Three-year results of a prospective, controlled clinical study evaluating treatment of intra-bony defects with PRF or EMD- a randomized control trial.

BACKGROUND

Periodontal regenerative surgery is a well-established treatment modality for intrabony periodontal defects. Enamel matrix derivative (EMD) is one of the most extensively documented biologic agents, whereas platelet-rich fibrin (PRF) has emerged as a promising autologous alternative. This prospective randomized controlled clinical study aimed to compare the long-term clinical outcomes of PRF and EMD in the treatment of periodontal intrabony defects.

METHODS

Thirty patients with periodontitis Stage III/IV, grade B/C and at least one intrabony defect [probing pocket depth (PPD) ≥ 6 mm; intrabony component ≥ 4 mm] were randomly assigned to surgery using PRF (test group) or EMD (control group). The primary outcome was clinical attachment level (CAL) gain. Secondary outcomes included PPD reduction, gingival recession (GR), and bone sounding (BS) changes. Clinical parameters were recorded at baseline, 6 months, and 3 years postoperatively. Intergroup comparisons of mean clinical changes were performed using appropriate parametric and nonparametric statistical tests (α = 0.05).

RESULTS

Twenty-six patients completed the 3-year follow-up. Both treatment modalities resulted in significant clinical improvements that remained stable over time. At 6 months, mean PPD reduction was 4.40 ± 2.44 mm in the PRF group and 3.53 ± 2.67 mm in the EMD group, while mean CAL gain measured 3.87 ± 2.20 mm and 2.13 ± 2.80 mm, respectively. GR increase was lower in the PRF group compared with the EMD group (0.53 ± 1.13 mm vs. 1.40 ± 1.45 mm), although the difference did not reach statistical significance (p = 0.079). At 3 years, mean PPD reduction was 3.69 ± 1.70 mm in the PRF group and 3.31 ± 3.45 mm in the EMD group, while CAL gain measured 3.77 ± 1.48 mm and 2.54 ± 3.62 mm, respectively. A significantly lower increase in GR was observed in the PRF group compared with the EMD group at 3 years (- 0.08 ± 0.64 mm vs. 0.77 ± 1.30 mm; p = 0.046). No statistically significant intergroup differences were detected for PPD reduction, CAL gain, or BS reduction.

CONCLUSIONS

PRF and EMD provided comparable and stable long-term clinical improvements following regenerative periodontal surgery of intrabony defects. PRF may represent a reliable autologous alternative to EMD in periodontal regenerative therapy.

TRIAL REGISTRATION: ClinicalTrials.gov registration number NCT07183631 retrospectively registered, 14/09/2025.