Platelet-Rich Fibrin in Bone Regenerative Strategies in Orthodontics: A Systematic Review

Abstract

Preservation of the alveolar bone is a determinant in the outcome of orthodontic treatment. Alveolar bone defects or a decrease of their height and width may occur due to common reasons such as inflammation, tooth extraction, or cleft lip and palate. The aim of this systematic review was to investigate and appraise the quality of the most up to date available evidence regarding the applications and effects of platelet-rich fibrin (PRF) in orthodontics. This study was carried out according to preferred reporting items for systematic reviews and meta-analyses guidelines using the following databases: Medline via PubMed, Cochrane Library, Web of Science Core Collection and EMBASE. The qualitative assessment of the included studies was performed using Cochrane Risk of Bias tool and ROBINS-I guidelines. Results: From a total of 489 studies, nine studies were selected. The majority of the included studies demonstrate that autogenous anterior iliac graft with PRF had a higher amount of newly formed bone. Furthermore, this review also suggests that the application of platelet derivatives in the extraction socket can accelerate orthodontic tooth movement. Despite the limitations in the included studies, this systematic review suggested that PRF can improve alveolar cleft reconstruction and orthodontic tooth movement.

From Blood to Bone—The Osteogenic Activity of L-PRF Membranes on the Ex Vivo Embryonic Chick Femur Development Model

“…According to these authors, L-PRF does not have any additional effect on bone regeneration, since no differences within the four studied groups (L-PRF, bovine hydroxyapatite (BHA), BHA + L-PRF, and control) were found regarding bone quality and quantity [38]. Therefore, the direct interaction between platelet-rich fibrin and osseous cells in the healing process is insufficiently documented, presenting contradictory results [12][13][14][15][16]. The distinct results between studies may be caused by the different protocols used regarding L-PRF preparation or regarding experimental protocols (with diverse study models, surgical procedure and characterization methodologies).…”

“…Despite the promising characteristics of L-PRF that may potentially assist with soft and hard tissue healing/regeneration, previous studies have shown contradictory results [14][15][16]. Lee et al reported that after two months of follow-up, the L-PRF without associated bone graft material failed to enhance bone formation, as compared to the unfilled control group [17].…”

“…These distinct findings may be due to the lack of standardization across the studies regarding the protocol of L-PRF preparation, outcome measurement methods (two or three dimensional image diagnostic tool or unit of measurement-cubic centimeter or percentage of newly formed bone) and follow-up times (which varies from days to months). On the other hand, it must be pointed out that the current evidence comes from in vitro, in vivo and clinical studies with small sample sizes [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. Thus, the heterogeneous results present in the literature reinforce the need for an experimental approach with a representative model to validate the potential effects of L-PRF-mediated osteogenic modulation.…”

Three-dimensional evaluation of the effects of injectable platelet rich fibrin (i-PRF) on alveolar bone and root length during orthodontic treatment: a randomized split mouth trial

“…The potential benefits of PRF have been widely investigated in dentistry (e.g. bone regeneration and grafting) [19] but remain controversial in the orthodontic field [20,21].…”

Regenerative Strategies in Cleft Palate: An Umbrella Review

“…Besides the bone regeneration capacity, these strategies can modulate inflammation and enhance the healing process [22]. Many substitute materials or agents alone or combined with autogenous bone have been suggested to regenerate bone, such as growth factors like bone morphogenic protein 2 (BMP-2) platelet-rich fibrin, bone scaffolds with or without cell treatment (e.g., mesenchymal stem cells (MSCs) or osteoblast), biocomposites (e.g., calcium phosphate and hydroxyapatite) and haemostatic agents (e.g., fibrin glue) [16,[23][24][25][26][27][28][29]. Stem cellbased therapies have been explored based on several stem cell types: bone-marrow stem cells, adipose-derived stem cells, umbilical cord mesenchymal stem cells, and others [30,31].…”