The Feasibility of Exosome-Enriched Platelet-rich Fibrin (PRF) for the Treatment of Gingival Recessions: A Case Series of 27 Patients.

Abstract

<h4>Purpose</h4>Given the emerging potential of bioactive, cell-free regenerative therapies, integrating exosomes into dental practice may provide a biologically driven, minimally invasive method to improve soft tissue healing and root coverage outcomes. Hence, this first case series aimed to clinically assess the efficacy and safety of exosome-enriched solid platelet-rich fibrin (Exos-solid-PRF) to treat gingival recessions.<h4>Materials and methods</h4>Twenty-seven patients (125 teeth) treated between January 2023 and July 2024 using a minimally invasive vestibular access technique with Exos-solid-PRF and liquid-PRF were included. Autologous PRF was prepared via horizontal centrifugation and hydrated with exosomes before surgical application. Clinical parameters, such as attachment gain (AG), keratinized tissue (KT), recession depth (RD), and recession width (RW), were measured at baseline and at a 6-month follow-up.<h4>Results</h4>According to the Cairo classification system for recession, out of 125 teeth, 23 (18.4%) were recession type 1 (RT1) and 102 (81.6%) were RT2. Statistically significant improvements were observed in AG (+0.46 ± 0.84mm), RD (-1.93 ± 1.05 mm), and RW (-1.43 ± 1.43mm), with a mean root coverage of 68% and complete root coverage in 34 teeth. RT1 cases demonstrated 86% coverage, and RT2 cases achieved 64%, exhibiting the regenerative potential of this novel therapy in treating both isolated and multiple adjacent gingival recessions, particularly in the esthetic zone.<h4>Conclusions</h4>While the outcomes for RT1 defects are comparable to those of gold-standard CTG approaches, the modest improvements in RT2 defects reflect both the potential and the limitations of this novel method. Additional controlled studies, long-term follow-up, and mechanistic investigations are required to validate these outcomes and optimize the therapeutic application of exosomes in clinical periodontology.