Efficacy of Nanocrystalline Calcium Sulphate Bone Graft (NanoGen®) and Platelet Rich Fibrin in the Treatment of Periodontal Intrabony Defects: A Split Mouth Randomised Clinical Study

Abstract

Introduction: Periodontal disease leads to the loss of supporting structures of the tooth. Recent years have witnessed the evolution of many regenerating materials that have shown to be effective in regenerating the loss structures. Aim: To evaluate and compare clinically and radiographically the efficacy of Platelet Rich Fibrin (PRF) and Nanocrystalline Calcium Sulphate Bone Graft (NanoGen®) in the treatment of intrabony defects. Materials and Methods: A split mouth randomised clinical study was conducted in the Department of Periodontology, DAPM RV Dental College, Bangalore from November 2018 to May 2020. In this study, 30 surgical sites were selected from 15 chronic periodontitis patients American Academy of Periodontology (AAP, 1999) of age between 35-65 years and with interproximal probing depth ≥5 mm following phase I therapy and radiographic evidence of intrabony defects ≥3 mm deep. They were divided into two groups: Group I (n=15) received open flap debridement with nanocrystalline Calcium Sulphate (nCS) and Group II (n=15) open flap debridement with PRF. Clinical parameters assessed were Gingival Index (GI), Plaque Index (PI), Gingival Recession (GR), Probing Pocket Depth (PPD) and Clinical Attachment Level (CAL). Intragroup was compared using Repeated Measures of Analysis of Variance (ANOVA) followed by Bonferroni’s Post hoc test and intergroup was compared using Independent student’s t-test. Results: Total 15 patients were selected in each group of which 10 were male and 5 were female patients. Mean age of the patients was 39.3 years. There was significant reduction in GI (p-value=0.04), PPD (p-value=0.04) and gain in CAL (p-value=0.04) in group I. The mean difference in CAL at six months was also statistically significant in group II (p-value=0.01). The mean difference of PI was not statistically significant between baseline to three months and baseline to six months in both groups. GR increased from baseline to three months and remained same at six months (p-value for group I and group II=0.36) in both groups. On intergroup comparison, group I (nCS) showed better improvement in clinical parameters like PPD (p-value=0.01), CAL (p-value=0.01) and BF (p-value=0.002) at all time intervals compared to group II (PRF). Conclusion: There was improvement in all clinical parameters except GR in both groups. So both can be used as regenerative materials. But based on this study nanocrystalline calcium sulphate bone graft can be preferred over PRF as a regenerative material.

Keywords

• bone fill
• bone grafting
• periodontal disease
• regeneration