Regenerative potential of connective tissue grafts vs. platelet-rich fibrin preparations in periodontal therapy: a comparative review

Sanehi Punse; Prasad Dhadse; Anand Wankhede; Ruchita Patil; Rutuja Karamore; Sanehi Punse; Prasad Dhadse; Anand Wankhede; Ruchita Patil; Rutuja Karamore

doi:10.3934/bioeng.2025012

AIMS Bioengineering

2025, Volume 12, Issue 2: 249-264. doi: 10.3934/bioeng.2025012

Previous Article Next Article

Review

Regenerative potential of connective tissue grafts vs. platelet-rich fibrin preparations in periodontal therapy: a comparative review

Department of Periodontology and Implantology, Sharad Pawar Dental College, Datta Meghe Institute of Higher Education and Research, Sawangi(M), Wardha 442001, India

Received: 23 February 2025 Revised: 15 April 2025 Accepted: 22 May 2025 Published: 18 June 2025

Connective tissue graft (CTG) is widely considered the gold standard due to its predictable and stable long-term results, particularly in cases requiring significant soft tissue augmentation. However, it necessitates a second surgical site, increasing patient discomfort. Platelet-rich fibrin (PRF), a minimally invasive alternative, promotes tissue regeneration through growth factor release, enhancing healing while reducing postoperative morbidity. A comprehensive analysis of scientific literature, including clinical studies and case reports, was conducted to compare the effectiveness of both techniques in achieving root coverage, increasing gingival thickness, and improving esthetic and patient-related outcomes. While CTG consistently demonstrates superior long-term stability, PRF offers promising regenerative potential with less postoperative discomfort. This review evaluates the efficacy, clinical outcomes, and patient satisfaction associated with CTG and PRF in the management of gingival recession. However, limitations such as variability in PRF preparation methods, lack of standardized protocols, and limited long-term clinical data hinder its widespread acceptance. Despite these challenges, PRF remains a viable option for patients seeking a less invasive approach with improved healing. Future research should focus on refining PRF protocols and establishing their long-term efficacy to broaden their application in periodontal therapy.
- connective tissue graft,
- growth factors,
- healing,
- periodontal regeneration,
- platelet-rich fibrin
Citation: Sanehi Punse, Prasad Dhadse, Anand Wankhede, Ruchita Patil, Rutuja Karamore. Regenerative potential of connective tissue grafts vs. platelet-rich fibrin preparations in periodontal therapy: a comparative review[J]. AIMS Bioengineering, 2025, 12(2): 249-264. doi: 10.3934/bioeng.2025012

Related Papers:

Abstract

Connective tissue graft (CTG) is widely considered the gold standard due to its predictable and stable long-term results, particularly in cases requiring significant soft tissue augmentation. However, it necessitates a second surgical site, increasing patient discomfort. Platelet-rich fibrin (PRF), a minimally invasive alternative, promotes tissue regeneration through growth factor release, enhancing healing while reducing postoperative morbidity. A comprehensive analysis of scientific literature, including clinical studies and case reports, was conducted to compare the effectiveness of both techniques in achieving root coverage, increasing gingival thickness, and improving esthetic and patient-related outcomes. While CTG consistently demonstrates superior long-term stability, PRF offers promising regenerative potential with less postoperative discomfort. This review evaluates the efficacy, clinical outcomes, and patient satisfaction associated with CTG and PRF in the management of gingival recession. However, limitations such as variability in PRF preparation methods, lack of standardized protocols, and limited long-term clinical data hinder its widespread acceptance. Despite these challenges, PRF remains a viable option for patients seeking a less invasive approach with improved healing. Future research should focus on refining PRF protocols and establishing their long-term efficacy to broaden their application in periodontal therapy.

Acknowledgments

We extend our heartfelt gratitude to Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, for providing the necessary infrastructure, academic support, and research environment essential for the successful completion of this study. We are especially thankful to the Sharad Pawar Dental College and Hospital, and the Department of Periodontology and Implantology, for their constant guidance, encouragement, and access to clinical facilities. We also appreciate the contribution of all faculty members, staff, and participants who played a significant role in this research. Their cooperation and involvement have been invaluable in achieving the objectives of our work.

Conflict of interest

The authors declare no conflict of interest related to this study.

Authors contribution

Dr. Sanehi Punse was primarily responsible for the conception of the study, data collection, clinical procedures, analysis, and drafting of the manuscript. Dr. Prasad Dhadse provided overall supervision and expert guidance throughout the study, contributed to the study design, and critically reviewed the manuscript for important intellectual content. Dr. Anand Wankhede played a key role in the planning of the study, assisted with data interpretation, and provided valuable inputs during manuscript preparation. Dr. Ruchita Patil contributed to the literature review, clinical support, and compilation of data. Dr. Rutuja Karamore was involved in case documentation, clinical photography, and manuscript formatting. All authors have read and approved the final version of the manuscript.

References

[1]	Jung UW, Um YJ, Choi SH (2008) Histologic observation of soft tissue acquired from maxillary tuberosity area for root coverage. J periodontol 79: 934-940. https://doi.org/10.1902/jop.2008.070445
[2]	Amin PN, Bissada NF, Ricchetti PA, et al. (2018) Tuberosity versus palatal donor sites for soft tissue grafting: a split-mouth clinical study. Quintessence Int 49: 589. https://doi.org/10.3290/j.qi.a40510
[3]	Das AC, Panda S, Kumar M, et al. (2020) Treatment of gingival recession by lateral positioned pedicle graft: a case report. Indian J Forensic Med Toxicol 14: 8160-8163.
[4]	Uzun BC, Ercan E, Tunalı M (2018) Effectiveness and predictability of titanium-prepared platelet-rich fibrin for the management of multiple gingival recessions. Clin Oral Invest 22: 1345-1354. https://doi.org/10.1007/s00784-017-2211-2
[5]	Dohan Ehrenfest DM, Rasmusson L, Albrektsson T (2009) Classification of platelet concentrates: from pure platelet-rich plasma (P-PRP) to leucocyte- and platelet-rich fibrin (L-PRF). Trends Biotechnol 27: 158-167. https://doi.org/10.1016/j.tibtech.2008.11.009
[6]	Anitua E, Andia I, Ardanza B, et al. (2004) Autologous platelets as a source of proteins for healing and tissue regeneration. Thromb Haemost 91: 4-15. https://doi.org/10.1160/TH03-07-0440
[7]	Ghanaati S, Booms P, Orlowska A, et al. (2014) Advanced platelet-rich fibrin: a new concept for cell-based tissue engineering by means of inflammatory cells. J Oral Implantol 40: 679-689. https://doi.org/10.1563/aaid-joi-D-14-00138
[8]	Dohan Ehrenfest DM, De Peppo GM, Doglioli P, et al. (2009) Slow release of growth factors and thrombospondin-1 in Choukroun's platelet-rich fibrin (PRF): a gold standard to achieve for all surgical platelet concentrates technologies. Growth Factors 27: 63-69. https://doi.org/10.1080/08977190802636713
[9]	Miron RJ, Fujioka-Kobayashi M, Hernandez M, et al. (2017) Injectable platelet rich fibrin (i-PRF): opportunities in regenerative dentistry?. Clin Oral Invest 21: 2619-2627. https://doi.org/10.1007/s00784-017-2063-9
[10]	Jhaveri HM, Chavan MS, Tomar GB, et al. (2010) Acellular dermal matrix seeded with autologous gingival fibroblasts for the treatment of gingival recession: A proof-of-concept study. J periodontol 81: 616-625. https://doi.org/10.1902/jop.2009.090530
[11]	Reiser GM, Bruno JF, Mahan PE, et al. (1996) The subepithelial connective tissue graft palatal donor site: anatomic considerations for surgeons. Int J Periodontics Restorative Dent 16: 130-137.
[12]	Farid Shehab M, Hamid NMA, Askar NA, et al. (2018) Immediate mandibular reconstruction via patient-specific titanium mesh tray using electron beam melting/CAD/rapid prototyping techniques: One-year follow-up. Robot Comp Surg 14: e1895. https://doi.org/10.1002/rcs.1895
[13]	Bhangdiya K, Wankhede A, Madhu PP, et al. (2023) An overview on platelet concentrates in tissue regeneration in periodontology. AIMSBOA 10: 53-61. https://doi.org/10.3934/bioeng.2023005
[14]	Kyyak S, Blatt S, Pabst A, et al. (2020) Combination of an allogenic and a xenogenic bone substitute material with injectable platelet-rich fibrin – a comparative in vitro study. J Biomater Appl 35: 83-96. https://doi.org/10.1177/0885328220914407
[15]	Tunalı M, Özdemir H, Küçükodacı Z, et al. (2014) A novel platelet concentrate: titanium-prepared platelet-rich fibrin. BioMed Res Int 2014: 1-7. https://doi.org/10.1155/2014/209548
[16]	Edel A (1974) Clinical evaluation of free connective tissue grafts used to increase the width of keratinised gingiva. J Clin Periodontol 1: 185-196. https://doi.org/10.1111/j.1600-051X.1974.tb01257.x
[17]	Broome WC, Taggart EJ (1976) Free autogenous connective tissue grafting: report of two cases. J Periodontol 47: 580-585. https://doi.org/10.1902/jop.1976.47.10.580
[18]	Langer B, Calagna L (1980) The subepithelial connective tissue graft. J Prosthet Dent 44: 363-367. https://doi.org/10.1016/0022-3913(80)90090-6
[19]	Langer B, Langer L (1985) Subepithelial connective tissue graft technique for root coverage. J Periodontol 56: 715-720. https://doi.org/10.1902/jop.1985.56.12.715
[20]	Harris RJ, Miller LH, Harris CR, et al. (2005) A comparison of three techniques to obtain root coverage on mandibular incisors. J Periodontol 76: 1758-1767. https://doi.org/10.1902/jop.2005.76.10.1758
[21]	Hürzeler MB, Weng D (1999) A single-incision technique to harvest subepithelial connective tissue grafts from the palate. Int J Periodontics Restorative Dent 19: 278.
[22]	Zucchelli G, Mele M, Stefanini M, et al. (2010) Patient morbidity and root coverage outcome after subepithelial connective tissue and de-epithelialized grafts: a comparative randomized-controlled clinical trial. J Clin Periodontol 37: 728-738. https://doi.org/10.1111/j.1600-051X.2010.01550.x
[23]	Cairo F, Nieri M, Pagliaro U (2014) Efficacy of periodontal plastic surgery procedures in the treatment of localized facial gingival recessions. a systematic review. J Clin Periodontology 41: S44-S62. https://doi.org/10.1111/jcpe.12182
[24]	Tadepalli A, Ramachandran L, Parthasarathy H, et al. (2024) Advanced platelet-rich fibrin versus connective tissue graft in maxillary gingival recession management. Clin Adv Periodontics 2024: cap.10317. https://doi.org/10.1002/cap.10317
[25]	Harris RJ (1992) The connective tissue and partial thickness double pedicle graft: a predictable method of obtaining root coverage. J Periodontol 63: 477-486. https://doi.org/10.1902/jop.1992.63.5.477
[26]	Bouchard P, Etienne D, Ouhayoun J, et al. (1994) Subepithelial connective tissue grafts in the treatment of gingival recessions. a comparative study of 2 procedures. J Periodontol 65: 929-936. https://doi.org/10.1902/jop.1994.65.10.929
[27]	Lorenzana ER, Allen EP (2000) The single-incision palatal harvest technique: a strategy for esthetics and patient comfort. Int J Periodontics Restorative Dent 20: 297-305.
[28]	Del Pizzo M, Modica F, Bethaz N, et al. (2002) The connective tissue graft: a comparative clinical evaluation of wound healing at the palatal donor site: a preliminary study. J Clin Periodontol 29: 848-854. https://doi.org/10.1034/j.1600-051X.2002.290910.x
[29]	Bosco AF, Bosco JMD (2007) An alternative technique to the harvesting of a connective tissue graft from a thin palate: enhanced wound healing. Int J Periodontics Restorative Dent 27: 132.
[30]	McLeod DE, Reyes E, Branch-Mays G (2009) Treatment of multiple areas of gingival recession using a simple harvesting technique for autogenous connective tissue graft. J periodontol 80: 1680-1687. https://doi.org/10.1902/jop.2009.090187
[31]	Teodoro De Carvalho VA, Mattedi MAM, Vergara-Buenaventura A, et al. (2023) Influence of graft thickness on tunnel technique procedures for root coverage: a pilot split-mouth randomized controlled trial. Clin Oral Invest 27: 3469-3477. https://doi.org/10.1007/s00784-023-04955-x
[32]	Huang LH, Neiva REF, Soehren SE, et al. (2005) The effect of platelet-rich plasma on the coronally advanced flap root coverage procedure: a pilot human trial. J periodontol 76: 1768-1777. https://doi.org/10.1902/jop.2005.76.10.1768
[33]	Aroca S, Barbieri A, Clementini M, et al. (2018) Treatment of class III multiple gingival recessions: Prognostic factors for achieving a complete root coverage. J Clin Periodontol 45: 861-868. https://doi.org/10.1111/jcpe.12923
[34]	Jankovic S, Aleksic Z, Milinkovic I, et al. (2010) The coronally advanced flap in combination with platelet-rich fibrin (PRF) and enamel matrix derivative in the treatment of gingival recession: a comparative study. Eur J Esthet Dent 5: 260-273. https://doi.org/10.4103/0972-124X.145790
[35]	Eren G, Atilla G (2014) Platelet-rich fibrin in the treatment of localized gingival recessions: a split-mouth randomized clinical trial. Clin Oral Invest 18: 1941-1948. https://doi.org/10.1007/s00784-013-1170-5
[36]	Agarwal C, Purohit P, Sharma S K, et al. (2014) Modified approach of double papillae laterally positioned flap technique using Alloderm® for root coverage. JCDR 8: ZD25. https://doi.org/10.7860/JCDR/2014/8367.4606
[37]	Periodontology KM, Karatay A (2017) The use of platelet-rich fibrin versus subepithelial connective tissue graft in treatment of multiple gingival recessions: a randomized clinical trial. Int J Periodontics Restorative Dent 37: 265-271. https://doi.org/10.11607/prd.2741
[38]	Bozkurt Doğan Ş, Öngöz Dede F, Ballı U, et al. (2015) Concentrated growth factor in the treatment of adjacent multiple gingival recessions: a split-mouth randomized clinical trial. J Clin Periodontol 42: 868-875. https://doi.org/10.1111/jcpe.12444
[39]	Xue F, Zhang R, Zhang Y, et al. (2022) Treatment of multiple gingival recessions with concentrated growth factor membrane and coronally advanced tunnel technique via digital measurements: a randomized controlled clinical trial. J Dent Sci 17: 725-732. https://doi.org/10.1016/j.jds.2021.10.012
[40]	Tazegül K, Doğan ŞB, Ballı U, et al. (2022) Growth factor membranes in treatment of multiple gingival recessions: a randomized clinical trial. Quintessence Int 53: 288-297. https://doi.org/10.3290/j.qi.b2407765
[41]	Kumar A, Bains V, Jhingran R, et al. (2017) Patient-centered microsurgical management of gingival recession using coronally advanced flap with either platelet-rich fibrin or connective tissue graft: a comparative analysis. Contemp Clin Dent 8: 293. https://doi.org/10.4103/ccd.ccd_70_17
[42]	Gupta S, Banthia R, Singh P, et al. (2015) Clinical evaluation and comparison of the efficacy of coronally advanced flap alone and in combination with platelet rich fibrin membrane in the treatment of Miller Class I and II gingival recessions. Contemp Clin Dent 6: 153. https://doi.org/10.4103/0976-237X.156034
[43]	Jain A, Jaiswal GR, Kumathalli K, et al. (2017) Comparative evaluation of platelet rich fibrin and dehydrated amniotic membrane for the treatment of gingival recession- a clinical study. J Clin Diagn Res 11: ZC24-ZC28. https://doi.org/10.7860/JCDR/2017/29599.10362
[44]	Rehan M, Khatri M, Bansal M, et al. (2018) Comparative evaluation of coronally advanced flap using amniotic membrane and platelet-rich fibrin membrane in gingival recession: An 18-month clinical study. Contemp Clin Dent 9: 188-194. https://doi.org/10.4103/ccd.ccd_799_17
[45]	Del Pizzo M, Zucchelli G, Modica F, et al. (2005) Coronally advanced flap with or without enamel matrix derivative for root coverage: a 2-year study. J Clin Periodontol 32: 1181-1187. https://doi.org/10.1111/j.1600-051X.2005.00831.x
[46]	Subbareddy BV, Gautami PS, Dwarakanath CD, et al. (2020) Vestibular incision subperiosteal tunnel access technique with platelet-rich fibrin compared to subepithelial connective tissue graft for the treatment of multiple gingival recessions: a randomized controlled clinical trial. Contemp Clin Dent 11: 249-255. https://doi.org/10.4103/ccd.ccd_405_19
[47]	Collins JR, Cruz A, Concepción E, et al. (2021) Connective tissue graft vs platelet-rich fibrin in the treatment of gingival recessions: a randomized split-mouth case series. J Contemp Dent Pract 22: 327-334. https://doi.org/10.5005/jp-journals-10024-3104
[48]	Hegde S, Madhurkar JG, Kashyap R, et al. (2021) Comparative evaluation of vestibular incision subperiosteal tunnel access with platelet-rich fibrin and connective tissue graft in the management of multiple gingival recession defects: a randomized clinical study. J Indian Soc Periodontol 25: 228-236. https://doi.org/10.4103/jisp.jisp_291_20
[49]	Joshi A, Suragimath G, Varma S, et al. (2020) Is platelet rich fibrin a viable alternative to subepithelial connective tissue graft for gingival root coverage?. Indian J Dent Res 31: 67-72. https://doi.org/10.4103/ijdr.IJDR_434_18
[50]	Tunalı M, Özdemir H, Arabacı T, et al. (2015) Clinical evaluation of autologous platelet-rich fibrin (L-PRF) in the treatment of multiple adjacent gingival recession defects: A 12-month study. Int J Periodontics Restorative Dent 35: 105-114. https://doi.org/10.11607/prd.1826
[51]	Zuiderveld EG, Van Nimwegen WG, Meijer HJA, et al. (2021) Effect of connective tissue grafting on buccal bone changes based on cone beam computed tomography scans in the esthetic zone of single immediate implants: a 1-year randomized controlled trial. J Periodontol 92: 553-561. https://doi.org/10.1002/JPER.20-0217
[52]	Mohale SA, Thakare PV, Gaurkar SS, et al. (2024) Effectiveness of injectable platelet-rich fibrin therapy in alopecia and facial rejuvenation: a systematic review. Cureus 16: e62198. https://doi.org/10.7759/cureus.62198
[53]	Alves R, Grimalt R (2018) A review of platelet-rich plasma: history, biology, mechanism of action, and classification. Skin Appendage Disord 4: 18-24. https://doi.org/10.1159/000477353

Reader Comments

Your name:*

Email:*
© 2025 the Author(s), licensee AIMS Press. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0)