Comparison of Platelet-Rich Fibrin versus Collagen Membrane in Periodontal Regeneration of Intrabony Defects: A Randomized Clinical Trial

Abstract

Background: Regenerative management of periodontal intrabony defects aims to restore lost periodontal attachment apparatus. Platelet-rich fibrin (PRF), a second-generation autologous platelet concentrate, releases growth factors capable of enhancing osteogenic and angiogenic responses, while bioresorbable collagen membranes act as space-providing barriers in guided tissue regeneration. Comparative evidence from Indian populations remains limited. The present trial compared the clinical and radiographic regenerative outcomes of PRF versus a bioresorbable collagen membrane, each combined with open flap debridement (OFD), in patients with chronic periodontitis and intrabony defects. Methods: A single-centre, prospective, randomized, parallel-arm, examiner-blinded clinical trial was conducted between January 2024 and December 2025. Sixty patients with stage III periodontitis harbouring ≥3 mm vertical bone defects were randomly assigned 1:1 to OFD with PRF (n = 30) or OFD with bioresorbable collagen membrane (n = 30). Plaque index, gingival index, probing pocket depth (PPD), clinical attachment level (CAL), gingival recession (GR) and radiographic defect depth (RDD) on standardized intraoral periapical radiographs were recorded at baseline, 3 months and 6 months. The primary outcome was the change in CAL at 6 months. Results: Both groups showed statistically significant intra-group improvement (p < 0.001). At 6 months, mean CAL gain was 3.42 ± 0.76 mm with PRF versus 3.04 ± 0.82 mm with collagen (p = 0.067). PPD reduction was 3.84 ± 0.78 mm vs 3.48 ± 0.86 mm (p = 0.094) and radiographic defect fill was 2.86 ± 0.62 mm vs 2.42 ± 0.68 mm (p = 0.012). Percentage bone fill favoured PRF (54.6 ± 11.8% vs 46.2 ± 12.4%; p = 0.009). GR change and post-operative pain were modestly lower with PRF. No adverse events occurred. Conclusion: Both PRF and bioresorbable collagen membrane combined with OFD produced significant clinical and radiographic improvement in intrabony defects at 6 months. PRF yielded numerically superior clinical gains and statistically significant superior radiographic bone fill, supporting its role as an affordable, autologous regenerative biomaterial in Indian periodontal practice.