Abstract
Periodontal bone regeneration relies on coupled and cooperative bone formation and resorption. Accordingly a novel strategy on concurrent use of platelet-rich fibrin (PRF) (anabolic agent) and 1% alendronate (ALN) (anticatabolic agent) was proposed recently in regenerative periodontal treatment. It was supposed to enhance bone formation and reduce bone resorption simultaneously. However, there is a lack of evidence-based studies to answer whether this concurrent application was superior to single application until now. Besides, concerns on ALN lead to some reservation on this synergistic way. ALN may impair new bone formation and necrotize jaws. Thus, in order to compare the clinical efficacy between PRF plus 1%ALN and PRF alone on periodontal bone regeneration, we performed present systematic review and meta-analysis. Because it is the prerequisite for measuring the combined efficacy of PRF plus 1%ALN, firstly we evaluated the effectiveness of 1%ALN. Our data indicated that adjunctive 1%ALN was effective in promoting periodontal bone repair. Further, PRF plus 1%ALN showed a greater capacity for periodontal regeneration than PRF alone with statistical significance. The findings of this study revealed the promising prospects on synergistic application of bone anabolic agents (PRF) and antiresorption medications (1%ALN) in regenerative periodontal treatment.
Highlights
Regenerative medicine in skeletal system always attracts clinicians and researchers [1, 2]
After selection according to our preestablished protocol, 14 randomized controlled clinical trials (RCTs) were included for quantitative meta-analysis [10,11,12, 23,24,25,26,27,28,29,30,31,32,33]
Our data showed a statistically significant mean difference of both vertical and horizontal CAL-regained between platelet-rich fibrin (PRF) plus 1%ALN group and PRF group in the predicted direction (MD of vertical clinical attachment level (VCAL) regained=0.89mm; 95%confidence intervals (CIs): 0.70, 1.09; p
Summary
Regenerative medicine in skeletal system always attracts clinicians and researchers [1, 2]. Bone formation and resorption are viewed as two major events during bone regeneration [5]. Based on this conception, bone anabolic treatments and antiresorption ways were introduced individually [1, 6]. Certain bone anabolic agents, such as PTH, recombinant human growth factors, and platelet-rich concentrates, as well as the major antiresorption medications, namely, bisphosphonates (BPs), have already been showed to be effective in regenerating periodontal bone [1, 7]. Since bone formation and resorption are coupled and coordinated with each other, concurrent application of anabolic and antiresorption agents are introduced in regenerative periodontology very recently [8,9,10]. In order to answer this question, we did present systematic review and meta-analysis
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