Use of platelet-rich fibrin for the treatment of periodontal intrabony defects: a systematic review and meta-analysis

• Published in: Clinical oral investigations Vol. 25; no. 5; pp. 2461 - 2478
• Main Authors: Miron, Richard J., Moraschini, Vittorio, Fujioka-Kobayashi, Masako, Zhang, Yufeng, Kawase, Tomoyuki, Cosgarea, Raluca, Jepsen, Soren, Bishara, Mark, Canullo, Luigi, Shirakata, Yoshinori, Gruber, Reinhard, Ferenc, Döri, Calasans-Maia, Monica Diuana, Wang, Hom-Lay, Sculean, Anton
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-05-2021; Springer Nature B.V
• Subjects: Alveolar Bone Loss - diagnostic imaging; Alveolar Bone Loss - drug therapy; Alveolar Bone Loss - surgery; Bisphosphonates; Bone grafts; Bone Transplantation; Clinical outcomes; Clinical trials; Dental enamel; Dentistry; Fibrin; Guided Tissue Regeneration, Periodontal; Humans; Medicine; Meta-analysis; Metformin; Periodontal Attachment Loss; Platelet-Rich Fibrin; Platelets; Review; Statins; Statistical analysis; Surgical Flaps - surgery; Platelet-rich fibrin; Advanced-PRF; Intrabony defect; L-PRF
• ISSN: 1432-6981; 1436-3771
• DOI: 10.1007/s00784-021-03825-8

Objectives
This study aims to compare the treatment outcomes of periodontal intrabony defects by using platelet-rich fibrin (PRF) with other commonly utilized modalities.
Materials and methods
The eligibility criteria comprised randomized controlled trials (RCTs) comparing the clinical outcomes of PRF with that of other modalities. Studies were classified into 10 categories as follows: (1) open flap debridement (OFD) alone versus OFD/PRF; (2) OFD/bone graft (OFD/BG) versus OFD/PRF; (3) OFD/BG versus OFD/BG/PRF; (4–6) OFD/barrier membrane (BM), OFD/PRP, or OFD/enamel matrix derivative (EMD) versus OFD/PRF; (7) OFD/EMD versus OFD/EMD/PRF; (8–10) OFD/PRF versus OFD/PRF/metformin, OFD/PRF/bisphosphonates, or OFD/PRF/statins. Weighted means and forest plots were calculated for probing depth (PD), clinical attachment level (CAL), and radiographic bone fill (RBF).
Results
From 551 articles identified, 27 RCTs were included. The use of OFD/PRF statistically significantly reduced PD and improved CAL and RBF when compared to OFD. No clinically significant differences were reported when OFD/BG was compared to OFD/PRF. The addition of PRF to OFD/BG led to significant improvements in CAL and RBF. No differences were reported between any of the following groups (OFD/BM, OFD/PRP, and OFD/EMD) when compared to OFD/PRF. No improvements were also reported when PRF was added to OFD/EMD. The addition of all three of the following biomolecules (metformin, bisphosphonates, and statins) to OFD/PRF led to statistically significant improvements of PD, CAL, and RBF.
Conclusions
The use of PRF significantly improved clinical outcomes in intrabony defects when compared to OFD alone with similar levels being observed between OFD/BG and OFD/PRF. Future research geared toward better understanding potential ways to enhance the regenerative properties of PRF with various small biomolecules may prove valuable for future clinical applications. Future research investigating PRF at histological level is also needed.
Clinical relevance
The use of PRF in conjunction with OFD statistically significantly improved PD, CAL, and RBF values, yielding to comparable outcomes to OFD/BG. The combination of PRF with bone grafts or small biomolecules may offer certain clinical advantages, thus warranting further investigations.