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

Richard J Miron; Vittorio Moraschini; Massimo Del Fabbro; Adriano Piattelli; Masako Fujioka-Kobayashi; Yufeng Zhang; Nikola Saulacic; Benoit Schaller; Tomoyuki Kawase; Raluca Cosgarea; Soren Jepsen; Delia Tuttle; Mark Bishara; Luigi Canullo; Meizi Eliezer; Andreas Stavropoulos; Yoshinori Shirakata; Alexandra Stähli; Reinhard Gruber; Ondine Lucaciu; Sofia Aroca; Herbert Deppe; Hom-Lay Wang; Anton Sculean

doi:10.1007/s00784-020-03400-7

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

Clin Oral Investig. 2020 Aug;24(8):2543-2557. doi: 10.1007/s00784-020-03400-7. Epub 2020 Jun 26.

Authors

Richard J Miron¹, Vittorio Moraschini², Massimo Del Fabbro^{3

4}, Adriano Piattelli^{5

6

7}, Masako Fujioka-Kobayashi⁸, Yufeng Zhang⁹, Nikola Saulacic⁸, Benoit Schaller⁸, Tomoyuki Kawase¹⁰, Raluca Cosgarea^{11

12}, Soren Jepsen¹², Delia Tuttle¹³, Mark Bishara¹⁴, Luigi Canullo¹⁵, Meizi Eliezer¹⁶, Andreas Stavropoulos¹⁷, Yoshinori Shirakata¹⁸, Alexandra Stähli¹⁶, Reinhard Gruber¹⁹, Ondine Lucaciu¹¹, Sofia Aroca¹⁶, Herbert Deppe²⁰, Hom-Lay Wang²¹, Anton Sculean¹⁶

Affiliations

¹ Department of Periodontology, University of Bern, Bern, Switzerland. richard.miron@zmk.unibe.ch.
² Department of Periodontology, Dental Research Division, School of Dentistry, Veiga de Almeida University, Rio de Janeiro, Brazil.
³ Department of Biomedical, Surgical, and Dental Sciences, University of Milan, Milan, Italy.
⁴ IRCCS Orthopedic Institute Galeazzi, Milan, Italy.
⁵ Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy.
⁶ Catholic University of San Antonio de Murcia (UCAM), Murcia, Spain.
⁷ Villaserena Foundation for Research, Città Sant'Angelo, PE, Italy.
⁸ Department of Cranio-Maxillofacial Surgery, University of Bern, Bern, Switzerland.
⁹ Department of Oral Implantology, University of Wuhan, Wuhan, China.
¹⁰ Division of Oral Bioengineering, Institute of Medicine and Dentistry, Niigata University, Niigata, Japan.
¹¹ Department of Prosthetic Dentistry, University Iuliu Hatieganu, Cluj-Napoca, Romania.
¹² Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany.
¹³ Canyon Lake Dental Office, Lake Elsinore, CA, USA.
¹⁴ West Bowmanville Family Dental, Bowmanville, Ontario, Canada.
¹⁵ , Rome, Italy.
¹⁶ Department of Periodontology, University of Bern, Bern, Switzerland.
¹⁷ Department of Periodontology, University of Geneva, Geneva, Switzerland.
¹⁸ Department of Periodontology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.
¹⁹ Department of Oral Biology, University of Vienna, Vienna, Austria.
²⁰ Department of Oral and Maxillofacial Surgery, Klinikum rechts der Isar der TUM, Munich, Germany.
²¹ Department of Periodontics and Oral Medicine, University of Michigan, Ann Arbor, MI, USA.

PMID: 32591868
DOI: 10.1007/s00784-020-03400-7

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.

Keywords: Gingival recession; L-PRF; Periodontal plastic surgery; Platelet-rich fibrin.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Connective Tissue
Gingiva
Gingival Recession*
Humans
Platelet-Rich Fibrin
Surgical Flaps
Tooth Root
Treatment Outcome