Comparison of injectable platelet-rich fibrin, titanium platelet-rich fibrin, and 0.8% hyaluronic acid applications versus periodontal dressing alone in wound healing after gingivectomy and gingivoplasty operations: randomized controlled clinical stu

The primary objective of this study was to evaluate the effects of injectable platelet-rich fibrin (I-PRF), titanium-prepared platelet-rich fibrin (T-PRF), and 0.8% hyaluronic acid (HA) gel compared with a naturally healing control group on gingival wound healing and epithelialization following gingivectomy and gingivoplasty in plaque-induced gingival enlargement. Secondary objectives were to assess clinical periodontal parameters and patient-reported outcomes during a 28-day follow-up period. The study included four groups: a control group and three test groups treated with I-PRF, T-PRF, and 0.8% HA gel. All patients underwent gingivectomy and gingivoplasty after the first step of periodontal therapy. Pain and burning were recorded using VAS during the first postoperative week, and analgesic consumption and bleeding were also recorded. Oral health–related quality of life was assessed using OHIP-14. Wound healing was evaluated using Mira-2 Tone staining with digital image analysis, the Landry, Turnbull, and Howley (LTH) wound-healing index, and the H₂O₂ foaming test at days 7, 14, 21, and 28, while clinical periodontal parameters were reassessed at day 28. A total of 60 systemically healthy patients were included in the study: I-PRF (n = 15), T-PRF (n = 15), 0.8% HA (n = 15), and control (n = 15). Significant intergroup differences were observed in several clinical and wound-healing parameters. At day 28, the HA group showed significantly lower gingival inflammation and bleeding compared with the I-PRF, T-PRF, and control groups (p < 0.05). All intervention groups demonstrated improved wound healing compared with the control group. On day 7, the control group exhibited a significantly larger non-epithelialized area (169,440 ± 23,583) than the HA group (122,262 ± 18,363), representing a mean reduction difference of 47,178. LTH wound-healing scores were significantly higher in the intervention groups than in the control group across all time points (all p ≤ 0.005). Pain, burning, and oral health–related quality of life improved significantly over time in all groups (p < 0.001), with the HA and I-PRF groups reporting lower discomfort scores. I-PRF, T-PRF, and HA enhanced epithelial wound healing and patient comfort compared with control, with HA providing superior reductions in gingival inflammation and bleeding. However, due to the subjective nature of some measures and the lack of histological/molecular analyses, further long-term studies are necessary to confirm these clinical outcomes and understand the underlying biological mechanisms. Adjunctive use of HA, I-PRF, and T-PRF may improve soft-tissue healing and patient comfort after gingivectomy. HA may be particularly practical in routine clinical settings because it does not require blood collection or centrifugation. Therefore, the choice of adjunctive treatment may depend on clinical logistics and cost considerations.