Efficacy of injectable platelet-rich fibrin with guided tissue regeneration and bone grafting in the management of alveolar bone defects in patients with chronic periodontitis and baseline vitamin D deficiency.

The aim of this study was to assess the clinical efficacy of injectable platelet-rich fibrin (i-PRF) combined with guided tissue regeneration (GTR) and bone grafting for site-specific reconstruction of alveolar bone defects in patients with chronic periodontitis and vitamin D deficiency. A total of 34 periodontal surgical sites in patients diagnosed with chronic periodontitis and baseline vitamin D deficiency defined as serum 25-hydroxyvitamin D₃ (25-[OH]D₃) levels < 20 µg/L were included. Sites were randomly assigned to either a study or control group using a random number table. All patients received basic periodontal therapy and standardized vitamin D supplementation. Upon correction of serum 25-[OH]D₃ levels to ≥ 30 µg/L, sites in the study group (n = 17) underwent GTR using sticky bone prepared from i-PRF combined with deproteinized bovine bone mineral (Bio‑Oss®, hereinafter referred to as Bio‑Oss bone powder). Sites in the control group (n = 17) received conventional GTR with bone grafting using physiological saline mixed with Bio-Oss bone powder. Probing depth (PD), clinical attachment level (CAL), bleeding index (BI), and intrabony defect depth (IBD) were assessed at baseline and 6 months postoperatively. Statistically significant improvements in PD, CAL, BI, and IBD were observed within each group between baseline and 6 months postoperatively (p < 0.05). At the 6-month follow-up, no statistically significant differences were found between groups for any of the assessed parameters (p > 0.05). However, numerical improvements in PD, CAL, and IBD were greater in the study group than in the control group, although these differences did not reach statistical significance (p > 0.05). The use of i-PRF in combination with GTR and bone grafting in patients with chronic periodontitis and baseline vitamin D deficiency resulted in clinically favorable and stable outcomes, comparable to those achieved with conventional GTR and bone grafting. Both treatments demonstrated comparable short-term efficacy at 6 months postoperatively, and both effectively promoted periodontal tissue repair and regeneration. Although the observation group showed a numerical trend toward greater improvements in PD, CAL, and IBD, suggesting a potential to partially compensate for the impaired osteogenic capacity induced by vitamin D deficiency, the between-group differences did not reach statistical significance. Therefore, its clinical advantages require further validation in larger-sample studies. Accordingly, the routine use of i-PRF for additional clinical benefit is not recommended in patients with vitamin D deficiency; instead, vitamin D deficiency should be prioritized for correction before considering whether to combine i-PRF or other adjunctive regenerative measures.