Open flap debridement with EDTA-conditioned root surface biomodification with or without injectable platelet-rich fibrin: a randomized controlled trial

This randomized controlled clinical trial evaluated the incremental clinical effect of adjunctive injectable platelet-rich fibrin (i-PRF) when added to open flap debridement (OFD) with 24% EDTA root surface conditioning. A total of 42 individuals diagnosed with Stage II–IV periodontitis and presenting with at least three adjacent teeth with probing pocket depth (PPD) ≥ 5 mm were enrolled. Participants were randomly allocated into two equal groups. Both groups underwent OFD combined with 24% EDTA root surface conditioning, and the test group additionally received a 5-min application of i-PRF. Clinical periodontal parameters, including plaque index (PI), gingival index (GI), bleeding on probing (BOP), gingival recession width (GRW), gingival recession depth (GRD), probing pocket depth (PPD), and clinical attachment level (CAL), were recorded using a calibrated periodontal probe under standardized conditions. Both groups demonstrated comparable improvements in PI, GI, BOP, GRW, and GRD (p > 0.05). At the 180-day follow-up, the test group exhibited significantly greater PPD reduction and greater CAL gain than the control group (p < 0.001 and p < 0.05, respectively). At surgically treated sites, the additional 6-month improvement in the test group was 1.02 mm for PPD and 1.14 mm for CAL. Postoperative pain and sensitivity scores remained low in both groups, and no clinically relevant intergroup differences in biocompatibility or soft-tissue healing were observed. Adjunctive use of i-PRF within an EDTA-conditioned OFD protocol resulted in more favorable early clinical healing outcomes, particularly with respect to PPD reduction and CAL gain, compared with OFD + EDTA alone. These findings suggest that injectable platelet concentrates may serve as a useful adjunct for improving early clinical outcomes following periodontal surgery. ClinicalTrials.gov Identifier: NCT07207668. Retrospectively registered on September 18,2025. Adjunctive use of injectable platelet-rich fibrin improved clinical outcomes following open flap debridement. Greater probing pocket depth reduction and clinical attachment gain were observed at 6 months. Root surface conditioning with 24% EDTA supported a biologically favorable healing environment. Injectable platelet concentrates enhanced early periodontal wound healing without increasing morbidity. The protocol represents a simple, autologous, and clinically feasible adjunct to periodontal surgery.