The effectiveness of locally injected platelet-rich plasma on orthodontic tooth movement acceleration

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.

Effectiveness of autologous leukocyte-platelet-rich fibrin on the rate of maxillary canine retraction, rotation, pain, and soft tissue healing: A split-mouth randomized controlled trial

Objective

To assess the effectiveness of leukocyte-platelet-rich fibrin (L-PRF) compared with conventional treatment on canine retraction, rotation, pain, and soft tissue healing.

Methods

Sixteen adult patients aged 18-25 years (10 females, and 6 males; mean age 22.25 ± 2.26 years) with Class I bimaxillary protrusion and Class II div 1 malocclusion participated in this single-center, split-mouth randomized controlled trial at the Orthodontics Department of a single hospital in SCB Dental College and Hospital, Cuttack, India. Randomization was performed using a computer-assisted function with a 1:1 allocation ratio. The intervention included the placement of L-PRF on the experimental side and follow-up for 90 days. The primary outcome measures were canine retraction, rotation, pain, and soft tissue healing. The range of tooth movement was evaluated at 15-day intervals: 0th day (T0), 15th day (T1), 30th day (T2), 45th day (T3), 60th day (T4), 75th day (T5), and 90th day (T6). Canine rotation was assessed at T0 and T6, and pain and soft tissue healing were evaluated on the 3rd, 7th, and 15th days of the treatment.

Results

Cumulatively, the L-PRF group demonstrated a significantly greater tooth movement as compared to conventional treatment group (P < 0.001). Overall, canine retraction was 1.5 times greater on the L-PRF side than on the control side. Canine rotation showed no significant relationship, whereas pain and soft tissue healing were significantly better on the L-PRF side than on the control side.

Conclusions

Local administration of L-PRF amplifies canine retraction while improving pain and soft tissue repair.

How to explain the beneficial effects of platelet-rich plasma

Platelet-rich plasma (PRP) is the platelet and leukocyte-containing plasmatic fraction of anticoagulated autologous blood. While evidence supporting the clinical use of PRP in dentistry is low, PRP is widely used in sports medicine, orthopedics, and dermatology. Its beneficial activity is commonly attributed to the growth factors released from platelets accumulating in PRP; however, evidence is indirect and not comprehensive. There is thus a demand to revisit PRP with respect to basic and translational science. This review is to (i) recapitulate protocols and tools to prepare PRP; (ii) to discuss the cellular and molecular composition of PRP with a focus on platelets, leukocytes, and the fibrin-rich extracellular matrix of coagulated plasma; and finally (iii) to discuss potential beneficial effects of PRP on a cellular and molecular level with an outlook on its current use in dentistry and other medical fields.

The effect of platelet-rich concentrates on orthodontic tooth movement: A review of randomized controlled trials

Objectives

Platelet-rich concentrates, namely platelet-rich plasma (PRP) and platelet-rich fibrin (PRF), have recently shown potential roles in accelerating orthodontic tooth movement (OTM) and reducing treatment duration. Our study aims to systematically evaluate the effect of platelet-rich concentrates on OTM.

Materials and methods

An electronic search of 11 databases, followed by a hand search of reference lists of eligible studies and related reviews, was conducted up to January 2022. Randomized controlled trials investigating OTM of patients with platelet-rich concentrates were included. Risk of bias was assessed by version 2 of Cochrane tool (RoB 2) for assessing risk of bias in randomized trials.

Results

Among 715 records initially identified, 9 studies were included, of which 3 used PRP and the other 6 applied PRF. 7 studies supported a positive relationship between platelet-rich concentrates and OTM, but the other 2 studies reported a null and a negative effect of PRF, respectively. The overall qualities of evidence were moderate to high.

Conclusions

Platelet-rich concentrates as PRP and PRF seem to be effective in accelerating OTM at early stages, while their long-term efficacy remains controversial. Repeated application of platelet concentrates may increase the accelerated stability of OTM.

Platelet-rich derivatives for accelerating the rate of orthodontic tooth movement - a systematic review and meta-analysis

Objective:

The aim of this systematic review and meta-analysis was to report on the effects of using platelet-rich derivatives on the rate of tooth movement.

Material and Methods:

Both electronic and manual searches were performed with specific eligibility criteria based on population, intervention, comparison, outcome, and study design. Risk of bias (RoB) assessment was done using the Cochrane RoB tool 2, the data were pooled and analyzed using review manager 4.5, and certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach. Two independent reviewers performed the study selection, data extraction, and analysis. Nine studies were included for qualitative analysis and two of them were subjected to meta-analysis.

Results:

The standard mean difference for the rate of canine distal movement with platelet-rich derivatives was not significantly higher than controls at any of the time intervals (P > 0.0001). Rotation of canines, molar mesialization, and pain scores were not affected by the administration of platelet-rich derivatives for accelerating tooth movement. A moderate to high RoB was noted in the included studies and the certainty of the available evidence as assessed by the GRADE approach was moderate.

Conclusion:

The included studies presented with high heterogeneity and more high-quality studies with strict protocols are needed. Even though individual studies report significant acceleration of tooth movement following administration of PR derivatives, moderate certainty of evidence suggests no acceleratory effect on tooth movement.

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

INTRODUCTION

This study aimed to evaluate the effect of platelet-rich plasma (PRP) on the rate of orthodontic tooth movement (OTM) during en-masse anterior retraction.

METHODS

Twenty adult patients with Angles Class I bimaxillary protrusion or crowding requiring first premolar extraction for routine orthodontic treatment were divided into control and experimental groups. The control group did not receive PRP, whereas the experimental group received PRP in the alveolar mucosa of the maxillary 6 anterior teeth just before starting en-masse retraction. Measurements were recorded on digital models made from scanned plaster casts at the beginning of space closure and the end of 3 months. The overall rate of OTM between both groups was compared. The amount of anchorage loss and type of anterior retraction on lateral cephalogram was also compared between the groups.

RESULTS

The overall rate of OTM was minimally increased but not statistically significant in the experimental vs control group (P = 0.838). Anterior retraction parameters in both groups showed incisors moving primarily by controlled tipping and partly by translation. An intergroup comparison of all cephalometric parameters for anchorage loss and anterior retraction showed statistically insignificant differences between both groups.

CONCLUSIONS

PRP is ineffective in accelerating the rate of OTM during en-masse anterior retraction.

The Effectiveness of Repetition or Multiplicity of Different Surgical and Non-Surgical Procedures Compared to a Single Procedure Application in Accelerating Orthodontic Tooth Movement: A Systematic Review and Meta-Analysis

In this study, we aimed to assess the current scientific evidence concerning the effectiveness of combining two acceleration techniques or repeating an acceleration procedure in comparison with the single application in terms of the speed of the orthodontic tooth movement (OTM). We performed a comprehensive electronic search to retrieve relevant studies on 10 databases. Randomized controlled trials (RCTs) on fixed orthodontic treatment patients who received multiple types of acceleration techniques or underwent a repeated acceleration procedure compared to a single application were included. Version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB 2) was used for assessing the risk of bias of retrieved studies. A total of six RCTs were included in this review. Regarding multiple acceleration methods, it seems that the combination of low-level laser therapy (LLLT) with a surgical technique outperforms the single application of each technique separately. Additionally, the combination of two surgical interventions may have a synergistic effect leading to reduced treatment time compared to the application of a single intervention. Regarding acceleration method repetition, it seems that the re-application of surgical procedures twice is more efficient than the single application. The meta-analysis showed a non-significant difference in the canine retraction rate between the four-weekly micro-osteoperforations (MOPs) (three times of applications) and both the eight-weekly MOPs (two times of applications) [mean difference (MD) = 0.24; 95% CI: -0.2-0.77; p = 0.36], as well as 12-weekly MOPs (two times of applications) (MD = 0.06; 95% CI: -0.14-0.27; p = 0.55). Based on very low evidence, combining two acceleration techniques is superior over a single application in accelerating tooth movement. Again, very low evidence suggests that the efficacy of repetition of surgical procedures twice and three times is similar. Further high-quality RCTs are required to assess the benefit of repeating an acceleration procedure or combining two different methods. In addition, more insight is needed into the possible side effects associated with the repetition or multiplicity of procedures.

The adjunctive effect of autologous platelet concentrates on orthodontic tooth movement: A systematic review and meta-analysis of current randomized controlled trials

OBJECTIVE

To evaluate the effectiveness of autologous platelet concentrates (APCs) as adjuncts on accelerating orthodontic tooth movement (OTM) of the human subjects undergoing orthodontic treatment and to critically appraise the available literature.

METHODS AND MATERIALS

Five electronic databases (PubMed, Scopus, Web of Science, Embase, and Cochrane Central Register of Controlled Trials) were searched from 2000 up to May 2021 to retrieve eligible randomized controlled trials (RCTs) investigating patients who underwent orthodontic treatment that involved OTM of maxillary and mandibular incisors and canines. All the enrolled cases were treated with APCs and had no local or systemic interfering factors. The quality of the included studies was assessed using the modified JADAD scale. The effect sizes were assessed using mean difference (MD). The heterogeneity analysis was conducted using (I²) statistic at α=0.10.

RESULTS

Finally, seven RCTs were included in the qualitative, and two RCTs were included in the quantitative analysis. The meta-analysis was performed regarding the effect of injectable platelet-rich fibrin (I-PRF) on the rate of canine tooth movement in millimeters at different intervals of the 1^st, 2^nd, and 3^rd months. In the 1^st month, I-PRF (WMD:0.12mm, CI95% -5.01 to 5.24, I²=90%) did not significantly affect OTM. In the 2^nd month, I-PRF (WMD:0.66mm, CI95% 0.60 to 0.73, I²=10%) significantly increased the OTM. However, in the 3^rd month, I-PRF did not significantly increase the OTM (WMD:0.54mm, CI95% -1.38 to 2.47, I²=67%).

CONCLUSIONS

According to the low certainty of evidence about this topic, providing a definite conclusion is not possible. However, applying I-PRF seems to be efficient in accelerating the OTM of the canines. Further high-quality studies with larger sample sizes will be indispensable to validate this conclusion.

An Evaluation of Microbial Flora, Alkaline Phosphatase and IL-8 Levels in GCF of Orthodontic Patients with Self-Ligating and Conventional Brackets

PURPOSE

To compare the microbial flora, alkaline phosphatase (ALP) and interleukin-8 (IL-8) levels during orthodontic treatment with self-ligating brackets versus conventional brackets.

PATIENTS AND METHODS

Forty patients were included in this study and distributed equally between two groups. One group received conventional edgewise brackets while the other group received DAMON self-ligating brackets. Periodontal parameters were recorded and biochemical and microbial analyses were conducted before bonding (baseline), and 14, 30, and 45 days after bonding. Paired t-test was performed to estimate the intergroup differences from the baseline at the various time points; unpaired t-test was used for intragroup comparisons.

RESULTS

A significantly higher prevalence of gram-negative as well as gram-positive microorganisms was found in the group with conventional brackets than that with self-ligating brackets. Alkaline phosphatase (ALP) activity and interleukin-8 (IL-8) levels were significantly higher in the gingival crevicular fluid of the group with conventional brackets than that with self-ligating brackets.

CONCLUSION

The conventional bracket-ligature technique exhibited an increase in IL-8 levels, ALP activity, and microbial colonization compared with that of the self-ligature technique. Accordingly, self-ligating brackets are recommended in orthodontic patients to improve periodontal health and minimize damage outcomes of periodontal tissue interventions.