Comparative analysis of connective tissue graft versus ozone-enriched platelet-rich fibrin in the treatment of Cairo class I gingival recessions: a randomized, double-blind, controlled clinical trial.

Abstract

Gingival recession is characterized by the apical displacement of the marginal gingiva, exposing the root surface and causing aesthetic and functional issues such as dentin hypersensitivity and cervical lesions. Subepithelial connective tissue grafts (SCTG) are considered the gold standard for root coverage. Recently, ozone-enriched advanced platelet-rich fibrin (A-PRF) has emerged as a promising alternative due to its regenerative potential and biocompatibility.

Objectives: To compare the clinical efficacy of ozone-enriched A-PRF and SCTG combined with the coronally advanced flap (CAF) technique to treat Cairo Class I gingival recessions.

Methodology: This randomized, double-blind, controlled clinical trial included 22 healthy patients (mean age 32.23±11.86 years, range 20-60 years), each with bilateral Cairo Class I recessions. Sites were treated with either CAF + SCTG (control) or CAF + ozone-enriched A-PRF (test). Clinical parameters were assessed at baseline, 90, and 180 days. Data were analyzed using the Shapiro-Wilk, repeated measures ANOVA, Tukey, and Friedman tests (α=0.05) on GraphPad Prism 8.0®. This study adhered to the CONSORT guidelines for randomized clinical trials.

Results: Complete root coverage (100%) was achieved in 13 of 22 sites (60%) in the SCTG group and in nine of 22 cases (43%) in the ozone-enriched A-PRF group. Both groups statistically and significantly improve over time in selected clinical parameters (p<0.05). The SCTG group showed significant gains in all evaluated outcomes, whereas the ozone-enriched A-PRF group showed significant improvements in clinical attachment level, recession height, recession width, and dentin hypersensitivity. SCTG more greatly increased gingival thickness (0.77±0.52 mm) and keratinized tissue width (0.81±0.95 mm) than ozone-enriched A-PRF (0.27±0.55 mm and 0.22±0.42 mm, respectively).

Conclusions: Both treatment approaches effectively managed Cairo Class I gingival recessions. SCTG promoted superior soft tissue augmentation, whereas ozone-enriched A-PRF achieved comparable reductions in recession-related parameters. The limitations of this study include its short follow-up period and the absence of histological assessment. Clinical Trial Register: RBR-537bzqt.