The effect of Stage I-II periodontitis on the mechanical, structural, and biological properties of leukocyte and platelet-rich fibrin

Authors

  • Sarvar Ibrahimli Kirikkale University, Faculty of Dentistry, Department of Periodontology
  • Meltem Karsiyaka Hendek Kirikkale University, Faculty of Dentistry, Department of Periodontology
  • Kubilay Baris Kirikkale University, Faculty of Dentistry, Department of Periodontology
  • Ebru Olgun Kirikkale University, Faculty of Dentistry, Department of Periodontology

DOI:

https://doi.org/10.1590/1678-7765-2025-0483

Keywords:

Leukocyte, Periodontitis, Platelet-rich fibrin, Tensile strength

Abstract

Objective  This study aimed to compare the mechanical, biological, and structural properties of a leukocyte- and platelet-rich fibrin (L-PRF) membrane in periodontally healthy patients and those with periodontitis. A total of 30 individuals (17 men and 13 women) with a median age of 41 years were divided into two groups as periodontally healthy (control group) and as having periodontitis (test group). Methodology  Blood samples were collected and centrifuged at 2700 rpm for 12 minutes. A tensile test was performed to determine the mechanical properties of L-PRF membranes. Elasticity-modulus, tensile strength, and stretch at rupture were calculated. Platelet and leucocyte counts and ratios were calculated. Fibril thickness and density were evaluated by scanning electron microscopy imaging. The comparisons between groups were analyzed by the Mann–Whitney U test, and a p<0.05 value was considered statistically significant. Results  In the comparison of the control group versus the test group, pocket depth (3.55 (1.59-3.97) vs. 1.52 (1.47-3.53)), clinical attachment level (3.11 (1.77-4.23) vs. 0.06 (0.05-3.68)), plaque index (1.63 (0.05-1.75) vs. 0.04 (0.04-1.58)), gingival index (1.55 (0.04-1.63) vs. 0.05 (0.04-1.49)), and bleeding on probing (56.25 (3.7-70.11) vs. 3.57 (2.67-47.12)) were statistically significantly higher in the test group than in the control group (p= 0.009, p=0.008, p=0.008, p=0.009, p=0.009, respectively). Elasticity-modulus, tensile strength, and stretch at rupture values showed no statistically significantly differences between groups (p=0.745, p=0.754, p=0.602, respectively). Fibril thickness and density values showed no statistically significant differences between groups (p=1.000, p=0.753, respectively). Platelet count and platelet and leukocyte ratio values showed no statistically significant differences between groups (p=0.754, p=0.600, p=0.142, respectively). Leukocyte count was found to be statistically significantly higher in the control group than in the test group (p=0.028). Conclusion  This study showed no effect of Stage I-II periodontitis on the mechanical, structural, and biological properties of L-PRF. Further studies with larger sample sizes are required to confirm these findings.

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References

1- Brozek R, Lorenz A, Dorocka-Bobkowska B, Kurpisz M. Immunoinflammatory response in periodontal diseases. J Physiol Pharmacol. 2025;76(3):10.26402/jpp.2025.3.02. doi:10.26402/jpp.2025.3.02

» https://doi.org/10.26402/jpp.2025.3.02

2- Tavares LT, Saavedra-Silva M, López-Marcos JF, Veiga NJ, Castilho RM, Fernandes GV. Blood and salivary inflammatory biomarkers profile in patients with chronic kidney disease and periodontal disease: a systematic review. Diseases. 2022;10(1):12. doi: 10.3390/diseases10010012

» https://doi.org/10.3390/diseases10010012

3- Villoria GE, Fischer RG, Tinoco EM, Meyle J, Loos BG. Periodontal disease: a systemic condition. Periodontol 2000. 2024;96(1):7-19. doi: 10.1111/prd.12616

» https://doi.org/10.1111/prd.12616

4- Martínez-García M, Hernández-Lemus E. Periodontal Inflammation and systemic diseases: an overview. Front Physiol. 2021;12:709438. doi: 10.3389/fphys.2021.709438

» https://doi.org/10.3389/fphys.2021.709438

5- Li X, Kolltveit KM, Tronstad L, Olsen I. Systemic diseases caused by oral infection. Clin Microbiol Rev. 2000;13(4):547-58. doi: 10.1128/CMR.13.4.547

» https://doi.org/10.1128/CMR.13.4.547

6- Botelho J, Machado V, Mendes JJ. Periodontal health and blood disorders. Curr Oral Health Rep. 2021;8:107-16. doi:10.1007/s40496-021-00301-w

» https://doi.org/10.1007/s40496-021-00301-w

7- Lobacz M, Mertowska P, Mertowski S, Kozinska A, Kwasniewski W, Kos M, et al. The bloody crossroads: interactions between periodontitis and hematologic diseases. Int J Mol Sci. 2024;25(11):6115. doi: 10.3390/ijms25116115

» https://doi.org/10.3390/ijms25116115

8- Bhattacharya HS, Srivastava R, Gummaluri SS, Agarwal MC, Bhattacharya P, Astekar MS. Comparison of blood parameters between periodontitis patients and healthy participants: a cross-sectional hematological study. J Oral Maxillofac Pathol. 2022;26(1):77-81. doi: 10.4103/jomfp.jomfp_349_21

» https://doi.org/10.4103/jomfp.jomfp_349_21

9- Wang X, Meng H, Xu L, Chen Z, Shi D, Lv D. Mean platelet volume as an inflammatory marker in patients with severe periodontitis. Platelets. 2015;26(1):67-71. doi: 10.3109/09537104.2013.875137

» https://doi.org/10.3109/09537104.2013.875137

10- Kumar V, Stewart Iv JH. Platelet's plea to Immunologists: please do not forget me. Int Immunopharmacol. 2024;143(Pt 3):113599. doi: 10.1016/j.intimp.2024.113599

» https://doi.org/10.1016/j.intimp.2024.113599

11- Blanco J, García A, Hermida-Nogueira L, Castro AB. How to explain the beneficial effects of leukocyte- and platelet-rich fibrin. Periodontol 2000. 2025;97(1):74-94. doi: 10.1111/prd.12570.

» https://doi.org/10.1111/prd.12570

12- Song P, He D, Ren S, Fan L, Sun J. Platelet-rich fibrin in dentistry. J Appl Biomater Funct Mater. 2024;22:22808000241299588. doi: 10.1177/22808000241299588

» https://doi.org/10.1177/22808000241299588

13- Sousa LL, Brunale DF, Fernandes GV, Giro G, Faveri M. A comparison of the dimensional characteristics and plasma parameters of different centrifuges used for the preparation of autologous platelet concentrates: a randomized correlational study. Materials (Basel). 2025;18(2):414. doi: 10.3390/ma18020414

» https://doi.org/10.3390/ma18020414

14- Dohan DM, Choukroun J, Diss A, Dohan SL, Dohan AJ, Mouhyi J, et al. Platelet-rich fibrin (PRF): a second-generation platelet concentrate. Part II: platelet-related biologic features. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;101(3):e45-50. doi: 10.1016/j.tripleo.2005.07.009

» https://doi.org/10.1016/j.tripleo.2005.07.009

15- Pavlovic V, Ciric M, Jovanovic V, Trandafilovic M, Stojanovic P. Platelet-rich fibrin: basics of biological actions and protocol modifications. Open Med (Wars). 2021;16(1):446-54. doi: 10.1515/med-2021-0259

» https://doi.org/10.1515/med-2021-0259

16- Pascoal MA, Santos NB, Completo AM, Fernandes GV. Tensile strength assay comparing the resistance between two different autologous platelet concentrates (leucocyte-platelet rich fibrin versus advanced-platelet rich fibrin): a pilot study. Int J Implant Dent. 2021;7(1):1. doi: 10.1186/s40729-020-00284-w

» https://doi.org/10.1186/s40729-020-00284-w

17- Simões-Pedro M, Tróia PM, Santos NB, Completo AM, Castilho RM, Oliveira Fernandes GV. Tensile strength essay comparing three different platelet-rich fibrin membranes (L-PRF, A-PRF, and A-PRF+): a mechanical and structural in vitro evaluation. Polymers (Basel). 2022;14(7):1392. doi: 10.3390/polym14071392

» https://doi.org/10.3390/polym14071392

18- Hutter JW, van der Velden U, Varoufaki A, Huffels RA, Hoek FJ, Loos BG. Lower numbers of erythrocytes and lower levels of hemoglobin in periodontitis patients compared to control subjects. J Clin Periodontol. 2001;28(10):930-6. doi: 10.1034/j.1600-051x.2001.028010930.x

» https://doi.org/10.1034/j.1600-051x.2001.028010930.x

19- Christan C, Dietrich T, Hägewald S, Kage A, Bernimoulin JP. White blood cell count in generalized aggressive periodontitis after non-surgical therapy. J Clin Periodontol. 2002;29(3):201-6. doi: 10.1034/j.1600-051x.2002.290303.x

» https://doi.org/10.1034/j.1600-051x.2002.290303.x

20- Tonetti MS, Greenwell H, Kornman KS. Staging and grading of periodontitis: framework and proposal of a new classification and case definition. J Periodontol. 2018;89 Suppl 1:159-72. doi: 10.1002/JPER.18-0006.

» https://doi.org/10.1002/JPER.18-0006

21- Silness J, Löe H. Periodontal disease in pregnancy. II. Correlation between oral hygiene and periodontal condition. Acta Odontol Scand. 1964;22:121-35. doi: 10.3109/00016356408993968

» https://doi.org/10.3109/00016356408993968

22- Löe H, Silness J. Periodontal disease in pregnancy. I. Prevalence and severity. Acta Odontol Scand. 1963;21:533-51. doi: 10.3109/00016356309011240

» https://doi.org/10.3109/00016356309011240

23- Choukroun J, Adda F, Schoeffler C, Vervelle, A. Une opportunite en paro-implantologie: Le PRF. Implantodontie. 2000;42:55-62.

24- Strauss FJ, Nasirzade J, Kargarpoor Z, Stähli A, Gruber R. Effect of platelet-rich fibrin on cell proliferation, migration, differentiation, inflammation, and osteoclastogenesis: a systematic review of in vitro studies. Clin Oral Investig. 2020;24(2):569-84. doi:10.1007/s00784-019-03156-9

» https://doi.org/10.1007/s00784-019-03156-9

25- Nakanishi Y, Matsushita T, Nagai K, Araki D, Hoshino Y, Kuroda R. Fibrin clot and Leukocyte-rich platelet-rich fibrin show similar release kinetics and amount of growth factors: a pilot study. J Orthop Surg Res. 2023;18(1):238. doi: 10.1186/s13018-023-03709-5

» https://doi.org/10.1186/s13018-023-03709-5

26- Hasan F, Tandon A, AlQallaf H, John V, Sinha M, Gibson MP. Inflammatory Association between Periodontal Disease and Systemic Health. Inflammation. 2025;48(6):3763-75. doi:10.1007/s10753-025-02317-1

» https://doi.org/10.1007/s10753-025-02317-1

27- Kumar RV, Shubhashini N. Platelet rich fibrin: a new paradigm in periodontal regeneration. Cell Tissue Bank. 2013;14(3):453-63. doi: 10.1007/s10561-012-9349-6

» https://doi.org/10.1007/s10561-012-9349-6

28- Weisel JW, Litvinov RI. Fibrin formation, structure and properties. Subcell Biochem. 2017;82:405-56. doi: 10.1007/978-3-319-49674-0_13

» https://doi.org/10.1007/978-3-319-49674-0_13

29- Miron RJ, Pinto NR, Quirynen M, Ghanaati S. Standardization of relative centrifugal forces in studies related to platelet-rich fibrin. J Periodontol. 2019;90(8):817-20. doi: 10.1002/JPER.18-0553

» https://doi.org/10.1002/JPER.18-0553

30- Ravi S, Santhanakrishnan M. Mechanical, chemical, structural analysis and comparative release of PDGF-AA from L-PRF, A-PRF and T-PRF - an in vitro study. Biomater Res. 2020;24:16. doi: 10.1186/s40824-020-00193-4

» https://doi.org/10.1186/s40824-020-00193-4

31- Rudresh V, Suchetha A, Srirangarajan S, Prabhu S, Rao RJ, Bhatnakar U. Does the diabetes status of an individual have effects on mechanical and biologic properties of platelet-rich fibrin? An in vitro comparative evaluation. Quintessence Int. 2022;53(10):840-9. doi: 10.3290/j.qi.b3418735

» https://doi.org/10.3290/j.qi.b3418735

32- Srirangarajan S, Sindhu V, Prabhu S, Rao RJ, Rudresh V. Does cigarette smoking induce changes in biologic and mechanical properties of platelet-rich fibrin membranes? Int J Periodontics Restorative Dent. 2021;41(6): 213-21. doi: 10.11607/prd.4573

» https://doi.org/10.11607/prd.4573

33- Andrade Aldana C, Ugarte Amenabar F, Inostroza Silva C, Diaz Calderon P, Rosenberg Messina D, Pinto Carrasco N, Quirynen M. The impact of gender and peripheral blood parameters on the characteristics of L-PRF membranes. J Oral Biol Craniofac Res. 2022;12(6):753-9. doi: 10.1016/j.jobcr.2022.08.020

» https://doi.org/10.1016/j.jobcr.2022.08.020

34- Yajamanya SR, Chatterjee A, Babu CN, Karunanithi D. Fibrin network pattern changes of platelet-rich fibrin in young versus old age group of individuals: a cell block cytology study. J Indian Soc Periodontol. 2016;20(2):151-6. doi: 10.4103/0972-124X.176390

» https://doi.org/10.4103/0972-124X.176390

35- Gupta S, Jain A, Gupta M, Gupta J, Kansal S, Bhansali A, et al. Influence of periodontitis and diabetes on structure and cytokine content of platelet-rich fibrin. Oral Dis. 2023;29(8):3620-9. doi: 10.1111/odi.14275

» https://doi.org/10.1111/odi.14275

36- Ockerman A, Hendrickx A, Willekens W, Fehervary H, Vastmans J, Coucke W, et al. Mechanical properties and cellular content of leukocyte- and platelet-rich fibrin membranes of patients on antithrombotic drugs. J Periodontal Res. 2022;57(3):623-31. doi: 10.1111/jre.12991

» https://doi.org/10.1111/jre.12991

37- Ockerman A, Braem A, EzEldeen M, Castro A, Coucke B, Politis C, et al. Mechanical and structural properties of leukocyte- and platelet-rich fibrin membranes: an in vitro study on the impact of anticoagulant therapy. J Periodontal Res. 2020;55(5):686-93. doi: 10.1111/jre.12755

» https://doi.org/10.1111/jre.1275

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Published

2026-03-09

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Section

Original Articles

How to Cite

Ibrahimli, S., Hendek, M. K., Baris, K., & Olgun, E. (2026). The effect of Stage I-II periodontitis on the mechanical, structural, and biological properties of leukocyte and platelet-rich fibrin. Journal of Applied Oral Science, 34, E2025-0483. https://doi.org/10.1590/1678-7765-2025-0483