Del Fabbro Massimo, Bucchi Cristina, Lolato Alessandra, Corbella Stefano, Testori Tiziano, Taschieri Silvio
Associate Professor, Dipartimento di Scienze Biomediche, Chirurgiche ed Odontoiatriche, Università degli Studi di Milano, Milan; Dental Clinic, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
Assistant Professor, Research Centre in Dental Sciences (CICO), Facultad de Odontología, Universidad de La Frontera, Temuco, Chile; PhD Candidate, Departamento de Patología i Terapeútica Experimental, Universitat de Barcelona, Barcelona, Spain.
J Oral Maxillofac Surg. 2017 Aug;75(8):1601-1615. doi: 10.1016/j.joms.2017.02.009. Epub 2017 Feb 20.
The true benefit of autologous platelet concentrates (APCs) for enhancing the healing of postextraction sites is still a matter of debate, and in recent years several clinical trials have addressed this issue. The purpose of this study was to determine the effectiveness of an APC adjunct in the preservation of fresh extraction sockets.
An electronic search was performed on Medline, Embase, Scopus, and the Cochrane Central Register of Controlled Trials. Only controlled clinical trials or randomized clinical trials were included. Selected articles underwent risk-of-bias assessment. The outcomes were complications and adverse events, discomfort and quality of life, bone healing and remodeling assessed by histologic and radiographic techniques, and soft tissue healing.
Thirty-three comparative studies were included. Nine articles had a parallel design and 24 had a split-mouth design. Twenty studies were considered to have a low risk of bias and 13 were considered to have a high risk. Overall, 1,193 teeth were extracted from 911 patients. Meta-analysis showed that soft tissue healing, probing depth at 3 months, and bone density at 1, 3, and 6 months were statistically better for the APC group. Qualitative analysis suggested that APCs might be associated with a decrease in swelling and trismus. However, no relevant difference among groups was found for probing depth at 1 month, incidence of alveolar osteitis, acute inflammation or infection, percentage of new bone, and indirect measurement of bone metabolism.
APCs should be used in postextraction 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.
自体血小板浓缩物（APCs）对促进拔牙后创口愈合的真正益处仍存在争议，近年来已有多项临床试验探讨了这一问题。本研究的目的是确定APC辅助治疗在保存新鲜拔牙窝方面的有效性。
对Medline、Embase、Scopus和Cochrane对照试验中央注册库进行电子检索。仅纳入对照临床试验或随机临床试验。对所选文章进行偏倚风险评估。结局指标包括并发症和不良事件、不适和生活质量、通过组织学和影像学技术评估的骨愈合和重塑，以及软组织愈合。
纳入33项比较研究。9篇文章采用平行设计，24篇采用分口设计。20项研究被认为偏倚风险较低，13项被认为偏倚风险较高。总体而言，从911例患者中拔除了1193颗牙齿。荟萃分析表明，APC组的软组织愈合、3个月时的探诊深度以及1、3和6个月时的骨密度在统计学上更好。定性分析表明，APCs可能与肿胀和牙关紧闭的减轻有关。然而，在1个月时的探诊深度、干槽症发生率、急性炎症或感染、新骨百分比以及骨代谢的间接测量方面，各组之间未发现相关差异。
APCs应用于拔牙后创口，可改善临床和影像学结局，如骨密度、软组织愈合和术后症状。APCs对减轻拔牙窝疼痛的实际益处仍无法量化。
