Microneedling with injectable platelet-rich fibrin as an adjunct to nonsurgical periodontal therapy in periodontitis patients: A split-mouth clinical trial.

Aim and Background: Contemporary minimally invasive periodontal approaches focus on conserving tissues and minimizing postoperative discomfort. Microneedling (MN), a technique that induces controlled collagen synthesis, has shown potential in stimulating soft-tissue regeneration and improving tissue volume. When used in addition to injectable platelet-rich fibrin (I-PRF), a biologically rich blood concentrate, the regenerative outcome may be further enhanced. In patients with chronic periodontitis, the current study sought to compare the clinical results of MN with I-PRF versus I-PRF alone after nonsurgical periodontal therapy. Materials and Methods: A randomized split-mouth clinical design was adopted, including 120 periodontal sites with Stage II periodontitis. Following initial therapy, the test sites (n = 60) underwent MN followed by I-PRF administration, while contralateral control sites (n = 60) received only I-PRF injections. Clinical parameters - probing pocket depth (PPD), gingival thickness (GT), keratinized tissue width (KTW), and relative attachment level (RAL) - were assessed at baseline, 1 month, and 3 months after treatment. Results: All recorded metrics showed a considerable improvement with both treatment regimens (P < 0.001). In the test and control groups, the mean PPD decreased to 3.38 ± 0.42 mm and 3.65 ± 0.57 mm, respectively. Correspondingly, the mean RAL in the test group showed a reduction from 4.91 ± 0.77 mm at baseline to 3.66 ± 0.65 mm after treatment, while the control group exhibited an improvement to 3.87 ± 0.69 mm. After 3 months, the test group demonstrated a mean gain in GT of 0.60 ± 0.31 mm and an increase in KTW of 0.80 ± 0.14 mm, indicating a larger enhancement in periodontal phenotype (P < 0.001). Conclusion: MN used adjunctively with I-PRF demonstrated superior outcomes in soft-tissue healing, phenotype improvement, and clinical attachment gain, highlighting its promise as a minimally invasive regenerative modality in nonsurgical periodontal therapy.