A Systematic Critical Appraisal of the Methodological Quality of Systematic Reviews on the Effect of Autologous Platelet Concentrates in the Treatment of Periodontal Intraosseous Defects.

Agostino Guida,Luigi Laino,Gennaro Cecoro,Massimo Del Fabbro,Rosario Rullo,Marco Annunziata

doi:10.3390/ma13184180

Abstract

The present study aimed to perform a systematic critical appraisal of the methodological quality of systematic reviews (SRs) on the effect of autologous platelet concentrates (APCs) in the treatment of periodontal intraosseous defects and to provide a synthesis of the main clinical findings available. An electronic and hand search was performed up to February 2020; 14 systematic reviews of randomized controlled trials (RCTs), of which 11 were meta-analyses, were included. Only one SR fully satisfied all 11 items of the AMSTAR (“A Measurement Tool to Assess Systematic Reviews”) checklist for methodological quality evaluation, 3 SRs were classified of high quality, 8 of medium quality, and 2 of low quality. There is some evidence on the beneficial additive effect of APCs in the surgical treatment of intraosseous defects when used alone or in combination with bone grafts. APCs did not show any advantage when used together with guided tissue regeneration (GTR) or enamel matrix derivative (EMD). Undertaking SRs which adhere to rigorous standards and protocols is strongly recommended. There are increasing data on the positive adjunctive effect of APCs in the surgical treatment of intraosseous defects but, due to the heterogeneity of the available primary studies, the quality of evidence remains rather low and further long-term well-designed RCTs are encouraged.

Highlights

Autologous platelet concentrates (APCs) have been applied since ’90 [1,2,3], as an autologous source of growth and differentiating factors to enhance the healing and regeneration of soft and hard tissues in different fields of oral surgery, including the treatment of periodontal intraosseous defects
The selected randomized controlled trials (RCTs) differ in their design with regard to therapeutic bioactive agents/procedures combined with Platelet-rich plasma (PRP) for the therapy of periodontal intraosseous defects
Diverse outcomes have been reported for the efficacy of PRP combined with various therapeutic bioactive agents/procedures, reflecting the limited and heterogeneous data available and possibly suggesting that the specific selection of agents/procedures combined with PRP could be important

Summary

Introduction

Autologous platelet concentrates (APCs) have been applied since ’90 [1,2,3], as an autologous source of growth and differentiating factors to enhance the healing and regeneration of soft and hard tissues in different fields of oral surgery, including the treatment of periodontal intraosseous defects. PRGF, first introduced by Anitua in 1999 [3], requires single centrifugation and, with respect to PRP, does not contain leukocytes and requires a smaller blood volume. Both PRP and PRGF need anticoagulants before centrifugation, and heterologous activators to trigger polymerization, which occurs rapidly, and produces a rapid release of a large amount of growth factors, which tends to decrease considerably within a few days

Objectives

Methods

Results

Discussion

Conclusion