Comparative Evaluation of Injectable Platelet-Rich Fibrin Alone and in Combination with Microneedling for Gingival Augmentation in Thin Gingival Phenotype: A Systematic Review and Meta-Analysis

Abstract

Context: In modern dentistry, esthetics alongwith function play an important role with periodontal phenotype having a significant impact on treatment outcomes. The 2017 World Workshop describes periodontal phenotype as combination of gingival phenotype (gingival thickness and width of keratinized tissue) and bone morphotype (buccal bone plate thickness).  Individuals with a thin phenotype are more susceptible to gingival recession in presence of trauma or inflammation. While conventional treatment modalities to improve gingival phenotype include surgical procedures such as soft tissue grafting (gold standard), non-surgical treatment options include microneedling (MN) and injectable platelet-rich fibrin (i-PRF). MN also known as percutaneous collagen induction therapy (PCIT), produces microinjuries that cause minor superficial bleeding which leads to a cascade of wound healing that releases numerous growth factors which facilitate neoangiogenesis. Among different types of PRF, injectable platelet-rich fibrin (i-PRF) forms a gel rich in fibrin consisting of leukocytes, platelets and growth factors, enhancing tissue regeneration and offering advantages such as sustained growth factor release and improved cellular migration. Also, i-PRF shows superior biological properties and clinical outcomes with minimal side effects when compared to PRP.

Aim: To assess the clinical efficacy of injectable platelet-rich fibrin alone and in combination with microneedling for gingival augmentation in patients with thin gingival phenotype.

Settings and Design: The eligible studies included randomized controlled trials (RCTs) with split mouth design. Studies comparing clinical efficacy of injectable platelet-rich fibrin alone and in combination with microneedling for gingival augmentation in patients with thin gingival phenotype, which were published in English language from January 2014 till December 2024 were included.

Methods and Material: A systematic search of literature in three databases: PubMed, Google Scholar and Science Direct and a hand search of relevant scientific journals was performed.

Results: Three RCTs that met the eligibility criteria were included in the qualitative analysis. Out of the three included studies, two studies demonstrated a low risk of bias while one study demonstrated high risk of bias. The clinical parameters assessed in all studies were GT and KTW. All the studies showed improvement in all clinical parameters in both groups. A significant improvement in GT was found in the intervention groups of all the three studies whereas in case of KTW there was no significant difference found in the intervention and control groups in two of the included studies.

Conclusions: This review indicates that i-PRF when used alongwith MN resulted in significant improvement in gingival thickness, indicating that i-PRF alongwith MN may increase GT without the need for surgical periodontal procedures.

Key Messages: The present systematic review and meta -analysis emphasizes on the use of i-PRF alongwith MN for increasing the gingival thickness thereby avoiding the need for surgical periodontal procedures.