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1.
The Use of Platelet Concentrates in the Reconstruction of the Alveolar Cleft Defect: A Systematic Review and Meta-Analysis
Vásquez-Álvarez, M., Wang, Q., Zapata, U.
The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association. 2024;:10556656231222076
Abstract
OBJECTIVE Evaluate quantitative and qualitative outputs when comparing the incidence of platelet concentrates (PCs) combined with autogenous bone grafts to an autograft control group for the reconstruction of alveolar cleft defects. DESIGN Systematic review and meta-analysis. PATIENTS/PARTICIPANTS Randomized and nonrandomized controlled clinical trials where PCs were used in the reconstruction of alveolar cleft defects. INTERVENTIONS Use of PCs in combination with autogenous bone graft in the experimental group and autogenous bone graft alone in the control group. MAIN OUTCOME MEASURE(S): Average bone formation and bone density were evaluated, mean differences were calculated and pooled by a meta-analysis technique. Additionally, clinical outcomes such as wound dehiscence, closure of the oronasal fistula, pain, swelling, discharges, infections, and bleeding were considered in the qualitative synthesis. RESULTS After an evaluation of forty-nine articles, nineteen were considered for the review. The qualitative assessment of bone density, bone formation, and clinical outcomes showed no differences between groups in most of the included studies. The meta-analysis showed no statistical differences between PCs groups when compared to the control group in bone density at three months (mean difference 45.67 HU, P = .23) and six months (mean difference 48.57 HU, P = .64). Neither were statistical differences in the percentage of regenerated bone volume at six months (mean difference 6.39%, P = .15) and the volume of newly formed bone at 12 months (mean difference 0.37 mm3, P = .99). CONCLUSIONS There were no significant differences in terms of bone formation, bone density, and clinical outputs between groups.
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2.
Efficacy of autologous platelet concentrate products for alveolar preservation: A meta-analysis
Zhang, Y., Du, R., Yang, B., Tao, J., Jing, W.
Oral diseases. 2024
Abstract
PURPOSE The purpose of the study was to systematically evaluate the efficacy of autologous platelet concentrate products in the preservation of the alveolar ridge after tooth extraction through meta-analysis and provide a theoretical basis for the clinical application of autologous platelet concentrates to reduce alveolar bone resorption. METHODS This study conducted a meta-analysis of clinical trials between 2013 and 2023, focusing on autologous platelet concentrate products (e.g., PRP, PRF, CGF, and PRCF) used for alveolar ridge preservation after tooth extraction. The analysis included 122 articles and 371 extraction sockets. All statistical analyses were performed using Review Manager version 5.4. RESULTS Results indicate that these platelet concentrates effectively reduced changes in horizontal width 1 mm below the alveolar crest and vertical socket height. They also promoted a higher percentage of new bone formation in extraction sockets compared with control groups. However, they did not significantly prevent horizontal bone resorption at 3 and 5 mm below the alveolar crest. CONCLUSION In conclusion, autologous platelet concentrates are useful for alveolar ridge preservation, but larger clinical studies are needed to confirm these findings due to the relatively small sample size in this study.
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3.
The effectiveness of chitosan as a hemostatic in dentistry in patients with antiplatelet/anticoagulant therapy: systematic review with meta-analysis
Minervini, G., Franco, R., Marrapodi, M. M., Di Blasio, M., Cicciù, M., Ronsivalle, V.
BMC oral health. 2024;24(1):70
Abstract
Hemorrhage control is a crucial aspect of dental procedures, and achieving efficient hemostasis remains a key challenge. The advent of hemostatic dressings has revolutionized the field of dentistry by providing effective and convenient solutions for managing bleeding in vari-ous dental scenarios. This article aims to provide an overview of hemostatic dressings, their mechanisms of action, and their diverse applications in dentistry. We applied the following Pop-ulation, Exposure, Comparator, and Outcomes (PICO) model to assess the document eligibility. A literature search was performed on major search engines, using keywords. At the end of the search, 3 articles were selected that matched the PICO. Three items were selected after the screen-ing process, and bleeding times were analyzed between the control group and the study group. The overall effect showed a substantial and statistically significant difference with bleeding time in favour of HDD-treated patients, showing that this garrison is very useful in controlling bleed-ing for patients taking anticoagulants and antiplatelets (Mean difference - 5.61; C.I. -5.70, - 5.52); Overall, hemostatic dressings have revolutionized the management of bleeding in dentistry, offering a promising solution to achieve optimal hemostasis, improve treatment outcomes, and enhance patient care, particularly Hemcon.
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4.
Laser Devices and Autologous Platelet Concentrates in Prevention and Treatment of Medication-Related Osteonecrosis of the Jaws: A Systematic Review
Scribante A, Ghizzoni M, Pellegrini M, Pulicari F, Spadari F
Medicina (Kaunas, Lithuania). 2023;59(5)
Abstract
Background and Objectives: Medication-related osteonecrosis of the jaws (MRONJ) is a disease that affects many patients taking anti-angiogenic and antiresorptive medicines. Since the pathogenetic mechanism is still partially unknown, preventive strategies, as well as treatment alternatives, are needed. Therefore, the aim of this research is to describe the main evidence from the last 10 years of clinical trials regarding the use of auxiliary devices such as autologous platelet concentrates (APCs) and laser, other than their effects against MRONJ disease onset or therapy. Advantages in the healing process and recurrence rates were also analyzed. Materials and Methods: A systematic search of the electronic databases of PubMed and Scopus was carried out. Data from the studies were analyzed, and the risk of bias was evaluated. Results: Nineteen studies between interventional studies, observational studies, and cohort studies have been considered in this review. Conclusions: Based on the studies included, the literature analysis shows that APCs could be a beneficial alternative in preventing and treating MRONJ. Laser technology, as a surgical tool or used on the antimicrobial photodynamic or photobiomodulation side, has been becoming increasingly popular in the last few years. The latest proposal concerning the combination of both auxiliary tools suggests interesting effects, but more studies should be conducted to evaluate eventual relapses and long-term consequences.
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5.
Effectiveness of Tranexamic Acid in Orthognathic Surgery: A Systematic Review of Systematic Reviews
AlQahtani, F. A., Kuriadom, S. T., Varma, S., AlAnzy, H., AlOtaibi, S.
Journal of stomatology, oral and maxillofacial surgery. 2023;:101592
Abstract
PURPOSE This study aimed to review the currently available evidence on the effectiveness of administering tranexamic acid (TXA) to patients undergoing orthognathic surgery. METHODS A study protocol was developed in accordance with the Preferred Reporting Guideline for Overviews of Reviews (PRIOR) and registered on the International Prospective Register of Systematic Reviews (PROSPERO) under Registration No. CRD42021232931. Furthermore, the reporting of the present systematic review was performed based on the PRISMA checklist. RESULTS The search strategy yielded a total of 50 articles. After reading the abstracts, 28 articles were excluded, and the English full texts of the remaining 22 studies were separately examined for eligibility by two authors; 15 articles were excluded because they did not meet the inclusion criteria. Finally, seven systematic reviews and meta-analysis satisfied the criteria for inclusion and were processed for critical review evaluation. CONCLUSIONS Within the limits of the present study and the reviews of the 7 articles included, it is observed that TXA is able to reduce the amount of intraoperative blood loss and the amount of irrigation fluids required. However, it does not influence postoperative levels of hemoglobin or hematocrit, nor does it affect the requirement for blood transfusions. It was interestingly discovered that TXA could increase the quality of the surgical site. These data imply that TXA may be an effective adjuvant in lowering bleeding during orthognathic surgery. As a result, the potential risk of problems related with considerable blood loss may be minimized.
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6.
A Systematic Review of the Efficacy and Safety of Tranexamic Acid in Facelift Surgery
Al-Hashimi, M., Kaur, P., Charles, W., Bhasta, M., Nahai, F., Khajuria, A.
Aesthetic surgery journal. 2023
Abstract
Tranexamic acid (TXA) has become widely utilized in different specialities including facelift surgery. To robustly evaluate the quality of available evidence on the efficacy and safety of TXA use in facelift surgery. We searched MEDLINE, EMBASE, CINAHL, CENTRAL, Google Scholar, Science Citation Index and LILAC databases for randomized controlled trials (RCTs), and observational studies. Primary outcomes were blood loss, post-operative hematoma, ecchymosis, and swelling, in addition to technical considerations and complications. We assessed reviews quality using the AMSTAR 2 tool, studies quality using GRADE, and risk of bias using Cochrane's Risk of Bias tool for RCTs and ROBINS-I for non-randomized studies. Of the 368 articles, a total of three studies including 150 patients met the inclusion criteria. The RCT reported a significant reduction in postoperative serosanguineous collections in the TXA group (p < 0.01), and the surgeon rated postoperative ecchymosis and bruising. The prospective cohort study reported reduced drainage output in first 24 hours in the TXA group (P < 0.01). The retrospective cohort study reported lower intraoperative blood loss, mean POD1 drain output, percentage of drain removal on POD1 and number of days to drain removal the TXA group (all, p < 0.01). The quality of studies was moderate, and this review was the highest rated compared to previous reviews, as per the AMSTAR2 tool. Based on limited literature, TXA improves clinical outcomes regardless of the route of administration. Topical TXA is an emerging route, expediting drain removal and reducing blood loss. Future Level I high-quality studies are required.
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7.
The Effect of Platelet-Rich Plasma on Bone Volume in Secondary Alveolar Bone Grafting in Alveolar Cleft Patients: A Systematic Review
Vishva, P., R, N., Harikrishnan, S.
Cureus. 2023;15(9):e46245
Abstract
This systematic review aims to investigate the impact of platelet-rich plasma (PRP) in conjunction with bone grafting on bone volume outcomes in secondary alveolar bone grafting (SABG) procedures among alveolar cleft patients. An exhaustive search involving PubMed, Cochrane, and Google Scholar databases yielded 20 relevant titles, ultimately leading to the inclusion of four articles meeting all specified criteria. Based on the Cochrane risk of bias in systematic reviews (ROBIS) tool, the studies showed a high risk of bias. The primary outcome, bone volume assessment, was analyzed across these articles. While the Cochrane ROBIS tool deemed the included articles to have a high risk of bias, the comparison between PRP and Non-PRP groups did not reveal a significant difference in bone volume. Radiographic data illustrated an initial three-month period of bone resorption post-graft, regardless of PRP application, followed by a six-month phase of heightened bone density, particularly discernible in the PRP groups. To sum up, our findings indicate an absence of substantial bone density increase in cleft patients undergoing SABG with PRP augmentation. Nonetheless, there was a modest trend that suggests potential incremental bone density improvement with PRP usage, underscoring the need to conduct rigorously designed, randomized controlled trials (RCTs) with low bias to validate these observations.
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8.
The Effect of Advanced Platelet-Rich Fibrin in Tissue Regeneration in Reconstructive and Graft Surgery: Systematic Review
Santos Pereira VB, Barbirato DDS, Lago Capd, Vasconcelos Bcde
The Journal of craniofacial surgery. 2023
Abstract
This systematic review answered the guiding question using the PICO system: "What are the effects of advanced platelet-rich fibrin (A-PRF) on alveolar ridge preservation and tissue gain in reconstructive and jaw graft surgery?" Searches were performed in the PubMed|MEDLINE, Scopus, Embase, Web of Science, Cochrane Library, and LILACS|bvs databases. In total, 573 articles were found in the initial search, and 564 were evaluated after the removal of duplicates, of which 5 randomized controlled trials met the eligibility criteria and were included 2 studies investigated the effect of A-PRF on the preservation of the bone ridge, 1 study evaluated the tissue repair after tooth extraction with A-PRF, 1 evaluated the peri-implant gap filling with A-PRF-xenograft mixture, and other the A-PRF on the treatment of alveolar osteitis. Advanced-PRF preparation protocol varied between the included studies from 8 to 13 minutes of centrifugation, at 1300 RPM (200g). The use of A-PRF provided greater dimensions of height and more favorable maintenance of the ridge profile, probing depth, and gingival margin level after extraction. Advanced-PRF also increased bone density, vital bone, epithelial healing, and control of postoperative pain and swelling after tooth extraction and in the treatment of alveolar osteitis.
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9.
Comparing efficacies of autologous platelet concentrate preparations as mono-therapeutic agents in intra-bony defects through systematic review and meta-analysis
Varshney, S., Dwivedi, A., Dwivedi, V.
Journal of oral biology and craniofacial research. 2023;13(6):671-681
Abstract
AIM: This systematic review and meta-analysis aimed to assess individually the regenerative potential of PRF (Platelet-rich Fibrin), PRP (Platelet-rich Plasma), and PRGF (Plasma Rich in Growth Factors) in comparison to OFD (Open Flap Debridement) alone for treating Intrabony defects, by calculating pooled effect sizes. BACKGROUND Relevant randomized controlled trials on humans were searched in PUBMED, COCHRANE CENTRAL, and GOOGLE SCHOLAR. Mean differences (MD) of Clinical Attachment level (CAL), Probing Pocket depth (PPD), and Defect Depth Reduction (DDR) between the Experimental and Control groups were used for calculating pooled effect sizes. Risk of bias was assessed using Cochrane's tool, and publication bias was evaluated through Funnel plots, Trim & Fill Method, and Rosenthal's Fail-Safe N Test. REVIEW RESULT A total of 23 studies were identified for qualitative and quantitative analysis. These studies were categorized into PRF, PRP, and PRGF groups based on the type of APC used. PRF showed the highest CAL gain (1.60 mm, 95% CI = 0.963-2.232 mm, P < 0.001, I2 = 93.83%) and PPD reduction (1.76 mm, 95% CI = 1.056 to 2.446, P < 0.001, I2 = 96.05%). However, PRP exhibited the greatest DDR (3.42 mm, 95% CI = -13.67 to -20.50, P = 0.011, I2 = 87.27%). PRF and PRP demonstrated large effect sizes, while PRGF showed a small effect size. CONCLUSION The use of PRF, PRP, and PRGF showed advantages in treating intrabony defects. However, caution is advised when interpreting the results due to heterogeneity and publication bias among the studies.
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10.
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
Abstract
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.