Sinus Lift Associated with Leucocyte-Platelet-Rich Fibrin (Second Generation) for Bone Gain: A Systematic Review
Journal of clinical medicine. 2022;11(7)
The purpose of this systematic review was to analyze sinus lifting procedures and to compare the efficiency of this treatment associated with the second generation of platelet-rich fibrin related to its effects on bone gain and to clarify the regenerative efficacy in sinus lift procedure, whether alone or as a coadjutant to other bone graft materials. The PICOT question was, "In clinical studies with patients needing a maxillary sinus lift (P), does the use of PRF either alone (I) or in conjunction with other biomaterials (C) improve the clinical outcome associated with bone gain and density (O), with at least three months of follow-up (T)?" An electronic search was conducted in the MEDLINE (PubMed), Science Direct, and Scopus databases through a search strategy. A total of 443 articles were obtained from the electronic database search. Sixteen articles met all criteria and were included in this review. Within the limitation of this study and interpreting the results carefully, it was suggested that a higher risk for implant failure after a sinus elevation might be seen in patients with residual bone ≤4 mm, and PRF application was effective, suggesting reducing the time needed for new bone formation.
Effect of platelet rich fibrin on stability of dental implants: A systematic review and meta-analysis
International journal of health sciences. 2022;16(5):58-68
OBJECTIVE The aim of the study is to provide a systematic review of the potential evidence for the effect of platelet rich fibrin (PRF) on stability of dental implants. METHODS A systematic review was performed based on the Preferred Reporting Items for Systematic review and Meta-analysis. An extensive and comprehensive electronic search was carried out from January 2000 to March 2021, independently by author in PUBMED, Cochrane Central Register of Controlled Trials, Google Scholar, Scopus, Embase, and Web of Science irrespective of publication status, date, or language. For any registered ongoing or completed but unpublished trial, ClinicalTrials.gov, World Health Organization International Clinical Trials Registry Platform, and Cochrane Oral Health's Trials Register websites were searched. Randomized, controlled, and clinical trials which assessed the stability of implant with and without use of PRF using Osstell device by radiofrequency analysis were selected. RESULTS The electronic and manual search yielded 630 studies. In all the eight included studies implant stability was measured using same ISQ units by Osstell device. Meta-analysis was carried out in six studies that had similar comparisons and reported the same outcomes at same time interval. Random effect models have shown pooled mean difference of 4.49 (95% CI 1.22-7.76) for 1-week post-insertion, 3.65 (95% CI 2.21-5.09) for 4-week post insertion, 3.25 (95% CI 0.03-6.47) for 8-week post-insertion, and 2.79 with 95% CI of 0.48, 5.10 for 12-week post-insertion. CONCLUSIONS The present systematic review suggests that PRF is effective in improving secondary implant stability with certain limitations and displays possible implication for clinical practice.
Regenerative Potential of Platelet Rich Fibrin (PRF) in Socket Preservation in Comparison with Conventional Treatment Modalities: A Systematic Review and Meta-Analysis
Tissue engineering and regenerative medicine. 2022
BACKGROUND Platelet rich fibrin (PRF) has shown great potential in osteogenesis; however, some studies still question utilizing it as a grafting material. Thus, the aim of this review is to evaluate the effect of PRF when used in socket and ridge preservation procedures. METHODS Electronic searches through MEDLINE, EMBASE, and Cochrane, Science Citation Index Expanded databases and manual searches of unpublished data, academic theses, and journals were conducted up until July 2021. The outcomes were to assess the ability of PRF as a graft material to preserve bone width, height, and density after tooth extraction. RESULTS Twelve studies were included in the review, using PRF showed significant results in all three outcomes when compared to no grafting at all, however when compared to other commonly used grafting materials it showed a lesser effect. On the other hand, most studies included reported mixing PRF with a graft material showed the best result. The meta-analysis also revealed the significant results in using PRF on the three outcomes. CONCLUSION The meta-analysis of the studies included proved the beneficial effect of PRF in socket preservation surgeries alone or in combination with other graft materials, but further individual multi-centre randomized controlled studies with appropriate sample size are still needed to further confirm our findings.
The use of advanced platelet-rich fibrin after surgical removal of mandibular third molars: a systematic review and meta-analysis
International journal of oral and maxillofacial surgery. 2022
The objective of this systematic review was to test the hypothesis of no difference in recovery following surgical removal of mandibular third molars with the application of advanced platelet-rich fibrin (A-PRF) in the extraction socket compared with alternative biomaterials or natural wound healing. A search of MEDLINE (PubMed), Embase, Cochrane Library, and Scopus was conducted. Human randomized controlled trials published in English up until December 31, 2020 were included. Outcome measures were pain, facial swelling, trismus, soft tissue healing, alveolar osteitis, and quality of life; these were evaluated by descriptive statistics and meta-analysis including 95% confidence intervals (CI). Four studies with a low or moderate risk of bias fulfilled the inclusion criteria. A-PRF resulted in significantly lower pain scores when compared with leucocyte platelet-rich fibrin or natural wound healing after 2 days (-16.8, 95% CI -18.9 to -14.7), 3 days (-12.1, 95% CI -13.4 to -10.7), and 7 days (-1.9, 95% CI -2.9 to -0.9). A-PRF seems to have a negligible effect on facial swelling and trismus and some beneficial effect on soft tissue healing. Alveolar osteitis and quality of life were not assessed. The included studies were characterized by considerable heterogeneity and confounding variables. Thus, the level of evidence appears to be inadequate for clinical recommendations according to the focused question.
Fibrin sealant versus sutures in periodontal surgery: A systematic review
Annals of medicine and surgery (2012). 2022;76:103539
BACKGROUND The aim of this systematic review was to assess the effectiveness of fibrin sealant compared to sutures in periodontal surgery. METHODS Five electronic databases (PubMed, Scopus, EBSCO, Cochrane and Web of Science) were screened from initiation to January 2021 for randomized controlled trials (RCTs) comparing fibrin sealant to sutures in periodontal surgery using this search equation: (Periodont* OR Periodontitis) AND ("fibrin tissue adhesive" OR "fibrin glue" OR "fibrin sealant" OR "fibrin sealant system" OR "fibrin adhesive system" OR "fibrin fibronectin sealant system"). Quality assessment of the included studies was performed using the revised tool to assess risk of bias in randomized trials (RoB 2). The level of evidence was evaluated using the GRADE tool. RESULTS A total of 240 publications were found as search results in the screened databases. Four RCTs were included in this systematic review based on predetermined inclusion criteria. The trials were published between 1987 and 2014. All the RCTs compared fibrin sealant to sutures in periodontal surgery. The sample size included 101 patients. The overall risk of bias in this systematic review was at high risk in 75% of the studies, while 25% of the studies raised some concerns. The level of evidence evaluated using GRADE tool was very low. DISCUSSION The current systematic review indicates a low level of evidence of the use of fibrin sealant as an alternative to sutures in periodontal practice. More interventional and multicentric studies should be conducted to support and confirm the results of the included studies.
Effectiveness of platelet-rich concentrates on the rate of orthodontic tooth movement: a systematic review and meta-analysis
European journal of orthodontics. 2022
BACKGROUND Autologous platelet-rich concentrates (PRCs) are recently used as a local biological substance in orthodontics to accelerate the rate of tooth movement. OBJECTIVES This systematic review aimed to evaluate the effects of PRCs on the rate of orthodontic tooth movement (OTM). SEARCH METHODS Unrestricted search of five electronic databases supplemented by the manual and gray literature search were undertaken in March 2022. SELECTION CRITERIA Randomized controlled trials (RCTs) evaluating the effect of PRCs on the rate of OTM with their side effect were included in this systematic review. DATA COLLECTION AND ANALYSIS Data items were extracted by two authors using a pre-piloted extraction form. Similar outcomes within a comparable time frame were synthesized in a meta-analysis. RESULTS Fourteen studies were deemed eligible for inclusion and seven RCTs were pooled in a meta-analysis. Canine retraction rate was higher in the side of PRCs injection than the control side by 0.28 mm/month (95% CI: 0.16-0.40, I2 = 95.6 per cent, P < 0.001, 345 patients) in the first 4 months after PRCs injection. There was no statistically significant difference between the PRCs side and the control side regarding molar anchorage loss (MAL) (MD = 0.03 mm, 95% CI: -0.18 to 0.24, I2 = 46.3 per cent, P = 0.78, 44 patients), canine rotation (MD = -0.19o, 95% CI: -1.95 to 1.57, I2 = 45.4 per cent, P = 0.96, 48 patients), or en-masse retraction. Likewise, there was no difference between both groups in terms of the duration of de-crowding. The mandibular canine retraction was statistically higher on the PRCs side than on the control side by 0.17 mm/month (P < 0.001, one trial). Regarding root resorption, there was no statistically significant difference between the experimental and control sides within the follow-up time. Mild pain scores were reported by the patients in the first 24 hours after injections. CONCLUSIONS Low-level evidence indicates that the effect of PRCs on OTM is minor and clinically insignificant. The findings should be interpreted with caution due to the inherent limitations in the included RCTs. REGISTRATION PROSPERO (CRD42022300026).
The Adjunctive Use of Leucocyte- and Platelet-Rich Fibrin in Periodontal Endosseous and Furcation Defects: A Systematic Review and Meta-Analysis
Materials (Basel, Switzerland). 2022;15(6)
The aim of this systematic review of randomized controlled trials was to evaluate the adjunctive use of leucocyte- and platelet-rich fibrin (L-PRF) in periodontal endosseous and furcation defects, as compared without L-PRF. The endosseous defect group was subclassified into: L-PRF/open flap debridement (L-PRF/OFD) versus OFD, L-PRF/osseous graft (L-PRF/OG) versus OG, L-PRF/Emdogain (L-PRF/EMD) versus EMD, and L-PRF/guided tissue regeneration (L-PRF/GTR) versus GTR. The furcation defect group was subclassified into L-PRF/OFD versus OFD, and L-PRF/OG versus OG. Mean difference, 95% confidence intervals and forest plots were calculated for probing pocket depth (PPD), clinical attachment level (CAL) and radiographic defect depth (DD). Nineteen studies concerning systemically healthy non-smokers were included. The results of this systematic review and meta-analysis showed in two- and/or three-wall endosseous defects that the adjunctive use of L-PRF to OFD or OG was significantly beneficial for PPD reduction, CAL gain and DD reduction, as compared without L-PRF. Furthermore, the data showed that for two- and/or three-wall endosseous defects, the adjunctive use of L-PRF to GTR was significantly beneficial for CAL and DD improvement, whereas adding L-PRF to EMD had no significant effect, and that for class II furcation defects, the addition of L-PRF to OFD was significantly beneficial for PPD, CAL and DD improvement, whereas the addition of L-PRF to OG was significantly clinically beneficial. In conclusion, this systematic review and meta-analysis found that there was significant clinical and radiographic additive effectiveness of L-PRF to OFD and to OG in two- and/or three-wall periodontal endosseous defects of systemically healthy non-smokers, as compared without L-PRF.
Application of Platelet-Rich Fibrin Derivatives for Mandibular Third Molar Extraction Related Post-Operative Sequelae: A Systematic Review and Network Meta-Analysis
Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons. 2021
PURPOSE Leukocyte- and platelet-rich fibrin (L-PRF) and advanced-platelet-rich fibrin (A-PRF) that are derivatives of PRF (platelet-rich fibrin) accelerate wound healing and reduce postoperative sequelae after tooth extraction. This network meta-analysis aimed to investigate the effectiveness of L-PRF and A-PRF in mandibular third molar extraction and provide suggestions for alleviating postoperative symptoms and signs. METHODS A comprehensive search of the literature was conducted in PubMed, Embase, Web of Science, and SinoMed databases up to Oct 9, 2020. Three types of randomized controlled trials were included to investigate the effects of PRF derivatives after extracting mandibular third molars: A-PRF and L-PRF groups; A-PRF and control groups; L-PRF and control groups. Their relative effectiveness and ranking were assessed using network meta-analysis and the surface under the cumulative ranking curve (SUCRA) with STATA 16.0 and Revman 5.3, respectively. RESULTS Ten randomized controlled trials were included, with 307 mandibular third molar extraction patients involved. The results showed that A-PRF had the best effect among the 3 groups in improving postoperative pain on the third (SUCRA = 98.2%) and seventh (SUCRA = 88.4%) days; L-PRF promoted soft tissue healing (MD=-0.90, 95% CI [-1.40, -0.40], P = .0004) on the seventh day compared with the control. However, other comparisons showed no significant differences (P > .05). CONCLUSION The limited results confirmed that PRF derivatives only reduced some postoperative symptoms and did not prevent them all. Application of A-PRF after third molar extraction reduced postoperative pain, and L-PRF improved the degree of soft tissue healing.
Potential of Lyophilized Platelet Concentrates for Craniofacial Tissue Regenerative Therapies
Molecules (Basel, Switzerland). 2021;26(3)
OBJECTIVE The use of platelet concentrates (PCs) in oral and maxillofacial surgery, periodontology, and craniofacial surgery has been reported. While PCs provide a rich reservoir of autologous bioactive growth factors for tissue regeneration, their drawbacks include lack of utility for long-term application, low elastic modulus and strength, and limited storage capability. These issues restrict their broader application. This review focuses on the lyophilization of PCs (LPCs) and how this processing approach affects their biological and mechanical properties for application as a bioactive scaffold for craniofacial tissue regeneration. MATERIALS AND METHODS A comprehensive search of five electronic databases, including Medline, PubMed, EMBASE, Web of Science, and Scopus, was conducted from 1946 until 2019 using a combination of search terms relating to this topic. RESULTS Ten manuscripts were identified as being relevant. The use of LPCs was mostly studied in in vitro and in vivo craniofacial bone regeneration models. Notably, one clinical study reported the utility of LPCs for guided bone regeneration prior to dental implant placement. CONCLUSIONS Lyophilization can enhance the inherent characteristics of PCs and extends shelf-life, enable their use in emergency surgery, and improve storage and transportation capabilities. In light of this, further preclinical studies and clinical trials are required, as LPCs offer a potential approach for clinical application in craniofacial tissue regeneration.
Comparative analysis of the hemostatic, analgesic and healing effects of cyanoacrylate on free gingival graft surgical wounds in donor and recipient areas: a systematic review
Journal of materials science. Materials in medicine. 2021;32(9):98
To analyze the hemostatic, Dsurgical wounds in donor and recipient areas of free gingival grafts (FGG). Five databases (PubMed, Scopus, Science Direct, Cochrane and Web of Science) were searched up to March 2021 (PROSPERO CRD42019134497). The focus of the study (cyanoacrylate) was combined with the condition (periodontal surgery OR free gingival graft OR free soft tissue graft OR autografts), and outcome (healing OR epithelialization OR pain OR analgesia OR bleeding OR hemostasis OR hemostatic). Studies reporting cyanoacrylate isolated or associated with another substance in FGG stabilization and closure were investigated and assessed for the quality and risk of bias through the Cochrane Manual. Six studies with 323 participants were included. Evaluation of the quality and risk of bias highlighted a low risk for four articles, intermediate for one and unclear for another. The use of cyanoacrylate associated or not with the hemostatic sponge or the platelet-rich fibrin was more effective in healing (three studies), analgesia (four studies), and hemostasis in one study (p < 0.05). However, groups with the association in cyanoacrylate showed superior healing, and analgesic action to the isolated cyanoacrylate group. In addition, two studies demonstrated that cyanoacrylate use reduces surgery duration, one study showed that it reduces postoperative sensibility, and another present hemostatic effect (p < 0.05). There is scarce literature for the use of cyanoacrylate in FGG wounds indicates that it can promote a minor inflammatory response, reduce operation time, does not interfere with healing, relieves postoperative discomfort, and suggests the possibility immediate hemostasis. Its use presents an alternative to suturing in FGG surgeries. But, the limited number of cases and the relative heterogeneity of the included studies suggest caution in generalizing the indication. CLINICAL RELEVANCE Cyanoacrylate seems to present analgesic effects and less pain when applied to wound closure and covering donor and recipient areas reducing the need for postoperative analgesic medication; and has a healing effect in the closure of the donor area on the palate. In addition, it can reduce bleeding time after surgery, and prevents late bleeding during the first postsurgical week. Scientific justification: To evaluate the hemostatic, analgesic and healing actions of cyanoacrylate compared to the suture thread and other agents when used to close surgical wounds from periodontal free gingival graft surgical wounds in both the donor and recipient areas of the graft. MAIN FINDINGS The use of cyanoacrylate individually or in association with wound dressing agents presents analgesic effects because the patient reports less pain experienced when cyanoacrylate is applied to the wound closure and covering, thereby reducing the need for postoperative analgesic medication. In addition, a healing effect is observed in the closure of the donor area on the palate; as well as it seems to present hemostatic effects, reducing the bleeding time after surgery, and preventing late bleeding during the first postsurgical week. PRACTICAL IMPLICATIONS Dentists may cautiously apply cyanoacrylate after periodontal surgeries for free gingival graft in both the donor and recipient areas of the graft. However, they must consider the limitations of the surgery, tension-free positioning, the patient's dyscrasia and postoperative care, constituting a set of predictors for adequate clinical decision-making. Widespread use of such material for all patients and surgical configurations may not be recommended.