Richard J Miron1, Vittorio Moraschini2, Massimo Del Fabbro3,4, Adriano Piattelli5,6,7, Masako Fujioka-Kobayashi8, Yufeng Zhang9, Nikola Saulacic8, Benoit Schaller8, Tomoyuki Kawase10, Raluca Cosgarea11,12, Soren Jepsen12, Delia Tuttle13, Mark Bishara14, Luigi Canullo15, Meizi Eliezer16, Andreas Stavropoulos17, Yoshinori Shirakata18, Alexandra Stähli16, Reinhard Gruber19, Ondine Lucaciu11, Sofia Aroca16, Herbert Deppe20, Hom-Lay Wang21, Anton Sculean16. 1. Department of Periodontology, University of Bern, Bern, Switzerland. richard.miron@zmk.unibe.ch. 2. Department of Periodontology, Dental Research Division, School of Dentistry, Veiga de Almeida University, Rio de Janeiro, Brazil. 3. Department of Biomedical, Surgical, and Dental Sciences, University of Milan, Milan, Italy. 4. IRCCS Orthopedic Institute Galeazzi, Milan, Italy. 5. Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy. 6. Catholic University of San Antonio de Murcia (UCAM), Murcia, Spain. 7. Villaserena Foundation for Research, Città Sant'Angelo, PE, Italy. 8. Department of Cranio-Maxillofacial Surgery, University of Bern, Bern, Switzerland. 9. Department of Oral Implantology, University of Wuhan, Wuhan, China. 10. Division of Oral Bioengineering, Institute of Medicine and Dentistry, Niigata University, Niigata, Japan. 11. Department of Prosthetic Dentistry, University Iuliu Hatieganu, Cluj-Napoca, Romania. 12. Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany. 13. Canyon Lake Dental Office, Lake Elsinore, CA, USA. 14. West Bowmanville Family Dental, Bowmanville, Ontario, Canada. 15. , Rome, Italy. 16. Department of Periodontology, University of Bern, Bern, Switzerland. 17. Department of Periodontology, University of Geneva, Geneva, Switzerland. 18. Department of Periodontology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan. 19. Department of Oral Biology, University of Vienna, Vienna, Austria. 20. Department of Oral and Maxillofacial Surgery, Klinikum rechts der Isar der TUM, Munich, Germany. 21. Department of Periodontics and Oral Medicine, University of Michigan, Ann Arbor, MI, USA.
Abstract
OBJECTIVES: The aim of this systematic review and meta-analysis was to compare the use of platelet-rich fibrin (PRF) with other commonly utilized treatment modalities for root coverage procedures. MATERIALS AND METHODS: The eligibility criteria comprised randomized controlled trials (RCTs) comparing the performance of PRF with that of other modalities in the treatment of Miller class I or II (Cairo RT I) gingival recessions. Studies were classified into 5 categories as follows: (1) coronally advanced flap (CAF) alone vs CAF/PRF, (2) CAF/connective tissue graft (CAF/CTG) vs CAF/PRF, (3) CAF/enamel matrix derivative (CAF/EMD) vs CAF/PRF, (4) CAF/amnion membrane (CAF/AM) vs CAF/PRF, and (5) CAF/CTG vs CAF/CTG/PRF. Studies were evaluated for percentage of relative root coverage (rRC; primary outcome), clinical attachment level (CAL), keratinized mucosa width (KMW), and probing depth (PD) (secondary outcomes). RESULTS: From 976 articles identified, 17 RCTs were included. The use of PRF statistically significantly increased rRC and CAL compared with CAF alone. No change in KMW or reduction in PD was reported. Compared with PRF, CTG resulted in statistically significantly better KMW and RC. No statistically significant differences were reported between the CAF/PRF and CAF/EMD groups or between the CAF/PRF and CAF/AM groups for any of the investigated parameters. CONCLUSIONS: The use of CAF/PRF improved rRC and CAL compared with the use of CAF alone. While similar outcomes were observed between CAF/PRF and CAF/CTG for CAL and PD change, the latter group led to statistically significantly better outcomes in terms of rRC and KTW. In summary, the use of PRF in conjunction with CAF may represent a valid treatment modality for gingival recessions exhibiting adequate baseline KMW. CLINICAL RELEVANCE: The data indicate that the use of PRF in conjunction with CAF statistically significantly improves rRC when compared with CAF alone but did not improve KMW. Therefore, in cases with limited baseline KMW, the use of CTG may be preferred over PRF.
OBJECTIVES: The aim of this systematic review and meta-analysis was to compare the use of platelet-rich fibrin (PRF) with other commonly utilized treatment modalities for root coverage procedures. MATERIALS AND METHODS: The eligibility criteria comprised randomized controlled trials (RCTs) comparing the performance of PRF with that of other modalities in the treatment of Miller class I or II (Cairo RT I) gingival recessions. Studies were classified into 5 categories as follows: (1) coronally advanced flap (CAF) alone vs CAF/PRF, (2) CAF/connective tissue graft (CAF/CTG) vs CAF/PRF, (3) CAF/enamel matrix derivative (CAF/EMD) vs CAF/PRF, (4) CAF/amnion membrane (CAF/AM) vs CAF/PRF, and (5) CAF/CTG vs CAF/CTG/PRF. Studies were evaluated for percentage of relative root coverage (rRC; primary outcome), clinical attachment level (CAL), keratinized mucosa width (KMW), and probing depth (PD) (secondary outcomes). RESULTS: From 976 articles identified, 17 RCTs were included. The use of PRF statistically significantly increased rRC and CAL compared with CAF alone. No change in KMW or reduction in PD was reported. Compared with PRF, CTG resulted in statistically significantly better KMW and RC. No statistically significant differences were reported between the CAF/PRF and CAF/EMD groups or between the CAF/PRF and CAF/AM groups for any of the investigated parameters. CONCLUSIONS: The use of CAF/PRF improved rRC and CAL compared with the use of CAF alone. While similar outcomes were observed between CAF/PRF and CAF/CTG for CAL and PD change, the latter group led to statistically significantly better outcomes in terms of rRC and KTW. In summary, the use of PRF in conjunction with CAF may represent a valid treatment modality for gingival recessions exhibiting adequate baseline KMW. CLINICAL RELEVANCE: The data indicate that the use of PRF in conjunction with CAF statistically significantly improves rRC when compared with CAF alone but did not improve KMW. Therefore, in cases with limited baseline KMW, the use of CTG may be preferred over PRF.