Barootchi Shayan, Tavelli Lorenzo, Vinueza Maria Elisa Galarraga, Sabri Hamoun, Andrade Catherine, Pinto Nelson, Sanz Antonio, Wang Hom-Lay
Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA.
Center for Clinical Research and Evidence Synthesis in Oral Tissue Regeneration (CRITERION), Boston, Massachusetts, USA.
Periodontol 2000. 2025 Feb;97(1):215-235. doi: 10.1111/prd.12614. Epub 2024 Oct 15.
Gingival recessions are vastly prevalent among the general population. With regards to their treatment, recent advancements in periodontal and microsurgical procedures, focusing on minimal invasiveness and patient-centered therapies, have propelled a shift in their contemporary treatment, highlighting the field of biologics and bioactive mediators. Among different classes and types of biologics, autologous platelet concentrates (APCs), also referred to as autologous blood-derived products, are commonly used and preferred among many clinicians. These are essentially obtained via venipuncture (intravenous access) followed by centrifugation, for which numerous protocols and preparation methods have been used, leading to varieties of blood-derived products. In this review, via a systematic search, we explored the efficacy of the different utilized preparation methods and centrifugation protocols of APCs (e.g., platelet-rich plasma (PRP), platelet-rich fibrin (PRF), leucocyte-PRF, advanced-PRF, concentrated growth factor (CGF), etc.) for the treatment of type 1 gingival recessions (RT1, without interproximal attachment loss or noticeable tooth displacement), as well as their effectiveness relative to a common control (treatment with flap advancement alone without any additional material). Based on the available literature from randomized trials found in our systematic search, we observed that utilization of PRF can significantly enhance treatment outcomes when performing a coronally advanced flap, in terms of the amount of root coverage. The improvement in root coverage was further enhanced in the presence of baseline keratinized tissue width, and with an increasing relative magnitude (the more the baseline keratinized tissue width, the better the root coverage outcomes when using PRF). The efficacy of these products needs to be further explored with different graft substitutes and matrices, as well as relative to other commonly applied biologics, through well-conducted and adequately-powered randomized clinical trials.
牙龈退缩在普通人群中极为普遍。关于其治疗，牙周和显微外科手术的最新进展，聚焦于微创性和以患者为中心的疗法，推动了其当代治疗方式的转变，突出了生物制剂和生物活性介质领域。在不同种类和类型的生物制剂中，自体血小板浓缩物（APCs），也被称为自体血液衍生产品，在许多临床医生中被普遍使用且更受青睐。这些基本上是通过静脉穿刺（静脉通路）然后离心获得的，为此已经使用了众多方案和制备方法，从而产生了多种血液衍生产品。在本综述中，通过系统检索，我们探讨了不同的APCs制备方法和离心方案（例如富血小板血浆（PRP）、富血小板纤维蛋白（PRF）、白细胞-PRF、高级-PRF、浓缩生长因子（CGF）等）用于治疗1型牙龈退缩（RT1，无邻面附着丧失或明显牙齿移位）的疗效，以及它们相对于普通对照（仅进行瓣推进而不使用任何额外材料的治疗）的有效性。基于我们系统检索中发现的随机试验的现有文献，我们观察到在进行冠向推进瓣手术时，使用PRF在牙根覆盖量方面可显著提高治疗效果。在存在基线角化组织宽度的情况下，牙根覆盖的改善进一步增强，并且随着相对幅度的增加（基线角化组织宽度越大，使用PRF时牙根覆盖效果越好）。这些产品的疗效需要通过精心设计且有足够样本量的随机临床试验，与不同的移植替代物和基质以及相对于其他常用生物制剂进行进一步探索。
