Initial therapy consisted of oral hygiene instructions, TSA HDAC which were repeated until the patient achieved an O’leary plaque score of 20% or below.10 Scaling and root planing of the teeth were performed. Patient was referred to department of conservative dentistry and endodontics for root canal therapy in relation to #35 and #36 teeth (which were symptomatic to the heat test). Four weeks following phase 1 therapy, a periodontal re-evaluation was performed

to confirm the suitability of #36 tooth for this periodontal surgical procedure. Clinical measurements were made using william’s periodontal probe with graduation to a precision of 1 mm. Blood sample was taken on the day of the surgery according to the PRF protocol with a REMI 3000 centrifuge and collection kits. Briefly, 6 ml blood sample was taken from the patient without an anti-coagulant in 10 ml glass test tubes and immediately

centrifuged at 3000 rpm for 12 min. A fibrin clot was formed in the middle of the tube, whereas the upper JAK inhibitor part contained acellular plasma, and the bottom part contained red corpuscles. The fibrin clot was easily separated from the lower part of the centrifuged blood. The PRF clot was gently pressed between two sterile dry gauges to obtain a membrane which was later minced and added to the graft material (OSSIFI™) (Fig. 4). An intrasulcular incision was made on buccal and lingual aspect of the tooth of left mandibular teeth (# 35, 36, 37) along with a vertical incision, extending to the muco gingival junction in relation to distal aspect of #35. A full thickness triangular flap was raised and inner surface of the flap was curetted to remove the granulation tissue. Root surfaces were thoroughly planed using hand instruments and ultra sonic scalers. The left mandibular first molar demonstrated mesial intrabony defect after removing granulation tissue

thoroughly, mesial intrabony defect was found to extend in buccal and apical aspect (Fig. 3). Briefly, minced PRF was mixed with alloplast (OSSIFI™) and was applied to the defect walls and root surfaces (Fig. 5 and Fig. 6). The alloplast with PRF was then condensed using amalgam condensers. The flap were through repositioned to their pre surgical levels and sutured with silk utilizing an interrupted technique (Fig. 7). After the operation, the patient was prescribed systemic antibiotics (Amoxicyllin 500 mg tid, 3 days), Non-steroidal anti inflammatory drug (combiflam tid, 3 days) and 0.12% chlorhexidine rinse (twice a day for four weeks). Sutures were removed after 7 days. Clinical healing was normal with neither infectious episodes nor untoward clinical symptoms. The patient was seen at 1st week, 2nd week, 1st month, 3rd and 6th month (Fig. 8). Periapical intraoral radiographs were obtained from the periodontal defect site at baseline, 3 months and 6 months after surgery (Fig. 9).