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

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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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Author notes

  1. Richard J. Miron and Vittorio Moraschini contributed equally to this work.

Authors and Affiliations

  1. Department of Periodontology, University of Bern, Bern, Switzerland

    Richard J. Miron, Meizi Eliezer, Alexandra Stähli, Sofia Aroca & Anton Sculean

  2. Department of Periodontology, Dental Research Division, School of Dentistry, Veiga de Almeida University, Rio de Janeiro, Brazil

    Vittorio Moraschini

  3. Department of Biomedical, Surgical, and Dental Sciences, University of Milan, Milan, Italy

    Massimo Del Fabbro

  4. IRCCS Orthopedic Institute Galeazzi, Milan, Italy

    Massimo Del Fabbro

  5. Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy

    Adriano Piattelli

  6. Catholic University of San Antonio de Murcia (UCAM), Murcia, Spain

    Adriano Piattelli

  7. Villaserena Foundation for Research, Città Sant’Angelo, PE, Italy

    Adriano Piattelli

  8. Department of Cranio-Maxillofacial Surgery, University of Bern, Bern, Switzerland

    Masako Fujioka-Kobayashi, Nikola Saulacic & Benoit Schaller

  9. Department of Oral Implantology, University of Wuhan, Wuhan, China

    Yufeng Zhang

  10. Division of Oral Bioengineering, Institute of Medicine and Dentistry, Niigata University, Niigata, Japan

    Tomoyuki Kawase

  11. Department of Prosthetic Dentistry, University Iuliu Hatieganu, Cluj-Napoca, Romania

    Raluca Cosgarea & Ondine Lucaciu

  12. Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany

    Raluca Cosgarea & Soren Jepsen

  13. Canyon Lake Dental Office, Lake Elsinore, CA, USA

    Delia Tuttle

  14. West Bowmanville Family Dental, Bowmanville, Ontario, Canada

    Mark Bishara

  15. Rome, Italy

    Luigi Canullo

  16. Department of Periodontology, University of Geneva, Geneva, Switzerland

    Andreas Stavropoulos

  17. Department of Periodontology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan

    Yoshinori Shirakata

  18. Department of Oral Biology, University of Vienna, Vienna, Austria

    Reinhard Gruber

  19. Department of Oral and Maxillofacial Surgery, Klinikum rechts der Isar der TUM, Munich, Germany

    Herbert Deppe

  20. Department of Periodontics and Oral Medicine, University of Michigan, Ann Arbor, MI, USA

    Hom-Lay Wang

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  1. Richard J. Miron
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Contributions

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.

Corresponding author

Correspondence to Richard J. Miron.

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Conflict of interest

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

Ethical approval

No ethical approval was required for this study since it was a systematic review.

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No informed consent was required.

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Electronic supplementary material

Supplemental Figure 1

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).

ESM 1

(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 24, 2543–2557 (2020). https://doi.org/10.1007/s00784-020-03400-7

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  • DOI: https://doi.org/10.1007/s00784-020-03400-7

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