Autologous Platelet Concentrates to improve post extraction outcomes.

Abstract

Data sourcesElectronic search of Medline, Embase, Scopus and the Cochrane Central Register of Controlled Trials (CENTRAL). Manual search of multiple dental journals and review reference lists.Study selectionTwo authors searched studies without any language or follow-up duration restrictions. Randomised and controlled clinical trials with a minimum of five patients per group and a parallel or split-mouth design were included. Outcome variables assessed comparing APC use included: patient satisfaction, self-reported postoperative quality of life, radiographic bone healing, clinical and radiographic marginal bone remodelling, soft tissue healing and complications such as alveolar osteitis.Data extraction and synthesisMethodologic quality of research was assessed using the following parameters: random sequence generation method and allocation concealment, calibration and binding of outcome assessment, comparability of control and treatment groups at entry, clear definition of inclusion and exclusion criteria, clear definition of outcomes assessment and success criteria, completeness of the outcome data reported and explanation for dropouts/withdrawal, recall rate, sample size and number of surgeons involved. Meta-analysis was carried out with data from studies reporting the same outcome measurements at comparable observations times following tooth extraction. Dichotomous outcomes (ie development of alveolar osteitis) for different treatments were expressed as risk ratios with a 95% confidence interval and continuous outcomes (ie quantifiable bone changes) were expressed as mean differences with a 95% confidence interval. Study design risk of bias was assessed using sensitivity analysis.ResultsThirty three studies met the inclusion criteria. Soft tissue healing at seven days after extraction was better when APCs were used (mean difference of 1.01; 95% CI; 0.77 to 1.24). Three months postoperatively, the second mandibular molar distal probing depth was statistically better in the APC group, mean difference of -1.63; (95% CI; -2.05 to -1.22). There were no statistical differences between the APC and control groups for alveolar osteitis, acute inflammation or alveolar infection. Although the percentage of new bone and indirect measurement of bone metabolism were similar for both groups, bone density was statistically better for the APC group, mean difference of 5.06; (95% CI; 1.45 to 8.66). Qualitative analysis found decreased swelling in four of five studies and decreased trismus in two of three studies. The variations between different types of APCs were not evaluated as part of this review.ConclusionsAPCs including platelet-rich plasma (PRP), platelet-rich fibrin (PRF) and plasma rich in growth factors (PRGF) can be used following tooth extraction to improve soft tissue healing, probing depth and bone density, as well as to reduce swelling and trismus. However, their use in reducing other postoperative complications such as pain, alveolar osteitis, inflammation, infection, or in improving new bone percentage and metabolism cannot be recommended. Study heterogeneity made it impossible to perform meta-analysis for pain reduction; therefore further studies investigating the effect on pain are required.