Use of platelet-rich fibrin for the treatment of periodontal intrabony defects: a systematic review and meta-analysis

Abstract

Objectives This study aims to compare the treatment outcomes of periodontal intrabony defects by using platelet-rich fibrin (PRF) with other commonly utilized modalities. Materials and methods The eligibility criteria comprised randomized controlled trials (RCTs) comparing the clinical outcomes of PRF with that of other modalities. Studies were classified into 10 categories as follows: (1) open flap debridement (OFD) alone versus OFD/PRF; (2) OFD/bone graft (OFD/BG) versus OFD/PRF; (3) OFD/BG versus OFD/BG/PRF; (4–6) OFD/barrier membrane (BM), OFD/PRP, or OFD/enamel matrix derivative (EMD) versus OFD/PRF; (7) OFD/EMD versus OFD/EMD/PRF; (8–10) OFD/PRF versus OFD/PRF/metformin, OFD/PRF/bisphosphonates, or OFD/PRF/statins. Weighted means and forest plots were calculated for probing depth (PD), clinical attachment level (CAL), and radiographic bone fill (RBF). Results From 551 articles identified, 27 RCTs were included. The use of OFD/PRF statistically significantly reduced PD and improved CAL and RBF when compared to OFD. No clinically significant differences were reported when OFD/BG was compared to OFD/PRF. The addition of PRF to OFD/BG led to significant improvements in CAL and RBF. No differences were reported between any of the following groups (OFD/BM, OFD/PRP, and OFD/EMD) when compared to OFD/PRF. No improvements were also reported when PRF was added to OFD/EMD. The addition of all three of the following biomolecules (metformin, bisphosphonates, and statins) to OFD/PRF led to statistically significant improvements of PD, CAL, and RBF. Conclusions The use of PRF significantly improved clinical outcomes in intrabony defects when compared to OFD alone with similar levels being observed between OFD/BG and OFD/PRF. Future research geared toward better understanding potential ways to enhance the regenerative properties of PRF with various small biomolecules may prove valuable for future clinical applications. Future research investigating PRF at histological level is also needed. Clinical relevance The use of PRF in conjunction with OFD statistically significantly improved PD, CAL, and RBF values, yielding to comparable outcomes to OFD/BG. The combination of PRF with bone grafts or small biomolecules may offer certain clinical advantages, thus warranting further investigations.

The Adjunctive Use of Leucocyte- and Platelet-Rich Fibrin in Periodontal Endosseous and Furcation Defects: A Systematic Review and Meta-Analysis

“…The results of the present study on endosseous defects can be compared with those of previous systematic reviews and meta-analyses [60][61][62][63][64]. The present clinical findings on L-PRF agree with the findings of Del Fabbro et al's [60] systematic review, where superiority of APCs in total over OFD was showed in endosseous defects.…”

Platelet-Rich Fibrin Increases BMP2 Expression in Oral Fibroblasts via Activation of TGF-β Signaling

“…The clinical relevance of this study is hard to interpret even though PRF membranes are widely used in tissue regeneration, including in the dental field [ 34 , 35 , 36 ], but can be extended to studies showing the amazing capacity of PRF membranes to treat diabetic ulcers [ 37 ] and alveolar ridge preservation [ 38 ]. What remains unclear is which key components of PRF membranes appear in the proteomic signature, causing at least some of the beneficial effects of the treatment in clinical scenarios.…”

Clinical and radiographic effects of ascorbic acid-augmented platelet-rich fibrin versus platelet-rich fibrin alone in intra-osseous defects of stage-III periodontitis patients: a randomized controlled clinical trial

“…PRF with OFD could improve CAL, PPD and radiographic defect fill comparable or even superior to OFD in combination with bone grafts [65]. An incorporation of regenerative biomolecules into the PRF could further augment these effects [9]. Thus, PRF has been utilized as an autologous carrier for local delivery EMD, growth and morphogenetic/angiogenic factors, antibiotics and antiosteoporotic molecules [26,30,66].…”

“…Platelet-rich fibrin (PRF) is an easily prepared, autologous natural scaffold, harbouring a multitude of growth/ differentiation factors, including platelet-derived growth factor (PDGF), transforming growth factor-β (TGF-β), insulinlike growth factor (IGF), vascular endothelial growth factor (VEGF) and fibroblast growth factor-β (FGF-β) [4][5][6][7], with a potential to promote periodontal repair/regeneration [8]. It has been investigated in combination with open flap debridement (OFD) and with a variety of biomolecules, including statins, metformin, bisphosphonates, and enamel matrix derivatives (EMD), to achieve a sustained release into periodontal defects [9].…”