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Effectiveness of Injectable Platelet-Rich Fibrin in the Treatment of Oral Lichen Planus: A Systematic Review and Meta-Analysis
Gupta, N., Bhargava, A., Saigal, S., Sharma, S., Patel, M., Prakash, O.
Cureus. 2024;16(1):e51626
Abstract
Oral lichen planus (OLP) is a chronic inflammatory condition affecting the oral mucosa. The current review investigated the potential effectiveness of injectable platelet-rich fibrin (i-PRF) as a treatment for OLP when compared to other interventions. The current review adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search strategy was implemented across databases such as PubMed, Embase, Scopus, Web of Science, CINAHL, and Google Scholar. The search utilized a combination of Boolean operators (AND, OR) and Medical Subject Headings (MeSH) terms to capture relevant studies. Comparative clinical studies focusing on i-PRF as a treatment for OLP and other interventions were included. Outcomes assessed were pain, surface area of lesions, and patient satisfaction. Review Manager 5.4 was used for statistical analysis. The Risk of Bias 2.0 (RoB 2.0) tool was used to assess the methodological quality of the studies. Three studies were included for the final analysis. The findings indicated that both the i-PRF and comparison treatment groups demonstrated reductions in pain and lesion size. The post-treatment Visual Analogue Scale (VAS) scores showed a decrease in pain intensity, and there was an improvement in lesion extension in the i-PRF-treated sites. The results also revealed increased patient satisfaction with i-PRF treatment. Adverse effects were not reported or specified in the included studies. Quantitative analysis for pain (VAS) showed a mean difference of 0.38 (95% CI: 0.63-1.40), but there was no significant difference between the i-PRF and control groups at p=0.46. Though intragroup differences showed statistically significant differences between pre and post intervention, intergroup differences were not significant for any of the assessed outcomes. The findings from this study suggest that i-PRF holds promise as a potential treatment for OLP. The use of i-PRF resulted in pain reduction, lesion size improvement, and increased patient satisfaction. However, it is important to consider the limitations of the included studies, such as variability in study designs, small sample sizes, and the limited number of studies.
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2.
Efficacy of Platelet-Rich Plasma Therapy in Oral Lichen Planus: A Systematic Review
Sriram S, Hasan S, Alqarni A, Alam T, Kaleem SM, Aziz S, Durrani HK, Ajmal M, Dawasaz AA, Saeed S
Medicina (Kaunas, Lithuania). 2023;59(4)
Abstract
Background and Objectives: Oral lichen planus (OLP) is an autoimmune, mucocutaneous, oral potentially malignant disorder (OPMD), which characteristically manifests with chronic, recalcitrant lesions, with frequent flare-ups and remissions. The precise etiopathogenesis of OLP is still debatable, although it is believed to be a T-cell-mediated disorder of an unidentified antigen. Despite the availability of various treatments, no cure for OLP exists due to its recalcitrant nature and idiopathic etiology. Platelet-rich plasma (PRP) has antioxidant, anti-inflammatory, and immunomodulatory properties, in addition to its regulatory action on keratinocyte differentiation and proliferation. These salient properties substantiate the possible role of PRP in the treatment of OLP. Our systematic review focuses on assessing the therapeutic potential of PRP as a treatment modality in OLP. Materials and Methods: We conducted a detailed literature search for studies assessing PRP as a therapeutic regimen in OLP, using the Google Scholar and PubMed/MEDLINE search engines. The search was limited to studies published from January 2000 to January 2023 and included a combination of Medical Subject Heading (MeSH) terms. ROBVIS analysis was carried out for the assessment of publication bias. Descriptive statistics were performed using Microsoft Excel. Results: This systematic review included five articles that met the inclusion criteria. Most of the included studies demonstrated that PRP treatment considerably ameliorated both objective and subjective symptoms in OLP subjects, with comparable efficacy to the standard corticosteroid treatment. Further, PRP therapy offers the added benefit of minimal adverse effects and recurrences. Conclusion: This systematic review suggests that PRP has significant therapeutic potential for treating OLP. However, further research with larger sample sizes is imperative to corroborate these findings.
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3.
Effect of platelet concentrates for pain and symptom management in oral lichen planus: an evidence-based systematic review
Zhang, Y., Mao, C., Zhu, J., Yu, W., Wang, Z., Wang, Y., Kan, Q.
BMC oral health. 2023;23(1):594
Abstract
BACKGROUND Platelet Concentrate (PC) injection therapy has shown potential as a local therapy for oral lichen planus (OLP). However, its safety and efficacy have not yet been fully established. Our research compared the efficacy of PC with topical steroid treatment in alleviating pain and symptoms related to OLP. We aims to present evidence-based alternatives that dentists can use to improve patient outcomes while reducing potential side effects. METHODS We conducted a systematic search of five electronic databases up to April 2023, including Embase, Cochrane Central Register of Controlled Trials, PubMed, OVID Medline, and WanFang, to evaluate PCs' efficacy compared to topical corticosteroid therapy for OLP. The literature quality was assessed using the Cochrane ROB tool. A fixed-effects model was used to determine the Weighted Mean Difference (WMD) and Mean Difference (MD) at a 95% confidence interval (CI) for pain severity and other relevant clinical indicators. RESULTS The comparison between topical corticosteroid therapy and PCs showed no significant difference for pain relief (WMD = -0.07, CI = 95% -0.34 to 0.19), symptom improvement (MD = -0.21, CI = 95% -0.55 to 0.13), or the severity of included lesions measured by REU scores (MD = -0.25, CI = 95% -0.32 to 0.82). CONCLUSIONS Locally injected PC have been found efficient in managing oral lichen planus, indicating that they are a promising alternative option to steroid therapy for OLP patients, particularly those who have not responded favorably to steroid therapy. However, further research is needed to establish determining the recurrence rate and long-term adverse effects. TRIAL REGISTRATION The systematic review protocol has been registered in advance with the PROSPERO database (CRD42023415372).
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4.
Platelet-rich plasma protein as a therapeutic regimen for oral lichen planus: An evidence-based systematic review
Maddheshiya, N., Srivastava, A., Rastogi, V., Shekhar, A., Sah, N., Kumar, A.
National journal of maxillofacial surgery. 2023;14(1):22-26
Abstract
Oral Lichen Planus (OLP), an autoimmune disorder of unclear pathogenesis affects quality of life of affected individual. Intervention regimens are multiple and still evolving due to its resistance to recover and ability to recur. Platelet rich Plasma (PRP) is a newer, promising treatment modality tested by researchers because of its low cost and negligible adverse effects. Articles were retrieved from search engines of PubMed / Medline, Scopus and Web of Science which fulfilled the eligibility criteria. Cochrane risk of bias tool assessed quality of clinical studies and Joanna Briggs Institute for case reports. A total of 4 articles were included for the systematic review, of which 2 are clinical trials and 2 case reports. All cases were of erosive nature. PRP in case reports were administered when patients did not respond to conventional therapy. PRP demonstrated effective therapeutic benefit in regards to outcome of pain and lesion appearance. PRP can be considered as a potential alternative therapy in treating non-responsive OLP. Further studies are recommended to arrive at a definitive conclusion.
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5.
Efficacy and Safety of Platelet-Rich Plasma for Patients with Diabetic Ulcers: A Systematic Review and Meta-analysis
Hu, Z., Qu, S., Zhang, J., Cao, X., Wang, P., Huang, S., Shi, F., Dong, Y., Wu, J., Tang, B., et al
Advances in Wound Care. 2019;8(7):298-308
Abstract
Significance: Autologous platelet-rich plasma (PRP) has been suggested to be effective for wound healing. However, clinical evidence for its use in patients with diabetic ulcer remains inconsistent. The aim of this systematic review and meta-analysis was to evaluate the efficacy and safety of PRP in patients with diabetic ulcer. Recent Advances: Relevant randomized controlled trials (RCTs) were identified via systematic search of PubMed, MEDLINE, EMBASE, the Cochrane Library, and Web of Knowledge databases. Results were pooled using a random-effects model. The primary outcome of the study was the healing rate of ulcers in patients with PRP, when compared with controls. Secondary outcomes included the percentage of ulcer area reduction, recurrence rate, and amputation rate. Critical Issues: Eight RCTs that involved 431 participants were included. Compared with controls, PRP was associated with a significantly increased ratio of complete ulcer healing (odds ratio [OR] = 3.77, 95% confidence interval [CI] = 1.91-7.45, I(2) (=) 42.2%) and reduced areas of ulcers (standard mean difference = 0.86, 95% CI = 0.27-1.45, I(2) (=) 0.0%). No differences were observed between patients allocated to PRP or controls, in terms of the outcomes of recurrence rate (OR = 3.32, 95% CI = 0.41-27.18, I(2) (=) 66.3%) or amputation rate (OR = 0.15, 95% CI = 0.15-1.28). The results of the trial sequence analyses revealed that the cumulative Z-curve crossed both the traditional boundary (p = 0.05) and trial sequential monitoring boundary. Future Directions: Our findings suggest that PRP may improve ulcer healing without significant adverse effects for patients with diabetic ulcers.
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6.
Topical application of platelet-rich plasma for diabetic foot ulcers: A systematic review
Hirase T, Ruff E, Surani S, Ratnani I
World Journal of Diabetes. 2018;9((10)):172-179.
Abstract
AIM: To determine if topical application of platelet-rich plasma (PRP) to diabetic foot ulcers (DFUs) results in superior healing rates. METHODS A systematic review was registered with PROSPERO and performed using PRISMA guidelines. Level I-IV investigations of topical PRP application in DFUs were sought in multiple databases including: MEDLINE, Web of Science, and Cochrane Central Register of Controlled Trials. The search terms used were "platelet rich plasma", "diabetes", "ulcers", and "wound". The Modified Coleman Methodology Score (MCMS) was used to analyze study methodological quality. Study heterogeneity and a mostly non-comparative nature of evidence precluded meta-analysis. Only the outcome measurements used by more than 50% of the studies were included in the data synthesis to increase power of the measurement over that of individual studies. A weighted mean of healing rate per week between PRP group vs controls were compared using two-sample z-tests using P-value of less than 0.05 for significance. RESULTS One thousand two hundred and seventeen articles were screened. Eleven articles (322 PRP subjects, 126 controls, PRP subject mean age 58.4 +/- 7.2 years, control mean age 58.7 +/- 5.9 years) were analyzed. Six articles were level II evidence, four were level III, and one article was level IV. The mean MCMS was 61.8 +/- 7.3. Healing rate was significantly faster with PRP application compared to controls (0.68 +/- 0.56 cm(2)/wk vs 0.39 +/- 0.09 cm(2)/wk; P < 0.001). Mean heal time to > 90% of the original ulcer area was 7.8 +/- 2.7 wk and 8.3 +/- 3.7 wk for patients in the PRP group and control groups, respectively (P = 0.115). There were significantly lower adverse effects reported with PRP application compared to controls (7 wound infections, 1 contact dermatitis vs 14 wound infections, 1 maceration; P < 0.001). CONCLUSION The topical application of PRP for DFUs results in statistically superior healing rates and lower complication rates compared to controls.