Evaluation of Chitosan Membrane with or without Autologous Platelet Rich Plasma in the Treatment of Gingival Recession: A Randomized Controlled Clinical Study

Chitosan is known to be natural polymers and it is available, biodegradable, biocompatible, and non-toxic and has antimicrobial and anti-inflammatory effects. Platelet rich plasma (PRP) is an autologous source of platelet derived growth factor and transforming growth factor beta that play a role in periodontal regeneration. The present study was designed to evaluate and compare chitosan membrane with or without PRP versus CTG in the treatment of Miller Class I buccal gingival recession ≥ 4 mm in width. Thirty sites in patients with Miller Class I buccal gingival recession ≥ 4 mm in width were included in this study. The patients were classified randomly into three treatment groups, ten sites for each group. Selected recession sites were treated with one of the following three modalities. Group I: connective tissue graft in addition coronally advanced flap. Group II: chitosan membrane in addition coronally advanced flap. Group III: chitosan membrane, autologous platelet-rich plasma in addition coronally advanced flap. Plaque index (PI), gingival index (GI), probing pocket depth (PPD), clinical attachment level (CAL), recession height (RH), recession width (RW), digital measurements of area of recession and height of the keratinized tissue (HKT) were recorded at baseline and at 1, 3, 6 and 12 months post surgically, except for PPD & CAL which were assessed at 6 and 12 months post surgically. Gingival thickness (GT) was recorded at baseline and after 12 months post surgically. Percentage of root coverage (RC) was recorded at 1, 3, 6, 12 months and wound healing index (WHI) was recorded at 2 weeks, 1, 3, and 6 months after surgery. All groups showed comparable results at the end of the study period. The three treatment modalities showed a statistically significant reduction in CAL at 6 and 12 months as compared to the mean baseline value. Intergroup comparison showed that group III had significantly less RH, RW, and digital measurement of recession area as compared to group I at one month, while there was statistically insignificant difference between group II and I. On the other hand, the results at 3, 6 and 12 months post-surgery were comparable and statistically insignificant. Difference in all treated groups there was a statistically significant increase in the mean HKT up to 12 months as compared to the mean baseline value.  However, CTG lead to more HKT as compared to groups II & III. There was a statistically significant increase in the mean GT after 12 months post-surgery in all treated groups. The mean GT was more significantly increased in group I & III as compared to group II. A statistically significant reduction in WHI in chitosan membrane and chitosan membrane and PRP groups when compared to the CTG group at 2 weeks post-operatively. Clinical results of the present study indicated that, the addition of chitosan membrane with or without PRP to CAF resulted in root coverage comparable to CTG but without the discomfort as in the second surgical procedure and the potential clinical difficulties associated with the donor site surgery. Clinically the addition of PRP to chitosan resulted in an increase gingival thickness as compared to chitosan membrane alone. Gingival thickness in group III (chitosan with PRP) was comparable to CTG.