PRF and enamel matrix derivative produced an equal attachment gain

Attachment gain of 1.1 mm, the same in both groups

Non-surgical periodontal therapy remains the first choice, but in moderate and advanced cases its reach has a limit — hence the attempts to add a regenerative biomaterial to root scaling and planing. A split-mouth trial published in Oral Health & Preventive Dentistry directly compared two widely used ones: enamel matrix derivative (EMD) and platelet-rich fibrin (PRF).

The trial enrolled 15 patients with stage II/III, grade A/B periodontitis, 13 of whom completed it. Each patient contributed two approximal sites, randomised to EMD or PRF after full-mouth debridement. The EMD sites were pre-treated with EDTA, and PRF was prepared by standard horizontal centrifugation. Probing depth, gingival margin position, clinical attachment level and bleeding on probing were measured at baseline and after six months.

Both materials produced a significant improvement within their own group. Probing depth decreased by 1.1 ± 0.6 mm with EMD and 1.2 ± 0.7 mm with PRF, and the clinical attachment gain was 1.1 ± 0.7 mm and 1.1 ± 0.8 mm respectively. Bleeding on probing fell from 77% to 23% in the EMD group and from 85% to 31% in the PRF group, while the gingival margin position remained stable. Between-group differences were not statistically significant for any outcome (probing depth p > 0.999; gingival margin P = 0.174; attachment P = 0.556). Analysis of the distribution of deep sites (≥ 6 mm) showed that after six months 100% of them in the EMD group and 90% in the PRF group had been reduced to 6 mm.

Limitations

The sample is very small — 13 patients who completed the trial — follow-up lasts only six months, and the split-mouth design does not rule out carry-over of the effect between sites in the same mouth; more complex periodontal cases were not examined.

For your practice

• If you keep both materials on the shelf, on these data the choice comes down to cost, availability and habit, not to clinical outcome.
• PRF is obtained from the patient's own blood and requires only time and a centrifuge; that is the only clear argument these results support.
• Expectations need calibrating: an attachment gain of roughly a millimetre is the realistic reach of an adjunct to non-surgical therapy, not a reason to abandon a surgical solution in deep pockets.