Clinical and radiographic evaluation of platelet rich fibrin and bone graft material (β-tricalcium phosphate + hydroxyapatite) in the treatment of intrabony defects of periodontitis patients- A randomized controlled trial
Baghele ON, Thorat MS, Malpani PS
Quintessence international (Berlin, Germany : 1985). 2023;0(0):0
PURPOSE Present study aimed to assess the clinical and radiographic effect of the bone graft (BG) material (β-tricalcium phosphate + hydroxyapatite) alone and in combination with platelet rich fibrin (PRF) in intrabony defects (IBD) of periodontitis patients. METHODS It is a 6-month randomized controlled clinical trial carried out in 42 IBDs of periodontitis (average age 40 years). IBD ≥ 3 mm along with associated probing depth of ≥ 5 mm following phase-I therapy were treated either with open flap debridement (OFD) with bone graft (β-tricalcium phosphate + hydroxyapatite- i.e., Control group) or OFD with bone graft plus PRF membrane (i.e., Test group). Individual customized acrylic stent with grooves were used to ensure reproducible and repeatable measurements of clinical and radiographic parameters, including probing pocket depth (PPD), relative attachment loss (RAL), gingival marginal level (GML), vertical bone defect fill (VHD) and area of IBD (AOD) on intraoral periapical radiographs. PPD reduction and CAL gain were considered as primary outcomes and radiographic bone fill as secondary outcomes. [CTRI/2012/07/002793] Results: The preoperative PI, RAL, GML. PPD, VHD & AOD from control group was 1.06±0.08, 11.57±2.29 mm, 5.24±1.89 mm, 6.29±1.52 mm, 14.36±2.65 mm, & 7.79±4.39 mm2, whereas the same after 6-months was 1.08±0.14, 9.34±2.54mm, 5.81±2.20 mm, 3.52±0.93 mm, 12.64±2.34 mm, & 5.34±3.2 mm2 respectively. The preoperative PI, RAL, GML. PPD, VHD & AOD from experimental group was 1.14±0.05, 12.19±2.86mm, 4.38±1.63 mm, 7.81±2.6 mm, 13.46±3.42 mm, & 10.31±8.71 mm2 whereas the same after 6-months was 1.09±0.12, 8.62±2.62mm, 4.90±1.79 mm, 3.71±1.68 mm, 10.10±2.07 mm & 4.38±2.67 mm2 respectively. After 6 months of evaluation both the groups showed significant reduction in PPD (p<0.001) and significant gain in CAL (p<0.001), and significant improvement in radiographic VHD fill and AOD changes. Again, test group showed significant changes (p<0.001) over the control group considering the same outcomes. CONCLUSION With the study limitations in mind, we conclude that, the treatment of intrabony defects with bone graft (β -tricalcium phosphate + hydroxyapatite) material or the same along with PRF membrane results in statistically significant improvement in clinical (CAL and PPD) and radiographic (VHD and AOD) parameters; the latter having highly significant benefits. The indigenous bone graft material needs improvement.
The efficacy of non-surgical platelet-rich fibrin application on clinical periodontal parameters and periostin level in periodontitis: Clinical trial
Al-Rihaymee S, Sh Mahmood M
Journal of cellular and molecular medicine. 2023
Platelet-rich fibrin (PRF) has been widely used in regenerative dentistry due to many growth factors produced. Periostin, a matricellular protein, is a reliable marker for tissue regeneration. Periostin is part of the cellular matrix and regulates bone homeostasis. This study aims to explore the efficacy of PRF in improvement of the clinical periodontal parameters as an adjunct to the scaling and root planing and to evaluate periostin level in gingival crevicular fluid (GCF) at baseline, 1- and 3-month recall visits. Fourteen periodontitis patients who met the inclusion criteria were recruited in this study. Two contralateral periodontal pockets with 4-6 mm in depth in each patient were selected. The sites in every participant were randomly allocated into control sites or test sites. In control sites, only conventional scaling and root planing was carried out. In test sites, however, scaling and root planing method and PRF were applied. Periostin level in GCF and clinical periodontal parameters were measured. The test sites revealed greater relative attachment gain (2.614 ± 0.606 mm and 3.321 ± 0.668 mm) than control sites (1.285 ± 0.671 mm and 1.839 ± 0.632 mm) and a significant pocket reduction (2.535 ± 0.664 mm and 3.321 ± 0.668 mm) than the control sites (1.21 ± 0.508 mm and 1.892 ± 0.655 mm) at 1- and 3-month recall visits respectively. In the test sites, level of periostin (48.83 ± 9.3 ng/μl and 98.90 ± 24.94 ng/μl) were greater than periostin levels in the control sites (42.65 ± 7.03 ng/μl and 49.29 ± 15.14 ng/μl) at 1- and 3-month recall visits respectively. In conclusion, the non-surgical application of PRF as an adjunct to scaling and root planing significantly improved the clinical periodontal parameters through raising periostin level in GCF.
Clinical application of platelet-rich fibrin to enhance dental implant stability: A systematic review and meta-analysis
Guan S, Xiao T, Bai J, Ning C, Zhang X, Yang L, Li X
OBJECTIVE To investigate the effect of platelet-rich fibrin application on implant stability. STUDY DESIGN Five databases, namely, PubMed, Embase, Web of Science, Wiley, and China National Knowledge Infrastructure, were searched for reports published up to November 20, 2022. Randomized controlled trials (RCT), including parallel RCTs and split-mouth RCTs, with at least 10 patients/sites were considered for inclusion. RESULTS After screening based on the inclusion criteria, ten RCTs were included. Low heterogeneity was observed in study characteristics, outcome variables, and estimation scales (I(2) = 27.2%, P = 0.19). The qualitative and meta-analysis results showed that PRF increased the effect of implant stabilizers after implant surgery. CONCLUSIONS The results of the present systematic review and meta-analysis suggest that PRF can increase implant stability after implant surgery. PRF may also have a role in accelerating bone healing and tends to promote new bone formation at the implant site.
Platelet-rich fibrin vs. buccal advancement flap for closure of oroantral communications: a prospective clinical study
Hunger S, Krennmair S, Krennmair G, Otto S, Postl L, Nadalini DM
Clinical oral investigations. 2023
OBJECTIVES The primary aim was to evaluate the success of the defect closure (tight or open) of oroantral communications (OAC) after treatment with platelet-rich fibrin (PRF) clots or a buccal advancement flap (BAF). Secondary outcome measurements were the evaluation of the wound healing, the displacement of the mucogingival border (MGB), and the pain level. MATERIAL AND METHODS Fifty eligible patients with an OAC defect larger than 3 mm were randomly assigned to either PRF (test group, n = 25) or BAF (control group, n = 25) for defect closure. In a prospective follow-up program of 21 days, the defect closure healing process, the wound healing course using Landry's wound healing index (score: 0-5), the displacement of the MGB, and the postoperative pain score were evaluated. RESULTS Five patients in each group were lost to follow-up resulting in 40 patients (20 in each group) for continuous evaluation. On postoperative day 21 (study endpoint), no difference regarding success rate (defined as closure of OAC) was noticed between the test (90%; 18/20) and control group (90%; 18/20). A univariate analysis showed significant differences for age and defect size/height for the use of PRF between successful-tight and open-failed defect healing. At the final evaluation, a significantly (p = 0.005) better wound healing score, a lower displacement of the MGB as well as lower pain-score were seen for the use of PRF. CONCLUSIONS Based on the findings of the current study, the use of platelet-rich fibrin represents a reliable and successful method for closure of oroantral communications. The use of PRF clots for defect filling is associated with lowered pain levels and less displacement of the mucogingival border. CLINICAL RELEVANCE The defect size should be taken into account when choosing the number and size of PRF plugs.
Does the Choice of Preparation Protocol for Platelet-Rich Fibrin Have Consequences for Healing and Alveolar Ridge Preservation After Tooth Extraction? A Meta-Analysis
Al-Badran A, Bierbaum S, Wolf-Brandstetter C
Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons. 2023
PURPOSE Multiple preparation protocols for platelet-rich fibrin (PRF) are in use today, and clinical results are often heterogeneous. This study analyzes the impact of the chosen PRF preparation protocol on 1) wound healing and 2) alveolar ridge preservation. METHODS For this systematic review and meta-analysis, eligible studies were identified in PubMed and Cochrane databases. Included were randomized controlled and controlled clinical trials with healthy patients treated with PRF after atraumatic tooth extraction compared to untreated socket(s), reporting at least one of the following outcome variables: pain, swelling, soft tissue healing, alveolar osteitis risk, horizontal and vertical bone loss, socket fill, and new bone formation. Main predictor variable was relative centrifugal force (RCF) comparing high RCF (high PRF), intermediate RCF (standard [S-PRF]), low RCF (advanced PRF), and various RCF settings (concentrated growth factor preparation [CGF]). The type of centrifugation tubes (silica-coated plastic and glass) was a secondary predictor. Weighted or standardized mean differences, risk ratio and corresponding 95% confidence intervals were calculated. RESULTS Forty studies published between 2012 and 2022 were selected. The pooled effects of all outcomes were significant against untreated sockets. Within the subgroups high PRF or advanced PRF had the lowest efficacy for many outcome parameters. Pain reduction (in visual analog scale units) was highest for S-PRF (-1.18 [-1.48, -0.88], P < .00001) and CGF (-1.03 [-1.16, -0.90], P < .001). The relative risk of alveolar osteitis (0.09 [0.01, 0.69], P < .02) and soft tissue healing (standardized mean difference = 2.55 [2.06, 3.03], P < .001) were best for CGF. No subgroup differences were found for bone-related outcomes. No meaningful analysis of the tube material effect was possible. CONCLUSION This study confirms that PRF is associated with reduced postoperative complications but indicates that preparation protocol influences clinical outcomes. S-PRF and CGF protocols appear to be superior for several outcome parameters.
Dorsal Wrist Ganglion: Pilot for Randomized Control Trial Comparing Aspiration Alone or Combined with Injection of Platelet-Rich Plasma
Hamlin K, Haddon A, Khan Y, Miller C, Lawrie D
Journal of wrist surgery. 2023;12(1):18-22
This pilot study assessed the feasibility of performing a randomized control trial (RCT) investigating injection with platelet-rich plasma (PRP) for dorsal wrist ganglion (DWG). Aspiration alone was compared with aspiration plus injection of PRP. Seventeen patients were enrolled. Nine patients received PRP and eight aspiration alone. Patients were followed up at 6 weeks and 1 year; recurrence of the ganglion and Patient Evaluation Measure scores were measured. At 6 weeks seven patients in the aspiration group had a recurrence and five in the PRP group, but by 1 year, this has increased to seven out of eight in the PRP group whereas in the aspiration group four had resolved leaving three out of eight patients with a ganglion still present. From the basis of our work an RCT would require a minimum of 46 patients per group; however, it is unlikely that PRP will be a panacea for ganglia. This is a Level II study.
Effect of adjuvant autologous platelet concentrates on secondary repair of alveolar clefts: A systematic review and meta-analysis
Siddiqui HP, Sennimalai K, Bhatt K, Samrit VD, Duggal R
Special care in dentistry : official publication of the American Association of Hospital Dentists, the Academy of Dentistry for the Handicapped, and the American Society for Geriatric Dentistry. 2023
OBJECTIVE To review the existing evidence on the adjuvant use of autologous platelet concentrates (APCs) with iliac crest bone graft (ICBG) in the reconstruction of the secondary alveolar cleft. METHODS Electronic databases were searched systematically until November 2022. Clinical trials comparing the three-dimensional radiological outcomes of patients who underwent secondary alveolar bone grafting (SABG) with ICBG and APCs to those with ICBG alone and the radiological outcomes assessed 6 months after surgery were included. Two authors performed the study selection and the assessment of the risk of bias. Meta-analysis was performed using the random-effects model to determine the risk ratio (RR) for developing wound dehiscence and the mean difference (MD) with a 95% confidence interval (CI) for the percentage of newly formed bone. RESULTS Nine studies (seven RCT and two CCT) were included with a low to high risk of bias. At the 6-month follow-up, the study group revealed insignificant results regarding the percentage of newly formed bone (MD = 6.49; 95% CI: -0.97, 13.94; p = .09; χ(2) = 0.01; I(2) = 71%). In addition, the overall risk of developing wound dehiscence was lower in the study group (RR = 0.34; 95% CI: 0.15, 0.78; p = .01; χ(2) = 0.67; I(2) = 0%). CONCLUSION Currently, there is insufficient evidence to support the adjuvant use of APCs with ICBG on enhanced bone regeneration following secondary alveolar bone grafting. However, combining ICBG and APCs might be beneficial in reducing the risk of developing wound dehiscence.
Does the use of platelet-rich plasma in sinus augmentation improve the survival of dental implants? A systematic review and meta-analysis
Sivakumar I, Arunachalam S, Mahmoud Buzayan M, Sharan J
Journal of oral biology and craniofacial research. 2023;13(1):57-66
BACKGROUND Platelet-rich plasma is considered an effective modality to promote bone regeneration, improve hard and soft tissue healing in surgical procedures including sinus augmentation. However, the survival of dental implants in sinus augmented sites with platelet-rich plasma has shown equivocal results in recent studies. PURPOSE In this systematic review, data on dental implants' survival in sinus augmentation sites with platelet-rich plasma were examined. MATERIALS AND METHODS Randomized controlled trials on the topic with a minimum mean follow-up of 6 months with no language restriction were considered. Other study designs on the topic were excluded. Accordingly, relevant articles were searched in Clinicaltrials.gov, Cochrane databases, PubMed/Medline, and Scopus up to April 2021. Using the Cochrane risk of bias assessment tool, the listed studies' risk of bias was evaluated. From the included studies, the pertinent information was taken and pooled for qualitative and quantitative analysis using R software 4.1.1. RESULTS Six randomized controlled trials involving 188 patients who underwent sinus augmentation with and without platelet-rich plasma, and 781 implants were included for qualitative and quantitative analysis. Four hundred and eleven implants were placed in the intervention group (with platelet-rich plasma) and 370 implants were placed in the control group (without platelet-rich plasma). The pooled estimate (OR 0.84, 95% CI 0.37 to 1.91; I(2) = 0%) indicated that there was no statistically significant difference observed between the groups. The test for subgroup differences showed no statistically significant differences between the subgroups (p = 0.45) with no heterogeneity (I(2) = 0%). CONCLUSION The bias associated with selective reporting of outcome data was considered as some concern for bias. This systematic review revealed that the effect of platelet-rich plasma is uncertain on the survival of dental implants.
Randomized control trial to study the efficacy and safety of platelet-rich plasma as intraoperative holding solution in hair restoration surgery: A pilot study
Pathania V, Sood A, Beniwal N, Baveja S, Shankar P, Patrikar S
Medical journal, Armed Forces India. 2023;79(1):46-53
BACKGROUND Hair restoration surgery is a definitive surgical procedure undertaken for androgenetic alopecia (AGA). Platelet-rich plasma (PRP) therapy has gained importance in recent times as a valuable adjunct to therapy in hair restoration. However, the various beneficial effects of PRP as intraoperative holding solution hair restoration surgery remain to be objectively defined. METHODS Twenty cases of AGA were allocated into two groups (PRP and non-PRP). The follicular grafts harvested were stored in platelet-rich plasma/chilled ringers lactate solution depending on subject/control and were implanted in receding hairline using hair implanters. Patients were reviewed at the end of 2 weeks, 4 weeks, 8 weeks, 3 months, and 6 months using clinical and folliculoscopic images. The analysis was performed using SPSS version 20.0. RESULTS Follicular growth as assessed using the percentage of grafts in actively growing phase posttransplant showed faster recovery from 'shock effluvium' in the PRP group when compared with the non-PRP group from Week 4, through Week 8 and 3 months with the 'lead' increases of percentage growth difference being statistically significant(P = 0.02) between the two groups. At the end of 6 months, 100% of patients recorded a hair shaft length of >10 mm in the PRP group, whereas only 20% achieved >10 mm length. The difference in hair densities between PRP and the non-PRP group from 4 weeks up to 6 months in the non PRP group remained significant (P < 0.05). CONCLUSION Intraoperative PRP as a holding solution improves outcome in hair restoration surgery by a significant improvement in the mean density of the implanted follicular unit grafts at 6 months.
Network meta-analysis of platelet-rich fibrin in periodontal intrabony defects
Ye L, Mashrah MA, Ge L, Fang Y, Guo X, Ge Q, Wang L
Journal of oral pathology & medicine : official publication of the International Association of Oral Pathologists and the American Academy of Oral Pathology. 2023
OBJECTIVES To evaluate the effect of platelet-rich fibrin alone or in combination with different biomaterials for the treatment of periodontal intra-bony defect. METHODS Up to April 2022, Cochrane library, Medline, EMBASE, and Web of Science databases were searched for randomized clinical trials. The outcomes of interest were probing pocket depth reduction, clinical attachment level gain, bone gain, and bone defect depth reduction. Bayesian network meta-analysis with 95% credible intervals was calculated. RESULTS Thirty-eight studies with 1,157 participants were included. Platelet-rich fibrin alone or platelet-rich fibrin +biomaterials showed a statistically significant difference when compared with open flap debridement (P<0.05, low to high certainty evidence). Neither biomaterials alone nor platelet-rich fibrin +biomaterials showed a statistically insignificant difference when compared to platelet-rich fibrin alone (P>0.05, very low to high certainty evidence). Platelet-rich fibrin +biomaterials showed insignificant differences as compared to biomaterials alone (P>0.05, very low to high certainty evidence). Allograft +collagen membrane ranked the best in probing pocket depth reduction while platelet-rich fibrin +hydroxyapatite ranked the best in bone gain. CONCLUSION It seems that 1) Platelet-rich fibrin with/without biomaterials were more effective than open flap debridement. 2) Platelet-rich fibrin alone provides a comparable effect to biomaterials alone and platelet-rich fibrin +biomaterials. 3)Platelet-rich fibrin +biomaterials provide a comparable effect to biomaterials alone. Although allograft +collagen membrane and platelet-rich fibrin +hydroxyapatite ranked the best in terms of probing pocket depth reduction and bone gain respectively, the difference between different regenerative therapies remains insignificant, and therefore, further studies are still needed to confirm these results.