Clinical Outcomes of Open Flap Debridement with Metronidazole-Infused Titanium Platelet-Rich Fibrin versus Titanium Platelet-Rich Fibrin Alone: A Randomized Clinical Trial

Abstract

Background: Residual periodontal pockets following conventional periodontal therapy may continue to harbor pathogenic microorganisms and compromise healing. Metronidazole is an effective antimicrobial agent against anaerobic periodontal pathogens, while Titanium-Platelet Rich Fibrin (T-PRF) provides a biologically active scaffold that promotes periodontal regeneration. This study evaluated the clinical efficacy of Metronidazole-infused T-PRF as an adjunct to open flap debridement (OFD) in the management of periodontal pockets.
Materials and Methods: Thirty patients diagnosed with Stage III–IV periodontitis presenting with residual periodontal pockets (PPD ≥5 mm) were enrolled in this single-blinded randomized clinical trial and allocated into two groups (n=15 each). The test group received OFD with Metronidazole-infused T-PRF, while the control group received OFD with T-PRF alone. Plaque Index (PI), Gingival Index (GI), Probing Pocket Depth (PPD), and Relative Clinical Attachment Level (RCAL) were recorded at baseline, 3 months, and 6 months postoperatively.
Results: Both groups demonstrated significant improvements in all clinical parameters from baseline to 6 months (p<0.001). The test group showed greater reductions in PPD (2.2 ± 0.6 mm) compared with the control group (1.8 ± 0.7 mm), although the difference was not statistically significant (p>0.05). RCAL gain was significantly greater in the Metronidazole-infused T-PRF group (2.3 ± 0.6 mm) than in the T-PRF group (1.7 ± 0.7 mm) (p<0.05). No significant intergroup differences were observed for PI and GI.
Conclusion: Both T-PRF and Metronidazole-infused T-PRF used in conjunction with OFD resulted in significant clinical improvements. However, Metronidazole-infused T-PRF demonstrated superior clinical attachment gain, suggesting that incorporation of metronidazole into the T-PRF matrix may enhance periodontal healing and improve treatment outcomes in periodontal pocket therapy.