Regenerative potential of leucocyte- and platelet-rich fibrin. Part A: intra-bony defects, furcation defects and periodontal plastic surgery. A systematic review and meta-analysis

Abstract

Aim: To analyse the regenerative potential of leucocyte- and platelet-rich fibrin (L-PRF) during periodontal surgery.

Materials and methods: An electronic and hand search were conducted in three databases. Only randomized clinical trials were selected and no follow-up limitation was applied. Pocket depth (PD), clinical attachment level (CAL), bone fill, keratinized tissue width (KTW), recession reduction and root coverage (%) were considered as outcome. When possible, meta-analysis was performed.

Results: Twenty-four articles fulfilled the inclusion and exclusion criteria. Three subgroups were created: intra-bony defects (IBDs), furcation defects and periodontal plastic surgery. Meta-analysis was performed in all the subgroups. Significant PD reduction (1.1 ± 0.5 mm, p < 0.001), CAL gain (1.2 ± 0.6 mm, p < 0.001) and bone fill (1.7 ± 0.7 mm, p < 0.001) were found when comparing L-PRF to open flap debridement (OFD) in IBDs. For furcation defects, significant PD reduction (1.9 ± 1.5 mm, p = 0.01), CAL gain (1.3 ± 0.4 mm, p < 0.001) and bone fill (1.5 ± 0.3 mm, p < 0.001) were reported when comparing L-PRF to OFD. When L-PRF was compared to a connective tissue graft, similar outcomes were recorded for PD reduction (0.2 ± 0.3 mm, p > 0.05), CAL gain (0.2 ± 0.5 mm, p > 0.05), KTW (0.3 ± 0.4 mm, p > 0.05) and recession reduction (0.2 ± 0.3 mm, p > 0.05).

Conclusions: L-PRF enhances periodontal wound healing.

Keywords: bone regeneration; gingival recession; intra-bony defects; leucocyte-platelet-rich fibrin; open flap debridement; platelet-rich fibrin; tissue regeneration.

Figure 1

Differences among PCs preparation. (a) platelet‐rich plasma (PRP): after the first centrifugation, the platelet‐poor plasma, the “yellow” part called buffy coat and a few red blood cells are carefully collected (pipetting) and centrifuged again in order to obtain the PRP (Dohan et al. 2006a,b,c); (b) PRGF: after centrifugation, the blood is divided in five layers; by pipetting, the undesired parts are discarded; the most concentrated part with growth factors (PRGF) is collected (Anitua, 2001); (c) PRF: after centrifugation, a fibrin clot is obtained in the middle of the tube, which is ready to be used (Dohan et al. 2006a).

Figure 2

PRISMA flow diagram.

Figure 3

Forest plot comparing OFD versus OFD + L‐PRF in the treatment of intra‐bony defects (IBDs) and furcation defects.: ▲ different follow‐up from the rest of the studies included. *: study with split‐mouth design. (a) Forest plot comparing OFD versus OFD + L‐PRF in the treatment of IBDs, PD reduction (mm). (b) Forest plot comparing OFD versus OFD + L‐PRF in the treatment of IBDs, CAL gain (mm). (c) Forest plot comparing OFD versus OFD + L‐PRF in the treatment of IBDs, bone fill (mm). (d) Forest plot comparing OFD versus OFD + L‐PRF in the treatment of furcation defects, CAL gain (mm). (e) Forest plot comparing OFD versus OFD + L‐PRF in the treatment of furcation defects, bone fill (mm). CAL, clinical attachment level; OFD, open flap debridement; PD, Pocket depth.

Figure 4

Forest plot comparing CAF + L‐PRF versus CAF and CAF + L‐PRF versus CAF + CTG in periodontal plastic surgery. *: study with split‐mouth design. (a) Forest plot comparing CAF versus CAF + L‐PRF in periodontal plastic surgery, recession reduction (mm). (b) Forest plot comparing CAF versus CAF + L‐PRF in periodontal plastic surgery, root coverage 6 months (%). (c) Forest plot comparing CAF + CTG versus CAF + L‐PRF in periodontal plastic surgery, recession reduction (mm). CAF, Coronally advanced flap; CTG, connective tissue graft.