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

Observation on the effect of platelet-rich plasma combined with drugs in the treatment of herpes zoster neuralgia

PURPOSE

To observe the effect of ultrasound-guided platelet-rich plasma (PRP) injection in the treatment of herpes zoster neuralgia (HZN).

METHODS

Eighty patients with HZN were randomly divided into observation group and control group, with 40 cases in each group. The observation group was treated with ultrasound-guided PRP injection of target nerves combined with drugs. The control group was treated with drugs alone. The pain scores of before treatment (T0), and 1 week (T1), 1 month (T2), 3 months (T3) and 6 months (T4) after treatment were recorded with Numerical Rating Scale (NRS). The sleep quality of patients was assessed with the Athens Insomnia Scale, and the dosage used at each time point, skin lesions, adverse reactions, and the occurrence of postherpetic neuralgia (PHN) were recorded.

RESULTS

The NRS score of the two groups after treatment showed a downward trend. Compared with T0 at each time point, the difference was statistically significant (p < 0.05). And the NRS score of the observation group was lower than control group (p < 0.05). The sleep quality of the observation group was better. The dosage of the observation group was less, and the time of herpes dry-up, scab crusting and shedding in the observation group was significantly shorter (p < 0.05). The incidence of dizziness, lethargy, ataxia and PHN in the observation group was significantly reduced (p < 0.05).

CONCLUSION

Compared with traditional drug treatment alone, the ultrasound-guided PRP injection has the advantages of better analgesia and fewer side effects, which provides a new idea for the treatment of HZN.

Does the use of platelet-rich fibrin enhance the rate of orthodontic tooth movement? A systematic review and meta-analysis

Introduction

This review synthesizes the available evidence pertinent to the effect of platelet-rich fibrin on the rate of orthodontic tooth movement during comprehensive orthodontic treatment.

Method

This review followed the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Nine electronic databases were searched until January 2024 without restrictions, followed by a hand search of the reference lists. Controlled randomized split-mouth human studies assessing the effect of platelet-rich fibrin on the rate of orthodontic tooth movement were included. All relevant data from the included studies were extracted and pooled for qualitative and quantitative analysis. Risk-of-Bias was assessed using the Cochrane Risk of Bias tool. The certainty of the evidence was graded using the Grading of Recommendations, Assessment, Development, and Evaluation tool.

Results

From 515 studies, eleven randomized clinical trials were included for qualitative analysis and nine for quantitative analysis. The certainty of the evidence for these studies was low to moderate. The overall risk of bias for most studies was of some concern. The pooled estimate of the data from ten studies has a mean revealed difference of 1.31 (0.13-2.48) at a 95 % confidence interval with significant heterogeneity.

Conclusions

This systematic review suggest that platelet-rich fibrin enhances the orthodontic tooth movement rate, but the evidence quality was moderate. Further, based on the currently available evidence, the effectiveness of platelet-rich fibrin on the acceleration of orthodontic tooth movement could not be fully established.

Trial registration

PROSPERO: (CRD42021261836).

Does leukocyte-platelet-rich fibrin (L-PRF) cause long term acceleration in the rate of canine retraction? A split-mouth, two-arm parallel group, randomized control trial

OBJECTIVE

The present study was conducted to investigate the effects of leukocyte-platelet-rich fibrin (L-PRF) on the rate of maxillary canine retraction for a period of 5 months.

METHODS

A split-mouth study was conducted on 16 subjects (9 males and 7 females; age range 17-25 years; mean age, 21.85±2.45 years) who required therapeutic extraction of bilateral maxillary first premolars. After the initial leveling and alignment, L-PRF plugs were placed in a randomly selected extraction socket (Experimental Group), and the other side served as a control (Control Group). Canine retraction was carried out by the activation of nickel-titanium (NiTi) closed-coil springs delivering 150 g of force. The rates of canine movement, canine rotation, tipping, root resorption, and molar movement were assessed at monthly intervals for five months (T0-T5). Pain, swelling and discomfort accompanying the procedure were assessed using a Likert scale.

RESULTS

The study revealed a significant increase in the rate of canine movement on the experimental side in the first two months, and significant molar anchorage loss was observed only in the first month for control side. There were no statistically significant differences between the groups regarding canine rotation, tipping, probing depth, root resorption, and pain perception.

CONCLUSIONS

The use of L-PRF plugs in extraction sockets considerably enhanced the rate of canine movement only in the first two months, and long-term efficacy was not observed in this study.

Evidence Mapping and Quality Analysis of Systematic Reviews on Various Aspects Related to Cleft Lip and Palate

BACKGROUND

Management of cleft lip and palate is interdisciplinary. An evidence-mapping approach was envisaged to highlight the existing gaps in this field, using only the highest level of evidence.

OBJECTIVES

To conduct evidence mapping and quality analysis of systematic reviews and meta-analyses related to any aspect of cleft lip and palate.

SEARCH METHODS

The cleft lip and palate field was divided into 9 domains and 50 subdomains and a method of categorization of systematic reviews was established. A comprehensive search strategy was carried out in seven databases along with the search of gray literature and references of included articles.

SELECTION CRITERIA

Systematic reviews related to any aspect of cleft lip and palate, conducted by a minimum of two reviewers, with a comprehensive search strategy and adequate quality analysis were included.

DATA COLLECTION AND ANALYSIS

A self-designed, pre-piloted data-extraction sheet was used to collect information that was analyzed through an expert group discussion. Quality analysis was performed using ROBIS-I, AMSTAR 2, and the PRISMA checklist.

RESULTS

A total of 144 systematic reviews published between 2008 and 2022 were included. The largest number of these could be categorized in the therapeutic domain (n = 58). A total of 27% of the studies were categorized as inconclusive, 40% as partially conclusive, and 33% as conclusive. As per ROBIS-I, 77% of reviews had high risk of bias while 58% were graded as critically low in quality as per AMSTAR 2. The majority of systematic reviews showed low reporting errors.

CONCLUSIONS

The majority of systematic reviews related to cleft lip and palate relate to therapeutic and prognostic domains and show high risk of bias and critically low quality regardless of the source journal. The results of this paper might serve as a starting point encouraging authors to carry out high-quality research where evidence is lacking.

REGISTRATION

A multidisciplinary expert-group formulated an a priori protocol, registered in Open Science Framework (DOI 10.17605/OSF.IO/NQDV2).

Effect of Injectable platelet-rich fibrin (i-PRF) on new bone formation in surgical expansion with mini-screw assisted rapid palatal expander: A dog model study

OBJECTIVES

The objective of the study is to test whether the local injection of i-PRF may affect osteoblast, blood vessels and new bone formation in surgically expanded mid palatal suture using maxillary skeletal expander.

MATERIALS AND METHODS

Eighteen adult male local breed dogs were divided randomly into three groups: group I (control), includes the expansion with maxillary skeletal expander that was done without corticotomy and i-PRF. Group II, involves the expansion that was done with mid palatal corticotomy but without i-PRF injection. Group III, has the expansion that was done with mid palatal corticotomy and has injection with 2 ml of i-PRF. Each group consisted of 6 dogs which were subdivided into 3 dogs. Three dogs were sacrificed after 15 days and the other 3 dogs were sacrificed after 45 days. The number of osteoblast, blood vessels and new bone formation percentage were statistically analyzed using Sigma plot platform. Mean and standard error, ANOVA and Duncan were performed among the different groups. Values of P ≤ 0.05 were considered significant.

RESULTS

After expansion, the i-PRF group demonstrated a considerable increase in the amount of new bone in the mid-palatal suture at 15 and 45 days compared with other 2 groups which were indicated by highest percentages of new bone formation (29.30% of 15 days and 76.55% at 45 days) if compared to control group which were (7.72% at 15 days and 22.30% at 45 days). The corticotomy groups were in between, 15.33% and 46.84% respectively. Moreover the number of osteoblasts was higher in corticotomy with i-PRF group on 15 days and decreased on 45 days than the other two groups, while the blood vessels were highest in this group than the other two groups both on 15 and 45 days.

CONCLUSION

I-PRF enhanced the production of osteoblast, blood vessels, and new bone in the surgically expanded mid palatal suture.

Three-Dimensional Impression of Biomaterials for Alveolar Graft: Scoping Review

Craniofacial bone defects are one of the biggest clinical challenges in regenerative medicine, with secondary autologous bone grafting being the gold-standard technique. The development of new three-dimensional matrices intends to overcome the disadvantages of the gold-standard method. The aim of this paper is to put forth an in-depth review regarding the clinical efficiency of available 3D printed biomaterials for the correction of alveolar bone defects. A survey was carried out using the following databases: PubMed via Medline, Cochrane Library, Scopus, Web of Science, EMBASE, and gray literature. The inclusion criteria applied were the following: in vitro, in vivo, ex vivo, and clinical studies; and studies that assessed bone regeneration resorting to 3D printed biomaterials. The risk of bias of the in vitro and in vivo studies was performed using the guidelines for the reporting of pre-clinical studies on dental materials by Faggion Jr and the SYRCLE risk of bias tool, respectively. In total, 92 publications were included in the final sample. The most reported three-dimensional biomaterials were the PCL matrix, β-TCP matrix, and hydroxyapatite matrix. These biomaterials can be combined with different polymers and bioactive molecules such as rBMP-2. Most of the included studies had a high risk of bias. Despite the advances in the research on new three-dimensionally printed biomaterials in bone regeneration, the existing results are not sufficient to justify the application of these biomaterials in routine clinical practice.

The preliminary outcomes of platelet-rich fibrin injection on pain perception following insertion of archwire: A randomized controlled clinical study

Objectives:

This study aimed to determine the efficacy of platelet-rich fibrin (PRF) injection on orthodontic pain perception during the 1st week of the alignment and leveling process.

Material and Methods:

The study sample included 18 patients (11 females and 7 males). The patients were randomly divided into two groups, the PRF group (9 patients) and the control group (9 patients). The mean age of the sample members was 21.9 ± 2.5 and 20.8 ± 2.4 in the control and the PRF group, respectively. Conventional brackets were applied for both groups. PRF was injected into the six upper front teeth at a rate of 0.6 mm for each point before starting the primary wire insertion process. The pain parameters of each patient were evaluated for both groups during the 1st week of the alignment and leveling process by application of the Visual Analog Scale (VAS) at the durations of (2 h, 6 h, 1 day, 2 days, and 7 days) and all patients were followed up until the end of the alignment and leveling process.

Results:

PRF injection can reduce pain perception in orthodontic patients, overall (P < 0.05), with an effect size of approx. 53 ± 0.13%. The biggest effect was observed 2 h after exposure (P < 0.1) which showed a 50% reduction in pain in the PRF group. No significant effects were observed at later times (P > 0.1).

Conclusion:

The present study concludes that PRF injection can be an effective alternative for decreasing pain perception levels; however, its efficacy needs to be leveraged immediately after the injection of PRF.

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.

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.

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

(1) Background: To evaluate the effects of the direct and indirect contact of leukocyte and platelet-rich fibrin (L-PRF) on bone development, in an ex vivo embryonic chick femur model. (2) Methods: Both sections of L-PRF membranes (red and yellow portions) were evaluated with scanning electron microscopy and histochemical staining. The in vivo angiogenic activity was evaluated using a chorioallantoic membrane model. The osteogenic activity was assessed with an organotypic culture of embryonic chick femora through direct and indirect contact, and assessment was conducted by microtomographic and histological analysis. Descriptive statistics, One-Way ANOVA and Tukey’s multiple comparisons tests were performed for datasets that presented a normal distribution, and Kruskal-Wallis tests were performed for non-parametric datasets. A significance level of 0.05 was considered. (3) Results: The L-PRF induced angiogenesis reflected by a higher number and a larger and more complex gauge in the vessels that invaded the membrane. The physical presence of the membrane over the bone (direct contact) unleashes the full potential of the L-PRF effects on bone growth enhancement. The greatest increase in mineral content was observed in the diaphysis region. (4) Conclusion: The L-PRF direct contact group presented higher values on mineral content for bone volume, bone surface and bone mineral density than the indirect contact and control groups.

Regenerative Strategies in Cleft Palate: An Umbrella Review

(1) Background: Alveolar bone defects or decreased alveolar bone height and width may have different causes, such as cleft palate. Regenerative procedures in oro-dental defects are challenging due to anatomical factors and the distinct cell populations involved. The iliac crest bone graft remains the gold-standard for cleft palate closure. However, tissue regeneration approaches have been employed and their outcome reviewed, but no conclusions have been made about which one is the gold-standard. (2) Methods: this umbrella review aims to critically appraise the effectiveness of the current approaches in bone defects regeneration in non-syndromic patients with cleft palate. A search was performed in PubMed, Cochrane Library, Scopus, Web of Science and EMBASE databases. (3) Results: Systematic reviews of randomized and non-randomized controlled trials with or without meta-analysis were included. Nine articles were included in the qualitative analysis and five in the quantitative one. The included studies quality was evaluated with AMSTAR2. (4) Conclusions: The use of new regenerative strategies, such as bone morphogenic protein 2, appears to provide similar results regarding bone volume, filling, and height to the standard technique with the iliac crest bone graft.

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

Background

The role of injectable platelet rich fibrin (i-PRF) in orthodontic treatment has not been investigated with focus on its effect on dental and bony periodontal elements.

Objective

To evaluate the efficacy of i-PRF in bone preservation and prevention of root resorption.

Methods

A randomized split-mouth controlled trial included 21 patients aged 16–28 years (20.85 ± 3.85), who were treated for Class II malocclusion with the extraction of the maxillary first premolars. Right and left sides were randomly allocated to either experimental treated with i-PRF or control sides. After the leveling and alignment phase, the canines were retracted with 150gm forces. The i-PRF was prepared from the blood of each patient following a precise protocol, then injected immediately before canine retraction on the buccal and palatal aspects of the extraction sites. Localized maxillary cone beam computed tomography scans were taken before and after canine retraction to measure alveolar bone height and thickness and canine root length (indicative of root resorption), and the presence of dehiscence and fenestration. Paired sample t-tests and Wilcoxon signed rank tests were used to compare the changes between groups.

Results

No statistically significant differences in bone height, bone thickness were found between sides and between pre- and post-retraction period. However, root length was reduced post retraction but did not differ between sides. In both groups, postoperative dehiscence was observed buccally and palatally and fenestrations were recorded on only the buccal aspect.

Conclusions

I-PRF did not affect bone quality during canine retraction or prevent canine root resorption. I-PRF did not reduce the prevalence of dehiscence and fenestration.

Trial registration ClinicalTrials.gov (identifier number: NCT 03399760. 16/01/2018).