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 value of platelet-rich plasma in women with previous implantation failure: a systematic review and meta-analysis
Maged, A. M., El-Mazny, A., Kamal, N., Mahmoud, S. I., Fouad, M., El-Nassery, N., Kotb, A., Ragab, W. S., Ogila, A. I., Metwally, A. A., et al
Journal of Assisted Reproduction and Genetics. 2023
OBJECTIVE To assess the value of intrauterine PRP to improve IVF outcome in women with previous implantation failure. METHODS Screening of Pubmed, Web of Science, and other databases from inception to August 2022 using the keywords related to "platelet-rich plasma" OR "PRP" AND "IVF" "implantation failure." Twenty-nine studies (3308 participants) were included in our analysis, 13 were RCTs, 6 were prospective cohorts, 4 were prospective single arm, and 6 were retrospective analyses. Extracted data included settings of the study, study type, sample size, participants' characteristics, route, volume, timing of PRP administration, and outcome parameters. RESULTS Implantation rate was reported in 6 RCTs (886 participants) and 4 non-RCTs (732 participants). The odds ratio (OR) effect estimate was 2.62 and 2.06, with 95% CI of 1.83, 3.76, and 1.03-4.11, respectively. Endometrial thickness was compared in 4 RCTs (307 participants) and 9 non-RCTs (675 participants), which showed a mean difference of 0.93 and 1.16, with 0.59-1.27 and 0.68-1.65 95% CI, respectively. CONCLUSION PRP administration improves implantation, clinical pregnancy, chemical pregnancy, ongoing pregnancy, live birth rates, and endometrial thickness in women with previous implantation failure.
Safety and efficacy of intra-articular injection of platelet-rich plasma for the treatment of ankle osteoarthritis: a systematic review and meta-analysis
Ding SL, Ji LF, Zhang MZ, Xiong W, Sun CY, Han ZY, Wang C
International orthopaedics. 2023
PURPOSE To evaluate the safety and efficacy of platelet-rich plasma (PRP) intra-articular injective treatments for ankle osteoarthritis (OA). METHODS A systematic literature search was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in PubMed, Scopus, Embase, Google Scholar, and the Cochrane library until May 2022. Both randomized and non-randomized studies were included with the assessment of the risk of bias. We recorded the participant's age, gender, type of PRP, injection volume, the kit used, and activating agent. We subsequently assessed the short-term and long-term efficacy of PRP using the functional scores and visual analog scale (VAS). RESULTS We included four studies with a total of 127 patients, with a mean age of 56.1 years. 47.2% were male (60/127), according to eligibility criteria. There were three cohort studies and one randomized controlled trial (RCT) study, and no study reported severe adverse events. All included studies used the Leukocyte-poor PRP. Short-term follow-up results suggested significant improvement of the American Orthopaedic Foot and Ankle Society (AOFAS) score in the PRP injection group compared to the control group (n = 87 patients; MD: 6.94 [95% CI: 3.59, 10.29]; P < 0.01). Consistently, there was a statistical difference in AOFAS score between PRP injection and control groups in the final follow-up (≥ 6 months) (n = 87 patients; MD: 9.63 [95% CI: 6.31, 12.94]; P < 0.01). Furthermore, we found a significant reduction in VAS scores in the PRP groups at both the short-term follow-up (n = 59 patients; MD, - 1.90 [95% CI, - 2.54, - 1.26]; P < 0.01) and the ≥ six months follow-up (n = 79 patients; MD, - 3.07 [95% CI, - 5.08, - 1.05]; P < 0.01). The improvement of AOFAS and VAS scores at ≥ six months follow-up reached the minimal clinically important difference (MCID). Nevertheless, the treatment effect of AOFAS and VAS scores offered by PRP at short-term follow-up did not exceed the MCID. Substantial heterogeneity was reported at the ≥ six months follow-up in VAS scores (I(2): 93%, P < 0.01). CONCLUSION This meta-analysis supports the safety of PRP intra-articular injection for ankle OA. The improvements of AOFAS and VAS scores in the PRP group at short-term follow-up do not exceed the MCID to be clinically significant. PRP injection provides significant improvement of AOFAS score and reduced pain at ≥ six months follow-up. The efficacy of PRP should be interpreted with caution regarding the high heterogeneity and the scarcity of available literature, which urges large-scale RCTs with longer follow-up to confirm the potential efficacy of PRP injection for ankle OA.
Effects of Platelet-Rich Plasma in Tear Size Reduction in Partial-Thickness Tear of the Supraspinatus Tendon Compared to Corticosteroids Injection
Tanpowpong T, Thepsoparn M, Numkarunarunrote N, Itthipanichpong T, Limskul D, Thanphraisan P
Sports medicine - open. 2023;9(1):11
OBJECTIVES Corticosteroid (CS) injection is commonly used in partial-thickness rotator cuff tears to decrease pain. However, this could result in unwanted side effects, such as tendon rupture. Alternatively, platelet-rich plasma (PRP) injection is frequently used to treat tendinopathies because it enhances healing. This study aimed to compare the differences in tear size and functional scores between intralesional PRP and subacromial CS injections. METHODS Patients with symptomatic partial-thickness tears of the supraspinatus tendon who underwent conservative treatment for ≥ 3 months were enrolled. All patients underwent magnetic resonance imaging (MRI) to confirm the diagnosis. Fourteen and 15 patients were randomized to receive intralesional PRP and subacromial CS injections, respectively. Tears were measured in the coronal and sagittal planes. The patients underwent another MRI 6 months after the injection. Tear size was compared between the two MRI results. The American Shoulder and Elbow Surgeons Shoulder score (ASES) and Constant-Murley score (CMS) were also obtained. RESULTS The baseline data were similar between the groups. In the coronal plane, PRP and CS showed tear size reductions of 3.39 mm (P = 0.003) and 1.10 mm (P = 0.18), respectively. In the sagittal plane, PRP and CS showed tear size reductions of 2.97 mm (P = 0.001) and 0.76 mm (P = 0.29), respectively. Functional scores improved 6 months after injection in both groups, but PRP showed better functional scores than CS (P = 0.002 for ASES, P = 0.02 for CS). CONCLUSION Intralesional PRP injection can reduce the tear size in partial-thickness tears of the supraspinatus tendon. Subacromial steroid injection did not significantly affect the tear size. While CS improved functional scores compared with baseline, PRP resulted in better improvement 6 months post-injection. Trial registration Thai Clinical Trials Registry, TCTR20210428004. Registered 28 April 2021-retrospectively registered, TCTR20210428004 .
Effectiveness of the platelet-rich fibrin in the control of pain associated with alveolar osteitis: a scoping review
La Rosa GRM, Marciano A, Priolo CY, Peditto M, Pedulla E, Bianchi A
Clinical oral investigations. 2023
OBJECTIVES The aim of this scoping review was to determine the effectiveness of the platelet-rich fibrin in the control of pain associated with alveolar osteitis. MATERIALS AND METHODS Reporting was based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Extension for Scoping Reviews. A literature search was conducted in the PubMed and Scopus databases to identify all clinical studies on the application of platelet-rich fibrin in the control of pain caused by alveolar osteitis. Data were extracted independently by two reviewers and qualitatively described. RESULTS The initial search returned 81 articles, with 49 identified after duplicates removal; of these, 8 were selected according to the inclusion criteria. Three of the eight studies were randomized controlled clinical trials, and four were non-randomized clinical studies, two of which were controlled. One study was case series. In all of these studies, pain control was evaluated using the visual analog scale. Overall, the use of platelet-rich fibrin resulted effective in the control of pain determined by alveolar osteitis. CONCLUSIONS Within the limits of this scoping review, the application of platelet-rich fibrin in the post-extra-extraction alveolus reduced the pain associated with alveolar osteitis in almost all the included studies. Nevertheless, high-quality randomized trials with adequate sample size are warranted to draw firm conclusions. CLINICAL RELEVANCE Pain associated with alveolar osteitis causes discomfort to the patient and is challenging to be treated. Use of platelet-rich fibrin could be a promising clinical strategy for pain control in alveolar osteitis if its effectiveness will be confirmed by further high-quality studies.
Retrospective Analysis of Factors Associated with the Treatment Outcomes of Intradiscal Platelet-Rich Plasma-Releasate Injection Therapy for Patients with Discogenic Low Back Pain
Akeda K, Fujiwara T, Takegami N, Yamada J, Sudo A
Medicina (Kaunas, Lithuania). 2023;59(4)
Background and Objectives: Recently, the clinical application of platelet-rich plasma (PRP) has gained popularity for the treatment of degenerative disc diseases. However, the regenerative effects and factors associated with treatment outcomes after intradiscal injection of PRP remain unknown. This study aimed to evaluate time-dependent changes in imaging findings related to intervertebral disc (IVD) degeneration and to identify factors associated with the outcomes of PRP injection therapy. Materials and Methods: A retrospective analysis of a previous randomized clinical trial of intradiscal injection of the releasate isolated from PRP (PRPr) in patients with discogenic low back pain (LBP) was performed. Radiographic parameters (segmental angulation and lumbar lordosis) and MRI phenotypes, including Modic changes, disc bulge, and high-intensity zones (HIZs), were evaluated at baseline and 6 and 12 months post-injection. Treatment outcomes were evaluated based on the degree of LBP and LBP-related disability at 12 months post-injection. Results: A total of 15 patients (mean age: 33.9 ± 9.5 years) were included in this study. Radiographic parameters showed no significant changes after the PRPr injection. There were no remarkable changes in the prevalence or type of MRI phenotype. Treatment outcomes were significantly improved after treatment; however, the number of targeted discs and the presence of posterior HIZs at baseline were significantly but negatively associated with treatment outcomes. Conclusions: Intradiscal injection of PRPr significantly improved LBP and LBP-related disability 12 months post-injection; however, patients with multiple target lesions or posterior HIZs at baseline were significantly associated with poor treatment outcomes.
Comparison of Clinical and Functional Outcomes after Platelet-Rich Plasma Injection and Corticosteroid Injection for the Treatment of de Quervain's Tenosynovitis
Kumar V, Talwar J, Rustagi A, Krishna LG, Sharma VK
Journal of wrist surgery. 2023;12(2):135-142
Background Platelet-rich plasma (PRP) has local anti-inflammatory actions, which is being used as a treatment in various tendinopathies. Purpose The aim of the study is to compare the clinical results of PRP injection and corticosteroid injection in the management of de Quervain's tenosynovitis (DQTSV). Patients and Methods In this prospective study, 60 patients of DQTSV, fulfilling the predefined inclusion and exclusion criteria, were randomised into two groups. In group 1 ( n = 30), patients received a single injection of autologous PRP and in group 2 ( n = 30) they received a single injection of corticosteroid (methylprednisolone). All patients were followed up at 1 month, 3 months, 6 months, and 1 year for evaluation by Finkelstein test, visual analogue scale (VAS), DASH (Disabilities of the Arm, Shoulder and Hand) score, and Modified Mayo Wrist score (MMWS). Results In both the groups improvement occurred in Finkelstein test, VAS score, DASH score, and MMWS which were found to be statistically significant at all points of follow-ups when compared to the pre-intervention values. Comparison of scores between the two groups did not show any statistical significance. No complications were reported in PRP group. Statistically significant complications ( p -value = 0.026) like subcutaneous fat atrophy, depigmentation, and temporary increase in pain were seen in eight patients in the corticosteroid group with an overall complication rate of 26.67%. Conclusion Both the modalities are equally effective in the management of DQTSV remittance. PRP is equally effective as corticosteroid in reducing symptoms of first dorsal compartment stenosing tenosynovitis. PRP may have a lower complication profile, however, this benefit should be weighed against the slight increase in cost and time of PRP preparation and injection. Level of Evidence Level 2, prospective comparative study.
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
Thakur V, Mittal S, Tewari S, Kamboj M, Duhan J, Sangwan P, Kumar V, Gupta A
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.
Efficacy of Platelet-Rich Plasma Injection on Range of Motion, Pain, and Disability in Patients with Adhesive Capsulitis: A Systematic Review and Meta-Analysis
Lin HW, Tam KW, Liou TH, Rau CL, Huang SW, Hsu TH
Archives of physical medicine and rehabilitation. 2023
OBJECTIVE To investigate the therapeutic effects of platelet-rich plasma (PRP) injection on range of motion (ROM), pain, and disability in patients with adhesive capsulitis (AC). DATA SOURCES The authors performed the literature search in the PubMed, Embase, and Cochrane Library databases in February 2023. STUDY SELECTION Prospective studies comparing the outcomes of PRP with other intervention in patients with AC. DATA EXTRACTION The quality of included randomized trials was assessed using the revised Cochrane Risk of Bias (RoB 2.0) tool. The Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) tool was applied to assess the quality of nonrandomized trials. The mean difference (MD) or standardized mean difference (SMD) was determined as the effect size for continuous outcomes, and outcome accuracy was determined using 95% confidence intervals (CIs). DATA SYNTHESIS Fourteen studies involving 1,139 patients were included. Our meta-analysis revealed that PRP injection can significantly improve passive abduction (MD = 3.91, 95% CI: 0.84-6.98), passive flexion (MD = 3,90, 95% CI: 0.15-7.84), and disability (SMD = -0.50, 95% CI: -1.29--0.74) within one month after intervention. Moreover, PRP injection can significantly improve passive abduction (MD = 17.19, 95% CI: 12.38-22.01), passive flexion (MD = 17.74, 95% CI: 9.89-25.59), passive external rotation (MD = 12.95, 95% CI: 10.04-15.87), pain (MD = -8.40, 95% CI: -16.73--0.06), and disability (SMD = -1.02, 95% CI: -1.29--0.74) three months after intervention. PRP injection can also significantly improve pain (MD = -18.98, 95% CI: -24.71 to -13.26), and disability (SMD = -2.01, 95% CI: -3.02 to -1.00) six months after intervention. In addition, no adverse effects of PRP injection were reported. CONCLUSION PRP injection may serve as an effective and safe treatment for patients with AC.
Patient-reported outcome measures (PROMs) of leucocyte and platelet-rich fibrin (L-PRF) or hemostatic agent application at palatal donor sites after free gingival graft harvesting: a randomized controlled clinical trial
Gatti F, Iorio-Siciliano V, Scaramuzza E, Tallarico M, Vaia E, Ramaglia L, Chiapasco M
Quintessence international (Berlin, Germany : 1985). 2023;0(0):0
OBJECTIVE The aim of this study was to evaluate the patient's morbidity and post-surgical complications after treatment of palatal donor sites after free gingival graft (FGG) harvesting using Leucocyte-and Platelet Rich Fibrin (L-PRF) membranes or a hemostatic agent with oxidized and regenerated cellulose. METHODS AND MATERIALS Forty-two palatal donar sites after FGG haversting in 42 patients were randomly assigned to experimental (L-PRF membrane) or control procedure (hemostatic agent). The primary outcome was postoperative pain related to the wound located at palatal area, while the secondary outcomes were post-operative discomfort, inability to chew, post-operative stress, surgical chair time, thickness of palatal fibromucosa and thickness of FGG. The PROMs were recorded after one week. RESULTS After one week, a statistically significant difference was found between groups in terms of post operative stress (p=0.0083). No statistically significant differences in terms of postoperative pain (p=0.326), patient discomfort (p=0.509), inability to chew (p=0.936), surgical chair time (p=0.932) were recorded between test and control group. No statistically significant differences were recorded in terms of thickness of palatal fibromucosa (p=0.647) and thickness of FGG (P=0.756) between groups. Post-surgical wound healing complications (i.e., necrosis or infections) were not observed in both groups. CONCLUSION Within their limitations, the present outcomes indicated that the application of L-PRF membrane at palatal donor sites after FGG harvesting did not produce significant advantages for the patients.