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.
Highlights
Gingival recession is the downward migration of attachment apparatus leading to an apical displacement of gingival margin and oral exposure of the root [1]
A total of 8 randomized controlled trials (RCTs) selected for this systematic review compared the additive effect of leukocyte and platelet-rich fibrin (L-PRF)
The surgical protocol employed among all included trials was similar in carrying out the coronally advanced flap (CAF) procedure, except 1 study [24] employed a modified approach (MCAF) and another study [31]
Summary
Gingival recession is the downward migration of attachment apparatus leading to an apical displacement of gingival margin and oral exposure of the root [1]. The most common patient-related symptoms include compromised aesthetics and lingering hypersensitivity [2]. The root coverage procedures aim primarily at reducing hypersensitivity and improving the gingival aesthetics. The other objectives include increasing the width of keratinized gingiva, improving gingival biotype, preventing root caries, managing noncarious cervical lesions (NCCL) and maintaining tooth-supporting structures. Various root coverage procedures and techniques are employed based on numerous factors, such as recession type, location, adequacy of keratinized gingiva, single or multiple teeth involved, gingival biotype, presence of NCCL and need of a secondary donor site [3]. Aesthetic concern is one of the main reasons behind the treatment of gingival recession defects
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