Abstract
ObjectivesThis study aims to compare the treatment outcomes of periodontal intrabony defects by using platelet-rich fibrin (PRF) with other commonly utilized modalities.Materials and methodsThe 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).ResultsFrom 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.ConclusionsThe 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 relevanceThe 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.
Highlights
Periodontal disease is one of the most prevalent chronic diseases known to man that begins as a superficial
The overall risk of biased judgment used the following criteria: low risk, when the five areas of the study were judged as low risk; some concerns, when the study is judged as raising some concerns in at least one area; and high risk, when the study is judged to be at high risk in at least one domain or when the study is judged to have some concerns for multiple domains in a way that substantially lowers confidence in the result
Of the 27 randomized controlled trials (RCTs), the most highly researched centrifugation system utilized in 15 of 27 studies (56% of studies) was the Remi centrifuge whereas the IntraSpin/Hettich PC-02 system was utilized in 1/27 studies (4% of studies)
Summary
Periodontal disease is one of the most prevalent chronic diseases known to man that begins as a superficialRichard J. Periodontal disease is one of the most prevalent chronic diseases known to man that begins as a superficial. Results investigating the distribution of the disease from a national survey conducted in the USA found that over 47% of the adult population was affected with 38.5% of the population having either moderate or severe cases (stage III or stage IV) [5]. This finding is most alarming as the disease is characterized with an exponentially more difficult resolution and regeneration once advanced progression has taken place.
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