Effect of platelet-rich plasma on the rate of orthodontic tooth movement

Evaluating the efficacy of platelet-rich plasma on orthodontic tooth movement rate: A systematic review and meta-analysis

BACKGROUND

The main objective of this study was to evaluate the effect of autologous platelet-rich plasma (PRP) on acceleration of the orthodontic tooth movement and assess the evidence based on the available literature.

METHODS

The trial was registered and reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Electronic databases including PubMed, Cochrane, Scopus, Central Register of Controlled Trials, and Google Scholar were searched for randomized controlled studies of PRP on the rate of tooth movement. The search was restricted to articles published in English between January 2000 to 31 December 2023. The search was completed by two reviewers independently and the risk of bias was evaluated using the Cochrane Risk of Bias tool (RoB 2.0) and meta-analysis was performed. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was done to determine the certainty of evidence.

RESULTS

Thirteen studies were included in the systematic review and 10 were included in the quantitative analysis. A random-effects model for meta-analysis of seven studies evaluating the rate of canine retraction revealed a statistically significant increase in the rate of orthodontic tooth movement of 0.38 mm/month in 1 month (121 patients; 95% confidence interval [CI] 0.27-0.49; I2 = 35%; P < 0.001) which decreased to 0.09mm/month in the fourth month (80 patients; 95% CI 0.02-0.17; I2 = 0%; P < 0.02). Three studies that considered en masse retraction revealed a mean difference of 0.36mm over 3 months (40 patients; 95% CI -0.23 to 0.94; I2 = 74%; P < 0.23).

CONCLUSIONS

The study suggests that PRP application can accelerate tooth movement, but its effects decreased over 4 months. The results should be interpreted cautiously due to the study's inherent limitations.

An Evaluation of the Rate and Type of Orthodontic Tooth Movement When Injecting Platelet-Rich Plasma During Mini-Implant-Based Segmented en-Masse Retraction of Upper Anterior Teeth

INTRODUCTION

The study aimed to determine the influence of palatal injection of platelet-rich plasma (PRP) on the rate and type of orthodontic tooth movement (OTM) during the en-masse retraction of upper anterior teeth.

MATERIALS AND METHODS

Two-arm parallel-group trial, in which 30 class II division 1 adult patients (7 males and 23 females) aged 16 to 27 years were recruited. The sample was randomly divided into two groups: the experimental group, in which PRP was injected in the palatal mucosa of the maxillary six anterior teeth immediately before starting the en-masse retraction of upper anterior teeth, whereas in the control group, traditional treatment was employed. Following the first premolar extraction, space closure was accomplished using frictionless mechanics for the en-masse retraction of upper anterior teeth. In both groups, a rigid segmented arch made of stainless steel with a diameter of 0.021 x 0.025 inch and an 8-mm power arm was used for the upper anterior teeth, and mini-implants were inserted between the upper second premolar and first molar at 8 mm apical from the archwire line. NiTi coil springs were used for retraction. Measurements were recorded at the onset of space closure (T0) and every 40 days till the middle of the en-masse retraction of upper anterior teeth (T1).

RESULTS

Thirty patients completed the trial, and no patients were lost to follow-up in both groups. The OTM rate in the PRP group was similar to that of the control group (P = 0.596). The upper anterior teeth in the two groups were retracted mostly by controlled tipping and partially by translation. Statistically insignificant differences were observed between the two groups regarding the rest of the cephalometric variables. No serious harms were observed in either group.

CONCLUSIONS

PRP was ineffective in accelerating the OTM rate during the en-masse retraction of upper anterior teeth and it did not affect the type of tooth movement.

Does the application of autologous injectable Platelet-Rich Fibrin (i-PRF) affect the patient's daily performance during the retraction of upper canines? A single-centre randomized split-mouth controlled trial

BACKGROUND

Previous studies have assessed different aspects concerning the applications of i-PRF in the oral cavity. However, nothing is known regarding patients' perceptions of the injection of autologous platelet-rich fibrin (i-PRF).

OBJECTIVES

To investigate patients' perceptions after injecting platelet-rich fibrin (i-PRF) in the course of retracting upper canines.

METHODS

Twenty-one patients, whose treatments required extractions of both upper first premolars, were recruited. Extraction side was randomly allocated to the intervention or control sides. After the alignment phase, i-PRF was injected twice with a one-month interval on the buccal and palatal aspects of the extraction sites (intervention side). Patients' perceptions were evaluated with two questionnaires: the first was used to assess the level of pain, discomfort, swelling, eating and swallowing difficulties as well as jaw movement restriction after 1 h (T1), 2 h (T2), 6 h (T3), 24 h (T4) and 48 h (T5) of the second injection; the second questionnaire was used to assess the acceptance of the i-PRF injection and overall satisfaction with this technique at the end of canine retraction phase. Visual Analogue Scale (VAS) was adopted for this purpose. Wilcoxon Signed Rank Test was used to compare between both sides at all time points while Friedman's Test was the selected test for detecting variables' changes over time. Post-hoc Wilcoxon Matched-Pairs Signed-Rank Tests were applied when any of the results were significant. As to the multiplicity of tests, Bonferroni Correction was implemented.

RESULTS

Pain and swelling levels were significantly higher on the experimental compared to the control sides at T1, T2, and T3 (P < 0.05), whereas they declined sharply and went back to almost normal values at T4 (after 24 h). At T5 they were 0. Discomfort and difficulty in mastication on intervention sides were significant only at T1 and T2. Pain, swelling, and chewing difficulties were significant (P < 0.001) during the 4 assessed time points. The increase was insignificant regarding swallowing difficulties and jaw movement limitations at all time intervals.

CONCLUSIONS

Injecting autologous (i-PRF) during orthodontic canine retraction is a well-perceived and well-tolerated method due to the limited discomfort which significantly diminishes 24 h afterwards.

TRIAL'S REGISTRATION

ClinicalTrials.gov (Identifier Number: NCT03399422. 16/01/2018).

Comparative Efficacy of Traditional Corticotomy and Flapless Piezotomy in Facilitating Orthodontic Tooth Movement: A Systematic Review and Meta-Analysis

Background and Objectives: This study aimed to perform a meta-analysis comparing the effects of corticotomy and flapless piezocision on accelerated tooth movement. Materials and Methods: A comprehensive search using a combination of controlled vocabulary (MeSH) and free-text terms was undertaken by two reviewers to identify published systematic reviews. Three major electronic databases (Medline via PubMed, Cochrane Database, and Embase) were searched up to 2 June 2023. Results: The results of the meta-analysis showed that the pooled standardized mean difference values of accumulative movement distances for flapless piezocision were 1.43 (95% CI, 0.38 to 2.48; p < 0.01), 1.09 (95% CI, -0.08 to 2.26; p = 0.07), and 0.73 (95% CI, -0.58 to 4.02; p = 0.14). The results of the meta-analysis demonstrated that the pooled SMD values of accumulative movement distances for the corticotomy were 2.76 (95% CI, 0.18 to 5.34; p = 0.04), 1.43 (95% CI, -1.10 to 3.96; p = 0.27), and 4.78 (95% CI, -4.54 to 14.10; p = 0.32). Although the test for overall effectiveness was significant for piezocision and corticotomy, there were no significant differences between piezocision and corticotomy. Conclusions: The study determined that both conventional corticotomy and flapless piezosurgery are effective as adjuncts to orthodontic treatment. Moreover, no significant difference was observed in the short-term effectiveness of canine retraction acceleration between conventional corticotomy and flapless piezocision. While piezocision may be a favorable option for orthodontic treatment, corticotomy can be considered in cases requiring additional procedures such as bone grafting.

Effectiveness of platelet-rich concentrates on the rate of orthodontic tooth movement: a systematic review and meta-analysis

BACKGROUND

Autologous platelet-rich concentrates (PRCs) are recently used as a local biological substance in orthodontics to accelerate the rate of tooth movement.

OBJECTIVES

This systematic review aimed to evaluate the effects of PRCs on the rate of orthodontic tooth movement (OTM).

SEARCH METHODS

Unrestricted search of five electronic databases supplemented by the manual and gray literature search were undertaken in March 2022.

SELECTION CRITERIA

Randomized controlled trials (RCTs) evaluating the effect of PRCs on the rate of OTM with their side effect were included in this systematic review.

DATA COLLECTION AND ANALYSIS

Data items were extracted by two authors using a pre-piloted extraction form. Similar outcomes within a comparable time frame were synthesized in a meta-analysis.

RESULTS

Fourteen studies were deemed eligible for inclusion and seven RCTs were pooled in a meta-analysis. Canine retraction rate was higher in the side of PRCs injection than the control side by 0.28 mm/month (95% CI: 0.16-0.40, I2 = 95.6 per cent, P < 0.001, 345 patients) in the first 4 months after PRCs injection. There was no statistically significant difference between the PRCs side and the control side regarding molar anchorage loss (MAL) (MD = 0.03 mm, 95% CI: -0.18 to 0.24, I2 = 46.3 per cent, P = 0.78, 44 patients), canine rotation (MD = -0.19o, 95% CI: -1.95 to 1.57, I2 = 45.4 per cent, P = 0.96, 48 patients), or en-masse retraction. Likewise, there was no difference between both groups in terms of the duration of de-crowding. The mandibular canine retraction was statistically higher on the PRCs side than on the control side by 0.17 mm/month (P < 0.001, one trial). Regarding root resorption, there was no statistically significant difference between the experimental and control sides within the follow-up time. Mild pain scores were reported by the patients in the first 24 hours after injections.

CONCLUSIONS

Low-level evidence indicates that the effect of PRCs on OTM is minor and clinically insignificant. The findings should be interpreted with caution due to the inherent limitations in the included RCTs.

REGISTRATION

PROSPERO (CRD42022300026).