Tooth extraction remains one of the commonest surgical interventions carried out.  Changes to alveolar bone following extraction vary with a majority of resorption in the area of the took socket occurring in the first 6 months. and the changes can compromise rehabilitation. Consequently, a number of approaches to preserve alveolar bone  have been tested. One approach is the use of autologous platelet concentrates (APCs) which have a high concentration of platelets.

The aim of this review was to assess the effectiveness of autologous platelet concentrates (APCs) in the preservation of fresh extraction sockets.

Methods

Searches were conducted in the Medline, Embase and Cochrane Central databases. This was supplements by hand searching the dental journals; British Dental Journal, British Journal of Oral and Maxillofacial Surgery, Clinical Implant Dentistry and Related Research, Clinical Oral Implants Research, Clinical Oral Investigations, European Journal of Oral Sciences, Implant Dentistry, International Journal of Oral and Maxillofacial Implants, International Journal of Oral and Maxillofacial Surgery, International Journal of Periodontics and Restorative Dentistry, Journal of Clinical Periodontology, Journal of Dental Research, Journal of Dentistry, Journal of Maxillofacial and Oral Surgery, Journal of Oral and Maxillofacial Surgery, Journal of Periodontal Research, Journal of Periodontology, and Oral Surgery, Oral Medicine, Oral Pathology, and Oral Radiology.

Randomised controlled trials (RCTs) or controlled clinical trials (CCTs) with a minimum of 5 patients per group were included.  Two reviewers selected studies, abstracted data and assessed risk of bias independently. The outcomes considered were complications and adverse events, discomfort and quality of life, bone healing and remodelling assessed using histology and radiographic techniques, and soft tissue healing. Meta-analysis was when similar outcomes were compared in trials.

Results

• 33 studies (23 RCTs; 10 CCTs) involving a total of 911 patients (1193 teeth) were included.
• 24 studies used a split mouth design, 9 a parallel design
• Platelet-rich plasma (PRP) was the most commonly used APC (14 studies) followed by platelet-rich fibrin (PRF) used in 12 studies.
• 13 studies were considered to be at high risk of bias, 20 a low risk.
• Meta-analysis (5 studies) suggested that soft tissue healing was statistically better for sockets treated with APCs at 7 days postop; mean difference (MD) =1.01 (95%CI; 0.77-1.24) P < .05.
• Meta-analysis (3 studies) suggest that probing depth was statistically better the treated APC group at 3 months; MD = -1.63 (95%CI; -2.05 to -1.22) P < .05.
• There were no statistical differences in alveolar osteitis, or acute inflammation or infection between the groups.
• Meta-analysis (2 studies) indicated that the percentage of new bone formation was similar for the 2 groups, MD = 1.55% (95%CI; 6.37 to 9.48);P > .05.
• Bone density (2 studies) one was statistically better for APC group at one. Three and six months post operatively.

Conclusions

The authors concluded: –

APCs should be used in post-extraction sites to improve clinical and radiographic outcomes such as bone density and soft tissue healing and postoperative symptoms. The actual benefit of APCs on decreasing pain in extraction sockets is still not quantifiable.

Comments

The authors have searched 3 major databases for trials on this topic and chosen to include both RCTs and CCTs. Given that 23 of these were RCTs the review could have been restricted to those trial alone and the standard Cochrane risk of bias tool have been used to assess study quality.  The sample sizes of the studies were relatively small ranging from 5-78 participants and the follow up periods very variable being between 1 week and 5 years .  The 2005 Cochrane review of alveolar ridge preservation techniques by Atieh et al  look at a broader range of techniques. They restricted their inclusion criteria to studies with a 6-month follow up, which seems reasonable given that a majority of the changes are seen during this period.  If the authors of this current review had restricted their inclusion criteria to the same follow up period and only randomised controlled trials 5 studies would have fitted the criteria.

Although the reviewers recommend the use of APCs in post extraction site the majority of the available studies are small and few of them provide long term data. Consequently, the data should be interpreted cautiously until more data is available from high quality trials of appropriate size and duration. Ideally this technique should also be compared in well-designed trials against other alveolar ridge preservation techniques.

Links

Primary paper

Del Fabbro M, Bucchi C, Lolato A, Corbella S, Testori T, Taschieri S. Healing  of Post-extraction Sockets Preserved With Autologous Platelet Concentrates. A Systematic Review and Meta-Analysis. J Oral Maxillofac Surg. 2017 Feb 20. pii: S0278-2391(17)30218-5. doi: 10.1016/j.joms.2017.02.009. [Epub ahead of print] Review. PubMed PMID: 28288724.

Other references

 Dental Elf – 2nd Jun 2015

Alveolar ridge preservation: limited evidence for current techniques

 Dental Elf – 26^th Jul 2012

Limited evidence supports some clinical benefit of alveolar ridge preservation procedures