Comparative Evaluation of Recession Coverage Obtained Using the Pinhole Surgical Technique With and Without Platelet-Rich Fibrin: A Randomized Clinical Trial
The International journal of periodontics & restorative dentistry. 2023;43(4):e181-e188
This randomized controlled clinical trial evaluated the pinhole surgical technique (PST) combined with platelet-rich fibrin (PRF) for the management of multiple recession defects compared to PST alone. Ten patients with 51 Miller Class I/ II or III gingival recessions were selected. Control sites were treated with PST alone, whereas test sites were treated with PST with PRF. Gingival recession depth (GRD), gingival recession width (GRW), probing depth (PD), clinical attachment level (CAL), keratinized tissue width (KTW), total soft tissue gain (TSTG), Plaque Index (PI), Gingival Index (GI), and gingival bleeding index (GBI) were measured at baseline and at 1, 3, and 6 months posttreatment. Both groups showed statistically significant root coverage. The mean recession coverage was 60.25% in the test group and 49.6% in the control group. The recession reduction from baseline was 2.50 mm for the test group and 1.88 mm for the control group. At the end of 6 months, all sites achieved adequate root coverage. PRF is a feasible alternative to connective tissue grafts as an adjunct to PST for the treatment of multiple recession defects.
The effectiveness of using platelet-rich concentrate with iliac bone graft in the repair of alveolar cleft: a meta-analysis of randomized controlled trials
International journal of oral and maxillofacial surgery. 2023
The purpose of this study was to review the existing evidence from randomized controlled trials (RCTs) on the effect of autogenous bone grafts combined with a platelet-rich concentrate on alveolar clefts. An electronic search was conducted in the PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, Embase, and ClinicalTrials.gov databases for studies published between January 2000 and April 2022. This study included six RCTs to evaluate bone quantity (bone formation ratio, %) and quality (bone density in Hounsfield units, HU), as well as complications as a way to assess the safety of the technique. Two independent reviewers assessed the risk of bias. There was no statistically significant difference in bone formation ratio at 6 months of follow-up between the use of autologous bone alone for alveolar bone grafting or adding platelet-rich plasma (PRP) (mean difference (MD) 14.33%, 95% confidence interval (CI) - 7.19% to 35.85%; P = 0.196) or platelet-rich fibrin (PRF) (MD 9.38%, 95% CI -2.36% to 21.12%; P = 0.123) to autologous bone. The MD for the change in bone density at 6 months was in favour of PRP added to autologous bone graft (MD 155.69 HU, 95% CI 99.29-212.09 HU; P < 0.001); however, this result was based on only two studies, one of which had a high risk of bias. Patients who received autologous bone graft with PRP were significantly less likely to experience complications (odds ratio (OR) 0.21, 95% CI 0.05-0.92; P = 0.038), but this was no longer statistically significant after a sensitivity test (OR 0.24, 95% CI 0.04-1.56; P = 0.138). In conclusion, this systematic review and meta-analysis appears to show no benefit to using a platelet-rich concentrate combined with autologous bone for alveolar cleft grafting in terms of bone volume, bone density, or complications.
Comparative Investigation of Anti-Inflammatory Effect of Platelet-Rich Fibrin after Mandibular Wisdom Tooth Surgery: A Randomized Controlled Study
Journal of clinical medicine. 2023;12(13)
This study evaluated the anti-inflammatory effect of platelet-rich fibrin (PRF) applied to the extraction socket after impacted mandibular third molar surgery with subjective and objective parameters. Forty-eight patients with impacted wisdom teeth in bilateral and similar positions were included in the study. The control group was formed with the standard surgery and the PRF group was formed with local PRF application in addition to standard procedure (n = 96). The anti-inflammatory activity of PRF on postoperative 2nd and 7th days was evaluated subjectively by clinical parameters and objectively by biochemical parameters. Postoperative 2nd- and 7th-day follow-up data of pain, edema, and trismus in the PRF group were found to be statistically significantly lower. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were found to be statistically significantly lower in the PRF group than the control in the postoperative 2nd-day follow-up period (p < 0.001). There was no statistically significant difference in interleukin 6 (IL-6) and tumor necrosis factor-alpha (TNF-α) parameters when the PRF group and the control group were compared in both follow-up periods (p > 0.05). The study has demonstrated the effectiveness of locally applied PRF after ITM surgery via clinical parameters and objective data. The quantitative analysis of CRP and ERS can be an effective parameter in determining the amount of inflammation after ITM surgery.
Comparative Evaluation of Vestibular Incision Subperiosteal Tunnel Access (VISTA) Technique With and Without Advanced Platelet Rich Fibrin for Treatment of Maxillary Anterior Gingival Recessions
The International journal of periodontics & restorative dentistry. 2023
Gingival recession is an apical shift of the gingival margin with exposure of the root surface to the oral cavity which creates an aesthetic problem. The present study was attempted to compare Vestibular incision subperiosteal tunnel access (VISTA) with and without Advanced platelet rich fibrin(A-PRF) in the treatment of Miller's class I gingival recessions. 24 patients were assigned randomly either to test (VISTA with A-PRF) or control (VISTA alone) group. Clinical parameters like recession depth (RD), recession width (RW), clinical attachment loss (CAL), width of keratinized gingiva (WKG), gingival thickness (GT) and probing depth (PD) were recorded at baseline,3 and 6 months post operatively. Inter group comparison of mean RC in mm, %RC, ΔWKG and CAG revealed no statistically significant difference (p>0.05). Change in GT showed statistically significant improvement in test group. Within the limitations of this study, both treatment options (VISTA with A-PRF and VISTA alone) have resulted in predictable and comparable root coverage with increased gingival thickness in the test group.
Evaluation of platelet rich fibrin in the treatment of decorticated intrabony defects: a randomized clinical trial
Quintessence international (Berlin, Germany : 1985). 2023;0(0):0
OBJECTIVE The objective of the present study was to evaluate the clinical and radiographic outcomes of intrabony defects treated with decortication (intramarrow penetration) alone versus decortication combined with platelet rich fibrin in periodontitis patients followed up for 6-months post-surgery. METHOD AND MATERIALS A total of 46 intrabony defects (IBD) from periodontitis patients with mean age of 36.30±6.10 years were randomly assigned into two treatment groups. The Control Group (n=23) intrabony sites were accessed with simplified papilla preservation flap (SPPF) followed with debridement, decortication and closure. Whereas, the Test Group (n=23) sites were accessed with SPPF, followed with debridement, decortication and platelet rich fibrin (PRF) placement and closure. Clinical parameters plaque index (PI), gingival index (GI), probing pocket depth (PPD), Relative attachment level (RAL), gingival marginal level (GML), along with radiographic defect depth (rDD) and defect width (rDW) were recorded at baseline, 3-months, and 6-months post-surgery. Gain in clinical attachment level (CAL) was the primary and PPD reduction and radiographic bone fill were secondary outcomes of the study. RESULTS The PI and GI scores showed non-significant difference on intra- and inter-group comparison at baseline, 3-months, and 6-months. The PPD was 8.17 ±1.56, 6.65±1.30, and 5.26±1.18 mm for control group; whereas 8.17 ±2.01, 6.26 ±1.42, and 4.78±1.28 mm for test group, respectively at baseline, 3-months, and 6-months. The RAL was 8.83±1.40, 6.78±1.31, and 5.39 ±1.16 mm, whereas 8.39±1.62, 6.96±1.36 & 5.48 ± 1.20 mm for the control and test groups respectively at baseline, 3-months, and 6-months. Statistically significant reduction was observed for PPD for control (2.91mm, p<0.001) and test group (3.39 mm, p<0.001); and RAL for control (3.44mm, p<0.001) and test group (2.91mm, p<0.001), respectively. However, intergroup differences were nonsignificant for PPD and RAL. The rDD was reduced by 0.31mm for control and 1.57mm for test group; while the rDW was reduced by 0.18mm for control and 0.83mm for test group. Intergroup statistically significant differences were observed at 6-months follow-up (p<0.001) for rDD and rDW. CONCLUSION Within the limitations of the present study, the results demonstrate statistically significant intragroup improvements in clinical outcomes with decortication alone and decortication combined with platelet rich fibrin in treatment of intrabony defects in periodontitis patients. Addition of PRF didn't improve the clinical results beyond decortication alone, and unacceptable post-surgery residual pockets were observed in both the protocols. Considering the small sample size, addition of PRF resulted in significant bone fill over and above that of decortication alone.
Comparative histological evaluation of two PRF formulations (PRF High and PRF Medium) on quality of life and healing outcome of apicomarginal defects: A randomized clinical trial
Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery. 2023
The objective of this randomized clinical trial was to investigate the effects of two PRF formulations (PRF High and PRF Medium) on quality of life and healing outcome (2D and 3D) of apicomarginal defects. Patients presenting with endodontic lesions and concomitant periodontal communication were randomly allocated to PRF High and PRF Medium groups. The treatment protocol in each group included a periapical surgical procedure with placement of PRF clot and membrane in the bony defect and on the denuded root surface, respectively. Quality of life was assessed for 1 week after surgery following a modified version of the patient's perception questionnaire. Postoperative pain was assessed using a visual analog scale. Clinical and radiographic evaluations were performed using Rud and Molven 2D criteria and Modified PENN 3D criteria. Buccal bone formation was assessed using sagittal and corresponding axial sections in CBCT. Histological analysis was performed using hematoxylin and eosin (H and E) staining and attaching primary antibodies to tissue sections. In total, 40 patients were enrolled in the trial (N = 20 per group). PRF Medium group patients reported significantly less swelling on the 1st (p = 0.036), 2nd (p = 0.034), and 3rd (p = 0.023) days, and average pain on the 2nd (p = 0.031), 3rd (p = 0.03), and 4th (p = 0.04) days postoperatively. The difference in success rate for periapical healing was non-significant between the PRF Medium group (89.5%) and PRF High group (90%), in both 2D and 3D imaging (p = 0.957). The formation of buccal bone was observed in five cases (26.3%) and four cases (20%) in the PRF Medium and PRF High groups, respectively, with a non-significant difference (p = 0.575). PRF Medium clots had a loose fibrin structure with a significantly higher number of neutrophils (473.79 ± 82.89 per mm(2)) than PRF High clots, which had a dense structure and fewer neutrophils (253.15 ± 63.86 per mm(2)) (p = 0.001). Autologous platelet concentrates (APCs) promoted satisfactory periapical healing, with no significant difference between the groups. Within the limitations of the study, it seems that PRF Medium should be preferred over PRF High when the patients' quality of life is the priority.
Comparing efficacies of autologous platelet concentrate preparations as mono-therapeutic agents in intra-bony defects through systematic review and meta-analysis
Journal of oral biology and craniofacial research. 2023;13(6):671-681
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.
The Effect of Advanced Platelet-Rich Fibrin in Tissue Regeneration in Reconstructive and Graft Surgery: Systematic Review
The Journal of craniofacial surgery. 2023
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.
Liquid platelet-rich fibrin in root surface biomodification during gingival recession treatment: Randomized, controlled, split-mouth, clinical trial
Clinical and experimental dental research. 2023
BACKGROUND AND OBJECTIVE Free gingival graft (FGG) has been successfully used in the treatment of gingival recessions, as it is the most predictable technique for increasing the attached gingiva. This study aimed to evaluate the effect of liquid platelet-rich fibrin (PRF) with FGG on root surface coverage as root surface biomodification. MATERIALS AND METHODS The research sample consisted of 32 surgical sites in 16 patients, they had 2 bilateral recessions in the incisor area of the same dental arch, the sample was divided into 2 groups randomly, and liquid PRF was applied in the first group with the FGG (experimental group), and in the second group the FGG was applied alone (control group). Gingival recession depth (RD) and width of attached gingiva (WAG) were measured before starting, after 1, 3, and 6 months. The percentage of root coverage (RC) was calculated after 6 months. Healing Index (HI) was recorded after 1 week, 2 weeks, and 1 month. RESULTS Both groups showed a reduction in gingival RD during all follow-up periods but the difference between both groups was not statistically significant (p > 0.05) at 1 and 3 months, whereas there were significant differences at 6 months (p = 0.001). RC was better in the liquid PRF group than in the control group, but this difference was not statistically significant (p > 0.05). The postoperative 7th and 14th days HI scores of the liquid PRF group were significantly better than the control group (p = 0.000 and p = 0.004, respectively), whereas there were no significant differences in HI scores between both groups at first month (p > 0.05). CONCLUSIONS According to the results, the addition of liquid PRF to the root surface with FGG showed further development in terms of decreasing RD, increasing WAG, and accelerated wound-healing.
Comparison of Platelet-Rich Fibrin and Iodoform Gauze in the Treatment of dry Socket
Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons. 2023
PURPOSE Iodoform gauze is commonly used to treat patients with localized alveolitis; however, saliva can easily dilute the iodoform concentration. This study aimed to compare the efficacies of platelet-rich fibrin (PRF) and iodoform gauze in treating localized alveolitis. METHODS This prospective randomized controlled trial enrolled patients with localized alveolitis who received treatment at our hospital from January 2018 to July 2021. They were randomly assigned to the control (treated with iodoform gauze) or experimental (treated with PRF) groups. Treatment method was the predictor variable. The primary outcome variable was clinical efficacy, defined as symptom resolution 1 week after treatment. Secondary outcome variables included granulation tissue (GT) quantitative score, analgesic drug dosage, and pain score determined using a visual analog scale (VAS). Patient demographics were used as covariates. Data analysis was performed by carrying out the χ(2) and Mann-Whitney rank sum tests; P values <.05 indicated statistical significance. RESULTS This study included 60 patients, equally and randomly divided into the control and PRF groups (n = 30 each). There were no significant differences in demographic characteristics of patients between the 2 groups. One week after treatment, the PRF group showed a higher healing rate (93.3% vs 60.0%) and better GT quantitative score (3.13 ± 0.63 vs 1.70 ± 0.75) than the control group (P < .05). Moreover, the number of analgesic tablets consumed within 1 week postoperatively was lesser in the PRF group than in the control group (3.93 ± 1.53 vs 9.67 ± 3.16, P < .05). The PRF group exhibited significantly lower VAS pain scores than those of the control group on the 3rd day (1.10 ± 1.03 vs 4.17 ± 1.49) and 7th day (0.30 ± 0.60 vs 1.73 ± 1.44, P < .05) postoperatively. CONCLUSIONS Compared with iodoform gauze, PRF is associated with higher healing rate, faster promotion of GT growth in the extraction socket, better relief of alveolar pain, and lower intake of analgesic drugs when treating localized alveolitis.