Department of Health Technologies, Scientific Institute for Care and Clinical Research (IRCCS) Galeazzi Orthopedic Institute, University of Milan, Milan, Italy.
J Periodontol. 2011 Aug;82(8):1100-11. doi: 10.1902/jop.2010.100605. Epub 2010 Dec 28.
The aim of the present review is to systematically evaluate the effects of autogenous platelet concentrates on clinical outcomes of the surgical treatment of periodontal diseases.
MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched using a combination of specific search terms. Furthermore, a hand search of relevant journals and bibliographies of reviews was performed. Only randomized clinical trials were included. For periodontal intrabony defects, the primary outcome variable was the clinical attachment level. For gingival recession, outcome variables were root coverage and keratinized tissue increase. Data were adjusted for baseline values. The methodologic quality of the included studies was assessed. The results of studies in which the only difference between test and control groups was the adjunct of platelet concentrates were aggregated using a meta-analysis. For intrabony defects, the influences of guided tissue regeneration (GTR) and study type (split-mouth versus parallel studies) were also evaluated.
The initial search yielded 424 studies. Of the 29 eligible studies, 24 studies were included. There were 16 studies on the treatment of periodontal intrabony defects, all of which used platelet-rich plasma (PRP); six studies on gingival recession treatment; and two studies on the treatment of furcation defects. A significant positive effect of the adjunct of PRP was found for intrabony defects. Such an effect was magnified in studies in which GTR was not used, whereas in studies using GTR, the use of PRP had no adjunctive effect. No effect of the study type was found. No significant effect of platelet concentrates was found for gingival recession treatment in which only studies with a follow-up ≤6 months displayed positive results. No significant benefit of PRP could be demonstrated for furcation treatment.
PRP may exert a positive adjunctive effect when used in combination with graft materials, but not with GTR, for the treatment of intrabony defects. No significant benefit of platelet concentrates was found for the treatment of gingival recession.
本综述的目的是系统地评估自体血小板浓缩物对牙周病手术治疗临床结果的影响。
使用特定搜索词组合，对 MEDLINE、EMBASE 和 Cochrane 对照试验中心注册库进行了搜索。此外，还对手头相关期刊和综述的参考文献进行了搜索。仅纳入随机临床试验。对于牙周内骨缺损，主要结局变量为临床附着水平。对于牙龈退缩，结局变量为根覆盖和角化组织增加。数据根据基线值进行了调整。评估了纳入研究的方法学质量。使用荟萃分析汇总了仅在实验组和对照组之间存在血小板浓缩物附加物差异的研究结果。对于内骨缺损，还评估了引导组织再生（GTR）和研究类型（分牙瓣与平行研究）的影响。
初步搜索产生了 424 项研究。在 29 项符合条件的研究中，有 24 项研究被纳入。其中 16 项研究用于治疗牙周内骨缺损，均使用富含血小板的血浆（PRP）；6 项研究用于治疗牙龈退缩；2 项研究用于治疗分叉缺损。PRP 的附加作用对内骨缺损有显著的积极影响。在未使用 GTR 的研究中，这种作用放大，而在使用 GTR 的研究中，PRP 的使用没有附加作用。研究类型没有影响。对于仅随访时间≤6 个月的研究显示阳性结果的牙龈退缩治疗，血小板浓缩物无显著作用。PRP 对分叉治疗没有明显的益处。
PRP 与移植物材料联合使用时可能具有积极的辅助作用，但与 GTR 联合使用时对内骨缺损的治疗没有明显益处。对于牙龈退缩的治疗，血小板浓缩物没有明显益处。
