depigmented gingiva: a clinical randomized controlled split mouth trial with histological assessment

Authors

  • Suzan Seif Allah Ibrahim Nahda University, Faculty of Dental Medicine, Department of Oral Medicine, Periodontology Oral Diagnosis and Radiology, Beni Suef https://orcid.org/0000-0002-2335-6507
  • Ibrahim Abu Mandil Ain-Shams University, Faculty of Dentistry, Department of Oral Medicine, Periodontology and Oral Diagnosis, Cairo
  • Ola Mohamed Ezzatt Ain-Shams University, Faculty of Dentistry, Department of Oral Medicine, Periodontology and Oral Diagnosis, Cairo https://orcid.org/0000-0003-0228-5786

DOI:

https://doi.org/10.1590/1678-7757-2022-0307

Keywords:

Hyperpigmentation, Diode laser, Submucosal, Mesotherapy, Platelet, Wound healing

Abstract

Objective: To determine whether intra-mucosal injection of injectable platelet-rich fibrin (i-PRF) can promote healing after Diode Laser Gingival Depigmentation (DLGD). Methodology: A total of 20 arch sites of hyperpigmented gingiva of 10 patients underwent DLGD. For each patient, two arch sites were randomly assigned for either intra-mucosal injection of i-PRF (G1-i-PRF) (n=10 sites) or no treatment (G2-Control): (n=10 sites). Wound Healing Score (WHS), patient satisfaction, and Pigmentation Index (DOPI) were measured at 1 week and 1 and 3 months postoperatively. Histological assessment of tissue specimens was performed at baseline and 1 week. Results: The percentage change in WHS at 1 week was significantly higher in G1 (58.34±15.43) compared to G2 (37.50±11.79). At day 1, 50% of patients in G1 were pain free compared with 75% in G2, who had mild pain. Mean DOPI decreased significantly at 3 months in both groups (P-value <0.001), without significant differences between groups. G1 specimens showed significantly higher epithelial thickness (P-value <0.001), as well as a higher number of blood vessels and less percentage of inflammatory cells. Conclusions: i-PRF demonstrated better clinical and histological healing potential and less patient discomfort compared to sites without treatment after DLGD. Registered at https://clinicaltrials.gov/ as (NCT05283668).

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References

Thangavelu A, Elavarasu S, Jayapalan P. Pink esthetics in periodontics – gingival depigmentation: a case series. J Pharm Bioallied Sci. 2012;4(Suppl 2): S186-90. doi: 10.4103/0975-7406.100267

Scully C, Felix DH. Oral medicine - update for the dental practitioner: red and pigmented lesions. Br Dent J. 2005;199(10):639-645. doi:

Feller L, Masilana A, Khammissa RA, Altini M, Jadwat Y, Lemmer J. Melanin: the biophysiology of oral melanocytes and physiologicaloral pigmentation. Head Face Med. 2014;10:8. doi: 10.1186/1746-160X-10-8

Tsatmali M, Ancans J, Thody AJ. Melanocyte function and its control by melanocortin peptides. J Histochem Cytochem. 2002;50(2):125-133. doi: 10.1177/002215540205000201

Ginwalla TM, Gomes BC, Varma BR. Surgical removal of gingival pigmentation. (A preliminary study). J Indian Dent Assoc.1966;38(6):147-50.

Sachs HA, Farnoush A, Checchi L, Joseph CE. Current status of periodontal dressings. J Periodontol. 1984;55(12):689-96. doi:10.1902/jop.1984.55.12.689

Gul M, Hameed MH, Nazeer MR, Ghafoor R, Khan FR. Most effective method for the management of physiologic gingival hyperpigmentation: a systematic review and meta-analysis. J Indian Soc Periodontol. 2019;23(3):203-15. doi: 10.4103/jisp.jisp_555_18

Lin YH, Tu YK, Lu CT, Chung WC, Huang CF, Huang MS, et al. Systematic review of treatment modalities for gingival depigmentation: a random-effects poisson regression analysis. J Esthet Restor Dent. 2014;26(3):162-78. doi: 10.1111/jerd.12087

Sharma T, Agrawal C, Shah M. An Overview on gingival depigmentation procedures: case series and follow up. Acta Sci Dent Sci. 2020;4(7):29-32. doi: 10.31080/ASDS.2020.04.0856

Elavarasu S, Naveen D, Thangavelu A. Lasers in periodontics. J Pharm Bioallied Sci. 2012;4(Suppl 2):S260-3. doi: 10.4103/0975-7406.100245

Gul M, Hameed MH, Nazeer MR, Ghafoor R, Khan FR. Most effective method for the management of physiologic gingival hyperpigmentation: a systematic review and meta-analysis. J Indian Soc Periodontol. 2019;23(3):203-15. doi: 10.4103/jisp.jisp_555_18

D’Arcangelo C, Di Nardo Di Maio F, Prosperi GD, Conte E, Baldi M, Caputi S. A preliminary study of healing of diode laser versus scalpel incisions in rat oral tissue: a comparison of clinical, histological, and immunohistochemical results. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007;103(6):764-73. doi: 10.1016/j.tripleo.2006.08.002

Chawla K, Lamba AK, Tandon S, Faraz F, Gaba V. Effect of low- level laser therapy on wound healing after depigmentation procedure: a clinical study. J Indian Soc Periodontol. 2016;20(2):184-8. doi: 10.4103/0972-124X.176393

Tualzik T, Chopra R, Gupta SJ, Sharma N, Khare M, Gulati L. Effects of ozonated olive oil and photobiomodulation using diode laser on gingival depigmented wound: a randomized clinical study. J Indian Soc Periodontol. 2021;25(5):422-6. doi: 10.4103/jisp.jisp_655_20

Dahiya R, Blaggana A, Panwar V, Kumar S, Kathuria A, Malik S. Clinical and histological comparison of platelet-rich fibrin versus non-eugenol periodontal dressing in the treatment of gingival hyperpigmentation. J Indian Soc Periodontol. 2019;23(4):345-50. doi: 10.4103/JISP.JISP_688_18

Debnath K, Chatterjee A. Clinical and histological evaluation on japplication of platelet concentrates on depigmented gingival epithelium.J Indian Soc Periodontol. 2018;22(2):150-7. doi: 10.4103/jisp.jisp_342_17

Bansal M, Kumar A, Puri K, Khatri M, Gupta G, Vij H. Clinical and histologic evaluation of platelet-rich fibrin accelerated epithelization of gingival wound. J Cutan Aesthet Surg. 2016;9(3):196-200. doi: 10.4103/0974-2077.191647

Choukroun J, Ghanaati S. Reduction of relative centrifugation force within injectable platelet-rich-fibrin (PRF) concentrates advances patients’ own inflammatory cells, platelets and growth factors: the first introduction to the low speed centrifugation concept. Eur J Trauma Emerg Surg. 2018;44(1):87-95. doi: 10.1007/s00068-017-0767-9

Miron RJ, Fujioka-Kobayashi M, Bishara M, Zhang Y, Hernandez M, Choukroun J. Platelet-rich fibrin and soft tissue wound healing: a systematic review. Tissue Eng Part B Rev. 2017;23(1):83-99. doi: 10.1089/ten.TEB.2016.0233

Ozsagir ZB, Saglam E, Sen Yilmaz B, Choukroun J, Tunali M. Injectable platelet-rich fibrin and microneedling for gingival augmentation in thin periodontal phenotype: a randomized controlled clinical trial. J Clin Periodontol. 2020;47(4):489-99. doi: 10.1111/jcpe.13247

Faour NH, Dayoub S, Hajeer MY. Evaluation of the hyaluronic acid versus the injectable platelet-rich fibrin in the management of the thin gingival phenotype: a split-mouth randomized controlled clinical trial.Cureus. 2022;14(5):e25104. doi: 10.7759/cureus.25104

Giannelli M, Formigli L, Bani D. Comparative evaluation of photoablative efficacy of erbium: yttrium-aluminium-garnet and diode laser for the treatment of gingival hyperpigmentation: a randomized split-mouth clinical trial. J Periodontol. 2014;85(4):554-561. doi: 10.1902/JOP.2013.130219

McCarthy FM, Malamed SF. Physical evaluation system to determine medical risk and indicated dental therapy modifications. J Am Dent Assoc. 1979;99(2):181-4. doi: 10.14219/jada.archive.1979.0271

Dummett CO, Gupta OP. Estimating the epidemiology of oral pigmentation. J Natl Med Assoc. 1964;56(5):419-20.

Jokar L, Bayani M, Hamidi H, Keivan M, Azari-Marhabi S. A comparison of 940 nm diode laser and cryosurgery with liquid nitrogen in the treatment of gingival physiologic hyperpigmentation using split mouth technique: 12 months follow up. J Lasers Med Sci. 2019;10(2):131-8. doi: 10.15171/jlms.2019.21

Choukroun J, Ghanaati S. Reduction of relative centrifugation force within injectable platelet-rich-fibrin (PRF) concentrates advances patients’ own inflammatory cells, platelets and growth factors: the first introduction to the low-speed centrifugation concept. Eur J Trauma Emerg Surg. 2018;44(1):87-95. doi: 10.1007/S00068-017-0767-9

Miron RJ, Xu H, Chai J, Wang J, Zheng S, Feng M, et al. Comparison of platelet-rich fibrin (PRF) produced using 3 commercially available centrifuges at both high (~ 700 g) and low (~ 200 g) relative centrifugation forces. Clin Oral Investig. 2020;24(3):1171-82. doi: 10.1007/s00784-019-02981-2

Miron R, Choukroun J, Ghanaati S. Controversies related to scientific report describing g-forces from studies on platelet-rich fibrin: Necessity for standardization of relative centrifugal force values. Int J Growth Factors Stem Cells Dent. 2018;1:80-9. doi: 10.4103/GFSC.GFSC_23_18

El-Mofty M, Elkot S, Ghoneim A, Yossri D, Ezzatt OM. Vitamin C mesotherapy versus topical application for gingival hyperpigmentation: a clinical and histopathological study. Clin Oral Investig. 2021;25(12):6881-9. doi: 10.1007/S00784-021-03978-6

El Shenawy HM, Nasry SA, Zaky AA, Quriba MAA. Treatment of gingival hyperpigmentation by diode laser for esthetical purposes. Open Access Maced J Med Sci. 2015;3(3):447-54. doi: 10.3889/OAMJMS.2015.071

Melzack R. The McGill Pain Questionnaire: major propertiesand scoring methods. Pain. 1975;1(3):277-99. doi: 10.1016/0304-3959(75)90044-5

Vasanthi V, Divya B, Ramadoss R, Deena P, Annasamy RK, Rajkumar K. Quantification of inflammatory, angiogenic, and fibrous components of reactive oral lesions with an insight into the pathogenesis. J Oral Maxillofac Pathol. 2022;26(4):600. doi: 10.4103/jomfp.jomfp_138_21

Miron RJ, Chai J, Fujioka-Kobayashi M, Sculean A, Zhang Y.

Evaluation of 24 protocols for the production of platelet-rich fibrin. BMC Oral Health. 2020;20(1):310. doi: 10.1186/s12903-020-01299-w34-

St-Supery V, Tahiri Y, Sampalis J, Brutus JP, Harris PG, Nikolis A. Wound healing assessment: does the ideal methodology for a research setting exist? Ann Plast Surg. 2011;67(2):193-200. doi: 10.1097/SAP.0b013e3181f3e0e8

Choukroun J, Diss A, Simonpieri A, Girard MO, Schoeffler C, Dohan SL,et al. Platelet-rich fibrin (PRF): a second-generation platelet concentrate. Part IV: clinical effects on tissue healing. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;101(3):e56-60. doi: 10.1016/j.tripleo.2005.07.011

Kim DS, Park SH, Park KC. Transforming growth factor-beta1 decreases melanin synthesis via delayed extracellular signal-regulated kinase activation. Int J Biochem Cell Biol. 2004;36(8):1482-91. doi: 10.1016/j.biocel.2003.10.023

Yun WJ, Bang SH, Min KH, Kim SW, Lee MW, Chang SE. Epidermal growth factor and epidermal growth factor signaling attenuate laser-induced melanogenesis. Dermatol Surg. 2013;39(12):1903-11. doi: 10.1111/dsu.12348

Sarkar R, Gupta M. Platelet-rich plasma in melisma: a systematic review. Dermatol Surg. 2022;48(1):131-4. doi: 10.1097/DSS.0000000000003266

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Published

2024-03-26

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Section

Original Articles

How to Cite

Ibrahim, S. S. A., Mandil, I. A., & Ezzatt, O. M. (2024). Injectable platelet rich fibrin effect on laser depigmented gingiva: a clinical randomized controlled split mouth trial with histological assessment. Journal of Applied Oral Science, 32, e20230307. https://doi.org/10.1590/1678-7757-2022-0307