Periodontal regeneration involves the complex, multi-step rebuilding of the tooth-supporting apparatus to re-establish clinical health. Complete restoration via currently available regenerative approaches remains achievable only to a limited degree. Platelet Rich Fibrin can be described as a polymerized fibrin construct created through a straightforward method aimed at potentiating the inherent wound-healing properties of a natural blood coagulum by enriching it with bioactive growth factors. This specialized framework doubles as a delivery platform for growth factor molecules while also shuttling cells critical for new tissue formation. Recognized shortcomings of PRF encompass possible silica-mediated cross-contamination, insufficient structural stiffness, and rapid breakdown in situ. Seeking to address these constraints, the third iteration of platelet concentrates—Titanium PRF—was fabricated using the body-friendly metal titanium. Within this formulation, the fibrin scaffold is characterized by a more prolonged resorption period, heightened osseointegrative properties, improved compatibility with blood components, superior cell-supporting architecture, and an enhanced capacity to stimulate periodontal regeneration. What this controlled clinical trial sets out to accomplish is a comparative evaluation of the clinical and radiographic performance of Leukocyte Rich Platelet Rich Fibrin [L-PRF] alongside open flap debridement versus Titanium-Platelet Rich Fibrin [T-PRF], as well as Open Flap Debridement [OFD] administered independently, when treating three-walled intrabony periodontal lesions. The present Randomized controlled clinical investigation took place at the Department of Periodontics, Rural Dental College, Loni. Twenty-five subjects, each presenting three-walled intrabony defects distributed across three distinct locations, underwent treatment allocation to one of three arms: OFD combined with L-PRF (experimental), OFD combined with T-PRF (experimental), and OFD as a standalone procedure (control). Shifts in probing pocket depth and improvements in clinical attachment level were documented at the 9-Month mark, whereas the extent of defect fill and crestal alveolar bone loss were quantified at both 6 and 9 Months following the surgical intervention; statistical evaluation was performed via Analysis of Variance (ANOVA) supplemented by Post hoc Tukey’s test. Probing Pocket depth values were determined by measuring from the free gingival margin down to the pocket floor, and Clinical attachment Level values were obtained by gauging the span from each tooth’s cementoenamel junction down to the soft tissue floor of the pocket with the aid of a customized stent. Before any surgical manipulation, a uniform digital periapical radiograph was obtained using a tailored bite plate and a paralleling angle technique. Radiographic assessments comprised (1) the measurement extending from the Cemento Enamel Junction [CEJ] to the most apical point of the vertical osseous lesion (BD), and (2) the measurement extending from the CEJ to the alveolar crest (AC). All values were recorded employing a calibrated millimeter grid. The discrepancy between the 6-month and 9-month readings and the initial CEJ-BD value indicated the volume of bone fill achieved. The discrepancy in CEJ-AC values was interpreted as the magnitude of crestal bone resorption, respectively. The evolution in Plaque Scores, tracked from Baseline to 9 Months across multiple assessment intervals, revealed that the alteration in average PI Scores observed between Baseline and 1 Month, Baseline and 3 Months, Baseline and 6 Months, and Baseline and 9 Months reached statistical significance across the entire study sample. Turning to the clinical indices, the head-to-head assessment of PPD reduction and CAL gain spanning Baseline to 9 Months across the three arms—OFD, L-PRF, and T-PRF—highlighted that the most substantial mean improvement was registered for T-PRF, followed sequentially by L-PRF and then OFD. Regarding the radiographic endpoint of defect fill, the data demonstrated that at both the 6- and 9-Month time points, osseous regeneration was most pronounced in the T-PRF cohort, followed by the L-PRF cohort, with the OFD cohort exhibiting the least bone formation. When the parameter of crestal bone resorption was scrutinized between baseline and 9 Months, the average CEJ-to-AC span in the OFD Group was found to have expanded; in the L-PRF group, no measurable shift was detected; and within the T-PRF group, the average CEJ-to-AC span was noted to have contracted (a finding indicative of bone apposition occurring solely within the T-PRF Group). While acknowledging the inherent limitations of this investigation, it may be deduced that the deployment of Titanium Platelet-Rich Fibrin unlocks novel avenues for amplified healing and functional reclamation in the context of intrabony defect management, delivering a more pronounced decrease in pocket depth, superior clinical attachment gain, and the capability of yielding a greater quantity of new bone over a condensed timeframe when contrasted with both L-PRF and OFD.
