Efficacy of T-PRF in Peri-implant Soft-tissue Augmentation and its Impact on Initial Marginal Bone Loss using the Bilayer Technique: A 6-month Prospective Clinical Trial

Introduction: Adequate peri-implant soft-tissue thickness plays a critical role in stabilising marginal bone and improving longterm implant success. Limited evidence exists regarding the effect of Titanium-prepared Platelet-rich Fibrin (T-PRF) on periimplant phenotype modification and early bone remodelling. Aim: To assess the effect of bilayer T-PRF on peri-implant softtissues augmentation and initial Marginal Bone Levels (MBL). Materials and Methods: This prospective, single-centre, singlearm clinical study included 15 systemically healthy patients reporting to Department of periodontics in GITAM Dental College and Hospital, Visakhapatnam, Andhra Pradesh, India with a single posterior edentulous site. The study period was May 2024 and November 2024. At implant placement, soft-tissue augmentation was performed using T-PRF membranes. Clinical parameters recorded at baseline, 3 and 6 months included Buccal Mucosal Thickness (BMT), Supracrestal Tissue Height (STH), Keratinised Mucosal Width (KMW) and Ridge Defect (RD), along with Plaque Index (PI) and Wound Healing Index (WHI) at one, three and six months postoperatively. MBL were assessed radiographically at baseline, three and six months. Patient-reported Outcome Measures (PROMs) were evaluated using a 100-mm Visual Analogue Scale (VAS) on postoperative days 1, 3, 7 and 14. Statistical analysis was performed using Statistical Packages of Social Sciences (SPSS) version 25.0 Descriptive statistics, Repeated measure Analysis of Variance (ANOVA), Banferroni Post-hoc test, Friedman test Wilcoxon sign rank test and Pearson's correlation test were used to analyse the data. p<0.05 was considered significant. Results: The mean age of the study participants was 34±9.5 years Significant gains were observed in BMT (1.93 mm), STH (2.10 mm), and KMW (0.43 mm) from baseline to six months (p<0.05). Mean MBL at six months was 0.55 mm mesially and 0.46 mm distally. BMT showed a strong negative correlation with MBL (r=-0.72), STH a moderate correlation (r=-0.58), KMW a weak correlation (r=-0.32), and RD a very weak, non significant correlation (r=-0.14). PROM scores progressively decreased and approached zero by day 14. Conclusion: The T-PRF effectively enhanced peri-implant softtissue thickness and was associated with minimal early Marginal Bone Loss (MBL). Its sustained growth-factor release and favourable biological behaviour support its use as a biomaterial for peri-implant soft-tissue augmentation.