Clinical and radiographic evaluation of advanced platelet rich fibrin block compared to injectable platelet rich fibrin with nanohydroxyapatite in the management of periodontal intrabony defects: A randomized controlled trial

Periodontitis is a biofilm-induced inflammatory disease that leads to the destruction of periodontal tissues and eventual tooth loss. Mechanical therapy alone is often insufficient in managing deep intrabony defects, necessitating regenerative approaches. The present randomized controlled clinical trial aimed to compare the clinical and radiographic outcomes of advanced platelet-rich fibrin (A-PRF) block combined with injectable platelet-rich fibrin (i-PRF) and nanohydroxyapatite (nHA) in the treatment of periodontal intrabony defects. A total of 26 patients with stage III periodontitis presenting with three-walled intrabony defects were randomly allocated by coin toss into either the A-PRF block (test) group or the i-PRF + nHA (control) group. Clinical parameters, including probing pocket depth (PPD), relative clinical attachment level (RCAL), plaque index (PI) and gingival index (GI), as well as radiographic parameters, including intrabony defect fill and radiographic linear defect depth (RLDD), were assessed at baseline and at 6 months. At 6 months, the A-PRF block group demonstrated greater reductions in PPD (P<0.001), greater RCAL gain (P<0.001), greater defect fill (P<0.001) and a greater RLDD reduction (P=0.004) compared with the control group. Radiographically, the test group exhibited a significantly greater defect fill and reduction in defect depth. No significant differences were observed in PI and GI between the groups. Within the limitations of the study, the A-PRF block demonstrated superior clinical and radiographic outcomes compared with i-PRF combined with nHA, suggesting its potential as an effective regenerative modality for periodontal intrabony defects.