Copyright © 2015 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited. Adjunctive Effect of Autologus Platelet-Rich Fibrin to Barrier Membrane in the Treatment of Periodontal Intrabony Defects Saurav Panda, MDS,  Malaiappan Sankari, MDS, y Anurag Satpathy, MDS,  Doraiswamy Jayakumar, MDS, y Marco Mozzati, MD, DDS, z Carmen Mortellaro, MD, DDS, § Giorgia Gallesio, DDS, z Silvio Taschieri, MD, DDS, jjô and Massimo Del Fabbro, BSc, PhD jjô Background and Aim: Autologous platelet-rich fibrin (PRF) and barrier membranes in the treatment of intrabony defects in chronic periodontitis patients have shown significant clinical benefits. This study evaluates the additive effect of autologous PRF in combination with a barrier membrane versus the use of barrier membrane alone for the treatment of intrabony defects in chronic periodontitis patients. Methods: A randomized split-mouth design was used. Sixteen patients with 32 paired intrabony defects were included. In each patient 1 defect was treated using a resorbable collagen membrane along with PRF (test group) and the other defect by guided tissue regeneration alone (control group). The following clinical parameters were measured at baseline and after 9 months: plaque index, modified sulcus bleeding index, probing pocket depth, clinical attachment level, and gingival marginal level. The radiographic defect depth was also assessed at baseline and after 9 months. Results: Test group showed a statistically significant improvement for probing depth (P ¼ 0.002), clinical attachment level (P ¼ 0.001), and radiographic defect depth (P < 0.001) after 9 months as compared with the control sites. Radiographic defect depth reduction was 58.19  13.24% in the test group as compared with 24.86  9.94% reduction in the control group. Conclusions: The adjunctive use of PRF in combination with barrier membrane is more effective in the treatment of intrabony defects in chronic periodontitis as compared with barrier membrane alone. Key Words: Barrier membrane, guided tissue regeneration, intrabony defects, periodontal regeneration, platelet-rich fibrin, randomized clinical trial (J Craniofac Surg 2016;27: 691–696) P eriodontal disease involves development of pocket induced by bacterial plaque and subsequent alveolar bone destruction, resulting in various bone destructive patterns and alteration of available alveolar bone. 1 Periodontal intrabony defects (IBDs) represent the anatomic sequel of an apical spread of dental plaque in the course of periodontal disease, 2 which when left untreated progress with advanced soft and hard tissue destruction 3 and need surgical intervention aiming to regenerate the lost periodontal tissues. Since periodontal regeneration follows the principles of tissue engineering is an orchestrated sequence of biologic events 4 requiring the presence of cells, scaffold, and signaling molecules, 5 it has encouraged clinicians to use platelet concentrates 6–9 that release growth factors to regulate cell proliferation, chemotaxis, and differ- entiation in surgical reconstructions of IBD. Different types of platelet concentrates such as platelet-rich plasma (PRP), platelet-rich fibrin (PRF), and concentrated growth factors have been used for periodontal regeneration. These concentrates mainly differ in con- centration of platelets, presence or absence of leukocytes, density of the fibrin network, and platelet activation mode. 10 Among these, PRF is characterized by a dense fibrin network with a high content of platelets and leukocytes that release an array of growth factors such as platelet-derived growth factor (PDGF), transforming growth factor (TGF-b1), insulin-like growth factor, vascular endothelial growth factor, and the anti-inflammatory cytokines in a sustained manner. Application of autologous PRF in the treatment of intrabony defects in chronic periodontitis patients has shown significant clinical benefits and enhanced periodontal defect bone fill as compared with open flap debridement alone. 11–15 In the process of periodontal regeneration, necessity for exclusion of epithelial and connective tissue cells of the gingiva led to development of barriers or mem- branes for guided tissue regeneration (GTR). Guided tissue regen- eration is now an integral part of periodontal regeneration. There have been attempts to incorporate growth factors in the barrier membrane for development of a third-generation GTR. 16 However, research is currently ongoing in this area with limited success so far. Our attempt through this study is to make use of PRF as a mode/vehicle for growth factor delivery along with GTR serving role as a barrier membrane. This may provide a simple, natural, and inexpensive alternative regenerative mixture. There is scarcity of evidence in previous literature with such an attempt and comparison. Therefore, this study aims to evaluate the additive effect of autologous PRF in combination with a barrier membrane versus the use of barrier membrane alone for the treatment of intrabony defects in chronic periodontitis patients. METHODS Study Design and Patients This split-mouth randomized controlled study was performed in the Department of Periodontics, Saveetha Dental College and Hospitals, From the  Department of Periodontics and Oral Implantology, Institute of Dental Sciences, Siksha ‘O’ Anusandhan University, Bhubaneswar, Odisha; y Department of Periodontia, Saveetha Dental College and Hospitals, Saveetha University, Chennai, Tamil Nadu, India; z SIOM Oral Surgery and Implantology Center, Turin; § Department of Health Sciences ‘‘A. Avogadro,’’ University of Eastern Piedmont, Novara; jj Department of Medicine, Surgery and Dentistry, Universita ` degli Studi di Milano; and ô IRCCS Istituto Ortopedico Galeazzi, Milano, Italy. Received December 19, 2015. Accepted for publication January 6, 2016. Address correspondence and reprint requests to Massimo Del Fabbro, BSc, PhD, Universita ` degli Studi di Milano, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milan, Italy; E-mail: massimo.delfabbro@unimi.it The authors report no conflicts of interest. Copyright # 2016 by Mutaz B. Habal, MD ISSN: 1049-2275 DOI: 10.1097/SCS.0000000000002524 CLINICAL STUDY The Journal of Craniofacial Surgery  Volume 27, Number 3, May 2016 691