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Stability of biomaterials used in adjunct to coronally advanced flap: A systematic review and network meta-analysis
Panda S, Khijmatgar S, Arbildo-Vega H, Das AC, Kumar M, Das M, Mancini L, Del Fabbro M
Clinical and experimental dental research. 2021
Abstract
AIM: The objective of this network meta-analysis was to rank different biomaterials used in adjunct to coronally advanced flap (CAF), based on their performance in root-coverage for Miller's Class I and II gingival recessions. MATERIALS AND METHODS An electronic database search was carried out in PUBMED, CENTRAL, SCOPUS, and EMBASE to identify the eligible articles and compiled into the citation manager to remove the duplicates. The primary outcome was keratinized gingival tissue width (KGW) and percentage of root coverage (%RC). The treatment effect of different biomaterials was estimated using predictive interval plots and ranked based on biomaterials performance, using multidimensional scale ranking. RESULTS CAF + connective tissue graft (CTG), CAF + platelet concentrate matrix (PCM) and acellular dermal matrix (ADM) ranked at the top positions in performance in improving KGW. The highest ranked materials in improving percentage of root coverage in gingival recession were CAF + collagen matrix (CM) + gingival fibroblasts (GF), CAF + ADM + platelet rich plasma (PRP) and CAF + ADM, as compared to CAF alone. CONCLUSION CTG, ADM, platelet concentrates, and CM + GFs, when used in adjunct to CAF, showed improved stability over ≥12 months of follow-up, better percentage of root coverage, and improved keratinized gingival width.
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2.
Comparative evaluation of bone regeneration with platelet-rich fibrin in mandibular third molar extraction socket: A randomized split-mouth study
Malhotra A, Kapur I, Das D, Sharma A, Gupta M, Kumar M
National journal of maxillofacial surgery. 2020;11(2):241-247
Abstract
PURPOSE Platelet-rich fibrin (PRF) is a new platelet concentrate concept consisting of an autologous fibrin gel having accumulation of platelets and the released cytokines in a fibrin clot. The study aims to evaluate the efficacy of autologous PRF in accelerating bone regeneration and repair in fresh third molar extraction sockets. The investigators hypothesized the cicatricial properties and accumulation of growth factors in a single clot which will improve bone density and quality. MATERIALS AND METHODS PRF results from a natural and progressive polymerization occurring during centrifugation. Two groups were made with bilaterally impacted third molar patients. PRF was obtained and surgical extraction was carried out under aseptic conditions. Quantitative data are presented as mean. Statistical significance was inferred at P < 0.05. RESULTS Results obtained were evaluated statistically and found a significant difference between the groups in improvement in alveolar bone density of regenerate measured radiographically. The study demonstrates a faster bone formation in the extracted sockets with PRF as compared to control. CONCLUSION PRF proved to be an autologous biomaterial with useful features that allowed efficient postextraction bone defect filling and faster bone regeneration.
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3.
Additive Effect of Platelet Rich Fibrin with Coronally Advanced Flap Procedure in Root Coverage of Miller's Class I and II Recession Defects-A PRISMA Compliant Systematic Review and Meta-Analysis
Panda S, Satpathy A, Chandra Das A, Kumar M, Mishra L, Gupta S, Srivastava G, Lukomska-Szymanska M, Taschieri S, Del Fabbro M
Materials (Basel, Switzerland). 2020;13(19)
Abstract
AIM: This systematic review and meta-analysis aims to assess the additive effect of leukocyte and platelet-rich fibrin (L-PRF) on coronally advanced flap (CAF) procedures in root coverage of Miller's class I and II gingival recession defects. Review methodology: A comprehensive search in MEDLINE (PubMed), Scopus and CENTRAL (the Cochrane Central Register of Controlled Trials), along with an additional hand search, provided eight randomized clinical trials to be included in this review. A total of 167 patients with 470 gingival recession defects were analyzed. A meta-analysis was carried out to assess the change in gingival thickness (GT), width of keratinized gingiva (WKG), root coverage percentage (%RC), clinical attachment level (CAL) and recession depth (RD) at all follow-ups between CAF alone and CAF + L-PRF groups for all included studies. A subgroup analysis was carried out based on recession type (single/multiple). RESULTS Overall, a significant improvement in GT, CAL and RD was found when treated with CAF + L-PRF. There was a trend for a positive effect in terms of an increase in WKG when using L-PRF, especially in the treatment of single recession, though significance was not achieved (p = 0.08 overall). The results of heterogeneity among the subgroups were varied and were found to be greater than 91.3% for GT and 32.8% for WKG. CONCLUSION L-PRF when used in addition to CAF showed favorable results for the treatment of class I and II gingival recession defects.
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4.
Plasma rich in growth factors (PRGF) in non-surgical periodontal therapy: a randomized clinical trial
Panda S, Purkayastha A, Mohanty R, Nayak R, Satpathy A, Das AC, Kumar M, Mohanty G, Panda S, Fabbro MD
Braz Oral Res. 2020;34:e034
Abstract
The aim of this split mouth, double blinded, randomized clinical trial was to evaluate the clinical efficacy of use of Plasma rich in growth factors (PRGF) as an adjunct to scaling and root planing (SRP) in the treatment of periodontal pockets. Twenty six patients (15 males, 11 females) diagnosed with generalized periodontitis with Pocket Depth > 5mm and plaque index score < 1.5, were randomly allocated by using computer generated random sequence, into two groups, one treated with intra-pocket application of PRGF adjunct to SRP and other with SRP alone. The clinical outcomes like pocket depth (PD), relative attachment level (RAL) and sulcus bleeding index (SBI) were assessed at baseline, 3 months and 6 months. Twenty two patients (44 sites) were analyzed at the end of 6 month follow-up, using SPSS 20.0v software. There was a significant statistical difference observed between both the groups favouring SRP +PRGF group in terms of PD (p = 0.007) and RAL (p = 0.021) at the end of 6 month follow-up. Also there was a statistical significant difference (< 0.001) at all time points compared to baseline, for all parameters in intra-group comparison. Moreover, the sites with PD>4mm necessitating further treatment after 6-month follow-up were significantly lesser for SRP+PRGF group. The use of PRGF technology in non-surgical periodontal therapy, by single intra-pocket application in to periodontal pockets as an adjunct to SRP, in chronic periodontitis patients, was found to be effective in reduction of pocket depth and gain in clinical attachment level.
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5.
Autologous Platelet Concentrates in Treatment of Furcation Defects-A Systematic Review and Meta-Analysis
Panda S, Karanxha L, Goker F, Satpathy A, Taschieri S, Francetti L, Das AC, Kumar M, Panda S, Fabbro MD
International journal of molecular sciences. 2019;20(6)
Abstract
BACKGROUND The aim of this review was to evaluate the adjunctive effect of autologous platelet concentrates (APCs) for the treatment of furcation defects, in terms of scientific quality of the clinical trials and regeneration parameters assessment. METHODS A systematic search was carried out in the electronic databases MEDLINE, SCOPUS, CENTRAL (Cochrane Central Register of Controlled Trials), and EMBASE, together with hand searching of relevant journals. Two independent reviewers screened the articles yielded in the initial search and retrieved the full-text version of potentially eligible studies. Relevant data and outcomes were extracted from the included studies. Risk of bias assessment was also carried out. The outcome variables, relative to baseline and post-operative defect characteristics (probing pocket depth (PPD), horizontal and vertical clinical attachment loss (HCAL, VCAL), horizontal and vertical furcation depth (HFD, VFD) were considered for meta-analysis. RESULTS Ten randomized trials were included in this review. Only one study was judged at high risk of bias, while seven had a low risk, testifying to the good level of the evidence of this review. The meta-analysis showed a favorable effect regarding all outcome variables, for APCs used in adjunct to open flap debridement (p < 0.001). Regarding APCs in adjunct to bone grafting, a significant advantage was found only for HCAL (p < 0.001, mean difference 0.74, 95% CI 0.54, 0.94). The sub-group analysis showed that both platelet-rich fibrin and platelet-rich plasma in adjunct with open flap debridement, yielded significantly favorable results. No meta-analysis was performed for APCs in combination with guided tissue regeneration (GTR) as only one study was found. CONCLUSION For the treatment of furcation defects APCs may be beneficial as an adjunct to open flap debridement alone and bone grafting, while limited evidence of an effect of APCs when used in combination with GTR was found.
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6.
Methodological quality assessment of systematic reviews on autologous platelet concentrates for the treatment of periodontal defects
Del Fabbro M, Lolato A, Panda S, Corbella S, Satpathy A, Das AC, Kumar M, Taschieri S
The Journal of Evidence-Based Dental Practice. 2017;17((3)):239-255.
Abstract
OBJECTIVES Evaluation of the methodological quality of systematic reviews (SRs) on the effectiveness of autologous platelet concentrates as an adjunct to regenerative procedures for the treatment of periodontal defects. MATERIAL AND METHODS After a literature screening, eligible SRs were qualitatively assessed using 2 validated instruments: A Measurement Tool to Assess systematic Reviews checklist and Overview Quality Assessment Questionnaire. The characteristics and findings of SRs were also reported. RESULTS Ten SRs fulfilled the inclusion criteria and were evaluated. With A MeaSurement Tool to Assess systematic Reviews tool, SRs displayed a generally satisfying quality. Six SRs satisfied ≥8 items of 11 (high-quality score), and 4 were classified of medium quality (score 4-7). Using Overview Quality Assessment Questionnaire instrument, more than half SRs (N = 6) satisfied ≥7 items of 9, resulting to be of high quality; 3 were classified as medium quality (4-6 criteria met); and only 1 of low quality (3 items satisfied). A significant correlation between the results of the 2 questionnaires was found (Spearman's r = 0.915, P = .0005). CONCLUSIONS SRs considered had an overall high methodological quality. However, some areas were not systematically addressed, like a thorough research strategy or publication bias assessment. Standard guidelines for designing, performing, and reporting SRs should always be followed. The use of platelet concentrates as an adjunct to periodontal surgery procedures may have beneficial effects for the treatment of periodontal defects.