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Jaiswal RK, Chandra D, Khan MA, Gupta S, Gowrav P, Yadav SK. Clinical Evaluation of Coronally Advanced Flap with or without a Platelet-Rich Fibrin Membrane for the Root Coverage. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2024; 16:S320-S323. [PMID: 38595503 PMCID: PMC11001028 DOI: 10.4103/jpbs.jpbs_509_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 08/15/2023] [Accepted: 08/20/2023] [Indexed: 04/11/2024] Open
Abstract
Aim To evaluate "coronally advanced flap" with or without "a platelet-rich fibrin membrane for the root coverage." Materials and Methods All the clinical parameters were assessed at different time intervals (at baseline, 1, 3, and 6 months) in both experimental and control group. Following "clinical parameters" were recorded using "UNC-15" "Probe-Plaque Index (PI)" (Silness and Loe, 1964), "Gingival Index" (GI) (Loe and Silness, 1963), "Recession depth (RD)," "Recession width (RW)," "Clinical attachment level (CAL)," and "Width of keratinized gingiva (WKG)". Results At final evaluation (i.e., mean change from baseline to 6 months), "the decrease in Plaque Index was 2.5% higher in Group B (66.0%) as compared to Group A (63.5%). The decrease in Gingival Index was 6.1% higher in Group B (91.4%) as compared to Group A (85.3%), and the decrease in recession width was 4.0% higher in Group B (75.2%) as compared to Group A (71.2%). The decrease in clinical attachment level was 4.4% higher in Group B (53.2%) as compared to Group A (48.4%). The increase in width of keratinized gingiva was 1.9% higher in Group A (28.8%) as compared to Group B (26.9%)." Conclusion The controlled, randomized, split mouth design showed that CAF surgery, either by alone or in combination with PRF, is an efficient treatment method for covering denuded roots. "This design was used to treat bilateral isolated Miller's class I and II recessions in gingival part. When compared to the CAF approach, the results from a combination of CAF and PRF after a 6-month period showed additional advantages in addition to mean root coverage in the treatment of Miller's classes I and II recessions in gingival part."
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Affiliation(s)
- Rajeev K. Jaiswal
- Assistant Professor, Department of Periodontology, Career Postgraduate Institute of Dental Sciences and Hospital, Lucknow, Uttar Pradesh, India
| | - Deepti Chandra
- Associate Professor, Department of Periodontology, Career Postgraduate Institute of Dental Sciences and Hospital, Lucknow, Uttar Pradesh, India
| | - Md Arif Khan
- Associate Professor, Department of Periodontology, Career Postgraduate Institute of Dental Sciences and Hospital, Lucknow, Uttar Pradesh, India
| | - Sanjay Gupta
- Professor, HOD, Department of Periodontology, Career Postgraduate Institute of Dental Sciences and Hospital, Lucknow, Uttar Pradesh, India
| | - Piyush Gowrav
- Assistant Professor, Department of Periodontology, Babu Banarasi Das Dental College, Lucknow, Uttar Pradesh, India
| | - Surendra Kumar Yadav
- Assistant Professor, Department of Periodontology, Dental College Azamgarh, Azamgarh, Uttar Pradesh, India
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Ardila CM, Pertuz M, Vivares-Builes AM. Clinical Efficacy of Platelet Derivatives in Periodontal Tissue Regeneration: An Umbrella Review. Int J Dent 2023; 2023:1099013. [PMID: 37435111 PMCID: PMC10332916 DOI: 10.1155/2023/1099013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/19/2023] [Accepted: 06/21/2023] [Indexed: 07/13/2023] Open
Abstract
Objectives This umbrella review aimed to consolidate the best available evidence regarding the clinical efficacy of platelet derivatives in the treatment of periodontal defects associated with periodontitis and in the management of mucogingival deformities. Materials and Methods The "umbrella review" strategy was used to identify systematic reviews and meta-analyses. The search was performed without language restrictions and updated at the end of February 2023. The PubMed and Scopus databases, together with gray literature, were included in the search. Results The search yielded 412 studies. Subsequently, 12 articles were selected for further examination based on relevance. Finally, eight systematic reviews and meta-analyses were assessed. Regarding intrabony defects, in terms of clinical attachment level (CAL) gain, platelet-rich fibrin (PRF) was observed to lead to a statistically significant attachment gain compared to surgical therapy alone. PRF was also found to show greater CAL gain compared to platelet-rich plasma (PRP) and other biomaterials. The parameter probing depth decreased significantly when PRF was used compared to surgical therapy alone (P < 0.05). Similar results were seen when leukocyte- and platelet-rich fibrin (L-PRF) was applied. In terms of radiographic bone fill, both PRF and PRP showed significantly greater bone fill compared to surgical therapy. Regarding the results of periodontal plastic surgery, PRF favored a slight root coverage compared to the coronally displaced flap. This result depended on the number of PRF and L-PRF membranes used, but Emdogain or connective tissue graft produced better results regardless. However, an improvement in the healing of periodontal tissues was reported. Conclusions Therapies with platelet derivatives applied to intrabony defects provided superior regenerative results compared to monotherapies, except in the case of root coverage.
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Affiliation(s)
- Carlos M. Ardila
- Biomedical Stomatology Research Group, Universidad de Antioquia UdeA, Medellín, Colombia
| | - María Pertuz
- Fundación Universitaria Visión de Las Américas, Medellín, Colombia
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Santamaria P, Paolantonio M, Romano L, Serroni M, Rexhepi I, Secondi L, Paolantonio G, Sinjari B, De Ninis P, Femminella B. Gingival phenotype changes after different periodontal plastic surgical techniques: a single-masked randomized controlled clinical trial. Clin Oral Investig 2023:10.1007/s00784-023-04944-0. [PMID: 36930368 DOI: 10.1007/s00784-023-04944-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 03/06/2023] [Indexed: 03/18/2023]
Abstract
ABSTRACT: OBJECTIVES: Aim of this clinical study was to evaluate the effects on gingival thickness of three surgical techniques for root coverage: the coronally advanced flap (CAF) alone, with a sub-epithelial connective tissue graft (SCTG) or with leukocyte- and platelet-rich fibrin (L-PRF) membranes. METHODS Sixty patients with RT1 single maxillary gingival recession were treated with CAF + L-PRF (20 patients), CAF + SCTG (20 patients) or CAF alone (20 patients). At baseline and 6-month after treatment, gingival thickness (GT), keratinized tissue width (KT), gingival recession (GR), clinical attachment level (CAL), probing depth (PD), PROMs, and the aesthetic outcome were recorded. RESULTS CAF + SCTG and CAF + L-PRF groups showed a significantly greater mean GT increase than CAF alone (0.31 ± 0.10 mm) with no significant differences between CAF + SCTG (0.99 ± 0.02 mm) and CAF + L-PRF (0.92 ± 0.52 mm) groups (p = 0.55). CAF + SCTG was associated with a significantly greater KT gain (3.85 ± 1.04 mm), while in CAF + L-PRF (2.03 ± 0.53 mm) and CAF (1.50 ± 0.69 mm) groups, KT was not significantly increased. Both GR and CAL showed a significant within groups' improvement, without among-groups differences. No significant among-groups difference for the aesthetic outcome but greater discomfort and pain-killer consumption in CAF + SCTG group was detected. CONCLUSION All investigated surgical techniques produced significant GR reduction and CAL gain. GT was similarly augmented by CAF + L-PRF and CAF + SCTG techniques; however, the CAF + SCTG technique produced a more predictable KT and GT increase. CLINICAL RELEVANCE The results of our study suggest that the CAF + SCTG technique represents the most predictable method for the clinician to improve the gingival phenotype, an important factor for long term gingival margin stability.
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Affiliation(s)
- Pasquale Santamaria
- Periodontology Unit, Centre for Host Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
- Department of Innovative Technologies in Medicine & Dentistry, "G. D'Annunzio" University, Chieti-Pescara, Italy
| | - Michele Paolantonio
- Department of Innovative Technologies in Medicine & Dentistry, "G. D'Annunzio" University, Chieti-Pescara, Italy
| | - Luigi Romano
- Department of Innovative Technologies in Medicine & Dentistry, "G. D'Annunzio" University, Chieti-Pescara, Italy
| | - Matteo Serroni
- Department of Innovative Technologies in Medicine & Dentistry, "G. D'Annunzio" University, Chieti-Pescara, Italy
| | - Imena Rexhepi
- Department of Innovative Technologies in Medicine & Dentistry, "G. D'Annunzio" University, Chieti-Pescara, Italy
| | - Lorenzo Secondi
- Department of Surgical Science, Plastic and Reconstructive Surgery, Tor Vergata University, Rome, Italy
| | - Giulia Paolantonio
- Department of Innovative Technologies in Medicine & Dentistry, "G. D'Annunzio" University, Chieti-Pescara, Italy
| | - Bruna Sinjari
- Department of Innovative Technologies in Medicine & Dentistry, "G. D'Annunzio" University, Chieti-Pescara, Italy
| | - Paolo De Ninis
- "Luisa D'Annunzio" Institute for High Culture, Pescara, Italy
| | - Beatrice Femminella
- Department of Innovative Technologies in Medicine & Dentistry, "G. D'Annunzio" University, Chieti-Pescara, Italy
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Shetty NR, Menaka KB. Effect of platelet concentrates on the treatment outcome of peri implantitis: A systematic review. J Indian Soc Periodontol 2023; 27:140-145. [PMID: 37152466 PMCID: PMC10159101 DOI: 10.4103/jisp.jisp_622_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 06/13/2022] [Accepted: 07/10/2022] [Indexed: 05/09/2023] Open
Abstract
Platelet concentrates (PCs) are biological agents known to promote soft as well as hard tissue healing. The review aimed at evaluating the effectiveness of PCs for treating peri-implantitis (PI). Five electronic databases were systematically reviewed followed by a handsearch of relevant journals. The selected studies focused on the predetermined primary and secondary outcomes. The primary outcomes were bleeding on probing, probing depth, marginal bone level. RevMan 5.4.1 software was used for risk bias analysis. The search retrieved 12 articles, and only one study compared PC and open flap debridement. Other three studies with different control arms were included to evaluate the overall effect of different PCs in treatment of PI. High heterogeneity was found regarding study design, sample size, surgical techniques, and methods for preparing PCs. The use of platelet-rich fibrin for PI over conventional therapy was beneficial in improving clinical parameters. In addition, PC when combined with graft materials provided a significant improvement in parameters assessed. The preliminary data regarding the use of different PC in treatment of PI seem to be promising. However, due to lack of comparative randomized controlled trials, future clinical research is necessary to comment on the role of PCs for treating PI.
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Affiliation(s)
- Nikitha Ravindra Shetty
- Department of Periodontics, KAHER'S KLE VK Institute of Dental Sciences, Belagavi, Karnataka, India
| | - K B Menaka
- Department of Periodontics, KAHER'S KLE VK Institute of Dental Sciences, Belagavi, Karnataka, India
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Öngöz Dede F, Bozkurt Doğan Ş, Çelen K, Çelen S, Deveci ET, Seyhan Cezairli N. Comparison of the clinical efficacy of concentrated growth factor and advanced platelet-rich fibrin in the treatment of type I multiple gingival recessions: a controlled randomized clinical trial. Clin Oral Investig 2023; 27:645-657. [PMID: 36401070 DOI: 10.1007/s00784-022-04775-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 11/06/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVES The purpose of this randomized controlled clinical trial was to compare and evaluate the clinical effects of concentrated growth factor (CGF) and advanced platelet-rich fibrin (A-PRF) applied together with coronally advanced flap (CAF) technique using a microsurgical approach in the treatment of type I multiple gingival recessions (GR). MATERIALS AND METHODS Sixteen patients with multiple recession defects (Cairo type I) were included in this randomized and controlled study. Forty-five gingival recession defects were randomly equally divided into three groups (n = 15): CAF + CGF (test site); CAF + A-PRF (test site), and CAF alone (control site). Clinical attachment level (CAL), vertical gingival recession (VGR), horizontal gingival recession (HGR), gingival thickness (GT), width of keratinized gingiva (KGW), percentages of the mean (MRC), and complete root coverage (CRC), patient esthetic score (PES), and hypersensitivity score (HS) were recorded at baseline and 6 months after surgery. Patient comfort score (PCS) was evaluated at the day of surgery. RESULTS Significant improvements were determined in CAL, VGR, HGR, KGW, and GT at 6 months when compared to baseline levels in intra-group comparisons for all groups, and also GT was increased in CAF + A-PRF and CAF + CGF compared to CAF alone at 6 months in intergroup comparisons (p < 0.05). At 6 months, MRC was detected 85.66 ± 22.68% in the CAF + CGF, 90.88 ± 20.87% in the CAF + A-PRF, and 75.10 ± 32,37% in the CAF alone, and a significant increase was detected in the CAF + A-PRF group compared to CAF alone (p < 0.05). CRC in CAF + CGF was 66.66%, in CAF + A-PRF 80% and in CAF alone was 53.33% (p > 0.05). PES and HS values showed significant improvement from baseline to 6 months for all groups and also in CAF + CGF and CAF + A-PRF compared to CAF alone at 6 months in intergroup comparisons (p < 0.05). CONCLUSIONS The present study showed that the use of A-PRF and CGF membranes in GR therapy may have an additional benefit in GT increase and also A-PRF may increase the percentages of MRC. The use of A-PRF and CGF membranes may be beneficial in terms of improving patient-related parameters. CLINICAL RELEVANCE A-PRF and CGF may be superior to CAF alone in terms of patient-related parameters and GT increase in multiple recession defects. TRIAL REGISTRATION NUMBER 17578e02-00a9-4a41-8c8d-42a637143531.
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Affiliation(s)
- Figen Öngöz Dede
- Faculty of Dentistry, Department of Periodontology, Ordu University, 52100, Altınordu. Ordu, Turkey.
| | - Şeyma Bozkurt Doğan
- Faculty of Dentistry, Department of Periodontology, Yıldırım Beyazıt University, Ankara, Turkey
| | - Kübra Çelen
- Faculty of Dentistry, Department of Periodontology, Ordu University, 52100, Altınordu. Ordu, Turkey
| | - Selman Çelen
- Faculty of Dentistry, Department of Periodontology, Ordu University, 52100, Altınordu. Ordu, Turkey
| | - Emre Taha Deveci
- Faculty of Dentistry, Department of Periodontology, Ordu University, 52100, Altınordu. Ordu, Turkey
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Chambrone L, Barootchi S, Avila-Ortiz G. Efficacy of biologics in root coverage and gingival augmentation therapy: An American Academy of Periodontology best evidence systematic review and network meta-analysis. J Periodontol 2022; 93:1771-1802. [PMID: 36279123 DOI: 10.1002/jper.22-0075] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND The aim of this systematic review was to assess the efficacy of three biologics, namely autologous blood-derived products (ABPs), enamel matrix derivatives (EMD) and recombinant human platelet-derived growth factor BB (rhPDGF-BB), in root coverage and gingival augmentation therapy. METHODS The protocol of this PRISMA 2020-compliant systematic review was registered in PROSPERO (CRD42021285917). After study selection, data of interest were extracted. A network meta-analysis (NMA) was conducted to assess the effect of different surgical interventions on the main clinical outcomes of interest (i.e., mean root coverage [MRC%], complete root coverage [CRC%], keratinized tissue width [KTW], gingival thickness [GT] change, and recession depth [RD] reduction). RESULTS A total of 48 trials reported in 55 articles were selected. All studies reported on the treatment of gingival recession defects for root coverage purposes. Forty-six treatment arms from 24 trials were included in the NMA. These arms consisted of treatment with coronally advanced flap (CAF) alone, EMD + CAF, platelet-rich fibrin (PRF) + CAF, and subepithelial connective tissue graft (SCTG) + CAF. Regarding MRC%, SCTG+CAF was associated with a significant higher estimate (13.41%, 95% CI [8.06-18.75], P < 0.01), while EMD+CAF (6.68%, 95% CI [-0.03 to 13.4], P = 0.061) and PRF+CAF (1.03%, 95% CI [-5.65 to 7.72], P = 0.71) failed to show statistically significant differences compared with CAF alone (control group) or with each other. Similarly, only SCTG+CAF led to a significantly higher CRC% (14.41%, 95% CI [4.21 to 24.61], P < 0.01), while treatment arms EMD + CAF (13.48%, 95% CI [-3.34 to 30.32], P = 0.11) and PRF+CAF (-0.91%, 95% CI [-15.38, 13.57], p = 0.81) did not show significant differences compared with CAF alone or with each other. Differences in the CI of PRF+CAF (symmetrical around a zero adjunctive effect) and EMD+CAF (non-symmetrical) suggest that EMD could have some additional value compared with PRF. Treatment with SCTG+CAF led to a statistically significant higher RD reduction (-0.39 mm, 95% CI [-0.55 to 0.22], P < 0.01), however EMD+CAF (-0.13 mm, 95% CI [-0.29 to 0.01], P = 0.08) and PRF+CAF (-0.06 mm, 95% CI [-0.23 to 0.09], P = 0.39) failed to show significant differences compared with CAF or with each other. While SCTG+CAF was associated with a statistically significant higher gain of KTW (0.71 mm, 95% CI [0.48 to 0.93], P < 0.01), EMD+CAF (0.24 mm, 95% CI [-0.02 to 0.51], P = 0.08) and PRF+CAF (0.08 mm, 95% CI [-0.23 to 0.41], P = 0.58) did not result into significant changes compared with CAF alone or with each other. Regarding the use of rhPDGF-BB+CAF, although available studies have reported equivalent results compared with SCTG+CAF, evidence is very limited. CONCLUSIONS The use of ABPs, EMD, or rhPDGF-BB in conjunction with a CAF for root coverage purposes is safe and generally promotes significant improvements respective to baseline clinical parameters. However, the adjunctive use of ABPs and EMD does not provide substantial additional improvements in terms of clinical outcomes and patient-reported outcome measures to those achieved using CAF alone, when baseline KTW is >2 mm. Both PRF+CAF and EMD+CAF rendered inferior MRC%, CRC%, RD reduction, and KTW gain compared with SCTG+CAF, which should still be considered the gold-standard in root coverage therapy. Although some studies have reported equivalent results for rhPDGF-BB+CAF compared with the gold-standard intervention, limited evidence precludes formal comparisons with CAF or SCTG+CAF that could be extrapolated to guide clinical practice.
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Affiliation(s)
- Leandro Chambrone
- Evidence-Based Hub, Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz-Cooperativa de Ensino Superior, Caparica, Almada, Portugal.,Graduate Dentistry Program, School of Dentistry, Ibirapuera University, São Paulo, Brazil.,Unit of Basic Oral Investigation (UIBO), Universidad El Bosque, Bogota, Colombia.,Department of Periodontics, University of Iowa College of Dentistry, Iowa City, Iowa, USA
| | - Shayan Barootchi
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
| | - Gustavo Avila-Ortiz
- Department of Periodontics, University of Iowa College of Dentistry, Iowa City, Iowa, USA
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Recession width evaluation after the use of Advanced PRF (A-PRF) verus subepithilial conncective tissue graft (SCTG) in combination with coronally advanced flap in treatment of gingival recession. Int J Health Sci (Qassim) 2022. [DOI: 10.53730/ijhs.v6ns4.6305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective: To evaluate the amount of recession width following the use CAF and advanced platelet rich fibrin (A-PRF) compared to CAF with SCTG in the treatment of single gingival recession. Materials and Methods: Twenty gingival recession defects were randomly assigned to receive either CAF+SCTG (n=10) or CAF+A-PRF (n=10). Recession width in mm was assessed at 3, 6 and 9 months post-operatively. Results: Patients in test group (CAF+A-PRF) reported 2.13 ± 0.35 recession width at 3 months, 2.00 ± 0 after 6 months. While, finally decreased to 1.25±1.04 after 9 months. In the control group (CAF+SCTG), the amount of recession width recorded 1.00 ± 1.07 at 3 months, while, after 6 and 9 months decreased to 0.5 ± 0.93. Conclusion and recommendation: There was no statistically significant difference between the two studied groups after 9 months. While, A significant difference reported at 3 and 6 months. Further studies with larger sample size and longer follow-up is needed.
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Tranexamic acid integrated into platelet-rich fibrin produces a robust and resilient antihemorrhagic biological agent: a human cohort study. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 134:449-456. [PMID: 35718721 DOI: 10.1016/j.oooo.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/08/2022] [Accepted: 03/12/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To investigate the incorporation of the antifibrinolytic agent tranexamic acid (TA) during platelet-rich fibrin (PRF) formation to produce a robust fibrin agent with procoagulation properties. STUDY DESIGN Blood from healthy volunteers was collected. Into 3 tubes, TA was immediately added in 1-mL, 0.4-mL, and 0.2-mL volumes, and the fourth tube was without additions. After PRF preparation, the clots were weighed in their raw (clot) and membrane forms. PRF physical properties were analyzed using a universal testing system (Instron). Protein and TA levels in the PRF were analyzed using a bicinchoninic acid assay and a ferric chloride assay, respectively. RESULTS The addition of TA to PRF led to a robust weight compared with sham control. PRF weight was greater in females in all tested groups. The addition of TA also led to greater resilience to tears, especially at 1-mL TA addition to the blood. Furthermore, TA addition led to a greater value of total protein within the PRF and entrapment of TA in the PRF. CONCLUSIONS Addition of TA to a PRF preparation leads to robust PRF with greater protein levels and the amalgamation of TA into the PRF. Such an agent may enhance the beneficial properties of PRF and attribute procoagulation properties to it.
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Mitra D, Kandawalla S, Potdar P, Patil S, Naniwadekar A, Shetty G. Evaluation of the efficacy of sticky bone and concentrated growth factor membrane along with a coronally advanced flap as compared to coronally advanced flap alone in the treatment of Miller's Class I and Class II gingival recession defects. J Indian Soc Periodontol 2022; 26:577-584. [PMID: 36582956 PMCID: PMC9793930 DOI: 10.4103/jisp.jisp_604_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 05/07/2022] [Accepted: 06/12/2022] [Indexed: 12/09/2022] Open
Abstract
Context Gingival recessions are commonly seen in the dentally cognizant population as well as those with limited access to dental attention. When root coverage is planned, the ultimate goal is to obtain complete root coverage, thus restoring the lost gingival unit covering the root. Aims To determine the efficacy of sticky bone and concentrated growth factor (CGF) membrane along with a coronally advanced flap (CAF) as compared to CAF alone in treating Miller's Class I and Class II gingival recessions (Cairo RT1). Settings and Design The current study was a randomized double-blind controlled trial on 15 subjects using a split-mouth design. Materials and Methods Fifteen subjects who were systemically healthy and had recession sites (30 sites) were randomly assigned to two groups: Group A (test group = CAF + CGF + sticky bone) and Group B (control group = CAF alone). Clinical outcome was assessed with parameters such as recession depth, recession width, keratinized gingival width, gingival mucosal thickness, and relative attachment level (RAL), and these were assessed at baseline and 1, 3, and 6 months. Results A distinct improvement was observed in the depth and width of recession, RAL, keratinized gingival width, and mucosal thickness of the gingiva in the two groups from baseline to 6 months. Statistical significance was not seen on intergroup comparisons. Conclusions Thus, clinical outcomes revealed noticeable improvement for both the groups. However, statistically, the efficacy of CGF and sticky bone was not perceived to be superior to that of CAF alone.
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Affiliation(s)
- Dipika Mitra
- Department of Periodontology, Terna Dental College, Navi Mumbai, Maharashtra, India
| | - Shazneen Kandawalla
- Department of Periodontology, Terna Dental College, Navi Mumbai, Maharashtra, India
| | - Priyanka Potdar
- Department of Periodontology, Terna Dental College, Navi Mumbai, Maharashtra, India
| | - Shruti Patil
- Department of Periodontology, Terna Dental College, Navi Mumbai, Maharashtra, India,Address for correspondence: Dr. Shruti Patil, Terna Dental college, Plot No 12, Sector 22, Nerul, Navi Mumbai - 400 706, Maharashtra, India. E-mail:
| | - Amruta Naniwadekar
- Department of Periodontology, Terna Dental College, Navi Mumbai, Maharashtra, India
| | - Gaurav Shetty
- Department of Periodontology, Terna Dental College, Navi Mumbai, Maharashtra, India
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Sethiya K, Dhadse P, Bajaj P, Durge K, Subhadarsanee C, Hassan S. Platelet rich fibrin in combination with bioabsorbable guided tissue regeneration (GTR) membrane and GTR membrane alone using double lateral sliding bridge flap for treatment of multiple gingival recession defects in humans: A randomized controlled clinical trail. J Indian Soc Periodontol 2022; 26:245-253. [PMID: 35602531 PMCID: PMC9118950 DOI: 10.4103/jisp.jisp_322_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 10/22/2021] [Accepted: 12/12/2021] [Indexed: 11/04/2022] Open
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Narayan S, Rajasekar A. Soft tissue re-growth after different crown lengthening techniques among Indian patients. Bioinformation 2021; 17:1130-1133. [PMID: 35291345 PMCID: PMC8900161 DOI: 10.6026/973206300171130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/27/2021] [Accepted: 09/27/2021] [Indexed: 11/23/2022] Open
Abstract
Patients often report complaining of fractured or decayed teeth with severe morphological deformities. However, all these clinical scenarios require the same level of care and consideration to rehabilitate form, function and esthetics. Some cases have sufficient clinical crown height while others often require an interdisciplinary approach in the form of orthodontic/surgical extrusion or surgical periodontal options. A common factor delaying treatment is soft tissue regrowth after crown lengthening which delays the impression required for final prosthesis. Therefore, it is of interest to compare the prevalence of soft tissue regrowth a week after different crown lengthening techniques including laser gingivectomy, electrocautery gingivectomy, modified Widman flap and apically repositioned. The parameters assessed included 1-week postoperative soft tissue regrowth after crown lengthening, age of patients and gender. It was observed that laser and electrocautery-assisted gingivectomy had a higher rate of soft tissue regrowth as compared to surgical techniques. It was further noted that laser and electrocautery assisted gingivectomy had a higher frequency of soft tissue rebound growth compared to surgical crown lengthening using modified widman flap and apically repositioned flap, which was statistically insignificant. Patients within the age groups of 26-60 years were found to have a higher tendency of soft tissue regrowth, which was found to be clinically and statistically significant (p<0.05).
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Affiliation(s)
- Siddharth Narayan
- Department of Periodontology, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Chennai-600077, Tamilnadu, India
| | - Arvina Rajasekar
- Department of Periodontology, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Chennai-600077, Tamilnadu, India
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12
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Murugan T, Inbasekaran D, Murthykumar K. Enhanced Gingival Recession Coverage by Er,Cr:YSGG Laser Root Biomodification. Contemp Clin Dent 2021; 12:328-331. [PMID: 34759695 PMCID: PMC8525809 DOI: 10.4103/ccd.ccd_720_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/10/2020] [Accepted: 11/24/2020] [Indexed: 11/25/2022] Open
Abstract
Gingival recession predisposes to functional and aesthetic concerns, for which many surgical procedures are available. Among these, till now subepithelial connective graft is considered as the gold standard technique for its higher predictability of achieving recession coverage. However, it does not heal by new attachment, thus many techniques to promote new attachment such as root biomodification are done. This case enumerates the use of Er, Cr: YSGG laser for root biomodification to treat a wide and deep gingival recession defect by subpedicle connective tissue graft. Six months results show better recession coverage inspite of a wide and deeper defect. Thus, Er, Cr: YSGG laser can be an adjunctive tool to enhance the recession coverage.
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Affiliation(s)
- Thamaraiselvan Murugan
- Department of Periodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India
| | - Dipika Inbasekaran
- Department of Periodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India
| | - Karthikeyan Murthykumar
- Department of Periodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India
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13
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Fernandes GVDO, Santos NBM, Siqueira RACD, Wang HL, Blanco-Carrion J, Fernandes JCH. Autologous Platelet Concentrate of 2 nd and 3 rd generations efficacy in the surgical treatment of gingival recession: an overview of systematic reviews. J Indian Soc Periodontol 2021; 25:463-479. [PMID: 34898911 PMCID: PMC8603797 DOI: 10.4103/jisp.jisp_515_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 03/21/2021] [Accepted: 07/21/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Autologous platelet concentrate (APC)/platelet-rich fibrin (PRF) of second and third generations has increased use in periodontics to optimize wound healing. Few systematic reviews (SRs) have reported improved clinical outcomes, while other studies reported significantly better results for the connective tissue graft (CTG). There is still unclear clinical evidence about APC/PRF use to treat gingival recession (GR) defects. Then, the purpose of this SR was to evaluate the use of APC/PRF membranes (2nd and 3rd generations) in root coverage (RC) procedures and assess its efficacy as a substitute biomaterial. MATERIALS AND METHODS An electronic search was conducted in PubMed, Cochrane Central, Web of Science, Google Scholar, BookSC databases, and gray literature. The search strategy, without date restriction up to April 2020, included keywords as "platelet-rich fibrin," "autologous platelet concentrates," "blood," "systematic review," "periodontics," "surgery," "tissue," "gingiva," "gingival recession," "connective tissue," "graft," and "root coverage." The methodological quality was evaluated through the AMSTAR2, and a population, index test, comparator, outcome strategy was used to assess specific clinical parameters such as recession depth, clinical attachment levels, and RC outcomes. RESULTS Nine SRs were included. Only three articles described the technique of APC/PRF production. Three studies reported unfavorable outcomes using APC, while six reported favorable results and postoperative discomfort reduction. Articles included in this SRs that provided information about APC/PRF membranes (n = 13) showed no significant difference between APC/PRF and the control group for the parameters analyzed. CONCLUSIONS This implies that APC/PRF may be considered a feasible substitute biomaterial for treating GR defects, although the CTG still provides superior outcomes. Further long-term and controlled studies are needed to verify this finding.
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Affiliation(s)
- Gustavo Vicentis De Oliveira Fernandes
- Faculty of Dental Medicine at Universidade Católica Portuguesa, Ann Arbor, Michigan, USA,
- Center for Interdisciplinary Research in Health, Institute of Health Sciences, Universidade Católica Portuguesa, Viseu, Portugal
- Department of Periodontics and Oral Medicine at the University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | | | | | - How-Lay Wang
- Department of Periodontics and Oral Medicine at the University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Juan Blanco-Carrion
- Department of Stomatology, Santiago de Compostela University, Santiago De Compostela, Spain
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14
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Goel A, Ghai D, Sood A, Singh GP, Nagi PK, Singh P. A Comparative Evaluation of Silk Suture and Cyanoacrylate Adhesive in the Stabilization of Free Gingival Graft Harvested with Erbium: Yttrium-Aluminum-Garnet Laser: A Clinical Study. J Pharm Bioallied Sci 2021; 13:S1672-S1678. [PMID: 35018053 PMCID: PMC8686908 DOI: 10.4103/jpbs.jpbs_404_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 05/21/2021] [Accepted: 05/28/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The most common technique for gingival augmentation is free gingival graft (FGG). The aim of this study is to clinically compare the efficacy of FGG harvested with erbium: yttrium-aluminum-garnet (Er: YAG) laser stabilized with 5-0 silk suture in comparison to N-butyl-2-cyanoacrylate tissue adhesive in increasing the width of keratinized gingiva (WK) for the management of Miller's Class I and II gingival recession. METHODOLOGY Forty-eight gingival recession defects were divided into two Groups I and II. Group I sites were treated with FGG harvested using Er: YAG laser stabilized with 5-0 silk suture and Group II sites were treated with FGG harvested using Er: YAG laser stabilized with N-butyl-2-cyanoacrylate tissue adhesive. Clinical parameters such as gingival recession depth, clinical attachment level (CAL), gain in gingival tissue thickness, and WK were recorded at baseline and 3 and 6 months postoperatively. RESULTS A significant reduction in gingival recession defects, gain in CAL, increase in WK, and gain in gingival tissue thickness were observed in both the groups. Intergroup comparison of gingival recession defects, CAL, WK, and gingival tissue thickness yielded nonsignificant differences. CONCLUSION Within the limits of this study, it can be concluded that both 5-0 silk suture and n-butyl-2-cyanoacrylate were equally efficacious in the stabilization of FGG. N-butyl-2-cyanoacrylate was easy to apply, consumed less operating time, and had no adverse effect. Hence, cyanoacrylate can be used as an alternative to suture in stabilization of FGG.
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Affiliation(s)
| | - Deepika Ghai
- MDS, Conservative Dentistry and Endodontics, Punjab, India
| | - Anchal Sood
- Department of Periodontology, Baba Jaswant Singh Dental College, Ludhiana, Punjab, India
| | - Gagan Preet Singh
- Department of Community Medicine, GGS Medical College and Hospital, Faridkot, Punjab, India,Address for correspondence: Dr. Gagan Preet Singh, Department of Community Medicine, GGS Medical College and Hospital, Faridkot, Punjab, India. E-mail:
| | - Puneet Kamal Nagi
- Department of Periodontology, Punjab Government Dental College and Hospital, Amritsar, Punjab, India
| | - Padam Singh
- Department of Periodontology, Desh Bhagat Dental College and Hospital, Mandi Gobindharh, Punjab, India
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15
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Salaria SK, Kalra P, Belkhede SG, Vinnakota G. Successful management of recurrent irritational fibroma and associated residual soft tissue defect in the posterior teeth through single-stage surgery: A rare case report. J Indian Soc Periodontol 2021; 25:258-261. [PMID: 34158695 PMCID: PMC8177181 DOI: 10.4103/jisp.jisp_182_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 06/14/2020] [Accepted: 06/16/2020] [Indexed: 11/04/2022] Open
Abstract
Inflammatory fibrous hyperplasia, pyogenic granuloma, peripheral ossifying fibroma, irritational fibroma (IF), peripheral giant cell granuloma, etc., are the different types of reactive gingival lesions that may occur in response to mild chronic irritation associated with subgingival factors, root remnant, iatrogenic factors, and trauma. Gingival IF is one of the most common reactive lesions and is usually sessile in nature, and its size is usually not more than 1.5 cm. Complete surgical excision along with the elimination of precipitating/aggravating factors is the treatment of choice generally adopted by a general dentist without giving due consideration to its size, location, and postoperative sequel. The present rare case describes the simple, easy to perform, and effective periodontal plastic treatment for the management of expected residual soft tissue defect, following surgical excision of large recurrent IF in the posterior maxillary teeth at 9 months postoperatively, in addition to its conceivable etiology and diagnosis.
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Affiliation(s)
- Sanjeev Kumar Salaria
- Department of Periodontology and Oral Implantology, Surendera Dental College and Research Institute, Sri Ganganagar, Rajasthan, India
| | - Punnet Kalra
- Department of Periodontology and Oral Implantology, Surendera Dental College and Research Institute, Sri Ganganagar, Rajasthan, India
| | - Samyak Gautam Belkhede
- Department of Periodontology and Oral Implantology, Surendera Dental College and Research Institute, Sri Ganganagar, Rajasthan, India
| | - Geyasri Vinnakota
- Department of Periodontology and Oral Implantology, Surendera Dental College and Research Institute, Sri Ganganagar, Rajasthan, India
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16
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Kang J, Yi M, Chen J, Peng M. Comparative assessment between bio-adhesive material and silk suture in regard to healing, clinical attachment level and width of keratinized gingiva in gingival recession defects cases. Sci Prog 2021; 104:368504211011868. [PMID: 33940998 PMCID: PMC10454994 DOI: 10.1177/00368504211011868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The objective of this study was to compare the silk suture with a cyanoacrylate adhesive to stabilize the free gingival graft in conjunction with Er: YAG laser-assisted recipient site preparation to augment the keratinized tissue in gingival recession cases. This randomized trial comprised of 300 recession defects patients. All the included patients were diagnosed using Miller class I and II gingival recession defects classification. Group I sites were treated with a free gingival graft (FGG) harvested using an Er: YAG laser and further sutured with silk. Group II sites were stabilized with isoamyl 2 cyanoacrylate bio-adhesive material. Clinical parameters, such as gingival recession depth, clinical attachment level, gain in gingival tissue thickness, and width of keratinized gingiva were recorded at baseline, and at third month, sixth month, and 12th month postoperatively. The mean changes in gingival recession from months 3 to 6 and months and 6 to 12 were significant (p < 0.05) in both groups. However, the improvement in recession depth was better in group II than in group I. The mean change in clinical attachment level did not differ significantly between the groups at the different time intervals. However, values tended to be higher in group II than in group I. The width of the keratinized gingiva tended to be higher from baseline to 3 months, baseline to 6 months, baseline to 12 months, 3 to 6 months, and from 6 to 12 months in group II as compared with group I (p > 0.05). Cyanoacrylate could be used as a substitute to silk sutures to stabilize FGGs. Cyanoacrylate was easy to apply, consumed less operating time, and was considered equally efficacious for stabilizing FGGs.
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Affiliation(s)
- Jing Kang
- Department of Orthodontics, Shanghai Huangpu District 2nd Dental Disease Prevention and Treatent Institute, Shanghai, China
| | - Min Yi
- Department of Periodontal, Shanghai Huangpu District 2nd Dental Disease Prevention and Treatment Institute, Shanghai, China
| | - Jie Chen
- Department of Radiology, Shanghai Huangpu District 2nd Dental Disease Prevention and Treatment Institute, Shanghai, China
| | - Minghui Peng
- Department of Orthodontics, Shanghai Huangpu District 2nd Dental Disease Prevention and Treatent Institute, Shanghai, China
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17
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Meenakshi SS, Sankari M. Effectiveness of Chitosan Nanohydrogel as a Bone Regenerative Material in Intrabony Defects in Patients With Chronic Periodontitis: A Randomized Clinical Trial. JOURNAL OF ADVANCED ORAL RESEARCH 2021. [DOI: 10.1177/2320206821998574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aim: Different procedures have been attempted to regenerate intrabony defects in periodontitis but complete regeneration is still a herculean feat. Nanoparticles could prove to be advantageous because of their small size and increased surface area. The aim was to evaluate the effectiveness of a chitosan nanohydrogel as a periodontal regenerative material in the management of intrabony defects. Materials and Methods: Twenty patients within the age group of 30 to 60 years with intrabony defects >3 mm and clinical attachment levels >5 mm were selected. They were divided randomly into two groups: group-1, which received only open flap debridement with bone graft and acted as control, and group-2, which received open flap debridement, bone graft mixed with a chitosan nanohydrogel, and acted as the test site. Clinical and radiographic measurements were recorded at baseline, three months, and six months. Intragroup comparison was done using a paired t-test and intergroup comparison was done using an unpaired t-test with the statistical value set at P < .05. Results: Chitosan hydrogel incorporated bone grafts showed improved bone regenerative potential. The mean reduction in clinical attachment level in group-2 (8.7 ± 0.6 to 1.6 ± 0.8) was significantly higher than that of group-1 (8.6 ± 0.5 to 2.4 ± 0.7). The mean reduction in probing depths in group-2 (test group) was significantly higher (8.3 ± 0.9 to 1.6 ± 0.8) when compared to group-1 (8 ± 0.8 to 2.3 ± 0.7). Significant amount of defect fill was obtained in both the groups from baseline to six-month period. Conclusion: Organic materials such as chitosan could have potential bone regenerative capacity.
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Affiliation(s)
- S. Swarna Meenakshi
- Department of Periodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai, Tamil Nadu, India
| | - M. Sankari
- Department of Periodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai, Tamil Nadu, India
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18
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Mancini L, Tarallo F, Quinzi V, Fratini A, Mummolo S, Marchetti E. Platelet-Rich Fibrin in Single and Multiple Coronally Advanced Flap for Type 1 Recession: An Updated Systematic Review and Meta-Analysis. ACTA ACUST UNITED AC 2021; 57:medicina57020144. [PMID: 33562581 PMCID: PMC7915928 DOI: 10.3390/medicina57020144] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 01/25/2021] [Accepted: 02/02/2021] [Indexed: 12/23/2022]
Abstract
Background and Objectives: The aim of the present systematic review and meta-analysis was to investigate the efficacy of leukocyte–platelet-rich fibrin (L-PRF) in addition to coronally advanced flap (CAF) for the treatment of both single and multiple gingival recessions (GRs) compared to the CAF alone and to the adjunct of connective tissue graft (CTG). Root coverage outcomes using platelet concentrates have gained increased interest. In particular, it has been suggested that adding L-PRF to CAF may provide further benefits in the treatment of GRs. Materials and Methods: An electronic and manual literature search was conducted to identify randomized controlled trials (RTCs) investigating root coverage outcomes with CAF + L-PRF. The outcomes of interest included mean root coverage (mRC), recession reduction, keratinized tissue width (KTW) gain, gingival thickness (GT) gain, and patient-reported outcome measures (PROms) such as pain perception and discomfort. Results: A total of 275 patients and 611 surgical sites were analyzed. L-PRF in adjunct to single CAF seems to show statistically significant results regarding clinical attachment level (CAL) with a weighted means (WM) 0.43 95% CI (−0.04, 0.91), p < 0.0001, GT (WM 0.17 95% CI (−0.02, 0.36), p < 0.0001, and mRC (WM 13.95 95% CI (−1.99, 29.88) p < 0.0001, compared to single CAF alone. Interesting results were obtained from the adjunct of PRF to multiple CAF with respect to multiple CAF alone with an increase in the mRC WM 0.07 95% CI (−30.22, 30.35), p = 0.0001, and PPD change WM 0.26 95% CI (−0.06, 0.58), p < 00001. On the other hand, no statistically significant data were obtained when L-PRF was added to single or multiple CAF combined with CTG according to the included outcomes such as mRC (p = 0.03 overall). Conclusions: L-PRF is a valid alternative to CAF alone. L-PRF compared to CTG in single and multiple CAF showed statistically significant results regarding pain perception and discomfort PROms (p < 0.0001). However, CTG remains the gold standard for treating gingival recession.
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19
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Kumar KM, Varghese SS. Views on antioxidant mouthwashes as adjunct in periodontal therapy. Bioinformation 2020; 16:1069-1079. [PMID: 34938007 PMCID: PMC8600207 DOI: 10.6026/973206300161069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 10/27/2020] [Accepted: 10/27/2020] [Indexed: 12/04/2022] Open
Abstract
Clinical decision is often difficult with chlorhexidine mouthwash. The use of antioxidant mouthwashes for the treatment of periodontal disease is in practise. Therefore, it is of interest to collect gleaned information on Antioxidant mouthwashes as periodontal therapy from known literature. Improvement in treatment using antioxidant mouthwashes is reported in several studies. The mouthwash with antioxidants has similar anti-gingivitis, antiplaque and antimicrobial effects as that of chlorhexidine mouthwash.
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Affiliation(s)
- Karthikeyan Murthy Kumar
- Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai 77, India
| | - Sheeja S Varghese
- Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai 77, India
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20
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Panda S, Satpathy A, Chandra Das A, Kumar M, Mishra L, Gupta S, Srivastava G, Lukomska-Szymanska M, Taschieri S, Del Fabbro M. Additive Effect of Platelet Rich Fibrin with Coronally Advanced Flap Procedure in Root Coverage of Miller's Class I and II Recession Defects-A PRISMA Compliant Systematic Review and Meta-Analysis. MATERIALS (BASEL, SWITZERLAND) 2020; 13:E4314. [PMID: 32992613 PMCID: PMC7579296 DOI: 10.3390/ma13194314] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/24/2020] [Accepted: 09/24/2020] [Indexed: 12/12/2022]
Abstract
AIM This systematic review and meta-analysis aims to assess the additive effect of leukocyte and platelet-rich fibrin (L-PRF) on coronally advanced flap (CAF) procedures in root coverage of Miller's class I and II gingival recession defects. Review methodology: A comprehensive search in MEDLINE (PubMed), Scopus and CENTRAL (the Cochrane Central Register of Controlled Trials), along with an additional hand search, provided eight randomized clinical trials to be included in this review. A total of 167 patients with 470 gingival recession defects were analyzed. A meta-analysis was carried out to assess the change in gingival thickness (GT), width of keratinized gingiva (WKG), root coverage percentage (%RC), clinical attachment level (CAL) and recession depth (RD) at all follow-ups between CAF alone and CAF + L-PRF groups for all included studies. A subgroup analysis was carried out based on recession type (single/multiple). RESULTS Overall, a significant improvement in GT, CAL and RD was found when treated with CAF + L-PRF. There was a trend for a positive effect in terms of an increase in WKG when using L-PRF, especially in the treatment of single recession, though significance was not achieved (p = 0.08 overall). The results of heterogeneity among the subgroups were varied and were found to be greater than 91.3% for GT and 32.8% for WKG. CONCLUSION L-PRF when used in addition to CAF showed favorable results for the treatment of class I and II gingival recession defects.
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Affiliation(s)
- Saurav Panda
- Department of Periodontics and Oral Implantology, Siksha ‘O’ Anusandhan University, Bhubaneswar 751003, India; (S.P.); (A.S.); (A.C.D.); (M.K.)
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, 20122 Milano, Italy;
| | - Anurag Satpathy
- Department of Periodontics and Oral Implantology, Siksha ‘O’ Anusandhan University, Bhubaneswar 751003, India; (S.P.); (A.S.); (A.C.D.); (M.K.)
| | - Abhaya Chandra Das
- Department of Periodontics and Oral Implantology, Siksha ‘O’ Anusandhan University, Bhubaneswar 751003, India; (S.P.); (A.S.); (A.C.D.); (M.K.)
| | - Manoj Kumar
- Department of Periodontics and Oral Implantology, Siksha ‘O’ Anusandhan University, Bhubaneswar 751003, India; (S.P.); (A.S.); (A.C.D.); (M.K.)
| | - Lora Mishra
- Department of Conservative Dentistry and Endodontics, Institute of Dental Sciences, Siksha ‘O’ Anusandhan University, Bhubaneswar 751003, India;
| | - Swati Gupta
- Private Practice, Gainesville, FL 32603, USA;
| | - Gunjan Srivastava
- Department of Prosthodontics, Institute of Dental Sciences, Siksha ‘O’ Anusandhan University, Bhubaneswar 751003, India;
| | | | - Silvio Taschieri
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, 20122 Milano, Italy;
- Dental Clinic, IRCCS Istituto Ortopedico Galeazzi, 20161 Milano, Italy
| | - Massimo Del Fabbro
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, 20122 Milano, Italy;
- Dental Clinic, IRCCS Istituto Ortopedico Galeazzi, 20161 Milano, Italy
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21
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Moraschini V, Calasans-Maia MD, Dias AT, de Carvalho Formiga M, Sartoretto SC, Sculean A, Shibli JA. Effectiveness of connective tissue graft substitutes for the treatment of gingival recessions compared with coronally advanced flap: a network meta-analysis. Clin Oral Investig 2020; 24:3395-3406. [DOI: 10.1007/s00784-020-03547-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 08/21/2020] [Indexed: 12/11/2022]
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22
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Holtzman LP, Blasi G, Rivera E, Herrero F, Downton K, Oates T. Gingival Thickness and Outcome of Periodontal Plastic Surgery Procedures: A Meta-regression Analysis. JDR Clin Trans Res 2020; 6:295-310. [PMID: 32718265 DOI: 10.1177/2380084420942171] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To evaluate the impact of soft tissue thickness (STT) on root coverage achieved with different periodontal plastic surgery procedures. BACKGROUND Gingival recession has been managed successfully through various surgical approaches, with great variability in outcomes. Anatomic characteristics of the recipient site and selected technique account in part for this variability. Gingival flap thickness is one of the most critical site-related characteristics. METHODS An electronic search was conducted on the major databases (PubMed, Embase, Web of Science). Human prospective studies with at least 6 mo of follow-up and with a numeric baseline measurement for gingival thickness were eligible. Only studies including nonsmoking patients were considered. Variables included surgical approach, participant characteristics, local anatomic factors, and follow-up time. Primary outcome was mean percentage root coverage (%RC) achieved, and complete root coverage was a secondary outcome. RESULTS A total of 42 studies were included (35 randomized controlled trials, 5 case series, 1 prospective cohort study, and 1 controlled clinical trial). Across studies, the pooled %RC was 81.9% (95% CI, 79.1% to 84.7%). The %RC was not significantly associated (P = 0.267) with baseline soft tissue thickness; however there was a significant (P = 0.031) inverse relationship between STT and %RC after 12-mo follow-up. Subgroup analysis showed that for no graft, there was a significant (P = 0.025) positive relationship between STT and %RC with the exclusion of the single outlier study based on STT. CONCLUSIONS STT plays a limited role in predicting root coverage across all approaches; when flaps are performed with no graft, the effect of STT is most critical. The length of time following surgery appears to influence outcomes, with 12-mo follow-up offering greater insight. KNOWLEDGE TRANSFER STATEMENT The results of this study can suggest to clinicians which periodontal plastic surgery technique to employ when treating challenging cases. In particular, it can be helpful when selecting the treatment approach to treat thin phenotype sites. This study could help clinicians provide a more appropriate treatment decision in such cases.
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Affiliation(s)
- L Paternò Holtzman
- Department of Periodontology and Prosthodontics, G. Eastman Dental Hospital, Rome, Italy.,Private practice, Rome, Italy.,Division of Periodontics, Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland, Baltimore, MD, USA
| | - G Blasi
- Division of Periodontics, Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland, Baltimore, MD, USA.,Department of Periodontology, International University of Catalonia, Barcelona, Spain
| | - E Rivera
- Division of Periodontics, Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland, Baltimore, MD, USA
| | - F Herrero
- Division of Periodontics, Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland, Baltimore, MD, USA.,Private practice, San Juan, Puerto Rico
| | - K Downton
- Health Sciences and Human Services Library, University of Maryland, Baltimore, Baltimore, MD, USA
| | - T Oates
- Division of Periodontics, Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland, Baltimore, MD, USA
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23
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Miron RJ, Moraschini V, Del Fabbro M, Piattelli A, Fujioka-Kobayashi M, Zhang Y, Saulacic N, Schaller B, Kawase T, Cosgarea R, Jepsen S, Tuttle D, Bishara M, Canullo L, Eliezer M, Stavropoulos A, Shirakata Y, Stähli A, Gruber R, Lucaciu O, Aroca S, Deppe H, Wang HL, Sculean A. Use of platelet-rich fibrin for the treatment of gingival recessions: a systematic review and meta-analysis. Clin Oral Investig 2020; 24:2543-2557. [PMID: 32591868 DOI: 10.1007/s00784-020-03400-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 06/09/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The aim of this systematic review and meta-analysis was to compare the use of platelet-rich fibrin (PRF) with other commonly utilized treatment modalities for root coverage procedures. MATERIALS AND METHODS The eligibility criteria comprised randomized controlled trials (RCTs) comparing the performance of PRF with that of other modalities in the treatment of Miller class I or II (Cairo RT I) gingival recessions. Studies were classified into 5 categories as follows: (1) coronally advanced flap (CAF) alone vs CAF/PRF, (2) CAF/connective tissue graft (CAF/CTG) vs CAF/PRF, (3) CAF/enamel matrix derivative (CAF/EMD) vs CAF/PRF, (4) CAF/amnion membrane (CAF/AM) vs CAF/PRF, and (5) CAF/CTG vs CAF/CTG/PRF. Studies were evaluated for percentage of relative root coverage (rRC; primary outcome), clinical attachment level (CAL), keratinized mucosa width (KMW), and probing depth (PD) (secondary outcomes). RESULTS From 976 articles identified, 17 RCTs were included. The use of PRF statistically significantly increased rRC and CAL compared with CAF alone. No change in KMW or reduction in PD was reported. Compared with PRF, CTG resulted in statistically significantly better KMW and RC. No statistically significant differences were reported between the CAF/PRF and CAF/EMD groups or between the CAF/PRF and CAF/AM groups for any of the investigated parameters. CONCLUSIONS The use of CAF/PRF improved rRC and CAL compared with the use of CAF alone. While similar outcomes were observed between CAF/PRF and CAF/CTG for CAL and PD change, the latter group led to statistically significantly better outcomes in terms of rRC and KTW. In summary, the use of PRF in conjunction with CAF may represent a valid treatment modality for gingival recessions exhibiting adequate baseline KMW. CLINICAL RELEVANCE The data indicate that the use of PRF in conjunction with CAF statistically significantly improves rRC when compared with CAF alone but did not improve KMW. Therefore, in cases with limited baseline KMW, the use of CTG may be preferred over PRF.
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Affiliation(s)
- Richard J Miron
- Department of Periodontology, University of Bern, Bern, Switzerland.
| | - Vittorio Moraschini
- Department of Periodontology, Dental Research Division, School of Dentistry, Veiga de Almeida University, Rio de Janeiro, Brazil
| | - Massimo Del Fabbro
- Department of Biomedical, Surgical, and Dental Sciences, University of Milan, Milan, Italy.,IRCCS Orthopedic Institute Galeazzi, Milan, Italy
| | - Adriano Piattelli
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy.,Catholic University of San Antonio de Murcia (UCAM), Murcia, Spain.,Villaserena Foundation for Research, Città Sant'Angelo, PE, Italy
| | | | - Yufeng Zhang
- Department of Oral Implantology, University of Wuhan, Wuhan, China
| | - Nikola Saulacic
- Department of Cranio-Maxillofacial Surgery, University of Bern, Bern, Switzerland
| | - Benoit Schaller
- Department of Cranio-Maxillofacial Surgery, University of Bern, Bern, Switzerland
| | - Tomoyuki Kawase
- Division of Oral Bioengineering, Institute of Medicine and Dentistry, Niigata University, Niigata, Japan
| | - Raluca Cosgarea
- Department of Prosthetic Dentistry, University Iuliu Hatieganu, Cluj-Napoca, Romania.,Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany
| | - Soren Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany
| | - Delia Tuttle
- Canyon Lake Dental Office, Lake Elsinore, CA, USA
| | - Mark Bishara
- West Bowmanville Family Dental, Bowmanville, Ontario, Canada
| | | | - Meizi Eliezer
- Department of Periodontology, University of Bern, Bern, Switzerland
| | | | - Yoshinori Shirakata
- Department of Periodontology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Alexandra Stähli
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - Reinhard Gruber
- Department of Oral Biology, University of Vienna, Vienna, Austria
| | - Ondine Lucaciu
- Department of Prosthetic Dentistry, University Iuliu Hatieganu, Cluj-Napoca, Romania
| | - Sofia Aroca
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - Herbert Deppe
- Department of Oral and Maxillofacial Surgery, Klinikum rechts der Isar der TUM, Munich, Germany
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Anton Sculean
- Department of Periodontology, University of Bern, Bern, Switzerland
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Ucak Turer O, Ozcan M, Alkaya B, Surmeli S, Seydaoglu G, Haytac MC. Clinical evaluation of injectable platelet-rich fibrin with connective tissue graft for the treatment of deep gingival recession defects: A controlled randomized clinical trial. J Clin Periodontol 2019; 47:72-80. [PMID: 31518440 DOI: 10.1111/jcpe.13193] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 08/29/2019] [Accepted: 09/09/2019] [Indexed: 12/14/2022]
Abstract
AIM The aim of this study was to determine whether the combined connective tissue graft (CTG) with injectable platelet-rich fibrin (i-PRF) with coronally advanced flap (CAF) improved root coverage of deep Miller Class I or II gingival recessions compared with CTG alone with CAF. MATERIAL AND METHODS Seventy-two patients with Miller class I and II gingival recessions were enrolled. Thirty-six patients were randomly assigned to the test group (CAF+CTG+i-PRF [700 rpm for 3 min]) or control group (CAF+CTG). Clinical evaluations were made at 6 months. RESULTS At 6 months, complete root coverage was obtained at 88% of the sites treated with CAF+CTG+i-PRF and 80% of the sites treated with CAF+CTG. Difference between the two groups was not statistically significant. At 6 months, the recession depth (RD) reduction and increase in keratinized tissue height (KTH) of the test sites were significantly better compared with the control sites. CONCLUSIONS According to the results, the addition of i-PRF to the CAF+CTG treatment showed further development in terms of increasing the KTH and decreasing RD. However, this single trial is not sufficient to advocate the true clinical effect of i-PRF on recession treatment with CAF+CTG and additional trials are needed.
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Affiliation(s)
- Onur Ucak Turer
- Department of Periodontology, Cukurova University, Adana, Turkey
| | - Mustafa Ozcan
- Department of Periodontology, Cukurova University, Adana, Turkey
| | - Bahar Alkaya
- Department of Periodontology, Cukurova University, Adana, Turkey
| | - Seren Surmeli
- Department of Periodontology, Cukurova University, Adana, Turkey
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The Additional Effect of Autologous Platelet Concentrates to Coronally Advanced Flap in the Treatment of Gingival Recessions: A Systematic Review and Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2019; 2019:2587245. [PMID: 31428630 PMCID: PMC6683801 DOI: 10.1155/2019/2587245] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 07/09/2019] [Indexed: 01/05/2023]
Abstract
Background To improve the efficacy of regenerative treatment for gingival recessions, the autologous platelet concentrates (APCs) combined with coronally advanced flap (CAF) have been investigated. However, few studies systematically assess the complementary effect of APCs in periodontal regeneration. The present study aims to evaluate the additional effect of different types of APCs to CAF in the treatment of gingival recessions. Methods Electronic databases (EMBASE, MEDLINE, and Cochrane Central Register of Controlled Trails) and relevant journals were searched until May 15, 2019. Only randomized controlled trials (RCTs) in English were included. Outcome variables include root coverage (RC), recession depth (RD), clinical attachment level (CAL), keratinized tissue width (KTW), and gingival thickness (GT). Data were analyzed with Revman5.3. The estimate of effect sizes was expressed as the mean differences and the 95% confidence interval. Results 8 RCTs involving 170 patients (328 sites) were included. Our meta-analysis indicated RC, RD, CAL, KTW, and GT were better improved in the CAF plus APCs groups than the CAF alone. The subgroup analyses revealed that platelet-rich fibrin (PRF) brought significant improvement in RC, RD, CAL, and GT. Concentrated growth factors (CGF) lead clinic beneficial in CAL, KTW, and GT. No significant effect of platelet-rich plasma (PRP) could be found in any clinical parameters when combined with CAF. Conclusions PRF could exert additional effect to CAF; the preferred treatment for gingival recessions was considered. Based on the limited studies, it seemed that PRP failed to show any additional effect and it was not suggested for gingival recessions. Given the limited research and high risk of bias, it is still needed to confirm the additional effect of CGF by more high-quality studies.
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Potey AM, Kolte RA, Kolte AP, Mody D, Bodhare G, Pakhmode R. Coronally advanced flap with and without platelet-rich fibrin in the treatment of multiple adjacent recession defects: A randomized controlled split-mouth trial. J Indian Soc Periodontol 2019; 23:436-441. [PMID: 31543617 PMCID: PMC6737843 DOI: 10.4103/jisp.jisp_387_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: The objective of our study was to evaluate and compare the effectiveness of coronally advanced flap (CAF) with or without the use of platelet-rich fibrin (PRF) membrane in the treatment of multiple adjacent recession defects (MARD) clinically and by cone-beam computed tomography (CBCT). Materials and Methods: Twenty healthy patients having 75 MARD were allocated randomly to CAF with orthodontic button group (CAFB) or CAFB + PRF membrane group (CAFB + PRF). Clinical parameters such as gingival recession depth (GRD), probing depth (PD), and keratinized tissue width (KTW) were calculated at baseline, 3 months, and 6 months. The distance from the facial alveolar crest of bone to gingival margin bone and gingival thickness (GT) at three different points were assessed by CBCT at baseline and 6-month postsurgery. Esthetic outcome and postoperative discomfort were evaluated using root coverage esthetic score and visual analog scale, respectively. Results: Percent root coverage achieved in CAFB category was 93.17% ± 13.23% and that in CAFB + PRF group was 95.68% ± 10.13% at 6 months, with no notable difference. Similarly, no difference was found in either group in GRD reduction, PD, and CAL postoperatively. Use of PRF resulted in statistically highly significant (P < 0.001) increased GT at 6 months’ time point as compared to participants treated with CAF without PRF, which indicates clinical and esthetic benefits achieved through the procedure. Conclusions: CAFB can be used successfully to treat MARD with predictable outcome. Additional benefit in terms of gain in KTW and GT can be achieved when PRF membrane is used as an adjunct.
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Affiliation(s)
- Anushree Manohar Potey
- Department of Periodontology and Implant Dentistry, VSPM Dental College and Research Centre, Nagpur, Maharashtra, India
| | - Rajashri Abhay Kolte
- Department of Periodontology and Implant Dentistry, VSPM Dental College and Research Centre, Nagpur, Maharashtra, India
| | - Abhay Pandurang Kolte
- Department of Periodontology and Implant Dentistry, VSPM Dental College and Research Centre, Nagpur, Maharashtra, India
| | - Dhawal Mody
- Department of Periodontology and Implant Dentistry, VSPM Dental College and Research Centre, Nagpur, Maharashtra, India
| | - Girish Bodhare
- Department of Periodontology and Implant Dentistry, VSPM Dental College and Research Centre, Nagpur, Maharashtra, India
| | - Resham Pakhmode
- Department of Periodontology and Implant Dentistry, VSPM Dental College and Research Centre, Nagpur, Maharashtra, India
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Del Fabbro M, Karanxha L, Panda S, Bucchi C, Nadathur Doraiswamy J, Sankari M, Ramamoorthi S, Varghese S, Taschieri S. Autologous platelet concentrates for treating periodontal infrabony defects. Cochrane Database Syst Rev 2018; 11:CD011423. [PMID: 30484284 PMCID: PMC6517213 DOI: 10.1002/14651858.cd011423.pub2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Periodontal disease is a condition affecting tooth-supporting tissues (gingiva, alveolar bone, periodontal ligament, and cementum), with the potential of introducing severe adverse effects on oral health. It has a complex pathogenesis which involves the combination of specific micro-organisms and a predisposing host response. Infrabony defects are one of the morphological types of alveolar bone defects that can be observed during periodontitis. Recent approaches for the treatment of infrabony defects, combine advanced surgical techniques with platelet-derived growth factors. These are naturally synthesized polypeptides, acting as mediators for various cellular activities during wound healing. It is believed that the adjunctive use of autologous platelet concentrates to periodontal surgical procedures produces a better and more predictable outcome for the treatment of infrabony defects. OBJECTIVES To assess the effects of autologous platelet concentrates (APC) used as an adjunct to periodontal surgical therapies (open flap debridement (OFD), OFD combined with bone grafting (BG), guided tissue regeneration (GTR), OFD combined with enamel matrix derivative (EMD)) for the treatment of infrabony defects. SEARCH METHODS Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 27 February 2018); the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 1) in the Cochrane Library (searched 27 February 2018); MEDLINE Ovid (1946 to 27 February 2018); Embase Ovid (1980 to 27 February 2018); and LILACS BIREME Virtual Health Library (from 1982 to 27 February 2018). The US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials on 27 February 2018. No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA We included randomised controlled trials (RCTs) of both parallel and split-mouth design, involving patients with infrabony defects requiring surgical treatment. Studies had to compare treatment outcomes of a specific surgical technique combined with APC, with the same technique when used alone. DATA COLLECTION AND ANALYSIS Two review authors independently conducted data extraction and risk of bias assessment, and analysed data following Cochrane methods. The primary outcomes assessed were: change in probing pocket depth (PD), change in clinical attachment level (CAL), and change in radiographic bone defect filling (RBF). We organised all data in four groups, each comparing a specific surgical technique when applied with the adjunct of APC or alone: 1. APC + OFD versus OFD, 2. APC + OFD + BG versus OFD + BG, 3. APC + GTR versus GTR, and 4. APC + EMD versus EMD. MAIN RESULTS We included 38 RCTs. Twenty-two had a split-mouth design, and 16 had a parallel design. The overall evaluated data included 1402 defects. Two studies were at unclear overall risk of bias, while the remaining 36 studies had a high overall risk of bias.1. APC + OFD versus OFD alone Twelve studies were included in this comparison, with a total of 510 infrabony defects. There is evidence of an advantage in using APC globally from split-mouth and parallel studies for all three primary outcomes: PD (mean difference (MD) 1.29 mm, 95% confidence interval (CI) 1.00 to 1.58 mm; P < 0.001; 12 studies; 510 defects; very low-quality evidence); CAL (MD 1.47 mm, 95% CI 1.11 to 1.82 mm; P < 0.001; 12 studies; 510 defects; very low-quality evidence); and RBF (MD 34.26%, 95% CI 30.07% to 38.46%; P < 0.001; 9 studies; 401 defects; very low-quality evidence).2. APC + OFD + BG versus OFD + BG Seventeen studies were included in this comparison, with a total of 569 infrabony defects. Considering all follow-ups, as well as 3 to 6 months and 9 to 12 months, there is evidence of an advantage in using APC from both split-mouth and parallel studies for all three primary outcomes: PD (MD 0.54 mm, 95% CI 0.33 to 0.75 mm; P < 0.001; 17 studies; 569 defects; very low-quality evidence); CAL (MD 0.72 mm, 95% CI 0.43 to 1.00 mm; P < 0.001; 17 studies; 569 defects; very low-quality evidence); and RBF (MD 8.10%, 95% CI 5.26% to 10.94%; P < 0.001; 11 studies; 420 defects; very low-quality evidence).3. APC + GTR versus GTR alone Seven studies were included in this comparison, with a total of 248 infrabony defects. Considering all follow-ups, there is probably a benefit for APC for both PD (MD 0.92 mm, 95% CI -0.02 to 1.86 mm; P = 0.05; very low-quality evidence) and CAL (MD 0.42 mm, 95% CI -0.02 to 0.86 mm; P = 0.06; very low-quality evidence). However, given the wide confidence intervals, there might be a possibility of a slight benefit for the control. When considering a 3 to 6 months and a 9 to 12 months follow-up there were no benefits evidenced, except for CAL at 3 to 6 months (MD 0.54 mm, 95% CI 0.18 to 0.89 mm; P = 0.003; 3 studies; 134 defects). No RBF data were available.4. APC + EMD versus EMDTwo studies were included in this comparison, with a total of 75 infrabony defects. There is insufficient evidence of an overall advantage of using APC for all three primary outcomes: PD (MD 0.13 mm, 95% CI -0.05 to 0.30 mm; P = 0.16; 2 studies; 75 defects; very low-quality evidence), CAL (MD 0.10 mm, 95% CI -0.13 to 0.32 mm; P = 0.40; 2 studies; 75 defects; very low-quality evidence), and RBF (MD -0.60%, 95% CI -6.21% to 5.01%; P = 0.83; 1 study; 49 defects; very low-quality evidence).All studies in all groups reported a survival rate of 100% for the treated teeth. No complete pocket closure was reported. No quantitative analysis regarding patients' quality of life was possible. AUTHORS' CONCLUSIONS There is very low-quality evidence that the adjunct of APC to OFD or OFD + BG when treating infrabony defects may improve probing pocket depth, clinical attachment level, and radiographic bone defect filling. For GTR or EMD, insufficient evidence of an advantage in using APC was observed.
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Affiliation(s)
- Massimo Del Fabbro
- University of MilanDepartment of Biomedical, Surgical and Dental SciencesMilanItaly
- IRCCS Orthopedic Institute GaleazziMilanItaly
| | - Lorena Karanxha
- University of MilanDepartment of Biomedical, Surgical and Dental SciencesMilanItaly
| | - Saurav Panda
- University of MilanDepartment of Biomedical, Surgical and Dental SciencesMilanItaly
- Institute of Dental Science and SUM Hospital, Siksha O AnusandhanDepartment of Periodontics and Oral ImplantologyK‐8, Kalinga NagarGhatikiaBhubaneswarOdishaIndia751002
| | - Cristina Bucchi
- Dental School, University of La FronteraResearch Centre in Dental SciencesManuel Montt #112TemucoChile4781176
| | | | - Malaiappan Sankari
- Saveetha UniversityDepartment of Periodontics162 PH RoadVelapanchavadiChennaiTamil NaduIndia600077
| | - Surendar Ramamoorthi
- Saveetha UniversityDepartment of Conservative Dentistry and Endodontics162, PH RoadVelapanchavadiChennaiTamil NaduIndia600077
| | - Sheeja Varghese
- Saveetha UniversityDepartment of Periodontics162 PH RoadVelapanchavadiChennaiTamil NaduIndia600077
| | - Silvio Taschieri
- University of MilanDepartment of Biomedical, Surgical and Dental SciencesMilanItaly
- IRCCS Orthopedic Institute GaleazziMilanItaly
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In vitro evaluation of decontamination effects on mechanical properties of fibrin membrane. Med J Islam Repub Iran 2018; 32:2. [PMID: 29977870 PMCID: PMC6025911 DOI: 10.14196/mjiri.32.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Indexed: 11/18/2022] Open
Abstract
Background: Tissue engineering has been investigated as a potential method for healing traumatized tissues. Biomaterials are material devices or implants used to repair or replace native body tissues and organs. The present study was conducted to evaluate the effects of decontamination methods on biological/mechanical properties and degradation/adhesion test of the platelet-rich fibrin (PRF) membranes to compare these properties with intact membranes as a biological biomaterial.
Methods: The in vitro degradation tests were conducted by placing the equal sizes of (i) intact PRF membrane, (ii) PRF membrane sterilized by autoclave (iii), ultraviolet (UV), and (iiii) gamma irradiation in phosphate buffer solution on a shaker. The degradation profiles were expressed. Adhesion test was performed by counting adhered mouse fibroblast and sterilized fibrin membrane was compared to normal fibrin membrane by different sterilization methods.
Results: The preliminary findings of sterilized PRF membranes showed that UV exposure (p<0.05) and autoclaved fibrin membranes (p<0.01) have significantly lower degradability compared to normal fibrin membranes. Gamma irradiation is similar to normal membrane in degradability. Cell adherence in all groups of fibrin membrane was significantly lower than the group without membrane, but there was no significant difference between intact and sterilized groups of fibrin membranes.
Conclusion: Sterilization of fibrin membrane with different protocols does not have any adverse effects on cell adhesion; however, cell adherence is naturally very weak even in normal membranes. Also, it seems that ultraviolet ray polymerizes fibrin filaments and merges them to each other and increases the ability of fibrin membrane against degradation. Autoclaved fibrin membrane content proteins are denatured because of pressure and heat and show an increase in hardness and stability against degradation.
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Alternatives to connective tissue graft in the treatment of localized gingival recessions: A systematic review. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2018; 119:25-32. [PMID: 28893718 DOI: 10.1016/j.jormas.2017.09.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Revised: 06/21/2017] [Accepted: 09/03/2017] [Indexed: 10/18/2022]
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Clinical evaluation of coronally advanced flap with or without platelet-rich fibrin for the treatment of multiple gingival recessions. Clin Oral Investig 2017; 22:1551-1558. [DOI: 10.1007/s00784-017-2225-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 09/27/2017] [Indexed: 01/23/2023]
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31
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Verma UP, Yadav RK, Dixit M, Gupta A. Platelet-rich Fibrin: A Paradigm in Periodontal Therapy - A Systematic Review. J Int Soc Prev Community Dent 2017; 7:227-233. [PMID: 29026693 PMCID: PMC5629849 DOI: 10.4103/jispcd.jispcd_429_16] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 07/20/2017] [Indexed: 12/19/2022] Open
Abstract
Periodontal tissue regeneration has always been a challenge for the periodontists owing to its structural complexity. Although with tissue engineering as a growing multidisciplinary field, this aim has partially been fulfilled. In recent years, platelet-rich fibrin (PRF) has gained wide attention for its utilization as a biocompatible regenerative material not only in dental but also in medical fields. The following systematic review has gathered all the currently available in vitro, animal, and clinical studies utilizing PubMed electronic database from January 2006 to August 2016 highlighting PRF for soft and hard tissue regeneration and/or wound healing. Although results are encouraging but require further validation from clinical studies to justify the potential role of PRF in periodontal regeneration so that this relatively inexpensive autologous biomaterial can be utilized at a wider scale.
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Affiliation(s)
- Umesh Pratap Verma
- Department of Periodontology, Faculty of Dental Sciences, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Rakesh Kumar Yadav
- Department of Conservative Dentistry and Endodontics, Faculty of Dental Sciences, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Manisha Dixit
- Department of Periodontology, Faculty of Dental Sciences, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Abhaya Gupta
- Department of Periodontology, Faculty of Dental Sciences, King George's Medical University, Lucknow, Uttar Pradesh, India
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32
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Miron RJ, Zucchelli G, Pikos MA, Salama M, Lee S, Guillemette V, Fujioka-Kobayashi M, Bishara M, Zhang Y, Wang HL, Chandad F, Nacopoulos C, Simonpieri A, Aalam AA, Felice P, Sammartino G, Ghanaati S, Hernandez MA, Choukroun J. Use of platelet-rich fibrin in regenerative dentistry: a systematic review. Clin Oral Investig 2017; 21:1913-1927. [PMID: 28551729 DOI: 10.1007/s00784-017-2133-z] [Citation(s) in RCA: 239] [Impact Index Per Article: 34.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 05/15/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Research across many fields of medicine now points towards the clinical advantages of combining regenerative procedures with platelet-rich fibrin (PRF). This systematic review aimed to gather the extensive number of articles published to date on PRF in the dental field to better understand the clinical procedures where PRF may be utilized to enhance tissue/bone formation. MATERIALS AND METHODS Manuscripts were searched systematically until May 2016 and separated into the following categories: intrabony and furcation defect regeneration, extraction socket management, sinus lifting procedures, gingival recession treatment, and guided bone regeneration (GBR) including horizontal/vertical bone augmentation procedures. Only human randomized clinical trials were included for assessment. RESULTS In total, 35 articles were selected and divided accordingly (kappa = 0.94). Overall, the use of PRF has been most investigated in periodontology for the treatment of periodontal intrabony defects and gingival recessions where the majority of studies have demonstrated favorable results in soft tissue management and repair. Little to no randomized clinical trials were found for extraction socket management although PRF has been shown to significantly decrease by tenfold dry sockets of third molars. Very little to no data was available directly investigating the effects of PRF on new bone formation in GBR, horizontal/vertical bone augmentation procedures, treatment of peri-implantitis, and sinus lifting procedures. CONCLUSIONS Much investigation now supports the use of PRF for periodontal and soft tissue repair. Despite this, there remains a lack of well-conducted studies demonstrating convincingly the role of PRF during hard tissue bone regeneration. Future human randomized clinical studies evaluating the use of PRF on bone formation thus remain necessary. CLINICAL RELEVANCE PRF was shown to improve soft tissue generation and limit dimensional changes post-extraction, with little available data to date supporting its use in GBR.
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Affiliation(s)
- Richard J Miron
- College of Dental Medicine, Department of Periodontology, Nova Southeastern University, Fort Lauderdale, FL, USA. .,Department of Periodontics and Oral Medicine, University of Michigan, Ann Arbor, MI, USA.
| | - Giovanni Zucchelli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | | | - Maurice Salama
- College of Dental Medicine, Department of Periodontology, Nova Southeastern University, Fort Lauderdale, FL, USA.,Department of Periodontology, Georgia University, Athens, GA, USA.,Goldstein Garber & Salama, Atlanta, GA, USA
| | - Samuel Lee
- International Academy of Dental Implantology, San Diego, CA, USA
| | | | - Masako Fujioka-Kobayashi
- College of Dental Medicine, Department of Periodontology, Nova Southeastern University, Fort Lauderdale, FL, USA.,Department of Cranio-Maxillofacial Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Oral Surgery, Clinical Dentistry, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Mark Bishara
- West Bowmanville Dental, Bowmanville, Ontario, Canada
| | - Yufeng Zhang
- Department of Oral Implantology, University of Wuhan, Wuhan, China
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Fatiha Chandad
- Department of Periodontology, Laval University, Quebec City, Canada
| | - Cleopatra Nacopoulos
- Laboratory for Research of the Musculoskeletal System, KAT Hospital, School of Medicine, National and Kapodistrian, University of Athens, Athens, Greece
| | - Alain Simonpieri
- Oral Surgery Department, University Federico II Naples, Naples, Italy.,Periodontology and Implantology, Beausoleil, France.,Periodontology and Implantology, Marseille, France
| | - Alexandre Amir Aalam
- Department of Advanced Periodontics, USC School of Dentistry, Los Angeles, CA, USA
| | - Pietro Felice
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Gilberto Sammartino
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Shahram Ghanaati
- FORM, Frankfurt Oral Regenerative Medicine, Clinic for Maxillofacial and Plastic Surgery, Johann Wolfgang Goethe University, Frankfurt am Main, Germany
| | - Maria A Hernandez
- College of Dental Medicine, Department of Periodontology, Nova Southeastern University, Fort Lauderdale, FL, USA
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Platelet Rich Fibrin “PRF” and Regenerative Medicine: ‘The Low-Speed Concept’. STEM CELL BIOLOGY AND REGENERATIVE MEDICINE 2017. [DOI: 10.1007/978-3-319-55645-1_2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Garg S, Arora SA, Chhina S, Singh P. Multiple Gingival Recession Coverage Treated with Vestibular Incision Subperiosteal Tunnel Access Approach with or without Platelet-Rich Fibrin - A Case Series. Contemp Clin Dent 2017; 8:464-468. [PMID: 29042736 PMCID: PMC5644008 DOI: 10.4103/ccd.ccd_142_17] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background: Gingival recession involves both soft tissue and hard tissue loss. In this evolutionary era of dentistry, newer techniques have evolved for complete coverage of isolated recession defects. Since 2012, vestibular incision subperiosteal tunnel access (VISTA) technique was used with various regenerative membranes to treat multiple recession defects (MRDs). Platelet-rich fibrin (PRF) membrane, a pool of growth factors but have any added advantage to recession coverage techniques is controversial. Thus, in this case series, we compare the effect of VISTA with or without PRF-membrane for the treatment of Classes I and III MRDs. Subjects and Methods: Four patients between of age 30 and 40 years (two patients having bilateral Class I and another two having bilateral Class III MRDs) were selected from the Department of Periodontics, ITS Dental College, Greater Noida and designated as Case I–IV simultaneously. Recession defects at antagonist sites in each patient were corrected by VISTA approach with or without PRF-membrane. Recorded clinical parameters included recession depth, recession width, pocket probing depth, and clinical attachment level (CAL) at baseline and 6 months postoperatively. Results: Patients having Class I recession defects showed almost complete root coverage with VISTA technique alone and reflected no added advantage of PRF-membrane. However, patients with Class III recession defects treated with VISTA + PRF-membrane showed more reduction in recession depth and gain in CAL as compared to sites treated with VISTA only. Conclusion: VISTA alone is a convenient technique for treatment of Class I MRDs. Addition of PRF-membrane for Class III recession defects give better outcome in term of reduction of recession depth and gain in CAL 6 month postoperatively.
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Affiliation(s)
- Surbhi Garg
- Department of Periodontics, ITS Dental College, Greater Noida, Uttar Pradesh, India
| | - Sachit Anand Arora
- Department of Periodontics, ITS Dental College, Greater Noida, Uttar Pradesh, India
| | - Shivjot Chhina
- Department of Periodontics, ITS Dental College, Greater Noida, Uttar Pradesh, India
| | - Padam Singh
- Department of Periodontics, ITS Dental College, Greater Noida, Uttar Pradesh, India
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Castro AB, Meschi N, Temmerman A, Pinto N, Lambrechts P, Teughels W, Quirynen M. Regenerative potential of leucocyte- and platelet-rich fibrin. Part A: intra-bony defects, furcation defects and periodontal plastic surgery. A systematic review and meta-analysis. J Clin Periodontol 2017; 44:67-82. [PMID: 27783851 PMCID: PMC5248642 DOI: 10.1111/jcpe.12643] [Citation(s) in RCA: 146] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2016] [Indexed: 12/20/2022]
Abstract
AIM To analyse the regenerative potential of leucocyte- and platelet-rich fibrin (L-PRF) during periodontal surgery. MATERIALS AND METHODS An electronic and hand search were conducted in three databases. Only randomized clinical trials were selected and no follow-up limitation was applied. Pocket depth (PD), clinical attachment level (CAL), bone fill, keratinized tissue width (KTW), recession reduction and root coverage (%) were considered as outcome. When possible, meta-analysis was performed. RESULTS Twenty-four articles fulfilled the inclusion and exclusion criteria. Three subgroups were created: intra-bony defects (IBDs), furcation defects and periodontal plastic surgery. Meta-analysis was performed in all the subgroups. Significant PD reduction (1.1 ± 0.5 mm, p < 0.001), CAL gain (1.2 ± 0.6 mm, p < 0.001) and bone fill (1.7 ± 0.7 mm, p < 0.001) were found when comparing L-PRF to open flap debridement (OFD) in IBDs. For furcation defects, significant PD reduction (1.9 ± 1.5 mm, p = 0.01), CAL gain (1.3 ± 0.4 mm, p < 0.001) and bone fill (1.5 ± 0.3 mm, p < 0.001) were reported when comparing L-PRF to OFD. When L-PRF was compared to a connective tissue graft, similar outcomes were recorded for PD reduction (0.2 ± 0.3 mm, p > 0.05), CAL gain (0.2 ± 0.5 mm, p > 0.05), KTW (0.3 ± 0.4 mm, p > 0.05) and recession reduction (0.2 ± 0.3 mm, p > 0.05). CONCLUSIONS L-PRF enhances periodontal wound healing.
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Affiliation(s)
- Ana B. Castro
- Department of Oral Health Sciences, PeriodontologyKU Leuven & Dentistry, University Hospitals LeuvenLeuvenBelgium
| | - Nastaran Meschi
- Department of Oral Health Sciences, EndodontologyKU Leuven & Dentistry, University Hospitals LeuvenLeuvenBelgium
| | - Andy Temmerman
- Department of Oral Health Sciences, PeriodontologyKU Leuven & Dentistry, University Hospitals LeuvenLeuvenBelgium
| | - Nelson Pinto
- Department of Oral Health Sciences, PeriodontologyKU Leuven & Dentistry, University Hospitals LeuvenLeuvenBelgium
- Faculty of DentistryPostgraduate Implant ProgramUniversity of the AndesSantiagoChile
| | - Paul Lambrechts
- Department of Oral Health Sciences, EndodontologyKU Leuven & Dentistry, University Hospitals LeuvenLeuvenBelgium
| | - Wim Teughels
- Department of Oral Health Sciences, PeriodontologyKU Leuven & Dentistry, University Hospitals LeuvenLeuvenBelgium
| | - Marc Quirynen
- Department of Oral Health Sciences, PeriodontologyKU Leuven & Dentistry, University Hospitals LeuvenLeuvenBelgium
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Moraschini V, Barboza EDSP. Use of Platelet-Rich Fibrin Membrane in the Treatment of Gingival Recession: A Systematic Review and Meta-Analysis. J Periodontol 2015; 87:281-90. [PMID: 26561997 DOI: 10.1902/jop.2015.150420] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The aim of this systematic review is to evaluate the effects of platelet-rich fibrin (PRF) membranes on the outcomes of clinical treatments in patients with gingival recession. METHODS Articles that were published before June 2015 were searched electronically in four databases without any date or language restrictions and searched manually in regular journals and unpublished studies. The eligibility criteria comprised randomized controlled trials (RCTs) and prospective controlled trials with follow-up periods of ≥ 6 months that compared the performance of PRF to other biomaterials in the treatment of Miller Class I or II gingival recessions. For the meta-analysis, the inverse variance method was used in fixed- or random-effect models, which were chosen according to heterogeneity. The estimates of the intervention effects were expressed as the mean differences in percentages or millimeters. RESULTS Six RCTs and one prospective clinical trial are included in this review. Root coverage (RC) and clinical attachment level (CAL) did not differ significantly between the analyzed subgroups (P = 0.57 and P = 0.50, respectively). The keratinized mucosa width (KMW) gain was significantly greater (P = 0.04) in the subgroup that was treated with connective tissue grafts. CONCLUSION The results of the meta-analysis suggest that the use of PRF membranes did not improve the RC, KMW, or CAL of Miller Class I and II gingival recessions compared with the other treatment modalities.
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Affiliation(s)
- Vittorio Moraschini
- Department of Periodontology, School of Dentistry, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
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