Fernandes Gustavo Vicentis De Oliveira, Santos Nuno Bernardo Malta, Siqueira Rafael Amorim Cavalcanti De, Wang How-Lay, Blanco-Carrion Juan, Fernandes Juliana Campos Hasse
Faculty of Dental Medicine at Universidade Católica Portuguesa, Ann Arbor, Michigan, USA.
Center for Interdisciplinary Research in Health, Institute of Health Sciences, Universidade Católica Portuguesa, Viseu, Portugal.
J Indian Soc Periodontol. 2021 Nov-Dec;25(6):463-479. doi: 10.4103/jisp.jisp_515_20. Epub 2021 Nov 1.
Autologous platelet concentrate (APC)/platelet-rich fibrin (PRF) of second and third generations has increased use in periodontics to optimize wound healing. Few systematic reviews (SRs) have reported improved clinical outcomes, while other studies reported significantly better results for the connective tissue graft (CTG). There is still unclear clinical evidence about APC/PRF use to treat gingival recession (GR) defects. Then, the purpose of this SR was to evaluate the use of APC/PRF membranes (2 and 3 generations) in root coverage (RC) procedures and assess its efficacy as a substitute biomaterial.
An electronic search was conducted in PubMed, Cochrane Central, Web of Science, Google Scholar, BookSC databases, and gray literature. The search strategy, without date restriction up to April 2020, included keywords as "platelet-rich fibrin," "autologous platelet concentrates," "blood," "systematic review," "periodontics," "surgery," "tissue," "gingiva," "gingival recession," "connective tissue," "graft," and "root coverage." The methodological quality was evaluated through the AMSTAR2, and a population, index test, comparator, outcome strategy was used to assess specific clinical parameters such as recession depth, clinical attachment levels, and RC outcomes.
Nine SRs were included. Only three articles described the technique of APC/PRF production. Three studies reported unfavorable outcomes using APC, while six reported favorable results and postoperative discomfort reduction. Articles included in this SRs that provided information about APC/PRF membranes ( = 13) showed no significant difference between APC/PRF and the control group for the parameters analyzed.
This implies that APC/PRF may be considered a feasible substitute biomaterial for treating GR defects, although the CTG still provides superior outcomes. Further long-term and controlled studies are needed to verify this finding.
第二代和第三代自体血小板浓缩物(APC)/富血小板纤维蛋白(PRF)在牙周病学中用于优化伤口愈合的应用日益增加。很少有系统评价(SR)报告临床结果有所改善,而其他研究报告结缔组织移植(CTG)的效果明显更好。关于使用APC/PRF治疗牙龈退缩(GR)缺损的临床证据仍不明确。因此,本SR的目的是评估APC/PRF膜(第二代和第三代)在根面覆盖(RC)手术中的应用,并评估其作为替代生物材料的疗效。
在PubMed、Cochrane Central、Web of Science、Google Scholar、BookSC数据库和灰色文献中进行电子检索。检索策略不受日期限制,截至2020年4月,包括“富血小板纤维蛋白”、“自体血小板浓缩物”、“血液”、“系统评价”、“牙周病学”、“手术”、“组织”、“牙龈”、“牙龈退缩”、“结缔组织”、“移植”和“根面覆盖”等关键词。通过AMSTAR2评估方法学质量,并使用人群、指标测试、对照、结局策略来评估特定的临床参数,如退缩深度、临床附着水平和RC结局。
纳入了9篇SR。只有3篇文章描述了APC/PRF的制备技术。3项研究报告使用APC的结果不佳,而6项报告了良好的结果且术后不适减轻。本SR中提供有关APC/PRF膜信息的文章(n = 13)显示,在分析的参数方面,APC/PRF与对照组之间无显著差异。
这意味着APC/PRF可被视为治疗GR缺损的一种可行替代生物材料,尽管CTG仍能提供更好的结果。需要进一步的长期对照研究来验证这一发现。