Regenerative potential of leucocyte- and platelet-rich fibrin. Part A: intra-bony defects, furcation defects and periodontal plastic surgery. A systematic review and meta-analysis

Ana B Castro, Nastaran Meschi, Andy Temmerman, Nelson Pinto, Paul Lambrechts, Wim Teughels, Marc Quirynen, Ana B Castro, Nastaran Meschi, Andy Temmerman, Nelson Pinto, Paul Lambrechts, Wim Teughels, Marc Quirynen

Abstract

Aim: To analyse the regenerative potential of leucocyte- and platelet-rich fibrin (L-PRF) during periodontal surgery.

Materials and methods: An electronic and hand search were conducted in three databases. Only randomized clinical trials were selected and no follow-up limitation was applied. Pocket depth (PD), clinical attachment level (CAL), bone fill, keratinized tissue width (KTW), recession reduction and root coverage (%) were considered as outcome. When possible, meta-analysis was performed.

Results: Twenty-four articles fulfilled the inclusion and exclusion criteria. Three subgroups were created: intra-bony defects (IBDs), furcation defects and periodontal plastic surgery. Meta-analysis was performed in all the subgroups. Significant PD reduction (1.1 ± 0.5 mm, p < 0.001), CAL gain (1.2 ± 0.6 mm, p < 0.001) and bone fill (1.7 ± 0.7 mm, p < 0.001) were found when comparing L-PRF to open flap debridement (OFD) in IBDs. For furcation defects, significant PD reduction (1.9 ± 1.5 mm, p = 0.01), CAL gain (1.3 ± 0.4 mm, p < 0.001) and bone fill (1.5 ± 0.3 mm, p < 0.001) were reported when comparing L-PRF to OFD. When L-PRF was compared to a connective tissue graft, similar outcomes were recorded for PD reduction (0.2 ± 0.3 mm, p > 0.05), CAL gain (0.2 ± 0.5 mm, p > 0.05), KTW (0.3 ± 0.4 mm, p > 0.05) and recession reduction (0.2 ± 0.3 mm, p > 0.05).

Conclusions: L-PRF enhances periodontal wound healing.

Keywords: bone regeneration; gingival recession; intra-bony defects; leucocyte-platelet-rich fibrin; open flap debridement; platelet-rich fibrin; tissue regeneration.

© 2016 The Authors. Journal of Clinical Periodontology Published by John Wiley & Sons Ltd.

Figures

Figure 1
Figure 1
Differences among PCs preparation. (a) platelet‐rich plasma (PRP): after the first centrifugation, the platelet‐poor plasma, the “yellow” part called buffy coat and a few red blood cells are carefully collected (pipetting) and centrifuged again in order to obtain the PRP (Dohan et al. 2006a,b,c); (b) PRGF: after centrifugation, the blood is divided in five layers; by pipetting, the undesired parts are discarded; the most concentrated part with growth factors (PRGF) is collected (Anitua, 2001); (c) PRF: after centrifugation, a fibrin clot is obtained in the middle of the tube, which is ready to be used (Dohan et al. 2006a).
Figure 2
Figure 2
PRISMA flow diagram.
Figure 3
Figure 3
Forest plot comparing OFD versusOFD + L‐PRF in the treatment of intra‐bony defects (IBDs) and furcation defects.: ▲ different follow‐up from the rest of the studies included. *: study with split‐mouth design. (a) Forest plot comparing OFD versusOFD + L‐PRF in the treatment of IBDs, PD reduction (mm). (b) Forest plot comparing OFD versusOFD + L‐PRF in the treatment of IBDs, CAL gain (mm). (c) Forest plot comparing OFD versusOFD + L‐PRF in the treatment of IBDs, bone fill (mm). (d) Forest plot comparing OFD versusOFD + L‐PRF in the treatment of furcation defects, CAL gain (mm). (e) Forest plot comparing OFD versusOFD + L‐PRF in the treatment of furcation defects, bone fill (mm). CAL, clinical attachment level; OFD, open flap debridement; PD, Pocket depth.
Figure 4
Figure 4
Forest plot comparing CAF + L‐PRF versusCAF and CAF + L‐PRF versusCAF + CTG in periodontal plastic surgery. *: study with split‐mouth design. (a) Forest plot comparing CAF versusCAF + L‐PRF in periodontal plastic surgery, recession reduction (mm). (b) Forest plot comparing CAF versusCAF + L‐PRF in periodontal plastic surgery, root coverage 6 months (%). (c) Forest plot comparing CAF + CTG versusCAF + L‐PRF in periodontal plastic surgery, recession reduction (mm). CAF, Coronally advanced flap; CTG, connective tissue graft.

References

    1. Agarwal, A. , Gupta, N. D. & Jain, A. (2016) Platelet rich fibrin combined with decalcified freeze‐dried bone allograft for the treatment of human intrabony periodontal defects: a randomized split mouth clinical trail. Acta Odontologica Scandinavica 74, 36–43.
    1. Agarwal, K. , Chandra, C. , Agarwal, K. & Kumar, N. (2013) Lateral sliding bridge flap technique along with platelet rich fibrin and guided tissue regeneration for root coverage. Journal of Indian Society of Periodontology 17, 801–805.
    1. Ajwani, H. , Shetty, S. , Gopalakrishnan, D. , Katharira, R. , Kulloli, A. , Dolas, R. S. & Pradeep, A. R. (2015) Comparative evaluation of platelet‐rich fibrin biomaterial and open flap debridement in the treatment of two and three wall intrabony defects. Journal of International Oral Health 7, 32–37.
    1. Anilkumar, K. , Geetha, A. , Umasudhakar, Ramakrishnan, T. , Vijayalakshmi, R. & Pameela, E. (2009) Platelet‐rich‐fibrin: a novel root coverage approach. Journal of Indian Society of Periodontology, 13, 50–54.
    1. Anitua, E. (2001) The use of plasma‐rich growth factors (PRGF) in oral surgery. Practical procedures & aesthetic dentistry 16, 487–493.
    1. Armilli, S. , Damratoski, B. E. , Bombick, B. , Borgerding, M. F. & Prasad, G. L. (2012) Evaluation of cytotoxicity of different tobacco product preparation. Regulatory Toxicology and Pharmacology 64, 350–360.
    1. Aroca, S. , Keglevich, T. , Barbieri, B. , Gera, I. & Etienne, D. (2009) Clinical evaluation of a modified coronally advanced flap alone or in combination with a platelet‐rich fibrin membrane for the treatment of adjacent multiple gingival recessions: a 6‐month study. Journal of Periodontology 80, 244–252.
    1. Bajaj, P. , Pradeep, A. R. , Agarwal, E. , Rao, N. S. , Naik, S. B. , Priyanka, N. & Kalra, N. (2013) Comparative evaluation of autologous platelet‐rich fibrin and platelet‐rich plasma in the treatment of mandibular degree II furcation defects: a randomized controlled clinical trial. Journal of Periodontal Research 48, 573–581.
    1. Bansal, C. & Bharti, V. (2013) Evaluation of efficacy of autologous platelet‐rich fibrin with demineralized‐freeze dried bone allograft in the treatment of periodontal intrabony defects. Journal of Indian Society of Periodontology 17, 361–366.
    1. Burnouf, T. , Goubran, H. A. , Chen, T. & Ou, K. (2013) Blood‐derived biomaterials and platelet growth factors in regenerative medicine. Blood Reviews 27, 77–89.
    1. Cairo, F. , Pagliaro, U. & Nieri, M. (2008) Treatment of gingival recession with coronally advanced flap procedures: a systematic review. Journal of Clinical Periodontology 35 (Suppl. 8), 136–162.
    1. Chambrone, L. , Chambrone, D. , Pustiglioni, F. E. , Chambrone, L. A. & Lima, L. A. (2009) The influence of tobacco smoking to the outcome achieved by root‐coverage procedures: a systematic review. Journal of the American Dental Association 140, 294–306.
    1. Choukroun, J. (2001) Une opportunité en paro‐implantologie: le PRF. Implantodontie, 42, 55–62. French.
    1. De Sanctis, M. & Clementini, M. (2014) Flap approaches in plastic periodontal and implant surgery: critical elements in design and execution. Journal of Clinical Periodontology 41 (Suppl. 15), S108–S122.
    1. Dohan, D. M. , Andia, I. , Zumstein, M. A. , Zhang, C. Q. , Pinto, N. R. & Bielecki, T. (2014a) Classification of platelet concentrates (Platelet‐Rich Plasma‐PRP, Platelet‐Rich Fibrin‐PRF) for topical and infiltrative use in orthopedic and sports medicine: current consensus, clinical implications and perspectives. Muscles Ligaments Tendons Journal 4, 3–9.
    1. Dohan, D. M. , Choukroun, J. , Diss, A. , Dohan, S. L. , Dohan, A. J. , Mouhyi, J. & Gigly, B. (2006a) Platelet‐rich fibrin (PRF): a second‐generation platelet concentrate. Part I: Technological concepts and evolution. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics 101, E37–E44.
    1. Dohan, D. M. , Choukroun, J. , Diss, A. , Dohan, S. L. , Dohan, A. J. , Mouhyi, J. & Gogly, B. (2006b) Platelet‐rich fibrin (PRF): a second‐generation platelet concentrate. Part II: platelet‐related biologic features. Oral Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontics 101, e45–e50.
    1. Dohan, D. M. , Choukroun, J. , Diss, A. , Dohan, S. L. , Dohan, A. J. , Mouhyi, J. & Gogly, B. (2006c) Platelet‐rich fibrin (PRF): a second‐generation platelet concentrate. Part III: Leucocyte activation: a new feature for platelet concentrates? Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics 101, E51–E55.
    1. Dohan, D. M. , Del Corso, M. , Diss, A. , Mouhyi, J. & Charrier, J. B. (2010) Three‐dimensional architecture and cell composition of a Choukroun's platelet‐rich fibrin clot and membrane. Journal of Periodontology 81, 546–555.
    1. Elgendy, E. A. & Abo Shady, T. E. (2015) Clinical and radiographic evaluation of nanocrystalline hydroxyapatite with or without platelet‐rich fibrin membrane in the treatment of periodontal intrabony defects. Journal of Indian Society of Periodontology 19, 61–65.
    1. Eren, G. & Atilla, G. (2014) Platelet‐rich fibrin in the treatment of localized gingival recessions: a split‐mouth randomized clinical trial. Clinical Oral Investigations 18, 1941–1948.
    1. Gupta, S. , Banthia, R. , Singh, P. , Banthia, P. , Raje, S. & Aggarwal, N. (2015) Clinical evaluation and comparison of the efficacy of coronally advanced flap alone and in combination with platelet rich fibrin membrane in the treatment of Miller Class I and II gingival recessions. Contemporary Clinical Dentistry 6, 153–160.
    1. Gupta, S. J. , Jhingran, R. , Gupta, V. , Bains, V. K. , Madan, R. & Rizvi, I. (2014) Efficacy of platelet‐rich fibrin vs. enamel matrix derivative in the treatment of periodontal intrabony defects: a clinical and cone beam computed tomography study. Journal of International Academy of Periodontology 16, 86–96.
    1. Jankovic, S. , Aleksic, Z. , Klokkevold, P. , Lekovic, V. , Dimitrijevic, B. , Kenney, E. B. & Camargo, P. (2012) Use of platelet‐rich fibrin membrane following treatment of gingival recession: a randomized clinical trial. International Journal of Periodontics and Restorative Dentistry 32, e41–e50.
    1. Jankovic, S. , Aleksic, Z. , Milinkovic, I. & Dimitrijevic, B. (2010) The coronally advanced flap in combination with platelet‐rich fibrin (PRF) and enamel matrix derivative in the treatment of gingival recession: a comparative study. European Journal of Esthetic Dentistry 5, 260–273.
    1. Keceli, H. G. , Kamak, G. , Erdemir, E. O. , Evqiner, M. S. & Dolgun, A. (2015) The adjunctive effect of Platelet‐Rich Fibrin to Connective Tissue Graft in the treatment of buccal recession defects: results of a randomized, parallel‐group controlled trial. Journal of Periodontology 86, 1221‐1230.
    1. Khorshidi, H. , Raoofi, S. , Bagheri, R. & Banihashemi, H. (2016) Comparison of the mechanical properties of early leukocyte‐ and platelet‐rich fibrin versus PRGF/endoret membranes. International Journal of Dentistry, 1849207. Published online 2016 Jan 6. doi: .
    1. Lekovic, V. , Milinkovic, I. , Aleksic, Z. , Jankovic, S. , Stankovic, P. , Kenney, E. B. & Camargo, P. M. (2012) Platelet‐rich fibrin and bovine porous bone mineral vs. platelet‐rich fibrin in the treatment of intrabony periodontal defects. Journal of Periodontal Research 47, 409–417.
    1. Marx, R. E. (2001) Platelet‐rich plasma (PRP): what is PRP and what is not PRP? Implant Dentistry 10, 225–228.
    1. Marx, R. E. , Carlson, E. R. , Eichstaedt, R. M. , Schimmele, S. R. , Strauss, J. E. & Georgeff, K. R. (1998) Platelet‐rich plasma: growth factor enhancement for bone grafts. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics, 85, 638–646.
    1. Mathur, A. , Bains, V. K. , Gupta, V. , Jhingran, R. & Singh, G. P. (2015) Evaluation of intrabony defects treated with platelet‐rich fibrin or autogenous bone graft: a comparative analysis. European Journal of Dentistry 9, 100–108.
    1. Matras, H. (1970) Effect of various fibrin preparations on reimplantations in the rat skin. Österreichische Zeitschrift für Stomatologie 67, 338–359.
    1. Moher, D. , Liberati, A. , Tetzlaff, J. & Altman, D. G. (2009) Preferred reporting items for systematic reviews and meta‐analyses: the PRISMA statement. PLoS Medicine 6, 1–6.
    1. Padma, R. , Shilpa, A. , Kumar, P. A. , Nagasri, M. , Kumar, C. & Sreedhar, A. (2013) A split mouth randomized controlled study to evaluate the adjunctive effect of platelet‐rich fibrin to coronally advanced flap in Miller's class‐I and II recession defects. Journal of Indian Society of Periodontology 17, 631–636.
    1. Pradeep, A. R. , Nagpal, K. , Karvekar, S. , Patnaik, K. , Naik, S. B. & Guruprasad, C. N. (2015) Platelet rich fibrin with 1% metformin for the treatment of intrabony defects in chronic periodontitis: a randomized controlled clinical trial. Journal of Periodontology 86, 632–641.
    1. Pradeep, A. R. , Rao, N. S. , Agarwal, E. , Bajaj, P. , Kumari, M. & Naik, S. B. (2012) Comparative evaluation of autologous platelet‐rich fibrin and platelet‐rich plasma in the treatment of 3‐wall intrabony defects in chronic periodontitis: a randomized controlled clinical trial. Journal of Periodontology 83, 1499–1507.
    1. PRISMA statement . Preferred Reporting Items for Systematic Reviews and Meta‐Analyses. Available at: (accessed 04 augustus 2015).
    1. Rock, L. (2013) Potential of platelet rich fibrin in regenerative periodontal therapy: literature review. The Canadian Journal of Dental Hygiene 47, 33–37.
    1. Rosamma, V. , Raghunath, A. & Sharma, N. (2012) Clinical effectiveness of autologous platelet rich fibrin in the management of infrabony periodontal defects. Singapore Dental Journal 33, 5–12.
    1. Rowe, S. L. , Lee, S. Y. & Stegemann, J. P. (2007) Influence of thrombin concentration on the mechanical and morphological properties of cell‐seeded fibrin hydrogels. Acta Biomaterialia 3, 59–67.
    1. Shah, M. , Deshpande, N. , Bharwani, A. , Nadig, P. , Doshi, V. & Dave, D. (2014) Effectiveness of autologous platelet‐rich fibrin in the treatment of intra‐bony defects: a systematic review and meta‐analysis. Journal of Indian Society of Periodontology 18, 698–704.
    1. Shah, M. , Patel, J. , Dave, D. & Shah, S. (2015) Comparative evaluation of platelet‐rich fibrin with demineralized freeze‐dried bone allograft in periodontal infrabony defects: a randomized controlled clinical study. Journal of Indian Society of Periodontology 19, 56–60.
    1. Sharma, A. & Pradeep, A. R. (2011a) Autologous platelet‐rich fibrin in the treatment of mandibular degree II furcation defects: a randomized clinical trial. Journal of Periodontology 82, 1396–1403.
    1. Sharma, A. & Pradeep, A. R. (2011b) Treatment of 3‐wall intrabony defects in patients with chronic periodontitis with autologous platelet‐rich fibrin: a randomized controlled clinical trial. Journal of Periodontology 82, 1705–1712.
    1. Singh, J. & Bharti, V. (2013) Laterally positioned flap‐revised technique along with platelet rich fibrin in the management of Miller class II gingival recession. Dental Research Journal 10, 268–273.
    1. Thamaraiselvan, M. , Elavarasu, S. , Thangakumaran, S. , Gadagi, J. S. & Arthie, T. (2015) Comparative clinical evaluation of coronally advanced flap with or without platelet rich fibrin membrane in the treatment of isolated gingival recession. Journal of Indian Society of Periodontology 19, 66–71.
    1. Thorat, M. , Pradeep, A. R. & Pallavi, B. (2011) Clinical effect of autologous platelet‐rich fibrin in the treatment of intra‐bony defects: a controlled clinical trial. Journal of Clinical Periodontology 38, 925–932.
    1. Tunali, M. , Ozdemir, H. , Arabaciota, T. , Gürbüzer, B. , Pikdoken, L. & Firatli, E. (2015) Clinical evaluation of autologous platelet‐rich fibrin in the treatment of multiple adjacent gingival recession defects: a 12‐month study. International Journal of Periodontics and Restorative Dentistry 35, 105–114.
    1. Yang, L. C. , Hu, S. W. , Yan, M. , Yang, J. J. , Tsou, S. H. & Lin, Y. Y. (2015) Antimicrobial activity of plasma‐rich plasma and other plasma preparations against periodontal pathogens. Journal of Periodontology 86, 310–318.

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