Periodontal regeneration using platelet-rich fibrin. Furcation defects: A systematic review with meta-analysis

Abstract

The objective of the study was to compare the treatment outcomes of periodontal furcation defects by using platelet-rich fibrin (PRF) with other commonly utilized modalities. The eligibility criteria comprised randomized controlled trials (RCTs) comparing the clinical outcomes of PRF with those of other modalities for the treatment of furcation defects. Studies were classified into 11 categories in 3 different groups as follows: Group I (addition of PRF): (1) open flap debridement (OFD) alone versus OFD/PRF, (2) OFD/bone graft (OFD/BG) versus OFD/BG/PRF; Group II (comparative studies to PRF): (3) OFD/BG versus OFD/PRF, (4) OFD/collagen membrane versus OFD/PRF, (5) OFD/PRP versus OFD/PRF, (6) OFD/rhBMP2 versus OFD/PRF; and Group III (addition of biomaterial/biomolecule to PRF): OFD/PRF versus … (7) OFD/PRF/BG, (8) OFD/PRF/amniotic membrane (AM), (9) OFD/PRF/metformin, (10) OFD/PRF/bisphosphonates, (11) OFD/PRF/statins. Weighted means and forest plots were calculated for the reduction of probing pocket depth (PPD), gain of vertical and horizontal clinical attachment levels (VCAL and HCAL), gain in vertical and horizontal bone levels (VBL, HBL), and radiographic bone fill (RBF). From 45 articles identified, 21 RCTs reporting on class II furcations were included. The use of OFD/PRF and OFD/BG/PRF statistically significantly reduced PPD and improved VCAL and HCAL when compared to OFD or OFD/BG, respectively. The comparison between OFD/PRF alone versus OFD/BG, OFD/CM, OFD/PRP, or OFD/rhBMP2 led to similar outcomes for all investigated parameters, including a reduction in PPD, VCAL/HCAL gain, and RBF. The additional incorporation of a BG to OFD/PRF only mildly improved outcomes, whereas the addition of AM improved clinical outcomes. The addition of small biomolecules such as metformin, bisphosphonates, or statins all led to significant improvements in PPD, VCAL, and HCAL when compared to OFD/PRF alone. Noteworthy, a very high heterogeneity was found in the investigated studies. The use of PRF significantly improved clinical outcomes in class II furcation defects when compared to OFD alone, with similar levels being observed between OFD/PRF and/or OFD/BG, OFD/CM, OFD/PRP, or OFD/rhBMP2. 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 histological research investigating PRF in human furcation defects is largely needed. The use of PRF in conjunction with OFD statistically significantly improved PPD, VCAL, and HCAL values, yielding comparable outcomes to commonly used biomaterials. The combination of PRF to bone grafts or the addition of small biomolecules may offer additional clinical benefits, thus warranting future investigation.

Keywords: L‐PRF; advanced‐PRF, horizontal centrifugation; furcation defect; leukocyte and platelet‐rich fibrin; meta‐analysis; periodontal regeneration; periodontitis; systematic review.

FIGURE 1

Search strategy.

FIGURE 2

Forest plot for the event reduction in “probing pocket depth” (PPD) (reported in mm) for furcation defects in Group 1: “Therapeutic modalities with/without PRF (FQ‐1).”

FIGURE 3

Forest plot for the event “vertical clinical attachment level (VCAL)” (reported in mm) for furcation defects in Group 1: “Therapeutic modalities with/without PRF (FQ‐1).”

FIGURE 4

Forest plot for the event “horizontal clinical attachment level (HCAL)” (reported in mm) for furcation defects in Group 1: “Therapeutic modalities with/without PRF (FQ‐1).”

FIGURE 5

Forest plot for the event reduction in “probing pocket depth” (PPD) (reported in mm) for furcation defects in Group 2: “Therapeutic modalities in comparison to PRF (FQ‐2).”

FIGURE 6

Forest plot for the event “vertical clinical attachment level (VCAL)” (reported in mm) for furcation defects in Group 2: (FQ‐2).”

FIGURE 7

Forest plot for the event “horizontal clinical attachment level (HCAL)” (reported in mm) for furcation defects in Group 2: “Therapeutic modalities in comparison to PRF (FQ‐2).”

FIGURE 8

Forest plot for the event reduction in “probing pocket depth” (PPD) (reported in mm) for furcation defects in Group 3: “Therapeutic modalities using PRF with addition of biomaterials/biomolecules (FQ‐3).”

FIGURE 9

Forest plot for the event “vertical clinical attachment level (VCAL)” (reported in mm) for furcation defects in Group 3: “Therapeutic modalities using PRF with addition of biomaterials/biomolecules (FQ‐3).”

FIGURE 10

Forest plot for the event “horizontal clinical attachment level (HCAL)” (reported in mm) for furcation defects in Group 3: “Therapeutic modalities using PRF with the addition of biomaterials/biomolecules (FQ‐3).”