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Meta-Analysis
. 2021 May;25(5):2461-2478.
doi: 10.1007/s00784-021-03825-8. Epub 2021 Feb 20.

Use of platelet-rich fibrin for the treatment of periodontal intrabony defects: a systematic review and meta-analysis

Richard J Miron #  1 , Vittorio Moraschini #  2 , Masako Fujioka-Kobayashi  3 , Yufeng Zhang  4 , Tomoyuki Kawase  5 , Raluca Cosgarea  6 , Soren Jepsen  7 , Mark Bishara  8 , Luigi Canullo  9 , Yoshinori Shirakata  10 , Reinhard Gruber  11 , Döri Ferenc  12 , Monica Diuana Calasans-Maia  13 , Hom-Lay Wang  14   15 , Anton Sculean  14
Affiliations
Meta-Analysis

Use of platelet-rich fibrin for the treatment of periodontal intrabony defects: a systematic review and meta-analysis

Richard J Miron et al. Clin Oral Investig. 2021 May.

Abstract

Objectives: This study aims to compare the treatment outcomes of periodontal intrabony defects by using platelet-rich fibrin (PRF) with other commonly utilized modalities.

Materials and methods: The 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).

Results: From 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.

Conclusions: The 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 relevance: The 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.

Keywords: Advanced-PRF; Intrabony defect; L-PRF; Platelet-rich fibrin.

PubMed Disclaimer

Conflict of interest statement

R.J.M. holds intellectual property on PRF. All other authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Flow diagram (PRISMA format) of the screening and selection process
Fig. 2
Fig. 2
Forest plot for the event reduction in “probing depth” (PD) (reported in mm) for intrabony defects
Fig. 3
Fig. 3
Funnel plot for the studies reporting reduction in probing depth (PD) (reported in mm) for intrabony defects
Fig. 4
Fig. 4
Forest plot for the event “clinical attachment level” (reported in mm) for intrabony defects
Fig. 5
Fig. 5
Forest plot for the event “bone fill” (reported in % change) for intrabony defects
See this image and copyright information in PMC

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