Clinical and Radiological Evaluation of Treatment of Grade II Furcation Defect Using Bio-Oss Bone Graft Alone and In Combination with Platelet-Rich Fibrin (PRF)

International Journal of Dental Science and Innovative Research (IJDSIR) IJDSIR : Dental Publication Service Available Online at:www.ijdsir.com Volume – 8, Issue – 5, September – 2025, Page No. : 288 - 300 Corresponding Author: Dr. Simran Aulakh, ijdsir, Volume – 8 Issue - 5, Page No. : 288 - 300 Page288 ISSN: 2581-5989 PubMed - National Library of Medicine - ID: 101738774 Clinical and Radiological Evaluation of Treatment of Grade II Furcation Defect Using Bio-Oss Bone Graft Alone and In Combination with Platelet-Rich Fibrin (PRF) 1Dr. Vikram Bali, Professor and HOD, Department of Periodontology, Desh Bhagat Dental College and Hospital, Mandi Gobindgarh 2Dr. Simran Aulakh, Post-graduate Student, Department of Periodontology, Desh Bhagat Dental College and Hospital, Mandi Gobindgarh 3Dr. Gagandeep Gupta, Professor, Department of Periodontology, Desh Bhagat Dental College and Hospital, Mandi Gobindgarh 4Dr. Rajneesh Parimoo, Associate Professor, Department of Periodontology, Desh Bhagat Dental College and Hospital, Mandi Gobindgarh 5Dr. Bhajandeep Singh, Post-graduate Student, Department of Periodontology, Desh Bhagat Dental College and Hospital, Mandi Gobindgarh Corresponding Author: Dr. Simran Aulakh, Post-graduate Student, Department of Periodontology, Desh Bhagat Dental College and Hospital, Mandi Gobindgarh. Citation of this Article: Dr. Vikram Bali, Dr. Simran Aulakh, Dr. Gagandeep Gupta, Dr. Rajneesh Parimoo, Dr. Bhajandeep Singh, “Clinical and Radiological Evaluation of Treatment of Grade II Furcation Defect Using Bio-Oss Bone Graft Alone and In Combination with Platelet-Rich Fibrin (PRF)”, IJDSIRSeptember – 2025, Volume – 8, Issue – 5, P. No. 288 – 300. Copyright: © 2025, Dr. Simran Aulakh, et al. This is an open access journal and article distributed under the terms of the creative common’s attribution non-commercial License. Which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given, and the new creations are licensed under the identical terms. Type of Publication: Original Research Article Conflicts of Interest: Nil Abstract Introduction: This case study explores the treatment of a Grade II furcation defect in a mandibular molar using deproteinized bovine bone mineral (Bio-Oss) as a bone graft material. The patient was treated using two different approaches: first, with Bio-Oss alone and, in the second instance, with Bio-Oss combined with Platelet-Rich Fibrin (PRF). Objectives: This study aims to evaluate the clinical outcomes, including probing pocket depth (PPD), Plaque Index (PI), Gingival Index(GI), Horizontal Depth Defect (HDD), Relative Clinical Attachment Level (RCAL), Relative Vertical Depth Defect (RVDD) and radiographic assessment of bone regeneration, were compared to evaluate the effectiveness of these two treatment modalities at baseline, 3 Months and 6 months interval. Conclusion: This case study demonstrates that Bio-Oss alone is effective in treating Grade II furcation defects, resulting in significant improvements in probing pocket Dr. Simran Aulakh, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page289 Page289 Page289 Page289 Page289 Page289 Page289 Page289 Page289 Page289 Page289 Page289 Page289 Page289 Page289 Page289 Page289 Page289 Page289 depth, clinical attachment level, and radiographic bone fill. However, the addition of PRF offers notable advantages in terms of soft tissue healing and bone regeneration, with faster healing times, reduced inflammation, and greater clinical outcomes. Keywords: Debridement, Mandibular Molars, RCAL, Systemic Diseases Introduction Grade II furcation defects present significant challenges in periodontal treatment. These defects are characterized by partial loss of the bone in the furcation area of a molar, leading to compromised periodontal support. Regenerative procedures aim to promote the regeneration of periodontal tissues, including bone and soft tissue, to restore the lost architecture and improve clinical outcomes. In this case study, we explore the application of Bio-Oss, a deproteinized bovine bone mineral with osteoconductive properties, in the treatment of Grade II furcation defects. In addition, we examine the potential synergistic effect of combining Bio-Oss with PlateletRich Fibrin (PRF), an autologous tissue regeneration material rich in growth factors. Materials and Methods In this study, 20 patients aged 2560 years old with mandibular Degree II furcation defects were selected from those attending the outpatient Department of Periodontology and Oral Implantology at Desh Bhagat Dental College and Hospital, Mandi Gobindgarh. The subjects for the study were selected randomly with no discrimination on the basis of sex, cast, and religion or socio economic status. Complete medical and Dental histories were obtained. Informed consent was taken from the patient in the form of a duly signed document prior to surgical phase. Study was approved from Institutional Ethical Committee. Criteria for patient selection Inclusion Criteria After completion of initial phase of therapy, the selected mandibular molars should have following findings:  Patients exhibiting clinical and radiographic evidence of degree II (Horizontal loss of periodontal tissue support exceeding 3mm but not encompassing the total width of the defect) furcation defects. (Hamp et al,1975).  Gingival margin coronal to or at the level of roof of furcation.  Systemically healthy. Exclusion Criteria  Smokers  Pregnant females  History of previous periodontal surgical treatment within 6 months  Furcation at third molars  Untreated non-vital teeth  Patients with systemic diseases  Grade II mobile teeth  Known allergies to the materials used in the study Clinical Measurements Customized acrylic occlusal stent was fabricated on the study casts and trimmed to the height of contour of the teeth, to serve as fixed reference point to take measurements. The stent was prominent on the buccal or lingual areas. One vertical groove was prepared in the stent with a fissure bur for the furcation that has to be measured. This groove is to provide reproducible alignment for a periodontal probe. Study Design In this study, the patients were divided into two groups: Group I: Involve patients that were treated with BioOss bone graft and platelet rich fibrin (BioOss+PRF). Dr. Simran Aulakh, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page290 Page290 Page290 Page290 Page290 Page290 Page290 Page290 Page290 Page290 Page290 Page290 Page290 Page290 Page290 Page290 Page290 Page290 Page290 Group II: Involve patients that were treated with BioOss bone graft alone (BioOss). Each patient was prepared for surgery with an initial phase of therapy including oral hygiene instructions, scaling and root planing, and occlusal adjustments were performed. Following data collection, the decision to use BioOss bone replacement graft material or only will be determined randomly. Clinical parameters will be obtained at baseline 3 months and 6 months postoperatively. The parameters recorded were: Plaque Index (PI) (Silness & Loe), 1964, Gingival Index (GI) (Loe & Silness), 1963, Gingival Recession (GR) Probing Pocket Depth (PPD), Relative Attachment Level (RAL) Horizontal Defect Depth (HDD, Relative Vertical Defect Depth (RVDD) All subjects underwent Phase 1 therapy, followed with oral hygiene instructions. After a 4 week reevaluation, eligible patients were scheduled for surgery. Intraoral periapical radiographs were taken to confirm the evidence of furcation involvement and include the teeth in study. Radiographs were again taken at baseline, 3 months and 6 months. Surgical Procedure After giving the adequate anesthesia, full thickness mucoperiosteal flap was raised. Thorough debridement was done with help of curette. After removing the subgingival deposits and granulation tissues. Bone graft with or without PRF was compressed into the defect. The flap was positioned back as coronally as possible. Haemostatis was achieved by surgical silk 3:0 suture. In Group 1, freshly prepared PRF was mixed with BioOss and placed into the defect. A PRF membrane was placed over the graft before flap closure. In Group 2, the furcation defect was filled with Bio-Oss particles and the flap was repositioned and sutured. PRF Preparations - PRF was prepared using Choukroun’s et al method. 10ml of venous blood was collected and centrifuged at 3000rpm for 10 minutes. The fibrin clot was separated and used immediately. Figure 1: Measuring Grade 2 furcation Defect using Naber’s Probe, tooth no. 46 Figure 2: Incision was given to raise the flap, tooth no. 46 (Group 1) Figure 3: PRF mixed with Bio-Oss placed in the furcation defect (GROUP 1) Dr. Simran Aulakh, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page291 Page291 Page291 Page291 Page291 Page291 Page291 Page291 Page291 Page291 Page291 Page291 Page291 Page291 Page291 Page291 Page291 Page291 Page291 Figure 4: PRF seen in centrifuged blood (Group 1) Figure 5: Measuring furcation depth defect using Naber’s Probe in Tooth No. 46 (GROUP 2) Figure 6: Tooth No. 46 showing furcation Defect (GROUP 2) Figure 7: Placement of Bone Graft (Bio-Oss) in Furcation Defect (GROUP 2) Figure 8: Suture Placement Done (GROUP 2) Post-Operative Care and Follow-up intervals  Necessary Antibiotics + Analgesics were prescribed.  Chlorhexidine mouthwash (0.12%) twice daily for 2 weeks.  Sutures removed after 10 days.  Patients were recalled at 3 and 6 months postoperatively for evaluation. Data Analysis After the completion of the study, statistical analysis was carried out. Results The present study evaluated and compared the clinical outcomes of Group I (Bio-Oss + PRF) and Group II (BioOss alone) in the management of Grade II furcation defects in mandibular molars. Clinical parameters assessed at baseline, 3 months, and 6 months included Plaque Index (PI), Gingival Index (GI), Gingival Recession (GR), Pocket Probing Depth (PPD), Relative Clinical Attachment Level (RCAL), Horizontal Defect Depth (HDD), and Relative Vertical Defect Depth (RVDD). Plaque Index (PI) Intergroup comparison is presented in Table 1 At baseline, mean PI was 1.40 ± 0.22 in Group I and 1.71 ± 0.20 in Group II, with a statistically significant difference (p = 0.004). Dr. Simran Aulakh, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page292 Page292 Page292 Page292 Page292 Page292 Page292 Page292 Page292 Page292 Page292 Page292 Page292 Page292 Page292 Page292 Page292 Page292 Page292 At 3 months, Group I showed a reduction to 0.93 ± 0.13, while Group II reduced to 0.91 ± 0.10, showing no significant intergroup difference (p = 0.81). At 6 months, further reduction was observed in both groups (0.74 ± 0.12 in Group I and 0.80 ± 0.13 in Group II), with no statistically significant difference (p = 0.29). Table 1: Intergroup comparison of plaque index (PI) at different time intervals Mean diff Std. Error Difference t Df P vale 95% Confidence Interval of the Difference Lower Upper PI at Baseline -.318 .095 -3.35 18 0.004* -.517 -.119 PI at 3 Month Interval .013 .054 18 0.81** -.100 .126 PI at 6 Month Interval -.063 .059 -1.072 18 0.29** -.186 .060 *statistically significant **statistically non-significant Gingival Index (GI) Results are shown in Table 2 At baseline, mean GI values were comparable (1.63 ± 0.27 in Group I vs. 1.61 ± 0.37 in Group II, p = 0.888). At 3 months, Group I improved to 0.88 ± 0.12 and Group II to 0.91 ± 0.11, with no significant difference (p = 0.577). At 6 months, values further reduced to 0.71 ± 0.13 in Group I and 0.80 ± 0.13 in Group II, showing no statistical significance (p = 0.160). Table 2: Intergroup comparison of Gingival Index (GI) at different time intervals Mean diff Std. Error Difference T Df P value 95% Confidence Interval of the Difference Lower Upper GI at Baseline .021 .147 .142 18 .888 -.289 .331 GI at 3 Month Interval -.031 .055 -.568 18 .577 -.146 .084 GI at 6 month Interval -.0890 .0607 -1.466 18 .160 -.2165 .0385 Gingival Recession (GR) Descriptive and intergroup comparisons are presented in Table 3. At baseline, both groups exhibited minimal gingival recession across surfaces with no significant differences (p > 0.05). At 3 months, slight changes were noted, but intergroup comparisons remained non-significant. By 6 months, recession values further decreased, particularly in Group I, yet no statistically significant intergroup difference was found across all sites (p > 0.05). Table 3: Intergroup comparison of Gingival Recession (GR) at different time intervals Mean diff Std. Error Difference t Df P vale 95% Confidence Interval of the Difference Lower Upper GR at baseline on buccal surface .0000 .1764 .000 18 1.000 -.3706 .3706 Dr. Simran Aulakh, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page293 Page293 Page293 Page293 Page293 Page293 Page293 Page293 Page293 Page293 Page293 Page293 Page293 Page293 Page293 Page293 Page293 Page293 Page293 GR at baseline on mesiobuccal surface .0000 .1155 .000 18 1.000 -.2426 .2426 GR at baseline on distobuccal surface -.0500 .1167 -.429 18 .673 -.2951 .1951 GR at baseline on lingual surface .0000 .1155 .000 18 1.000 -.2426 .2426 GR at baseline on mesiolingual surface .0500 .1462 .342 18 .736 -.2573 .3573 GR at baseline on distolingual surface .1000 .1453 .688 18 .500 -.2053 .4053 GR at 3 months on Buccal surface .0000 .1155 .000 18 1.000 -.2426 .2426 GR at 3 months on mesiobuccal surface .0000 .1155 .000 18 1.000 -.2426 .2426 GR at 3 months on distobuccal surface .0000 .1080 .000 18 1.000 -.2269 .2269 GR at 3 months on lingual surface -.0500 .1014 -.493 18 .628 -.2630 .1630 GR at 3 months on mesiolingual surface .1500 .1344 1.116 18 .279 -.1323 .4323 GR at 3 months on distolingual surface .2000 .1291 1.549 18 .139 -.0712 4712 GR at 6 months on buccal surface .0000 .1155 .000 18 1.000 -.2426 .2426 GR at 6 months on mesiobuccal surface .0000 .1080 .000 18 1.000 -.2269 .2269 GR at 6 months on lingual surface .0500 .0500 1.000 18 .331 -.0550 .1550 GR at 6 months on mesiolingual surface .0500 .0500 1.000 18 .331 -.0550 .1550 GR at 6 months on distolingual surface .0500 .0500 1.000 18 .331 -.0550 .1550 Pocket Probing Depth (PPD) Data is provided in Table 4. At baseline, mean PPD values were comparable across all sites in both groups (p > 0.05). At 3 months, Group I showed greater reduction (e.g., mesiobuccal surface: 3.90 ± 0.73 vs. Group II: 5.10 ± 0.56), with statistically significant differences across all sites (p < 0.01). At 6 months, further reduction was seen in Group I (e.g., buccal surface: 3.20 ± 0.42) compared to Group II (4.20 ± 0.42), with intergroup differences remaining statistically significant (p < 0.01). Table 4: Intergroup comparison of Pocket Probing Depth (PPD) at different time intervals Mean diff Std. Error Difference T df P value 95% Confidence Interval of the Difference Lower Upper PPD at baseline on mesiobuccal surface -.200 .294 -.679 18 .506** -.818 .418 PPD at baseline on buccal surface .000 .189 .000 18 1.000** -.396 .396 PPD at baseline on distobuccal surface -.200 .226 -.885 18 .388** -.675 .275 PPD at baseline on mesiolingual surface -.200 .294 -.679 18 .506** -.818 .418 PPD at baseline on lingual surface -.100 .203 -.493 18 .628** -.526 .326 PPD at baseline on distolingual surface .000 .231 .000 18 1.000** -.485 .485 PPD at 3 month on mesiobuccal surface -1.200 .294 4.076 18 .001* -1.818 -.582 PPD at 3 month on buccal surface -1.000 .189 5.303 18 .000* 1-1.396 -.604 PPD at 3 month on distobuccal surface -1.200 .226 5.308 18 .000* -1.675 -.725 Dr. Simran Aulakh, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page294 Page294 Page294 Page294 Page294 Page294 Page294 Page294 Page294 Page294 Page294 Page294 Page294 Page294 Page294 Page294 Page294 Page294 Page294 PPD at 3 month on mesiolingual surface -1.200 .294 4.076 18 .001* -1.818 -.582 PPD at baseline on lingual surface -1.100 .203 5.425 18 .000* -1.526 -.674 PPD at 3 month on distolingual surface -1.000 .231 4.330 18 .000* -1.485 -.515 PPD at 6month interval on mesiobuccal surface -1.200 .294 4.076 18 .001* -1.818 -.582 PPD at 6 month interval on buccal surface -1.000 .189 5.303 18 .000* -1.396 -.604 PPD at 6 month interval on distobuccal surface -1.200 .226 5.308 18 .000* -1.675 -.725 PPD at 6 month interval on mesiolingual surface -1.200 .294 4.076 18 .001* -1.818 -.582 PPD at 6 month interval on lingual surface -1.100 .203 5.425 18 .000* -1.529 -.674 PPD at 6 month interval on distolingual surface -.900 .233 3.857 18 .001* -1.390 -.410 *statistically significant **statistically non-significant Relative Clinical Attachment Level (RCAL) Results are presented in Table 5 At baseline, both groups were comparable (p > 0.05). At 3 months, Group I demonstrated greater attachment gain (e.g., buccal surface: 3.79 ± 0.21 vs. 4.14 ± 0.20 in Group II, p = 0.002). Statistically significant differences were also noted at lingual surfaces (p = 0.013). At 6 months, Group I showed consistently greater attachment gain (e.g., buccal surface: 3.41 ± 0.17 vs. 3.83 ± 0.21, p < 0.001; lingual surface: p < 0.001; distal surface: p = 0.011). Table 5: Intergroup comparison of Relative clinical attachment level (RCAL) at different time intervals Mean diff Std. Error Difference t Df P value 95% Confidence Interval of the Difference Lower Upper RCAL at baseline on mesial surface -.040 .202 -.198 18 .845** -.464 .384 RCAL at baseline on distal surface .010 .163 .061 18 .952** -.332 .352 RCAL at baseline on buccal surface -.090 .107 -.842 18 .411** -.315 .135 RCAL at baseline on lingual surface -.030 .102 -.293 18 .773** -.245 .185 RCAL at 3 month on mesial surface -.310 .165 1.881 18 .076** -.656 .036 RCAL at 3 month on distal surface -.240 .146 1.646 18 .117** -.546 .066 RCAL at 3 month on buccal surface -.350 .094 3.729 18 .002* -.547 -.153 RCAL at 3 month on lingual surface -.270 .098 2.760 18 .013* -.475 -.065 RCAL at 6 months on mesial surface 2.540 2.954 .860 18 .401** -3.666 8.746 RCAL at 6 month on distal surface -.400 .140 2.854 18 .011* -.694 -.106 RCAL at 6 months on buccal surface -.420 .089 4.729 18 .000* -.607 -.233 RCAL at 6 months on lingual surface -.420 .093 4.512 18 .000* -.616 -.224 Dr. Simran Aulakh, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page295 Page295 Page295 Page295 Page295 Page295 Page295 Page295 Page295 Page295 Page295 Page295 Page295 Page295 Page295 Page295 Page295 Page295 Page295 *statistically significant **statistically non-significant Horizontal Defect Depth (HDD) Comparative results are given in Table 6. At baseline, mean HDD values were similar across groups (p > 0.05). At 3 months and 6 months, Group I showed greater defect fill compared to Group II, although intergroup differences were not statistically significant (p > 0.05). Table 6: Intergroup comparison of Horizontal Depth Defect (HDD) at different time intervals Mean diff Std. Error Difference t df P value 95% Confidence Interval of the Difference Lower Upper HDD at baseline on buccal surface -.100 .987 .101 18 .920** -2.173 1.973 HDD at baseline on lingual surface .100 .961 .104 18 .918** -1.919 2.119 HDD at 3 months on buccal surface -.630 .840 -.750 18 0.04* -2.395 1.135 HDD at 3 months on lingual surface .370 .826 .448 18 0.04* -1.366 2.106 HDD at 6 months on buccal surface -.640 .712 -.899 18 0.03* -2.136 .856 HDD at 6 months on lingual surface .220 .692 .318 18 0.04* -1.234 1.674 Relative Vertical Defect Depth (RVDD) Data is presented in Table 7. At baseline, RVDD values were similar in both groups (p > 0.05). At 3 months and 6 months, both groups demonstrated reduction in RVDD, with Group I showing slightly better improvements. However, intergroup differences were not statistically significant (p > 0.05). Table 7: Intergroup comparison of Relative Vertical Defect Depth (RVDD) at different time intervals Mean diff Std. Error Difference t df P value 95% Confidence Interval of the Difference Lower Upper RVDD at baseline on mesiobuccal surface . 000 .825 .000 .18 1.00** -1.734 1.734 RVDD at baseline on distobuccal surface .150 .797 .188 18 .853** -1.524 1.824 RVDD at baseline on distal surface .200 1.280 .156 18 .878** -2.490 2.890 RVDD at baseline on lingual surface -.050 1.233 -.041 18 .968** -2.641 2.541 RVDD at baseline on mesiolingual surface -.400 .774 .517 18 .612** -2.026 1.226 RVDD at baseline on distolingual surface -.100 .789 .127 18 .901** -1.757 1.557 RVDD at 3 months on mesiobuccal surface -.050 .620 .081 18 .937** -1.353 1.253 RVDD at 3 months on distobuccal surface .150 .927 .162 18 .873* -1.797 2.097 RVDD at 3 months on lingual surface -.050 .827 .060 18 .952** -1.788 1.688 Dr. Simran Aulakh, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page296 Page296 Page296 Page296 Page296 Page296 Page296 Page296 Page296 Page296 Page296 Page296 Page296 Page296 Page296 Page296 Page296 Page296 Page296 RVDD at 3 months on mesiolingual surface -.150 .543 -.276 18 .785** -1.291 .991 RVDD at 3 months on distolingual surface -.150 .543 -.276 18 .785** -1.291 .991 RVDD at 6 months on mesiobuccal surface .050 .423 .118 18 .907** -.839 .939 RVDD at 6 months on distobuccal surface .200 .436 .459 18 .652** -.716 1.116 RVDD at 6 months on buccal surface .200 .707 .283 18 .781 -1.286 1.686 RVDD at 6 months on lingual surface -.050 .598 -.084 18 .934* -1.307 1.207 RVDD at 6 months on mesiolingual surface .000 .381 .000 18 1.000** -.800 .800 RVDD at 6 months on distolingual surface .000 .381 .000 18 1.000** -.800 .800 *statistically significant **statistically non-significant Treatment Approach Treatment with Bio-Oss Alone In the first phase of treatment, Bio-Oss was used as a bone graft material. The procedure was as follows: 1. Surgical Preparation: The area was anesthetized with local anesthesia, and a full-thickness flap was reflected to expose the defect area. 2. Debridement: The granulation tissue was carefully removed, and the roots were thoroughly scaled and planed to remove any residual calculus. 3. Bone Grafting: Bio-Oss was placed in the defect site, ensuring that the material filled the mesial and distal furcation areas. Bio-Oss was compacted gently to avoid dislodging the graft material. 4. Flap Closure: The flap was repositioned and sutured, ensuring primary closure. 5. Post-Operative Care: The patient was prescribed antibiotics and anti-inflammatory medications. Follow-up visits were scheduled at 1 week, 3 months, and 6 months. Treatment with Bio-Oss and PRF In the second phase, the same patient was treated with Bio-Oss in combination with PRF. The procedure was similar, with the following additional steps: 1. PRF Preparation: A blood sample was drawn from the patient, and the PRF was prepared using a centrifuge to concentrate the platelets and growth factors. 2. Bone Grafting: After debridement and root planing, Bio-Oss was placed into the defect, similar to the previous procedure. 3. Application of PRF: A membrane of PRF was placed over the graft site before suturing the flap into position. The PRF membrane was intended to promote soft tissue healing and potentially enhance bone regeneration. 4. Flap Closure: The surgical site was closed as before, with PRF applied to the soft tissue interface. 5. Post-Operative Care: Similar to the first phase, the patient received antibiotics and analgesics and was advised to follow a soft food diet for two weeks.