Effect of the use of platelet concentrates on new bone formation in alveolar ridge preservation: a systematic review, meta-analysis, and trial sequential analysis

PRF and PRP in Dentistry: An Umbrella Review

Introduction: Platelet-rich fibrin (PRF) and platelet-rich plasma (PRP) utilize autologous blood and share the objective of leveraging blood-derived growth factors to enhance the body's natural healing process. A large extensive use has been made in various branches of dentistry. Methods: A total of 4175 records were identified from the electronic search, specifically 291 from BioMed Central, 3406 from MEDLINE/PubMed, 304 from the Cochrane library databases, and 174 from the PROSPERO register. This review was performed in relation to the PRISMA flow chart and was annotated in the PROSPERO register. Results: In total, 3416 title abstracts were screened, and a total of 40 systematic reviews were finally included in the present umbrella review. Conclusions: Research supports the use of PRF and PRP in different fields of dentistry. This is a huge potential for the patient but also for the doctor as these products are from the patient and have zero cost. However, further studies are needed, especially RCTs, to have clearer evidence on the role of PRF and PRP.

Novel Ti6Al4V Surface Treatment for Subperiosteal Dental Implants: Evaluation of Osteoblast-like Cell Proliferation and Osteogenic Response

Nowadays, custom-made subperiosteal implants are emerging as a solution in all those cases where there is lack of healthy bone tissue to support endosseous implants. The development of innovative techniques has allowed the production of grids that precisely match the patient's anatomy. Elucidating the impact of laser-melted Ti6Al4V grids on both hard and soft tissues with which they come into contact is, therefore, mandatory. In this study, we analyzed the effects of five different surface treatments on a human osteoblast-like cell line (MG-63). In particular, the cell proliferation and osteogenic response were evaluated. Taken together, our data demonstrate that in our in vitro setting, the new surface treatment developed by Al Ti color could enhance osteogenesis and improve the stabilization of the implant to the residual bone by stimulating the best osteogenic response in MG-63 cells. Although further studies are required to validate our data in an in vivo model, our results provide the basis for future advances in implantology for the long-term maintenance of osseointegration.

Evaluation of the usefulness of platelet-rich fibrin (PRF) in mandibular third molar surgery with 3D facial swelling analysis: a split-mouth randomized clinical trial

BACKGROUND

Third molar surgery is associated with various postoperative complications (PC). Different strategies, including the application of platelet-rich fibrin (PRF), have been implemented to reduce PC. Digital technologies have proven useful in objectively assessing postoperative facial swelling. This study aimed to evaluate the effect of PRF on reducing facial swelling after lower third molar surgery using a 3D face scanner.

METHODS

A randomized split-mouth clinical trial was set up and 32 patients (18 to 32 years), requiring extraction of both mandibular third molars, were recruited at the Oral Surgery Clinic of the Magna Graecia University of Catanzaro. The primary predictive variable was the application or not of PRF plugs and membranes in the post-extraction socket. Primary outcome variable was facial swelling recorded with a face scanner preoperatively (T0), after three (T1) and seven (T2) days. Qualitative and quantitative data analysis were conducted following an automated and standardized imaging analysis workflow using the 3D Slicer software. Secondary outcome variables were trismus, recorded by measuring the maximum buccal opening with a caliper, pain, recorded using a visual analogue scale (VAS), and duration of the surgery. Descriptive and bivariate analysis were performed by setting the significance level [Formula: see text] = 0.05.

RESULTS

All patients exhibited a significant increase in facial swelling at T1, followed by a subsequent reduction from day 3 to day 7, with a slight persistence of edema observed on the seventh day. No significant data emerged from the statistical analysis conducted. Linear differences in PRF group reported improved values of postoperative swelling only in the T1-T2 and T0-T2 phases of analysis. Volumetric differences favored PRF group compared with control group in all phases. VAS was lower in PRF group only at T2, compared with control group.

CONCLUSIONS

Application of PRF in post-extraction sockets showed effectiveness in reducing facial swelling. Its advantages, including accessibility, cost-effectiveness, and absence of adverse reactions, make it an optimal treatment choice in reducing post-surgical sequelae.

Vertical and horizontal bone loss following alveolar socket preservation using bone grafts and autologous platelet concentrates vs bone grafts alone: a systematic review and meta-analysis

BACKGROUND

Socket preservation is a proactive approach that limits bone loss after tooth extraction to maintain adequate bone volume, height and width. Many methods have proven effective in achieving socket preservation, including using various bone grafts and autologous platelet concentrates (APCs). Combining these two methods may lead to improved results in socket preservation and patient outcomes.

AIMS

To compare the combined use of APCs and bone grafts in socket preservation, with the use of bone grafts alone. Primary outcomes were radiographic vertical bone loss (VBL) and horizontal bone loss (HBL).

METHODS

A search on Pubmed, Scopus, Embase and Google Scholar databases was conducted to identify human studies using APCs in extraction sockets between January 2014 and August 2024. The inclusion criteria involved comparative human studies ranging from evidence levels II to III (Oxford Centre for Evidence-Based Medicine Levels of Evidence). For assessing bias in the included studies, the Cochrane Risk of Bias tools were used. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to determine the quality of evidence available.

RESULTS

A total of five randomised controlled trials (RCTs) were included in the analysis. Studies included the use of platelet rich fibrin (PRF), injectable platelet rich fibrin (i-PRF), advanced platelet rich fibrin (A-PRF), advanced platelet rich fibrin plus (A-PRF+) and concentrated growth factors (CGF). The risk of bias was judged high and moderate for two out of five RCTs. The analysis revealed a combined effect size for VBL reduction, with a standardized mean difference (SMD) of -0.83 (p < 0.001; 95% confidence interval (CI) = [-1.2, -0.57]; I² = 73.13%). For HBL reduction, the combined effect size was SMD = -0.72 (p < 0.001; 95% CI = [-1.08, -0.37]; I² = 68.34%). The overall evidence quality rating for the use of APCs in combination with bone grafts to reduce VBL during socket preservation was assessed as moderate, whereas to reduce HBL it was determined to be low.

CONCLUSION

The current literature demonstrates the added benefits of APCs combined with bone grafts in alveolar socket preservation compared to bone grafts alone in reducing vertical and horizontal bone loss. However, based on the GRADE assessment, the quality of evidence was judged low-to-moderate. Further randomised clinical studies would increase the certainty of the evidence.

Clinical and radiographic retrospective examination of data from patients who received endosseous zygomatic dental implants to support maxillary full-arch prostheses

BACKGROUND

In recent decades, implant dentistry has evolved to become a highly predictable treatment modality in the rehabilitation of different types of edentulism. The present retrospective analysis aimed to report the middle-term outcome of severely atrophic jaws rehabilitated with extra-maxillary zygomatic implants placed in conjunction with standard implants.

METHODS

Thirty-one patients were included in the present study with 62 zygomatic implants and 90 standard implants positioned. Outcome measures were prosthetic success/survival, implant success/survival, complications, modified Plaque Index (mPLI), modified Bleeding Index (mBI), mucosal seal efficacy evaluation (MSEE) >4 mm, and zygomatic implants classification level (ZICL).

RESULTS

No implant and no prosthesis were lost; one patient had mucositis at one zygomatic implant; implant and prosthetic cumulative success rates at more than 3 years were respectively 98.4% and 87% using implant and patient as units of analysis. Mechanical and biological complications occurred in seven patients; all resolved. Eighty percent of the patients practiced proper hygiene and 77% of patients suffered absent or minor mucosal bleeding. Distribution of the variable "mucosal seal efficacy evaluation" led to 81% of sites with values less than 4, and 19% of sites with values higher than 4. In more than 80% of cases, so then, the zygomatic implants clinical level showed a level 1 at the end of the survey.

CONCLUSIONS

With 100% survival rates, zygomatic bilateral prosthetic configurations were an effective therapeutic option for individuals with highly reabsorbed maxillae undergoing initial full-arch fixed rehabilitation.

Pre-extraction alveolar buccal bone overbuilding: a preclinical investigation

BACKGROUND

The pre-extraction overbuilding procedure was designed aiming to mitigate buccal bone resorption following tooth extraction. The objective of this study was to compare the efficacy of pre-extraction and juxta-extraction buccal overbuilding treatments in preserving buccal bone volume following tooth extraction.

MATERIAL AND METHODS

At the test sites (pre-extraction sites), an alveolar crest overbuilding was performed on the buccal aspect of the distal root of the fourth premolar using a xenograft covered with a collagen membrane. No treatment was applied at the control sites. After 3 months, the distal roots of both fourth premolars were extracted and the alveoli were filled with a collagenated xenograft. An overbuilt procedure was performed also at the control sites (juxta-extraction sites). After 3 months, biopsies were collected.

RESULTS

Considering the initial height difference between the lingual and buccal bone plates at the time of extraction, histological evaluation revealed that the resorption of the buccal bone relative to the lingual bone wall was 3.2 mm at the pre-extraction sites and 3.3 mm at the juxta-extraction sites. New bone originated from the residual pre-existing bone crest in an attempt to restore the original dimension.

CONCLUSION

The buccal overbuilding procedures performed three months before tooth extraction did not contribute to preserve the buccal bone crest, despite necessitating an additional surgical procedure. Evidence of ongoing bone regeneration was observed within the augmented space maintained by the biomaterial, suggesting that a prolonged healing period, potentially exceeding six months as indicated by this study, might be required to achieve optimal outcomes.

A systematic review and meta-analysis of effect of leucocyte- and platelet-rich fibrin on dental extraction

BACKGROUND

Dental extraction is the most common oral surgery, but it leads to the remodelling of the socket, such that an implant is required for repair. We performed meta-analysis to determine whether leucocyte- and platelet-rich fibrin (L-PRF) improves dental extraction.

MATERIAL AND METHODS

Following a search of Scopus, Web of science, ProQuest and PubMed, six relevant studies were included (239 patients treated with L-PRF after dental extraction).

RESULTS

The results provide higher percentage of bone formation after dental extraction in L-PRF implant patients with a mean difference of -13.16 (-15.89, -10.43) than control. Socket filling and horizontal width were also higher in the L-PRF implant group. A sub-group meta-analysis showed a significantly higher healing index 7 and 14 days after dental extraction in the L-PRF-treated group. The VAS score for pain stimuli was lower in the L-PRF group with a mean difference of 1.26 (1.00, 1.51) than control group; the difference in the heterogeneity of the studies was significant.

CONCLUSIONS

These results show that L-PRF prevents ridge formation by improving the percentage of bone formation and socket width (improved horizontal width and socket filling). In such patients, the healing index was higher and the VAS score for pain stimuli lower than in the control group.

Comprehensive clinical and histological evaluation of bovine hydroxyapatite bone graft with polypropylene membrane versus leukocyte- and platelet-rich fibrin for alveolar preservation after tooth extraction

BACKGROUND

Osseointegrated implant placement in the ideal prosthetic position necessitates a sufficient residual alveolar ridge. Tooth extraction and the subsequent healing process often lead to bony deformities, characterized by a reduction in alveolar ridge height and width, resulting in unfavorable ridge architecture for dental implant placement. Several materials, including allografts, alloplastics, xenografts, and autogenous bone, are commonly used to address these concerns. In this context, leucocyte- and platelet-rich fibrin (L-PRF) emerges as a promising solution.

METHODS

This case report aims to compare the clinical and histological efficacy of bovine hydroxyapatite bone graft covered with polypropylene membrane (BHAG-PM) and leucocyte- and platelet-rich fibrin (L-PRF) in preserving dental alveoli following tooth extraction. Extraction, graft placement in the alveoli, and the anterior border between extracted elements were performed for both treatment groups.

RESULTS

Up to 24 months of follow-up revealed satisfactory and comparable clinical and histological outcomes. These results suggest that both BHAG-PM and L-PRF effectively promote alveolar preservation, paving the way for ideal implant placement.

CONCLUSIONS

In general, bone-substitute materials are effective in reducing alveolar changes after tooth extraction. Xenograft materials should be considered as among the best of the available grafting materials for alveolar preservation after tooth extraction. Both techniques effectively preserve the alveolar bone and facilitate the placement of osseointegrated implants in ideal positions, paving the way for successful oral rehabilitation.

Regeneration of periodontal intrabony defects using platelet-rich fibrin (PRF): a systematic review and network meta-analysis

One of the most promising approaches to correct periodontal bone defects and achieve periodontal regeneration is platelet-rich fibrin (PRF). This systematic review and meta-analysis aimed to evaluate the regeneration of periodontal bone defects using PRF compared to other regenerative treatments. The data search and retrieval process followed the PRISMA guidelines. An electronic search of MEDLINE, Cochrane, and PubMed databases was performed, selecting exclusively randomized clinical trials where the following were measured: probing depth reduction (PD), clinical attachment level gain (CAL), and radiographic bone fill (RBF). Out of 284 selected articles, 32 were chosen based on inclusion criteria. The use of platelet-rich fibrin (PRF) + open flap debridement (OFD), PRF + metformin, PRF + platelet-rich plasma (PRP), and PRF + OFD/bone graft (BG) significantly reduced PD and improved CAL and RBF. However, the combination of PRF + BG, PRF + metformin, and PRF + STATINS reduced CAL. The intervention of PRF combined with different treatments such as metformin, OFD, PRP, BG, and STATINS has a significant impact on improving PD and CAL. The use of PRF significantly improved the regeneration of periodontal bone defects compared to other treatments.

Healing of Extraction Sites after Alveolar Ridge Preservation Using Advanced Platelet-Rich Fibrin: A Retrospective Study

BACKGROUND

Over time, numerous surgical procedures and biomaterials have been proposed for the reconstruction of post-extraction bone defects, each with their advantages and disadvantages. The main objective of this study was to evaluate dimensional changes in the alveolar bone 3 months after tooth extraction, before implant planning, comparing alveolar ridge preservation (ARP) with spontaneous healing.

METHODS

A total of 84 patients with non-restorable molars were included in the study. Forty-two patients received ARP with advanced platelet-rich fibrin (A-PRF) and spontaneous healing was evaluated in these patients. Cone beam computed tomography (CBCT) analysis performed before and after surgical intervention was used to determine the changes in vertical and horizontal bone dimensions produced after tooth extraction.

RESULTS

CBCT measurements showed reduction in both vertical and horizontal alveolar bone size in both groups. For the study group, the alveolar parameters (height, width) were higher compared to the control group. The percentage variations between dimensional differences from the two groups were 38.58% for height, and for width were 36.88% at 0 mm, 35.56% at 3 mm, 36.61% at 5 mm, and 38.73% at 7 mm. The differences were statistically significant (p ˂ 0.0005).

CONCLUSIONS

The results obtained after ARP with A-PRF showed a reduced loss of bone volume compared to spontaneous healing.

Advancements in alveolar bone grafting and ridge preservation: a narrative review on materials, techniques, and clinical outcomes

This narrative review systematically explores the progression of materials and techniques in alveolar ridge preservation (ARP). We commence by delineating the evolution from traditional ARP methods to cutting-edge alternatives, including platelet-rich fibrin, injectable bone repair materials, and hydrogel systems. Critical examination of various studies reveals these innovative approaches not only accelerate bone healing but also significantly improve patient-reported outcomes, such as satisfaction, pain perception, and overall quality of life. Emphasis is placed on the correlation between advanced ARP techniques and enhanced patient comfort and clinical efficacy, underscoring their transformative potential in dental implantology. Highlighting the effectiveness of ARP, the implant survival rate over a span of 5 to 7 years was high, showcasing the reliability and success of these methods. Further, patients expressed high aesthetic satisfaction with the soft tissue outcome, evidenced by an average visual analog scale (VAS) score of 94. This positive aesthetic appraisal is linked to the clinical health of implants, potentially due to the employment of tooth-supported surgical guides. The economic analysis reveals a varied cost range for bone graft substitutes ($46.2 to $140) and socket sealing materials ($12 to $189), with a noteworthy correlation between the investment in barrier membranes and the diminished horizontal and vertical ridge resorption. This suggests that membrane usage significantly contributes to preserving ridge dimensions, offering a cost-effective strategy for enhancing ARP outcomes. In conclusion, this review illuminates the significant advancements in ARP, highlighting the shift towards innovative materials and techniques that not only promise enhanced bone regeneration and reduced healing times but also improve patient satisfaction and aesthetic outcomes. The documented high implant survival rate and the beneficial economic implications of membrane use further validate the effectiveness of contemporary ARP strategies, paving the way for their broader adoption in dental implantology.