The Additional Effect of Autologous Platelet Concentrates to Coronally Advanced Flap in the Treatment of Gingival Recessions: A Systematic Review and Meta-Analysis

Rong Li, Yanqing Liu, Tong Xu, Haijiao Zhao, Jingya Hou, Yun Wu, Dongmei Zhang, Rong Li, Yanqing Liu, Tong Xu, Haijiao Zhao, Jingya Hou, Yun Wu, Dongmei Zhang

Abstract

Background: To improve the efficacy of regenerative treatment for gingival recessions, the autologous platelet concentrates (APCs) combined with coronally advanced flap (CAF) have been investigated. However, few studies systematically assess the complementary effect of APCs in periodontal regeneration. The present study aims to evaluate the additional effect of different types of APCs to CAF in the treatment of gingival recessions.

Methods: Electronic databases (EMBASE, MEDLINE, and Cochrane Central Register of Controlled Trails) and relevant journals were searched until May 15, 2019. Only randomized controlled trials (RCTs) in English were included. Outcome variables include root coverage (RC), recession depth (RD), clinical attachment level (CAL), keratinized tissue width (KTW), and gingival thickness (GT). Data were analyzed with Revman5.3. The estimate of effect sizes was expressed as the mean differences and the 95% confidence interval.

Results: 8 RCTs involving 170 patients (328 sites) were included. Our meta-analysis indicated RC, RD, CAL, KTW, and GT were better improved in the CAF plus APCs groups than the CAF alone. The subgroup analyses revealed that platelet-rich fibrin (PRF) brought significant improvement in RC, RD, CAL, and GT. Concentrated growth factors (CGF) lead clinic beneficial in CAL, KTW, and GT. No significant effect of platelet-rich plasma (PRP) could be found in any clinical parameters when combined with CAF.

Conclusions: PRF could exert additional effect to CAF; the preferred treatment for gingival recessions was considered. Based on the limited studies, it seemed that PRP failed to show any additional effect and it was not suggested for gingival recessions. Given the limited research and high risk of bias, it is still needed to confirm the additional effect of CGF by more high-quality studies.

Conflict of interest statement

The authors declare that there are no conflicts of interest.

Figures

Figure 1
Figure 1
PRISMA flow diagram illustrating the selection process.
Figure 2
Figure 2
Risk of bias summary of the included studies.
Figure 3
Figure 3
Forest plots for RC change (a), RD reduction (b), CAL gain (c), KTW gain (d), and GT gain (e).
Figure 4
Figure 4
Sensitivity analysis was applied by comparing CAF+PRP/PRF/CGF with CAF alone. (a) RC change; (b) RD reduction; (c) CAL gain; (d) KTW gain; (e) GT gain.
Figure 5
Figure 5
Publication bias of RC change was applied by comparing CAF+PRP/PRF/CGF with CAF alone. (a) Egger's linear regression; (b) Begg's funnel plot.
Figure 6
Figure 6
Publication bias of RD reduction was applied by comparing CAF+PRP/PRF/CGF with CAF alone. (a) Egger's linear regression; (b) Begg's funnel plot.
Figure 7
Figure 7
Publication bias of CAL gain was applied by comparing CAF+PRP/PRF/CGF with CAF alone. (a) Egger's linear regression; (b) Begg's funnel plot.
Figure 8
Figure 8
Publication bias of KTW gain was applied by comparing CAF+PRP/PRF/CGF with CAF alone. (a) Egger's linear regression; (b) Begg's funnel plot.
Figure 9
Figure 9
Publication bias of GT gain was applied by comparing CAF+PRP/PRF/CGF with CAF alone. (a) Egger's linear regression; (b) Begg's funnel plot.

References

    1. George S. G., Kanakamedala A. K., Mahendra J., Kareem N., Mahendra L., Jerry J. J. Treatment of gingival recession using a coronally-advanced flap procedure with or without placental membrane. Journal of Investigative and Clinical Dentistry. 2018;9(3):p. 2340. doi: 10.1111/jicd.12340.
    1. Zucchelli G., Stefanini M., Ganz S, et al. Coronally advanced flap with different designs in the treatment of gingival recessions: A Comparative controlled randomized clinical trial. International Journal of Periodontics & Restorative Dentistry. 2016;36(3):319–327.
    1. Santamaria M. P., Queiroz L. A., Mathias I. F., et al. Resin composite plus connective tissue graft to treat single maxillary gingival recession associated with non-carious cervical lesion: Randomized clinical trial. Journal of Clinical Periodontology. 2016;43(5):461–468. doi: 10.1111/jcpe.12524.
    1. Henriques P. S. G., Nunes M. P., Pelegrine A. A. Treatment of gingival recession in two surgical stages: Free gingival graft and connective tissue grafting. General dentistry. 2011;59(6):e238–e241.
    1. Rehan M., Khatri M., Bansal M., Puri K., Kumar A. Comparative evaluation of coronally advanced flap using amniotic membrane and platelet-rich fibrin membrane in gingival recession: An 18-month clinical study. Contemporary Clinical Dentistry. 2018;9(2):188–194. doi: 10.4103/ccd.ccd_799_17.
    1. McGuire M. K., Cochran D. L. Evaluation of human recession defects treated with coronally advanced flaps and either enamel matrix derivative or connective tissue. Part 2: histological evaluation. Journal of Periodontology. 2003;74(8):1126–1135. doi: 10.1902/jop.2003.74.8.1126.
    1. Castro A. B., Meschi N., Temmerman A., et al. 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. Journal of Clinical Periodontology. 2017;44(1):67–82. doi: 10.1111/jcpe.12643.
    1. Schär M. O., Diaz-Romero J., Kohl S., Zumstein M. A., Nesic D. Platelet-rich concentrates differentially release growth factors and induce cell migration in vitro. Clinical Orthopaedics and Related Research. 2015;473(5):1635–1643. doi: 10.1007/s11999-015-4192-2.
    1. Al-Azem R., Ali N., Mostafa D. The effectiveness of platelet concentrations in periodontal surgeries. International Journal of Dental Research. 2018;6(2):61–65. doi: 10.14419/ijdr.v6i2.12414.
    1. Choukroun J., Adda F., Schoeffler C., et al. The opportunity in period-implantology: The PRF. Implantodontie. 2001;42:55–62.
    1. Park H., Kim S., Oh J., et al. Early Bone Formation at a Femur Defect Using CGF and PRF Grafts in Adult Dogs. Implant Dentistry. 2016;25(3):387–393. doi: 10.1097/ID.0000000000000423.
    1. Bernardi S., Mummolo S., Tecco S., Continenza M. A., Marzo G. Histological characterization of Sacco’s concentrated growth factors membrane. International Journal of Morphology. 2017;35(1):114–119. doi: 10.4067/S0717-95022017000100019.
    1. Rodella L. F., Favero G., Boninsegna R., et al. Growth factors, CD34 positive cells, and fibrin network analysis in concentrated growth factors fraction. Microscopy Research and Technique. 2011;74(8):772–777. doi: 10.1002/jemt.20968.
    1. Luo H., Li R., Wang C., Peng L., Ye L. The adjunctive use of platelet concentrates in the therapy of gingival recessions: a systematic review and meta-analysis. Journal of Oral Rehabilitation. 2015;42(7):552–561. doi: 10.1111/joor.12278.
    1. del Fabbro M., Bortolin M., Taschieri S., Weinstein R. Is platelet concentrate advantageous for the surgical treatment of periodontal diseases? A systematic review and meta-analysis. Journal of Periodontology. 2011;82(8):1100–1111. doi: 10.1902/jop.2010.100605.
    1. Moraschini V., Dos Santos Porto Barboza E. Use of platelet-rich fibrin membrane in the treatment of gingival recession: A systematic review and meta-analysis. Journal of Periodontology. 2016;87(3):281–290. doi: 10.1902/jop.2015.150420.
    1. Shamseer L., Moher D., Clarke M., et al. Preferred reporting items for systematic review and meta-analysis protocols (prisma-p) 2015: Elaboration and explanation. British Medical Journal. 2015;349 doi: 10.1136/bmj.g7647.g7647
    1. O'Leary T. J., Drake R. B., Naylor J. E. The plaque control record. Journal of Periodontology. 1972;43(1):38–39. doi: 10.1902/jop.1972.43.1.38.
    1. Keceli H. G., Sengun D., Berberoğlu A., Karabulut E. Use of platelet gel with connective tissue grafts for root coverage: a randomized-controlled trial. Journal of Clinical Periodontology. 2008;35(3):255–262. doi: 10.1111/j.1600-051X.2007.01181.x.
    1. Higgins J., Green S. Cochrane Handbook for Systematic Reviews of Interventions: Cochrane Book Series. 2008.
    1. Tsesis I., Rosen E., Taschieri S., Telishevsky Strauss Y., Ceresoli V., Del Fabbro M. Outcomes of surgical endodontic treatment performed by a modern technique: an updated meta-analysis of the literature. Journal of Endodontics. 2013;39(3):332–339. doi: 10.1016/j.joen.2012.11.044.
    1. Petrungaro P. S. Using platelet-rich plasma to accelerate soft tissue maturation in esthetic periodontal surgery. Compendium of Continuing Education in Dentistry. 2001;22(9):729–732.
    1. Saadoun A. P. Current trends in gingival recession coverage--Part II: Enamel matrix derivative and platelet-rich plasma. Practical procedures & aesthetic dentistry : PPAD. 2006;18(8):521–528.
    1. Naik A. R., Ramesh A. V., Dwarkanath C. D., Naik M. S., Chinnappa A. B. Use of autologous platelet rich plasma to treat gingival recession in esthetic periodontal surgery. Journal of Indian Society of Periodontology. 2013;17(3):345–353. doi: 10.4103/0972-124x.115665.
    1. Huang L., Neiva R. E., Soehren S. E., Giannobile W. V., Wang H. The effect of platelet-rich plasma on the coronally advanced flap root coverage procedure: a pilot human trial. Journal of Periodontology. 2005;76(10):1768–1777. doi: 10.1902/jop.2005.76.10.1768.
    1. Padma R., Shilpa A., Kumar P. A., Nagasri M., Kumar C., Sreedhar A. 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. 2013;17(5):631–636. doi: 10.4103/0972-124X.119281.
    1. Thamaraiselvan M., Elavarasu S., Thangakumaran S., Gadagi J., Arthie T. 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. 2015;19(1):66–71. doi: 10.4103/0972-124X.145790.
    1. Bozkurt Doğan Ş., Öngöz Dede F., Ballı U., Atalay E. N., Durmuşlar M. C. Concentrated growth factor in the treatment of adjacent multiple gingival recessions: a split-mouth randomized clinical trial. Journal of Clinical Periodontology. 2015;42(9):868–875. doi: 10.1111/jcpe.12444.
    1. Gupta S., Banthia R., Singh P., Banthia P., Raje S., Aggarwal N. 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. 2015;6(2):153–160. doi: 10.4103/0976-237X.156034.
    1. Biradar S. M., Satyanarayan A., Kulkarni A. J., Patti B., Mysore S. K., Patil A. Clinical evaluation of the effect of platelet rich plasma on the coronally advanced flap root coverage procedure. Dental Research Journal. 2015;12(5):469–475. doi: 10.4103/1735-3327.166226.
    1. Kuka S., Ipci S. D., Cakar G., Yılmaz S. Clinical evaluation of coronally advanced flap with or without platelet-rich fibrin for the treatment of multiple gingival recessions. Clinical Oral Investigations. 2018;22(3):1551–1558. doi: 10.1007/s00784-017-2225-9.
    1. Dixit N., Lamba A., Faraz F., Tandon S., Aggarwal K., Ahad A. Root coverage by modified coronally advanced flap with and without platelet-rich fibrin: A clinical study. Indian Journal of Dental Research. 2018;29(5):p. 600. doi: 10.4103/ijdr.IJDR_22_17.
    1. Kim T.-H., Kim S.-H., Sádor G. K., Kim Y.-D. Comparison of platelet-rich plasma (PRP), platelet-rich fibrin (PRF), and concentrated growth factor (CGF) in rabbit-skull defect healing. Archives of Oral Biolog. 2014;59(5):550–558. doi: 10.1016/j.archoralbio.2014.02.004.
    1. Dohan Ehrenfest D. M., Rasmusson L., Albrektsson T. Classification of platelet concentrates: from pure platelet-rich plasma (P-PRP) to leucocyte- and platelet-rich fibrin (L-PRF) Trends in Biotechnology. 2009;27(3):158–167. doi: 10.1016/j.tibtech.2008.11.009.
    1. Albanese A., Licata M. E., Polizzi B., Campisi G. Platelet-rich plasma (PRP) in dental and oral surgery: from the wound healing to bone regeneration. Immunity & Ageing. 2013;10(1):p. 23. doi: 10.1186/1742-4933-10-23.
    1. Jalaluddin M., Mahesh J., Mahesh R., et al. Effectiveness of platelet rich plasma and bone graft in the treatment of intrabony defects: A clinico-radiographic study. The Open Dentistry Journal . 2018;12:133–154. doi: 10.2174/1874210601812010133.
    1. Menezes D. J. B., Shibli J. A., Gehrke S. A., Beder A. M., Sendyk W. R. Effect of platelet-rich plasma in alveolar distraction osteogenesis: a controlled clinical trial. British Journal of Oral and Maxillofacial Surgery. 2016;54(1):83–87. doi: 10.1016/j.bjoms.2015.09.027.
    1. Cairo F., Nieri M., Pagliaro U. Efficacy of periodontal plastic surgery procedures in the treatment of localized facial gingival recessions. A systematic review. Journal of Clinical Periodontology. 2014;41:S44–S62. doi: 10.1111/jcpe.12182.
    1. Zhou S., Sun C., Huang S., et al. Efficacy of adjunctive bioactive materials in the treatment of periodontal intrabony defects: a systematic review and meta-analysis. BioMed Research International. 2018;2018:15. doi: 10.1155/2018/8670832.8670832
    1. Carroll R. J., Amoczky S. P., Graham S., et al. In: Characterization of Autologous Growth Factors in Cascade Platelet-Rich Fibrin Matrix (PRFM) Edison N. J., editor. Musculoskeletal Transplant Foundation; 2005.
    1. Ehrenfest D. M. D., Bielecki T., Jimbo R., et al. Do the fibrin architecture and leukocyte content influence the growth factor release of platelet concentrates? An evidence-based answer comparing a pure Platelet-Rich Plasma (P-PRP) gel and a leukocyte- and Platelet-Rich Fibrin (L-PRF) Current Pharmaceutical Biotechnology. 2012;13(7):1145–1152. doi: 10.2174/138920112800624382.
    1. Zumstein M. A., Bielecki T., Dohan Ehrenfest D. M. The future of platelet concentrates in sports medicine: platelet-rich plasma, platelet-rich fibrin, and the impact of scaffolds and cells on the long-term delivery of growth factors. Operative Techniques in Sports Medicine. 2011;19(3):190–197. doi: 10.1053/j.otsm.2011.01.001.
    1. Dohan D. M., Choukroun J., Diss A., et al. Platelet-rich fibrin (PRF): a second-generation platelet concentrate. Part I. Technological concepts and evolution. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. 2006;101(3):E37–E44. doi: 10.1016/j.tripleo.2005.07.008.
    1. Ehrenfest D. M. D., Del Corso M., Diss A., Mouhyi J., Charrier J.-B. Three-dimensional architecture and cell composition of a Choukroun's platelet-rich fibrin clot and membrane. Journal of Periodontology. 2010;81(4):546–555. doi: 10.1902/jop.2009.090531.
    1. Carnio J., Camargo P. M., Klokkevold P. R., Lin Y.-L., Pirih F. Q. Use of the modified apically repositioned flap technique to create attached gingiva in areas of no keratinized tissue: A clinical and histologic evaluation. International Journal of Periodontics and Restorative Dentistry. 2017;37(3):362–369. doi: 10.11607/prd.2824.
    1. Manjunath R. G. S., Rana A., Sarkar A. Gingival biotype assessment in a healthy periodontium: transgingival probing method. Journal of Clinical and Diagnostic Research. 2015;9(5):66–69.
    1. Liu F., Pelekos G., Jin L. J. The gingival biotype in a cohort of Chinese subjects with and without history of periodontal disease. Journal of Periodontal Research. 2017;52(6):1004–1010. doi: 10.1111/jre.12471.
    1. Aleksić Z., Janković S., Dimitrijević B., Divnić-Resnik T., Milinković I., Leković V. The use of platelet-rich fibrin membrane in gingival recession treatment. Srpski Arhiv za Celokupno Lekarstvo. 2010;138(1-2):11–18. doi: 10.2298/SARH1002011A.

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