富血小板纤维蛋白离心新方案是否能更好地控制下颌第三磨牙阻生术后的术后并发症和愈合？系统评价和荟萃分析。
Do the New Protocols of Platelet-Rich Fibrin Centrifugation Allow Better Control of Postoperative Complications and Healing After Surgery of Impacted Lower Third Molar? A Systematic Review and Meta-Analysis.
机构信息
Student, Department of Oral and Maxillofacial Surgery and Traumatology Integrated Clinic, Paulista State University, UNESP, Araçatuba, São Paulo, Brazil.
Student, Department of Oral and Maxillofacial Surgery and Traumatology Integrated Clinic, Paulista State University, UNESP, Araçatuba, São Paulo, Brazil.
出版信息
J Oral Maxillofac Surg. 2022 Jul;80(7):1238-1253. doi: 10.1016/j.joms.2022.03.011. Epub 2022 Mar 22.
PURPOSE
Platelet concentrate generation protocols have undergone several modifications in recent years; in light of these new developments, this study review aims to evaluate the effects of platelet-rich fibrin (PRF) and the new centrifugation protocols, advanced platelet-rich fibrin (A-PRF), and leukocyte platelet-rich fibrin (L-PRF), after extraction of impacted mandibular third molar. Specifically, we assessed pain control, edema, trismus, and soft tissue healing, and also measured the degree of periodontal regeneration adjacent to the second molar.
METHODS
PubMed, MEDLINE, EMBASE, Web of Science, Virtual health library (BVS), and Cochrane Library were searched up to Julye 2021; randomized controlled studies were included. This report followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and PICO (population, intervention, comparison, outcome) questions. This review has been registered at the International Prospective Register of Ongoing Systematic Reviews (PROSPERO) under the number CRD42019136701. The risk of bias screening and data extraction was performed according to the guidelines recommended by Cochrane. The quantitative analysis was performed using RevMan version 5.4.
RESULTS
Of 17 studies included in the systematic review, 11 were eligible for the meta-analysis. The use of L-PRF was not associated with better soft tissue healing at day 7. (standard mean difference = -0.70; 95% confidence interval, -3.50 to 2.10; Z = 0.49; P = .62; heterogeneity = 0.00001; I = 97%). With L-PRF, qualitative analysis revealed better pocket depth and insertion level, and also better pain control at 1 and 3 days. With A-PRF, a lower consumption of analgesics was observed than with L-PRF. With both A-PRF and L-PRF, better control of edema (but not trismus) was observed.
CONCLUSIONS
The use of L-PRF and A-PRF allows better control of pain and edema compared with the use of standard PRF protocols, but neither has an effect on trismus. The PRF and L-PRF protocols improve soft tissue healing, although not to a statistically significant degree; however, they could improve probing depth at the third month after third molar surgery.
目的
近年来，血小板浓缩物生成方案经历了多次修改；鉴于这些新进展，本研究旨在评估富血小板纤维蛋白（PRF）和新离心方案（先进富血小板纤维蛋白（A-PRF）和白细胞富血小板纤维蛋白（L-PRF））在提取下颌第三磨牙后的影响。具体而言，我们评估了疼痛控制、肿胀、牙关紧闭和软组织愈合，并测量了第二磨牙旁牙周再生的程度。
方法
检索了 PubMed、MEDLINE、EMBASE、Web of Science、Virtual Health Library（BVS）和 Cochrane Library 数据库，截至 2021 年 7 月；纳入随机对照研究。本报告遵循系统评价和荟萃分析的 Preferred Reporting Items（PRISMA）声明和 PICO（人群、干预、比较、结局）问题。该综述已在国际前瞻性注册持续系统评价（PROSPERO）中注册，注册号为 CRD42019136701。根据 Cochrane 推荐的指南对偏倚风险筛查和数据提取进行了评估。使用 RevMan 版本 5.4 进行定量分析。
结果
在系统评价中纳入的 17 项研究中，有 11 项符合荟萃分析的条件。使用 L-PRF 与第 7 天的软组织愈合情况无改善相关。（标准均数差=-0.70；95%置信区间，-3.50 至 2.10；Z=0.49；P=0.62；异质性=0.00001；I²=97%）。使用 L-PRF 时，定性分析显示在第 1 天和第 3 天，探诊深度和植入水平更好，疼痛控制也更好。与 L-PRF 相比，A-PRF 时镇痛药的消耗更少。使用 A-PRF 和 L-PRF 时，均能更好地控制水肿（但不是牙关紧闭）。
结论
与标准 PRF 方案相比，使用 L-PRF 和 A-PRF 可以更好地控制疼痛和水肿，但两者均不能影响牙关紧闭。PRF 和 L-PRF 方案改善了软组织愈合，但无统计学意义；然而，它们可以在第三磨牙手术后第三个月改善探诊深度。
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