The use of platelet-rich plasma in oral surgery: a systematic review and meta-analysis

Abstract

Background: The aim of this systematic review and meta-analysis was to evaluate the benefit of platelet rich plasma (PRP) in oral surgery.

Materials and methods: We performed a systematic search of the literature. The GRADE system was used to assess the certainty of the body of evidence.

Results: We found 21 randomised controlled trials that met our inclusion criteria: 12 studies included patients with periodontal defects, five studies focused on healing of extraction sockets, three studies on sinus lift augmentation, and one study on periapical osseous defects. However, for the quantitative synthesis (meta-analysis), we evaluated "periodontal defects" studies only, since for other clinical contexts the number of studies were too low and the procedural heterogeneity was too high to allow pooling of data. PRP-containing regimens were compared to non-PRP-containing regimens. Primary outcomes for the evaluation of periodontal defects were probing depths, clinical attachment level, gingival recession, and radiographic bone defect. It is not usually clear whether or not the use of PRP compared to controls affects "probing depth" at long-term follow up; the between group differences were small and unlikely to be of clinical importance (i.e., very low quality of evidence). For the other outcomes analysed ("clinical attachment levels", "gingival recession", "bony defect"), we observed a very slight marginal clinical benefit of PRP compared to controls. The available evidence for these comparisons was rated as low quality as most of the studies selected showed inconsistency, imprecision, and risk of bias.

Discussion: Evidence from a comparison between the use in oral surgery of PRP-containing regimens compared to other regimens not-containing PRP was of low quality. The results of the meta-analysis, limited to studies in patients with periodontal defects, document that PRP was slightly more effective compared to controls not-containing PRP.

Figure 1

Flow chart of the selection of the studies.

Figure 2

Risk of bias graph: review authors’ judgements about each risk of bias item presented as percentages across all included studies.

Figure 3

Risk of bias summary: review authors’ judgements about each risk of bias item for each included study.

Figure 4

Periodontal defects: forest plot for probing depths. MD: mean difference; 95% CI: 95% confidence interval.

Figure 5

Periodontal defects: forest plot for clinical attachment level. MD: mean difference; 95% CI: 95% confidence interval.

Figure 6

Periodontal defects: forest plot for gingival recession. MD: mean difference; 95% CI: 95% confidence interval.

Figure 7

Periodontal defects: forest plot for bone defects. MD: mean difference; 95% CI: 95% confidence interval.