Use of Platelet-Rich Fibrin in the Treatment of Periodontal Intrabony Defects: A Systematic Review and Meta-Analysis

Abstract

Background. Platelet-rich fibrin (PRF) is a kind of autologous platelet concentrate which is easy to obtain and cheap. In recent years, it has been studied to improve the effect of periodontal regeneration. However, few studies have systematically evaluated the complementary effect of PRF in the treatment of intrabony defects. The present review is aimed at systematically assessing the effects of PRF on clinical and radiological outcomes of the surgical treatment of periodontal intrabony defects. Methods. The protocol was registered at PROSPERO (International Prospective Register of Systematic Reviews) as CRD42020206056. An electronic search was conducted in MEDLINE, Cochrane, and EMBASE databases. Only randomized clinical trials were selected. Systematically healthy patients with two or three walls of intrabony defects were considered. Intrabony defect (IBD) depth reduction and bone fill (BF) % were set as primary outcomes while probing depth (PD) reduction, clinical attachment level (CAL) gain, and gingival margin level (GML) gain were considered as the secondary outcome. When possible, a meta-analysis was performed. Results. Eighteen articles fulfilled the inclusion criteria, and seventeen studies were quantitatively analyzed. Of 17 studies, four were rated as high risk of bias and thirteen as the moderate risk of bias. Two comparisons were set: (1) open flap debridement (OFD) combined with PRF and OFD alone and (2) bone grafting (BG) combined with PRF and BG alone. Compared to OFD alone, OFD+PRF showed significantly greater in all primary and secondary outcomes. Compared to BG alone, BG+PRF showed significantly greater in IBD depth reduction, PD reduction, CAL gain, and GML gain. Conclusions. The use of PRF was significantly effective in the treatment of periodontal intrabony defects. The benefit of OFD+PRF may be greater than BG+PRF. PRF can promote early wound healing in periodontal surgery. As all included studies were not at low risk of bias, well-designed RCTs having a high methodological quality are needed to clarify the additional effectiveness of PRF in the treatment of intrabony defects in the future.

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

“…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. The present significant additive effectiveness of L-PRF to OFD in terms of PPD reduction, CAL gain and DD reduction is in agreement with the results of the systematic reviews and meta-analyses on PRF by Li et al [ 62 ] and Chen et al [ 64 ]. Furthermore, the present significant clinical (PPD, CAL) superiority of L-PRF over OFD agrees with the results of the systematic reviews and meta-analyses by Castro et al [ 61 ] on L-PRF and Miron et al [ 63 ] on PRF.…”

“…In the present study, with the combined L-PRF/OFD approach (as compared with OFD alone) the mean difference in DD reduction (1.82 mm (95% CI: 1.59 to 2.05) is higher than the mean difference in CAL gain (1.02 mm (95% CI: 0.83 to 1.21). The higher mean difference in DD reduction than in CAL gain found in the present study with the combined L-PRF/OFD, as compared with OFD alone, is in accordance with findings in the systematic review and meta-analysis by Chen et al [64]. The statistically significant further DD reduction achieved in this study by adding L-PRF to OFD (1.82 mm (95% CI: 1.59 to 2.05)) seems to be clinically significant as well.…”

“…The present significant additive effectiveness of L-PRF to OG in terms of PPD reduction and DD reduction is in agreement with the findings by Chen et al [64] in non-smokers. The present statistically significant additive effectiveness of L-PRF to OG in terms of CAL gain is in agreement with the findings by Chen et al [64] and Miron et al [63]. Interestingly, the mean differences in CAL gain (1.08 mm vs. 1.09 mm) and DD reduction (0.93 mm vs. 0.92 mm) were almost the same for the present and Chen et al's study [64].…”

“…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.…”

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

“…In line with the current investigation, previous randomized controlled trials demonstrated the efficacy of PRF with OFD in achieving remarkable periodontal repair of intra-osseous defects [ 47 , 61 – 64 ]. 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 ].…”