ABSTRACT
Stage IV grade C periodontitis is characterized by advanced periodontal tissue destruction that occurs in a chronic time range. A regenerative approach using the tissue engineering principle is often used to restore periodontal tissue. Scaffold and growth factors play key roles in periodontal tissue engineering, alongside the availability of precursor cells. Hydroxyapatite (HA) is the most common biomaterial used as a synthetic bone graft due to its biocompatibility and bioactivity. Meanwhile, platelet-rich fibrin (PRF) has been identified as a fibrin matrix that contains cytokines, growth factors, and cells that enhance regeneration in periodontal defects. Therefore, to achieve a better regenerative result, a combination of HA and PRF is chosen in this case. A 41-year-old male patient came with the chief complaint that his right upper back tooth frequently bleeds when brushing. A clinical examination revealed bleeding on probing at 3%, probing depth of 4–6 mm, and clinical attachment loss at 4–8 mm on teeth 13, 15, and 17. A periapical radiograph on tooth 17 showed an intrabony defect. The intrabony defect on teeth 13, 15, and 17 were treated through the guided tissue regeneration (GTR) technique using an alloplastic bone graft (HA + ß-TCP + collagen) mixed with platelet-rich-fibrin from the patient's blood and a collagen membrane. One week after surgery, the gingiva of the surgical site appeared within normal limits, and the patient did not report any pain or swelling. Then, the stitches were removed after two weeks. An evaluation of the patient's periodontal condition for 3 months showed bleeding on probing at 0%, probing depth of 1–2 mm, and no additional clinical attachment loss. After 3 months, a periapical radiograph on teeth 13, 15, and 17 showed the radiographic appearance of a normal alveolar bone crest. There was no loss of epithelial attachment. The combination of alloplastic containing HA as bone graft material and PRF may enhance periodontal regeneration, which was examined clinically and radiographically.
