Use of platelet-rich fibrin for the treatment of gingival recessions: a systematic review and meta-analysis

Abstract

Objectives

The aim of this systematic review and meta-analysis was to compare the use of platelet-rich fibrin (PRF) with other commonly utilized treatment modalities for root coverage procedures.

Materials and methods

The eligibility criteria comprised randomized controlled trials (RCTs) comparing the performance of PRF with that of other modalities in the treatment of Miller class I or II (Cairo RT I) gingival recessions. Studies were classified into 5 categories as follows: (1) coronally advanced flap (CAF) alone vs CAF/PRF, (2) CAF/connective tissue graft (CAF/CTG) vs CAF/PRF, (3) CAF/enamel matrix derivative (CAF/EMD) vs CAF/PRF, (4) CAF/amnion membrane (CAF/AM) vs CAF/PRF, and (5) CAF/CTG vs CAF/CTG/PRF. Studies were evaluated for percentage of relative root coverage (rRC; primary outcome), clinical attachment level (CAL), keratinized mucosa width (KMW), and probing depth (PD) (secondary outcomes).

Results

From 976 articles identified, 17 RCTs were included. The use of PRF statistically significantly increased rRC and CAL compared with CAF alone. No change in KMW or reduction in PD was reported. Compared with PRF, CTG resulted in statistically significantly better KMW and RC. No statistically significant differences were reported between the CAF/PRF and CAF/EMD groups or between the CAF/PRF and CAF/AM groups for any of the investigated parameters.

Conclusions

The use of CAF/PRF improved rRC and CAL compared with the use of CAF alone. While similar outcomes were observed between CAF/PRF and CAF/CTG for CAL and PD change, the latter group led to statistically significantly better outcomes in terms of rRC and KTW. In summary, the use of PRF in conjunction with CAF may represent a valid treatment modality for gingival recessions exhibiting adequate baseline KMW.

Clinical relevance

The data indicate that the use of PRF in conjunction with CAF statistically significantly improves rRC when compared with CAF alone but did not improve KMW. Therefore, in cases with limited baseline KMW, the use of CTG may be preferred over PRF.

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All authors made substantial contribution to the conception and design of the manuscript. RJM and VM performed the literature search and interpretation of the data. All authors drafted the work and revised it critically for important intellectual content. All authors agree to be accountable for all aspects of the study design and its content. All authors approved the final submitted version.

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Correspondence to Richard J. Miron.

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Richard J Miron holds intellectual property on PRF. All other authors declare no conflict of interest.

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Supplemental Figure 1
figure6

Flow diagram (PRISMA format) of the screening and selection process. (PNG 1400 kb).

High resolution image (TIF 125 kb).

Supplemental Figure 2

Forest plot for the event “probing depth”. A) Comparison between CAF vs CAF/PRF. B) Comparison between CAF/CTG and CAF/PRF. (PDF 356 kb).

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(PDF 267 kb).

Supplemental Table 1

Assessments of the risk of bias of randomized clinical trials. (DOCX 17 kb).

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Miron, R.J., Moraschini, V., Del Fabbro, M. et al. Use of platelet-rich fibrin for the treatment of gingival recessions: a systematic review and meta-analysis. Clin Oral Invest (2020). https://doi.org/10.1007/s00784-020-03400-7

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Keywords

  • Gingival recession
  • Periodontal plastic surgery
  • Platelet-rich fibrin
  • L-PRF