Efficacy of platelet rich fibrin in the treatment of human intrabony defects with or without bone graft: A randomized controlled trial

Treatment of Unfavorable Intrabony Defects with Autogenous Bone Graft in Combination with Leukocyte- and Platelet-Rich Fibrin or Collagen Membranes: A Non-Inferiority Study

Background and Objectives: Unfavorable intrabony defects (IBDs) are associated with the progression of periodontal disease and tooth loss. Growing scientific evidence has demonstrated the effectiveness of platelet concentrations in periodontal treatment. The aim of our study was to demonstrate the non-inferiority of an autogenous bone graft (ABG) associated with leukocyte- and platelet-rich fibrin (L-PRF) compared to ABG + Collagen Membrane in the treatment of IBDs. Material and Methods: Sixty-four patients with at least one IBD were randomly assigned to two groups: ABG+L-PRF and CM+ABG. Clinical and radiographic evaluations were performed at baseline and 12-month follow-up. Clinical attachment level (CAL), gingival recession (GR), probing pocket depth (PPD), and radiograph defect bone level (DBL) were compared between the two treatments. To evaluate the effectiveness of ABG+L-PRF, a non-inferiority margin of =1 mm (-1 mm for GR) was chosen; a second non-inferiority margin of =0.5 mm (-0.5 mm for GR) was set for clinical relevance. Results: At 12-month follow up, both treatments showed clinical and radiographic improvements. The 90% confidence intervals of the CM+ABG-L-PRF+ABG mean difference for CAL gain (-0.0564 mm [-0.316 to 0.203]), DBL gain (-0.433 mm [-0.721 to -0.145]), and PPD reduction (0.232 mm [0.015 to 0.449]) were below the 0.5 mm non-inferiority margin; the GR increase (0.255 mm [0.0645 to 0.445]) stayed above the -0.5 mm. Conclusions: the L-PRF+ABG treatment of unfavorable IBDs is non-inferior with respect to the CM+ABG therapy for CAL gain, but with a lower GR, a slightly higher PPD, and DBL gain.

Demineralized bone matrix for repair and regeneration of maxillofacial defects: A narrative review

OBJECTIVES

Demineralized bone matrix (DBM) is a well-established bone graft material widely accepted by dentists and the public for its favorable osteoconductivity and osteoinductive potential. This article aimed to provide a narrative review of the current therapeutic applications and limitations of DBM in maxillofacial bone defects.

STUDY SELECTION, DATA, AND SOURCES

Randomized controlled trials, prospective or retrospective clinical studies, case series and reports, and systematic reviews. MEDLINE, PubMed, and Google Scholar were searched using keywords.

CONCLUSIONS

Some evidence supported the therapeutic application of DBM in periodontal intrabony defects, maxillary sinus lifts, ridge preservation, ridge augmentation, alveolar cleft repair, orthognathic surgery, and other regional maxillofacial bone defects. However, the limitations of DBM should be considered when using it, including potential low immunogenicity, instability of osteoinductive potential, handling of the graft material, and patient acceptance.

CLINICAL SIGNIFICANCE

With the increasing demand for the treatment of maxillofacial bone defects, DBM is likely to play a greater role as a promising bone graft material. Safe and effective combination treatment strategies and how to maintain a stable osteoinductive potential will be the future challenges of DBM research.

Comparing efficacies of autologous platelet concentrate preparations as mono-therapeutic agents in intra-bony defects through systematic review and meta-analysis

Aim

This systematic review and meta-analysis aimed to assess individually the regenerative potential of PRF (Platelet-rich Fibrin), PRP (Platelet-rich Plasma), and PRGF (Plasma Rich in Growth Factors) in comparison to OFD (Open Flap Debridement) alone for treating Intrabony defects, by calculating pooled effect sizes.

Background

Relevant randomized controlled trials on humans were searched in PUBMED, COCHRANE CENTRAL, and GOOGLE SCHOLAR. Mean differences (MD) of Clinical Attachment level (CAL), Probing Pocket depth (PPD), and Defect Depth Reduction (DDR) between the Experimental and Control groups were used for calculating pooled effect sizes. Risk of bias was assessed using Cochrane's tool, and publication bias was evaluated through Funnel plots, Trim & Fill Method, and Rosenthal's Fail-Safe N Test.

Review result

A total of 23 studies were identified for qualitative and quantitative analysis. These studies were categorized into PRF, PRP, and PRGF groups based on the type of APC used. PRF showed the highest CAL gain (1.60 mm, 95% CI = 0.963-2.232 mm, P < 0.001, I2 = 93.83%) and PPD reduction (1.76 mm, 95% CI = 1.056 to 2.446, P < 0.001, I2 = 96.05%). However, PRP exhibited the greatest DDR (3.42 mm, 95% CI = -13.67 to -20.50, P = 0.011, I2 = 87.27%). PRF and PRP demonstrated large effect sizes, while PRGF showed a small effect size.

Conclusion

The use of PRF, PRP, and PRGF showed advantages in treating intrabony defects. However, caution is advised when interpreting the results due to heterogeneity and publication bias among the studies.

Do autologous platelet concentrates (APCs) have a role in intra-oral bone regeneration? A critical review of clinical guidelines on decision-making process

In the past decades, personalized regenerative medicine has gained increased attention. Autologous platelet concentrates (APCs) such as PRP, PRGF, and L-PRF, all serving as a source of a large variety of cells and growth factors that participate in hard and soft tissue healing and regeneration, could play a significant role in regenerative periodontal procedures. This narrative review evaluated the relative impact of APCs in alveolar ridge preservation, sinus floor augmentation, and the regeneration of bony craters around teeth, both as a single substitute or in combination with a xenograft. L-PRF has a significant beneficial effect on alveolar ridge preservation (bone quality). The data for PRGF are less convincing, and PRP is controversial. L-PRF can successfully be used as a single substitute during transcrestal (≥3.5 mm bone gain) as well as 1-stage lateral window sinus floor elevation (>5 mm bone gain). For PRGF and especially PRP the data are very scarce. In the treatment of bony craters around teeth, during open flap debridement, L-PRF as a single substitute showed significant adjunctive benefits (e.g., >PPD reduction, >CAL gain, >crater depth reduction). The data for PRP and PRGF were non-conclusive. Adding PRP or L-PRF to a xenograft during OFD resulted in additional improvements (>PPD reduction, >CAL gain, >bone fill), for PRGF no data were found. Autologous platelet concentrates demonstrated to enhance bone and soft tissue healing in periodontal regenerative procedures. The data for L-PRF were most convincing. L-PRF also has the advantage of a greater simplicity of production, and its 100% autologous character.

Comparative evaluation of regenerative potential of injectable platelet-rich fibrin and platelet-rich fibrin with demineralized freeze-dried bone allograft in the treatment of intrabony defects: A randomized controlled clinical study

Background

Injectable platelet-rich fibrin (i-PRF) being in liquid form keeps graft particles clumped together forming agglutinated steak of bone graft. It has been shown to contain more platelets and long-term deliverance of growth factors in comparison with platelet-rich fibrin (PRF).

Aim

The aim of the present study was to assess regenerative potential of i-PRF and comparing it with PRF, along with demineralized freeze-dried bone allograft (DFDBA) in the treatment of intrabony alveolar defects.

Materials and Method

Thirty defect sites in 15 patients with bilateral intrabony defects were assigned randomly into two groups (Group I (Control group)- DFDBA + PRF and Group II (Test group)-DFDBA + i-PRF). Gingival index (GI), plaque index (PI), pocket probing depth (PPD), and relative attachment level (RAL) were recorded at baseline, 3 months, and 6 months. Linear bone growth (LBG) was recorded radiographically at baseline and 6 months.

Statistical Analysis

ANOVA test and post hoc Tukey test were used to assess intragroup comparison of clinical parameters. Paired t-test was used to assess intragroup comparison of the radiographic parameter. Unpaired t-test was used to assess intergroup variations in all the clinical as well as radiographic parameters.

Results

Statistically significant PPD reduction (P = 0.005) and RAL gain (P = 0.003) were found in Group II than in Group I, and no significant difference was found in other parameters. Percentage LBG was higher in Group II than Group I but the difference was not statistically significant.

Conclusion

i-PRF with DFDBA showed more favorable results as compared to PRF with DFDBA in the management of intrabony periodontal defects.

Clinical Efficacy of Platelet Derivatives in Periodontal Tissue Regeneration: An Umbrella Review

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.

Effectiveness of the use of platelet-rich fibrin associated with open flap debridement compared to open flap debridement alone for the treatment of periodontal intrabony defects: Overview of systematic reviews

In the recent years, platelet-rich fibrin (PRF) has gained importance in regenerative medicine due to its attributed tissue-inducing properties. However, it is still unclear whether there are benefits from using PRF with open flap debridement (OFD) for the treatment of intrabony defects compared to OFD alone. For this reason, in this study, we performed an overview of systematic reviews with Friendly Summaries of the Body of Evidence using Epistemonikos methodology on the use of PRF with OFD compared to OFD alone for the treatment of intrabony defects. We performed a systematic search in the Epistemonikos database. We extracted data from the included systematic reviews and reanalyzed the data of primary studies and generated a summary of the findings table. We used Review Manager (RevMan) v5.3 software and GRADEpro software for data analysis and data presentation. Eighteen systematic reviews were included after full-text screening, which had 16 clinical trials. Results were reported by the mean difference (MD); the following outcomes were analyzed: change in intrabony defect depth (MD: 1.37 mm more), change in radiographic bone defect filling (MD: 37.26% more), change in probing depth (MD: 1.22 mm more), change in clinical attachment level (MD: 1.32 mm more), and change in gingival margin level (MD: 0.31 more). We concluded that applying PRF with OFD to treat an intrabony defect has some clinical advantages compared to OFD alone.

El Said HA, A. EL Gendi HA. Evaluation of the effect of moringa oleifera gel and autologo platelet-rich fibrin in the treatment of rabbit intra bony defects. (Radio graphic and Histological study)

Purpose

Periodontitis is the most common condition, which causes bony defects; the ultimate goal of periodontal therapy is the regeneration of the destroyed tissues. There is always a need to search for better biomaterials that can be used for the treatment of intrabony defects. This study evaluated the effect of Moringa oleifera (MO) gel and platelet-rich fibrin (PRF) in the treatment of bone defects.

Hypothesis

We hypothesized that MO gel may increase the bone mineral contents and density of bone.

Methods

The study was conducted on 16 defects in 8 adult male rabbits divided into 2 groups; group (1) buccal bone defect treated with moringa hydrogel and PRF (right site), group (2) buccal bone defect treated with PRF (left site). Computed tomography (CT) radiography and histological examination were assessed at baseline, 14 and 28 days. The defects were induced in the form of one osseous wall defect between the 1st and the 2nd molars. Comparisons between groups were done using an unpaired t-test. For comparison within each group, analysis of variance (ANOVA) was used.

Results

CT radiograph results showed there was a significant increase in bone density at 28 days in group 1 than in group 2 (843.13 ± 97.82 to 713.0 ± 51.09). The histological result revealed the defect area on the (PRF + Moringa) was almost filled completely by newly formed bone with few spots of retarded calcification. While (PRF) showed complete filling of the defect area by more fibrous tissue. The healing score showed a significant elevation of bone defect healing score in (PRF + Moringa group) when compared to (PRF group) at both times of evaluation.

Conclusion

Radiographical examination, and histological and healing scores confirmed the superiority of Moringa + PRF results in an increase in bone fill and density in induced periodontal intrabony defects regeneration. Clinical trials should be considered to detect the effectiveness of MO in intrabony defects.

Efficacy of biologics for the treatment of periodontal infrabony defects: An American Academy of Periodontology best evidence systematic review and network meta-analysis

BACKGROUND

A large variety of biomaterials, biologics and membranes have been utilized in the past 40 years for the regenerative treatment of periodontal infrabony defects. Biologic agents have progressively gained popularity among clinicians and are routinely used for periodontal regeneration. In alignment with the goals of the American Academy of Periodontology (AAP) Best Evidence Consensus (BEC) on the use of biologic mediators in contemporary clinical practice, the aim of this sytematic review was to evaluate the effect of biologic agents, specifically autogenous blood-dervied products (ABPs), enamel matrix derivative (EMD) and recombinant human platelet-derived growth factor-BB (rhPDGF-BB), on the regenerative outcomes of infrabony defects.

METHODS

A detailed systematic search was conducted to identify eligible randomized control trials (RCTs) reporting the outcomes of periodontal regenerative therapy using biologics for the treatment of infrabony defects. A frequentist mixed-modeling approach to network meta-analysis (NMA), characterized by the assessment of three individual components for the treatment of an infrabony defect (the bone graft material [BG], the biologic agent, the application of a barrier membrane) was performed to evaluate and compare the relative efficacy of the different components, on the outcomes of different therapeutic modalities of periodontal regeneration.

RESULTS

A total of 153 eligible RCTs were included, with 150 studies contributing to the NMA. The quantitative analysis showed that the addition of biologic agents to bone graft significantly improves the clinical and radiographic outcomes, as compared to BG and flap procedures alone. Barrier membranes enhanced the regenerative outcomes of BG but did not provide further benefits in combination with biologics. The type of BG (autogenous, allogeneic, xenogeneic or alloplastic) and the biologic agent (EMD, platelet-rich fibrin [PRF], platelet-rich plasma [PRP] or rhPDGF-BB) played a significant role on the final outcomes of infrabony defects. Allogeneic and xenogeneic BGs exhibited statistically significantly superior clinical gain than synthetic and autogenous BGs (p < 0.05 in all the comparisons), while rhPDGF-BB and PRF demonstrated significantly higher stability of the gingival margin (p < 0.01) and radiographic bone fill/gain (p < 0.05), together with greater, although not statistically significant, clinical attachment level gain and pocket depth reduction, than EMD and PRP. Overall, rhPDGF-BB exhibited the largest effect size for most parameters, including clinical attachment level gain, pocket depth reduction, less gingival recession and radiographic linear bone gain. Considering the relatively high number of trials presenting an unclear or high risk of bias, the strength of recommendation supporting the use of PRP was judged weak, while the recommendation for EMD, PRF and rhPDGF-BB was deemed in favor.

CONCLUSIONS

Biologics enhance the outcomes of periodontal regenerative therapy. Combination therapies involving BGs + biologics or BGs + barrier membrane demonstrated to be superior to monotherapies. The choice of the type of BG and biologic agent seems to have significant impact on the clinical and radiographic outcomes of infrabony defects.

The Adjunctive Use of Leucocyte- and Platelet-Rich Fibrin in Periodontal Endosseous and Furcation Defects: A Systematic Review and Meta-Analysis

The aim of this systematic review of randomized controlled trials was to evaluate the adjunctive use of leucocyte- and platelet-rich fibrin (L-PRF) in periodontal endosseous and furcation defects, as compared without L-PRF. The endosseous defect group was subclassified into: L-PRF/open flap debridement (L-PRF/OFD) versus OFD, L-PRF/osseous graft (L-PRF/OG) versus OG, L-PRF/Emdogain (L-PRF/EMD) versus EMD, and L-PRF/guided tissue regeneration (L-PRF/GTR) versus GTR. The furcation defect group was subclassified into L-PRF/OFD versus OFD, and L-PRF/OG versus OG. Mean difference, 95% confidence intervals and forest plots were calculated for probing pocket depth (PPD), clinical attachment level (CAL) and radiographic defect depth (DD). Nineteen studies concerning systemically healthy non-smokers were included. The results of this systematic review and meta-analysis showed in two- and/or three-wall endosseous defects that the adjunctive use of L-PRF to OFD or OG was significantly beneficial for PPD reduction, CAL gain and DD reduction, as compared without L-PRF. Furthermore, the data showed that for two- and/or three-wall endosseous defects, the adjunctive use of L-PRF to GTR was significantly beneficial for CAL and DD improvement, whereas adding L-PRF to EMD had no significant effect, and that for class II furcation defects, the addition of L-PRF to OFD was significantly beneficial for PPD, CAL and DD improvement, whereas the addition of L-PRF to OG was significantly clinically beneficial. In conclusion, this systematic review and meta-analysis found that there was significant clinical and radiographic additive effectiveness of L-PRF to OFD and to OG in two- and/or three-wall periodontal endosseous defects of systemically healthy non-smokers, as compared without L-PRF.

Evaluation of Platelet-Rich Fibrin Matrix as a Regenerative Material in the Surgical Management of Human Periodontal Intraosseous Defects - A Randomized Controlled Trial

Background

Platelet-rich fibrin matrix (PRFM) has not been extensively studied as other platelet concentrates such as Choukron's platelet-rich fibrin (PRF). This randomized controlled trial aimed to evaluate PRFM regenerative ability in human periodontal intrabony defects.

Materials and Methods

Fifteen patients (age: 30-55 years) having probing pocket depth (PPD) ≥6 mm, and radiographic evidence of bilateral vertical intrabony defects were recruited. A split-mouth design was used in each patient; one quadrant of the arch was treated with open flap debridement (OFD) alone (control group) and the other quadrant with OFD + PRFM (test group). The PRFM was prepared by dual-spin technology using a patented thixotropic separator gel. Outcome measures comprising plaque index, gingival index (GI), PPD, clinical attachment level (CAL), depth of the defect, defect fill (DF), and percentage of DF (PDF) were recorded at baseline, after 3 months and 6 months. The parameters were applicably analyzed using the Friedman test, Fisher's exact test, t-test, paired t-test, repeated measures ANOVA, and Post Hoc-Bonferroni correction.

Results

The GI, a net reduction in CAL, and PPD of the test group were significantly better than the control group at 3 months and 6 months (P < 0.05), while DF and PDF showed significant results at 6 months (P < 0.05). A consistent early wound healing index of 1 at 1 week was displayed in the test group (66.7%) in comparison to the control group (33.7%).

Conclusion

PRFM can be a clinically significant periodontal regenerative material in the treatment of vertical intraosseous defects.

Effectiveness of Platelet-Rich Fibrin in the Treatment of Intrabony Defects with or Without Bone Graft: A Clinical Comparative Study

BACKGROUND

Periodontal diseases are a group of inflammatory diseases causing alveolar bone loss and eventually leading to loss of teeth. The present study was evaluated the effectiveness of platelet-rich fibrin (PRF) in the treatment of intrabony defects with or without bone graft.

MATERIALS AND METHODS

Thirty subjects with the presence of intrabony defects were enrolled. All subjects were included irrespective of age and gender. A questionnaire was prepared for extracting demographic and personal details of all the patients. William probe and moth mirror-tweezers set was used for carrying out clinical examination of all subjects. Random and unbiased division of all the subjects was done with ten patients in each group as follows: Group I: Subjects in which treatment was carried out using PRF with demineralized bone matrix, Group II: Subjects in which treatment was carried out using PRF alone, and Group III: Subjects in which treatment was carried in the form of open flap debridement (OFD). Pretreatment and posttreatment clinical variables were assessed which included plaque index (PI), gingival index (GI), probing depth (PD), relative attachment level (RAL), and gingival recession (GR) were assessed at baseline and 9 months postoperatively were calculated.

RESULTS

Mean PI among Group 1, Group 2, and Group 3 at baseline was 0.78, 0.8, and 0.84, respectively. Mean PI among Group 1, Group 2, and Group 3 at 9 months follow-up was 0.56, 0.55, and 0.72, respectively. Significant results were obtained while comparing the PI among the three study groups at follow-up. Mean GI among Group 1, Group 2, and Group 3 at baseline was 0.78, 0.8, and 0.84, respectively. Mean GI among Group 1, Group 2, and Group 3 at 9 months follow-up was 0.56, 0.55, and 0.72, respectively. Significant results were obtained while comparing the GI among the three study groups at follow-up. Significant difference was seen in PD, RAL, and GR from baseline to 9 months in all groups (P < 0.05).

CONCLUSION

PRF leads to significantly better improvement in the clinical parameters on follow-up in comparison to OFD alone in patients with the presence of intrabony defects.

Efficacy of inorganic bovine bone combined with leukocyte and platelet-rich fibrin or collagen membranes for treating unfavorable periodontal infrabony defects: Randomized non-inferiority trial

BACKGROUND

Growing evidence shows the efficacy of platelet concentrates in periodontal therapy. This study aimed to demonstrate that an inorganic bovine bone graft (IBB) in combination with a leukocyte and platelet rich fibrin (L-PRF) is non-inferior to a combination with a collagen membrane (CM) when managing unfavorable infrabony defects (IBDs).

METHODS

All patients exhibited at least one unfavorable IBD; they were randomly assigned to two groups, 31 treated with L-PRF+IBB and 31 with CM+IBB. A clinical and radiographic examination was performed at baseline and 12 months later. Clinical attachment level (CAL), gingival recession (GR), probing depth (PD), and radiographic defect bone level (DBL) post-therapy changes were compared between the two treatments. A non-inferiority margin = 1 mm was set to determine the efficacy of the test treatment (-1 mm for GR); a second non-inferiority margin = 0.5 mm (-0.5 mm for GR) was chosen for clinical relevance.

RESULTS

Twelve months after surgery a significant improvement of clinical and radiographic parameters was observed at both experimental sites. The 90% confidence intervals of the CM+IBB-L-PRF+IBB mean difference for CAL gain (-0.810 mm [-1.300 to -0.319]) and DBL gain (-0.648 mm [-1.244 to -0.052]) were below the 0.5 mm non-inferiority margin; GR increase (1.284 mm [0.764 to 1.804]) remained above the -0.5 mm, while PD reduction (0.499 mm [0.145 to 0.853]) crossed its 0.5-mm margin.

CONCLUSIONS

The L-PRF+IBB treatment of unfavorable IBDs offers non-inferior efficacy for CAL gain, showing less GR and more DBL gain too, while for PD reduction it is inferior to the CM+IBB treatment.

Evaluation of the Use of Platelet-Rich Fibrin Xenologous Membranes Derived from Bubaline Blood in Canine Periodontal Defects

Periodontal disease is the most common oral disease in dogs. Platelet-rich fibrin (PRF) is widely utilized to facilitate soft and hard tissue healing and has been proposed in periodontal healing in small animal treatment. However, the quality and amount of autologous PRF is compromised in animals with systemic diseases. The present study aimed to evaluate the efficacy of xenologous bubaline blood-derived PRF (bPRF) on periodontal tissue healing in canine periodontal defects. Split-mouth design was employed in twenty dogs diagnosed with periodontal disease. The defects were divided randomly into two groups: the open-flap debridement (OFD)-treated group and the OFD with bPRF (OFD+bPRF) application group. Results demonstrated that gingival index and periodontal probing depth decreased significantly in the OFD+bPRF group compared with those treated with OFD alone. Application of bPRF in periodontal defects also promoted fibrous tissue formation, as confirmed by the marked increase in fibrosis score. bPRF application significantly increased COL1A1 and PDGFB mRNA levels at day 14 compared with the baseline. Taking this evidence together, bPRF provided a favorable therapeutic modality in canine periodontal defects. bPRF could be an alternative biomaterial for the treatment of periodontal defects in dogs.

Periodontal regeneration by leukocyte and platelet-rich fibrin with autogenous bone graft versus enamel matrix derivative with autogenous bone graft in the treatment of periodontal intrabony defects: A randomized non-inferiority trial

BACKGROUND

Aim of the present study was to ascertain if a combination of leukocyte and platelet-rich fibrin (L-PRF) + autogenous bone graft (ABG) may be a clinically "non-inferior" treatment modality as compared with the association of enamel matrix derivative (EMD) with ABG in the management of intrabony defects (IBDs).

METHODS

A total of forty-four patients, exhibiting at least one unfavorable intraosseous defect, were treated by L-PRF associated with ABG (22 patients; test group) or EMD+ABG (control group) in each defect. At baseline and 12 months, a complete clinical and radiographic examination was done. Pre- and post-therapy clinical (probing pocket depth [PPD], clinical attachment level [CAL], gingival recession [GR]) and radiographic (defect Bone level [(DBL)] parameters for the different treatments were compared. To guarantee the test treatment's efficacy 1mm was chosen as non-inferiority margin; for clinical relevance, a second non-inferiority margin = 0.5 mm was set.

RESULTS

Clinical and radiographic parameters significantly improved 12 months after surgery in both test and control sites, without inter-groups differences for each measurement. The control group - test group differences for the parameters CAL gain -0.248 mm (-0.618 to 0.122), PPD Reduction -0.397 mm (-0.810 to 0.015), GR Change 0.059 mm (-0.300 to 0.418), DBL Gain -0.250 mm (-0.746 to 0.246) were all within the non-inferiority margin of 0.5 mm.

CONCLUSION

Our results suggest that the L-PRF+ABG combined treatment of non-contained IBDs produces non-inferior results in terms of CAL gain, PPD reduction, GR increase and DBL gain in comparison with the EMD+ABG combination.

Autologous platelet-rich fibrin stimulates canine periodontal regeneration

Platelet-rich fibrin (PRF) provides a scaffold for cell migration and growth factors for promoting wound healing and tissue regeneration. Here, we report using PRF in periodontal healing after open flap debridement (OFD) in canine periodontitis. A split-mouth design was performed in twenty dogs. Forty periodontitis surgical sites were randomly categorized into 2 groups; OFD alone and OFD with PRF treatment. Clinical parameters of periodontal pocket depth, gingival index, and the cemento-enamel junction-alveolar bone levels/root length ratio were improved in the OFD + PRF group. The OFD + PRF group also demonstrated a dramatically decreased inflammatory score compared with the OFD group. Collagen accumulation was improved in the OFD + PRF group at later time points compared with baseline. PRF application also significantly reduced inflammatory cytokine expression (TNFA and IL1B), and promoted the expression of collagen production-related genes (COL1A1, COL3A1, and TIMP1) and growth factors (PDGFB, TGFB1, and VEGFA). These findings suggest that PRF combined with OFD provides a new strategy to enhance the overall improvement of canine periodontitis treatment outcomes, especially in terms of inflammation and soft tissue healing. Therefore, PRF use in treating periodontitis could play an important role as a regenerative material to improve canine periodontitis treatment.

Clinical and radiographic evaluation of platelet-rich fibrin as an adjunct to bone grafting demineralized freeze-dried bone allograft in intrabony defects

Background:

Several bone graft materials are popularized in the treatment of intrabony defects. Demineralized freeze-dried bone allograft (DFDBA) is widely used in the treatment of intrabony defects. Platelet-rich fibrin (PRF) is autologous blood preparation which helps in wound healing and regeneration. Hence, this study focuses on evaluation of PRF, DFDBA, and their combination in the regeneration of intrabony defects.

Materials and Methods:

A total of 39 sites with intrabony defects were randomly assigned into three groups: (Group I - Open flap debridement, Group II - DFDBA alone, and Group III- DFDBA + PRF). Parameters such as probing pocket depth (PPD), relative attachment level (RAL), and radiographic bone fill were measured at baseline, 3 months, and 6 months. Intragroup comparison at various study intervals was made using one-way ANOVA test. Intergroup comparison was made using Tukey's multiple post hoc test.

Results:

Reduction in the PPD and greater difference in RAL was observed over the study period in all the three groups with greater reduction in DFDBA + PRF group. Reduction in the radiographic defect depths was observed over the study period in all the three groups with the greatest reduction of 38.99% in the DFDBA + PRF group. However, no statistically significant difference was reported by DFDBA versus DFDBA + PRF group.

Conclusion:

Combination of DFDBA and PRF improved the clinical and radiographic parameters compared to PRF and DFDBA alone. PRF was combined with DFDBA to produce a synergistic effect for treating intrabony defects in chronic periodontitis patients.

Platelet-Rich Fibrin as a Bone Graft Material in Oral and Maxillofacial Bone Regeneration: Classification and Summary for Better Application

Platelet-rich fibrin (PRF) is an autologous platelet concentrate that consists of cytokines, platelets, leukocytes, and circulating stem cells. It has been considered to be effective in bone regeneration and is mainly used for oral and maxillofacial bone. Although currently the use of PRF is thought to support alveolar ridge preservation, there is a lack of evidence regarding the application of PRF in osteogenesis. In this paper, we will provide examples of PRF application, and we will also summarize different measures to improve the properties of PRF for achieving better osteogenesis. The effect of PRF as a bone graft material on osteogenesis based on laboratory investigations, animal tests, and clinical evaluations is first reviewed here. In vitro, PRF was able to stimulate cell proliferation, differentiation, migration, mineralization, and osteogenesis-related gene expression. Preclinical and clinical trials suggested that PRF alone may have a limited effect. To enlighten researchers, modified PRF graft materials are further reviewed, including PRF combined with other bone graft materials, PRF combined with drugs, and a new-type PRF. Finally, we will summarize the common shortcomings in the application of PRF that probably lead to application failure. Future scientists should avoid or solve these problems to achieve better regeneration.

Platelet-rich fibrin along with a modified minimally invasive surgical technique for the treatment of intrabony defects: a randomized clinical trial

Purpose

The modified minimally invasive surgical technique (M-MIST) has been successfully employed to achieve periodontal regeneration. Platelet-rich fibrin (PRF) is known to enhance wound healing through the release of growth factors. This study aimed to observe the outcomes of periodontal surgery when M-MIST was used with or without PRF for the treatment of isolated intrabony defects.

Methods

This randomized clinical trial was conducted on 36 systemically healthy patients, who had chronic periodontitis associated with a single-site buccal probing pocket depth (PPD) and clinical attachment level of ≥5 mm. Patients were randomly divided into 2 groups: the test group treated with M-MIST and PRF, and the control group treated with M-MIST alone. The primary periodontal parameters analyzed were PPD, relative attachment level (RAL), and relative gingival margin level. The radiographic parameters analyzed were change in alveolar crest position (C-ACP), linear bone growth (LBG), and percentage bone fill (%BF). Patients were followed up to 6 months post-surgery.

Results

Intragroup comparisons at 3 and 6 months showed consistently significant improvements in PPD and RAL in both the groups. In intergroup comparisons, the improvement in PPD reduction, gain in RAL, and the level of the gingival margin was similar in both groups at 3 and 6 months of follow-up. Furthermore, an intergroup comparison of radiographic parameters also demonstrated similar improvements in C-ACP, LBG, and %BF at 6 months of follow-up.

Conclusions

M-MIST with or without PRF yielded comparable periodontal tissue healing in terms of improvements in periodontal and radiographic parameters. Further investigation is required to confirm the beneficial effects of PRF with M-MIST.

Trial Registration

ClinicalTrials.gov Identifier: NCT03169920.

Effects of leukocyte- and platelet-rich fibrin associated or not with bovine bone graft on the healing of bone defects in rats with osteoporosis induced by ovariectomy

OBJECTIVE

To evaluate the healing of critical size defects (CSDs) in calvaria of rats with osteoporosis induced by ovariectomy and treated with leukocyte- and platelet-rich fibrin (L-PRF) associated or not with bovine bone graft (XENO).

MATERIAL AND METHODS

A total of 32 rats underwent a bilateral ovariectomy procedure. After 3 months, one 5 mm in diameter CSD was created in the middle of the calvaria of each animal. In group C, defect was filled with blood clot only. In PRF, XENO, and PRF-XENO groups, defects were filled with 0.1 ml of L-PRF, 0.1 ml of XENO, and a mixture of 0.1 ml of L-PRF plus 0.1 ml of XENO, respectively. L-PRF compressed clots were used to cover the defects in PRF and PRF-XENO groups. Animals were submitted to euthanasia at 30 postoperative days. Histomorphometric, microtomographic, and immunohistochemical analyses were performed.

RESULTS

PRF-XENO group presented greater amount of neoformed bone (NB) when compared with XENO group, as well as higher expression of vascular endothelial growth factor (VEGF), osteocalcin (OCN), and bone morphogenetic protein (BMP-2/4) (p < .05). PRF group presented increased amount of NB and higher expression of VEGF, OCN, BMP-2/4, and Runt-related transcription factor 2 (RUNX-2) when compared with group C (p < .05).

CONCLUSIONS

(a) The isolated use of L-PRF clot can improve bone neoformation in CSDs in rats with osteoporosis induced by ovariectomy, but seems to lead to decreased amount of bone neoformation when compared to the isolated use of XENO; (b) L-PRF potentiates the healing of XENO in rats with osteoporosis induced by ovariectomy.

Actual quantitative attachment gain secondary to use of autologous platelet concentrates in the treatment of intrabony defects: A meta-analysis

Background

There are no authoritative meta-analyses and no clear quantitative assessments available estimating effects of open flap debridement (OFD) combined with platelet-rich fibrin (PRF) or platelet-rich plasma (PRP) over and above that of OFD. This study evaluated the actual quantitative mean gain for various clinical (clinical attachment level [CAL], probing pocket depth [PPD] and gingival marginal level [GML]) and radiographic (intrabony defect depth [IBD]) parameters of Platelet Concentrates- PCs (PRP/PRF) as sole grafting material along with OFD and OFD alone in the treatment of intrabony defects.

Materials and Methods

A detailed electronic search was carried out in PUBMED/MEDLINE, COCHRANE, EBSCOHOST, and Google Scholar databases by unifying related search terms with additional hand searches in select specialty journals up to May 2017. The eligibility criteria included human randomized clinical trials, either of a parallel group or a split-mouth design with follow-up period of at least 6 months. Periodontal intrabony defects with radiographic IBD ≥3 mm with corresponding CAL ≥5 mm were included. For the meta-analysis, the inverse variance method was used in fixed- or random-effect models.

Results

Actual quantitative mean gains were calculated for OFD with PRF/PRP (CAL = 1.1 mm, IBD = 1.68 mm, PPD = 0.97 mm and GML = 0.48 mm) over and above that of OFD alone.

Conclusion

Because of very high heterogeneity, the results may not be dependable. Apart from gains in radiographic bone fill, all other periodontal clinical parameters showed negligible gains. Using PRF technologies in periodontal intrabony defects may not be of great clinical significance over and above that of OFD alone, the effect sizes are also not large enough.

Tissue engineering in periodontology: Biological mediators for periodontal regeneration

Teeth and the periodontal tissues represent a highly specialized functional system. When periodontal disease occurs, the periodontal complex, composed by alveolar bone, root cementum, periodontal ligament, and gingiva, can be lost. Periodontal regenerative medicine aims at recovering damaged periodontal tissues and their functions by different means, including the interaction of bioactive molecules, cells, and scaffolds. The application of growth factors, in particular, into periodontal defects has shown encouraging effects, driving the wound healing toward the full, multi-tissue periodontal regeneration, in a precise temporal and spatial order. The aim of the present comprehensive review is to update the state of the art concerning tissue engineering in periodontology, focusing on biological mediators and gene therapy.

Autologous platelet concentrates for treating periodontal infrabony defects

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.