Comparative Efficacy of Platelet-Rich Fibrin and Enamel Matrix Derivative As Adjuncts to Non-Surgical Periodontal Therapy: A Split-Mouth Randomised Clinical Trial

Abstract

Background Periodontitis is a chronic multifactorial inflammatory condition resulting in the gradual breakdown of periodontal supporting structures. Although non-surgical periodontal therapy (NSPT) is the gold standard first therapeutic option, its effectiveness can be limited in moderate-to-severe cases, hence necessitating the application of adjunctive therapies. Platelet-rich fibrin (PRF) and enamel matrix derivative (EMD) are among the most extensively utilised regenerative biomaterials; nevertheless, direct comparative evidence related to their adjunctive advantage in NSPT is scarce. Aim This split-mouth randomised clinical trial compared the clinical effectiveness of EMD versus PRF as adjunct biological modalities to scaling and root planing (SRP) in the non-surgical management of Stage II/III and Grade A/B periodontitis. Methods and Materials Fifteen participants meeting the eligibility criteria were included, with thirteen completing the trial. Each patient contributed two interproximal sites randomly allocated to either adjunctive EMD or PRF after full-mouth SRP. Before the placement of biomaterial, EMD sites were treated with ethylenediaminetetraacetic acid (EDTA), whereas PRF was prepared utilising the standard horizontal centrifugation approach. Periodontal probing depth (PD), gingival margin (GM) position, clinical attachment level (CAL), and bleeding on probing (BOP) were measured at baseline and 6-month follow-up. Results Both biomaterials yielded significant intra-group improvements. Mean PD scores were reduced by 1.1 ± 0.6 mm in the EMD group and 1.2 ± 0.7 mm in the PRF group. CAL gains were 1.1 ± 0.7 mm and 1.1 ± 0.8 mm for EMD and PRF, respectively. GM levels remained stable across groups, and BOP markedly decreased (EMD: 77% to 23%; PRF: 85% to 31%). Intergroup comparisons revealed no statistically significant differences for PD (p > 0.999), GM (P = 0.174), or CAL (P = 0.556). Moreover, frequency distribution analysis showed that 100% of deep sites (≥ 6 mm) in the EMD group and 90% in the PRF group were reduced to < 6 mm at 6 months. Conclusion Both EMD and PRF showed comparable clinical outcomes as adjunctive regenerative biomaterials in NSPT to manage moderate periodontal pockets. These outcomes support the versatility of clinicians in selecting either biological option based on practitioner and patient preference, availability, and cost, while opening avenues for future studies investigating their application in more complex periodontal cases.