Platelet Rich Fibrin is a second generation platelet concentrate which has shown to successfully regenerate either soft or hard tissues, enhance new blood vessels (angiogenesis), and tissue formation during healing. (1) It is being used in oral surgical procedures to improve wound healing (2-8) although it’s efficacy is still a matter of debate.

The aim of this review was to assess the efficacy of platelet rich fibrin in oral surgery procedures.

Methods

Searches were conducted in: Medline,The Cochrane library,Web of science, Scopus, LILACS. A detailed manual search was also conducted including searching for grey literature in Clinicaltrials.gov and EU clinical trials register. There was no language or time constrictions applied to this procedure. Only randomised control trials were included for the study. The studies were screened and independently evaluated by two calibrated reviewers.Three reviewers assessed the risk of bias using the Cochrane Collaboration tool .

The primary outcome measures were:

• Orthognathic surgery – bone healing.
• Mandibular 3^rdmolar surgery – alveolar osteitis.
• Surgical treatment of osteonecrosis – prevalence of complete resolution.
• Sinus lift procedures – % of new bone formation.
• Oro-antral communication – success rate.
• Alveolar ridge preservation – socket dimensions.
• Alveolar cleft grafting – % of newly formed bone.
• Dental implants – marginal bone resorption.

Results

• 30 Randomised control trials included for qualitative analysis.
• 13 randomised control trails included for quantative analysis.
• None of the papers were considered to be of low risk of bias, 14 were considered to be at high risk of bias.
• 3^rdmandibular molar surgery – risk of alveolar osteitis reduced by 62% compared to no treatment.
• Sinus lift procedures – no significant difference in new bone formation.
• Alveolar ridge preservation – there is too much heterogeneity with in the studies therefore unable to perform a meta-analysis.
• Dental implants and cleft patients – there is too much heterogeneity with in the studies therefore unable to perform a meta-analysis.
• no studies were found evaluating the use of platelet rich fibrin in orthognathic surgery, osteonecrosis surgical treatment or for closure of Oro-antral communication.

Conclusions

The authros concluded –

Due to the lack of studies with low risk of bias and homogenous methodology to permit a more precise meta-analysis, further RCT’s are needed to confirm the evidence for the use of platelet rich fibrin in these surgical procedures.

Comments

The reviewers have undertaken a thorough database search but there are only a small number of papers related to each surgical procedure. Given the small number of papers for each procedure a large number of primary and secondary outcomes were considered.  The follow-up periods for the studies were short with no longer term outcomes. None of the included papers were considered to be at low risk of bias with 14 being at high risk of bias.

A previous review of the impact of platelet rich fibrin on third molar extraction outcomes which included a small number of studies mainly at high risk of bias. (Dental Elf – 22nd Jan 2018). At present the available evidence for platelet rich fibrin in oral surgery is limited and there is currently little scope for the use of platelet rich fibrin in general practice.

Links

Primary Paper

Canellas JVDS, Medeiros PJD, Figueredo CMDS, Fischer RG, Ritto FG. Platelet-rich fibrin in oral surgical procedures: a systematic review and meta-analysis. Int J Oral Maxillofac Surg. 2019 Mar;48(3):395-414. doi: 10.1016/j.ijom.2018.07.007. Epub 2018 Jul 30. Review. PubMed PMID: 30072300.

Original review protocol on PROSPERO

Other References

1. Dohan Ehrenfest DM, Rasmusson L, Albrektsson T. Classification of platelet concentrates: from pure platelet-rich plasma (P- PRP) to leucocyte- and platelet-rich fibrin (L-PRF). Trends Biotechnol 2009;27 (3):158–67.
2. Mazor Z, Horowitz RA, Del Corso M, Prasad HS, Rohrer MD, Ehrenfest DMD. Sinus floor augmentation with simultaneous implant placement using Choukroun’s platelet-rich fibrin as the sole grafting material: a radiologic and histologic study at 6 months. J Periodontology 2009;80(12):2056–64.
3. Eshghpour M, Dastmalchi P, Nekooei AH, Nejat A. Effect of platelet-rich fibrin on frequency of alveolar osteitis following mandibular third molar surgery: a double-blinded randomized clinical trial. J Oral Maxillofac Surg 2014;72(8):1463–7.
4. Kim JW, Kim SJ, Kim MR. Leucocyte-rich and platelet-rich fibrin for the treatment of bisphosphonate-related osteonecrosis of the jaw: a prospective feasibility study. Br J Oral Maxillofac Surg 2014;52(9):854–9
5. Boora P, Rathee M, Bhoria M. Effect of platelet rich fibrin (PRF) on peri-implant soft tissue and crestal bone in one-stage implant placement: a randomized controlled trial. J Clin Diagn Res 2015;9(4):Zc18–21.
6. Shawky H, Seifeldin SA. Does platelet-rich fibrin enhance bone quality and quantity of alveolar cleft reconstruction? Cleft Palate Craniofac J 2016;53(5):597–606.
7. Temmerman A, Vandessel J, Castro A, Jacobs R, Teughels W, Pinto N, Quirynen M. The use of leucocyte and platelet-rich fibrin in socket management and ridge pres- ervation: a split-mouth, randomized, controlled clinical trial. J Clin Periodontol 2016;43(11):990–9.
8. Bilginaylar K. The use of platelet-rich fibrin for immediate closure of acute oroantral communications: an alternative approach. J Oral Maxillofac Surg 2018;76(2):278–86.

Dental Elf – 22nd Jan 2018

Third molar extraction – does platelet-rich fibrin improve outcomes?

 

Acknowledgments

This blog was developed by MSc Students from @UClanDentistry during a workshop with the @TheDentalElf