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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

  • Authors:
    • Simran Genescia
    • Neetha J. Shetty
    • Himani Kotian
    • David Kadakampally
    • Shruti Singh
    • Preetha J. Shetty
  • View Affiliations / Copyright

    Affiliations: Department of Periodontology, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka 575001, India, Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka 575001, India, Department of Genetics and Molecular Medicine, College of Medicine, Dubai Medical University, Dubai P.O. Box 20170, United Arab Emirates
    Copyright: © Genescia et al. This is an open access article distributed under the terms of Creative Commons Attribution License [CC BY 4.0].
  • Article Number: 74
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    Published online on: June 30, 2026
       https://doi.org/10.3892/wasj.2026.489
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Abstract

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.
View Figures

Figure 1

Test group surgical procedure. (A)
Preoperative clinical measurement of relative clinical attachment
level and probing pocket depth. (B) Intrasulcular incisions. (C)
Intrasurgical measurement of the intrabony defect. (D) Preparation
of the A-PRF block: (Left panel) harvested advanced platelet-rich
fibrin (A-PRF) clot following centrifugation; (middle panel)
injectable platelet-rich fibrin (i-PRF) collected in a syringe;
(right panel) A-PRF block prepared by mixing diced A-PRF, i-PRF and
nanohydroxyapatite (SyboGraf®) before placement into the
periodontal intrabony defect. (E) Placement of the A-PRF block into
the defect. (F) Suturing. (G) Periodontal dressing placement.

Figure 2

Control group surgical procedure. (A)
Pre-operative clinical measurement of relative clinical attachment
level and probing pocket depth. (B) Intrasulcular incisions. (C)
Intrasurgical measurement of the intrabony defect. (D) Injectable
PRF mixed with nanohydroxyapatite. (E) Placement of graft material
into the defect. (F) Suturing. (G) Periodontal dressing
placement.

Figure 3

Test group clinical outcomes showing
si6x-month post-operative evaluation.

Figure 4

Control group clinical outcomes
showing six-month post-operative evaluation.

Figure 5

Test group cone-beam computed
tomography analysis illustrating (A) pre-operative and (B) 6-month
post-operative measurements. Intrabony defect fill and residual
linear defect depth were assessed using native -beam computed
tomography software.

Figure 6

Control group cone-beam computed
tomography analysis showing (A) pre-operative and (B) 6-month
post-operative measurements. Intrabony defect fill and residual
linear defect depth were assessed using native cone-beam computed
tomography software.

Figure 7

Intragroup comparison of clinical and
radiographic parameters in the test group at baseline and 6 months.
(A) Median and interquartile range values for PPD, RCAL and IDF.
Data are presented as the median and interquartile range. Error
bars represent the interquartile range. *P<0.05,
indicates a statistically significant difference between baseline
and 6-month measurements. (B) Mean ± standard deviation values for
RLDD, PI and GI. Data are presented as the mean and standard
deviation. Error bars represent the standard deviation.
*P<0.05, indicates a statistically significant
difference between baseline and 6-month measurements. PPD, probing
pocket depth; RCAL, relative clinical attachment level; IDF,
intrabony defect fill; RLDD, radiographic linear defect depth; PI,
plaque index; GI, gingival index.

Figure 8

Intragroup comparison of clinical and
radiographic parameters in the control group at baseline and six
months. (A) Median and interquartile range values for PPD, RCAL and
IDF. Data are presented as the median and interquartile range).
Error bars represent the interquartile range.
*P<0.05, indicates a statistically significant
difference between baseline and 6-month measurements. (B) Mean ±
standard deviation values for RLDD, PI and GI. Data are presented
as the mean and standard deviation. Error bars represent the
standard deviation. *P<0.05, indicates a
statistically significant difference between baseline and 6-month
measurements. PPD, probing pocket depth; RCAL, relative clinical
attachment level; IDF, intrabony defect fill; RLDD, radiographic
linear defect depth; PI, plaque index; GI, gingival index.
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Copy and paste a formatted citation
Spandidos Publications style
Genescia S, Shetty NJ, Kotian H, Kadakampally D, Singh S and Shetty PJ: 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. World Acad Sci J 8: 74, 2026.
APA
Genescia, S., Shetty, N.J., Kotian, H., Kadakampally, D., Singh, S., & Shetty, P.J. (2026). 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. World Academy of Sciences Journal, 8, 74. https://doi.org/10.3892/wasj.2026.489
MLA
Genescia, S., Shetty, N. J., Kotian, H., Kadakampally, D., Singh, S., Shetty, P. J."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". World Academy of Sciences Journal 8.5 (2026): 74.
Chicago
Genescia, S., Shetty, N. J., Kotian, H., Kadakampally, D., Singh, S., Shetty, P. J."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". World Academy of Sciences Journal 8, no. 5 (2026): 74. https://doi.org/10.3892/wasj.2026.489
Copy and paste a formatted citation
x
Spandidos Publications style
Genescia S, Shetty NJ, Kotian H, Kadakampally D, Singh S and Shetty PJ: 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. World Acad Sci J 8: 74, 2026.
APA
Genescia, S., Shetty, N.J., Kotian, H., Kadakampally, D., Singh, S., & Shetty, P.J. (2026). 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. World Academy of Sciences Journal, 8, 74. https://doi.org/10.3892/wasj.2026.489
MLA
Genescia, S., Shetty, N. J., Kotian, H., Kadakampally, D., Singh, S., Shetty, P. J."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". World Academy of Sciences Journal 8.5 (2026): 74.
Chicago
Genescia, S., Shetty, N. J., Kotian, H., Kadakampally, D., Singh, S., Shetty, P. J."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". World Academy of Sciences Journal 8, no. 5 (2026): 74. https://doi.org/10.3892/wasj.2026.489
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