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      Use of platelet-rich fibrin for the treatment of periodontal intrabony defects: a systematic review and meta-analysis


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          This study aims to compare the treatment outcomes of periodontal intrabony defects by using platelet-rich fibrin (PRF) with other commonly utilized modalities.

          Materials and methods

          The eligibility criteria comprised randomized controlled trials (RCTs) comparing the clinical outcomes of PRF with that of other modalities. Studies were classified into 10 categories as follows: (1) open flap debridement (OFD) alone versus OFD/PRF; (2) OFD/bone graft (OFD/BG) versus OFD/PRF; (3) OFD/BG versus OFD/BG/PRF; (4–6) OFD/barrier membrane (BM), OFD/PRP, or OFD/enamel matrix derivative (EMD) versus OFD/PRF; (7) OFD/EMD versus OFD/EMD/PRF; (8–10) OFD/PRF versus OFD/PRF/metformin, OFD/PRF/bisphosphonates, or OFD/PRF/statins. Weighted means and forest plots were calculated for probing depth (PD), clinical attachment level (CAL), and radiographic bone fill (RBF).


          From 551 articles identified, 27 RCTs were included. The use of OFD/PRF statistically significantly reduced PD and improved CAL and RBF when compared to OFD. No clinically significant differences were reported when OFD/BG was compared to OFD/PRF. The addition of PRF to OFD/BG led to significant improvements in CAL and RBF. No differences were reported between any of the following groups (OFD/BM, OFD/PRP, and OFD/EMD) when compared to OFD/PRF. No improvements were also reported when PRF was added to OFD/EMD. The addition of all three of the following biomolecules (metformin, bisphosphonates, and statins) to OFD/PRF led to statistically significant improvements of PD, CAL, and RBF.


          The use of PRF significantly improved clinical outcomes in intrabony defects when compared to OFD alone with similar levels being observed between OFD/BG and OFD/PRF. Future research geared toward better understanding potential ways to enhance the regenerative properties of PRF with various small biomolecules may prove valuable for future clinical applications. Future research investigating PRF at histological level is also needed.

          Clinical relevance

          The use of PRF in conjunction with OFD statistically significantly improved PD, CAL, and RBF values, yielding to comparable outcomes to OFD/BG. The combination of PRF with bone grafts or small biomolecules may offer certain clinical advantages, thus warranting further investigations.

          Supplementary Information

          The online version contains supplementary material available at 10.1007/s00784-021-03825-8.

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          Most cited references64

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          Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.

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            Utilization of the PICO framework to improve searching PubMed for clinical questions

            Background Supporting 21st century health care and the practice of evidence-based medicine (EBM) requires ubiquitous access to clinical information and to knowledge-based resources to answer clinical questions. Many questions go unanswered, however, due to lack of skills in formulating questions, crafting effective search strategies, and accessing databases to identify best levels of evidence. Methods This randomized trial was designed as a pilot study to measure the relevancy of search results using three different interfaces for the PubMed search system. Two of the search interfaces utilized a specific framework called PICO, which was designed to focus clinical questions and to prompt for publication type or type of question asked. The third interface was the standard PubMed interface readily available on the Web. Study subjects were recruited from interns and residents on an inpatient general medicine rotation at an academic medical center in the US. Thirty-one subjects were randomized to one of the three interfaces, given 3 clinical questions, and asked to search PubMed for a set of relevant articles that would provide an answer for each question. The success of the search results was determined by a precision score, which compared the number of relevant or gold standard articles retrieved in a result set to the total number of articles retrieved in that set. Results Participants using the PICO templates (Protocol A or Protocol B) had higher precision scores for each question than the participants who used Protocol C, the standard PubMed Web interface. (Question 1: A = 35%, B = 28%, C = 20%; Question 2: A = 5%, B = 6%, C = 4%; Question 3: A = 1%, B = 0%, C = 0%) 95% confidence intervals were calculated for the precision for each question using a lower boundary of zero. However, the 95% confidence limits were overlapping, suggesting no statistical difference between the groups. Conclusion Due to the small number of searches for each arm, this pilot study could not demonstrate a statistically significant difference between the search protocols. However there was a trend towards higher precision that needs to be investigated in a larger study to determine if PICO can improve the relevancy of search results.
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              Prevalence of periodontitis in adults in the United States: 2009 and 2010.

              This study estimated the prevalence, severity, and extent of periodontitis in the adult U.S. population, with data from the 2009 and 2010 National Health and Nutrition Examination Survey (NHANES) cycle. Estimates were derived from a sample of 3,742 adults aged 30 years and older, of the civilian non-institutionalized population, having 1 or more natural teeth. Attachment loss (AL) and probing depth (PD) were measured at 6 sites per tooth on all teeth (except the third molars). Over 47% of the sample, representing 64.7 million adults, had periodontitis, distributed as 8.7%, 30.0%, and 8.5% with mild, moderate, and severe periodontitis, respectively. For adults aged 65 years and older, 64% had either moderate or severe periodontitis. Eighty-six and 40.9% had 1 or more teeth with AL ≥ 3 mm and PD ≥ 4 mm, respectively. With respect to extent of disease, 56% and 18% of the adult population had 5% or more periodontal sites with ≥ 3 mm AL and ≥ 4 mm PD, respectively. Periodontitis was highest in men, Mexican Americans, adults with less than a high school education, adults below 100% Federal Poverty Levels (FPL), and current smokers. This survey has provided direct evidence for a high burden of periodontitis in the adult U.S. population.

                Author and article information

                Clin Oral Investig
                Clin Oral Investig
                Clinical Oral Investigations
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                20 February 2021
                20 February 2021
                : 25
                : 5
                : 2461-2478
                [1 ]GRID grid.5734.5, ISNI 0000 0001 0726 5157, Department of Periodontology, , University of Bern, ; Bern, Switzerland
                [2 ]GRID grid.412411.3, ISNI 0000 0001 1090 0051, Department of Periodontology, Dental Research Division, School of Dentistry, , Veiga de Almeida University, ; Rio de Janeiro, Brazil
                [3 ]GRID grid.5734.5, ISNI 0000 0001 0726 5157, Department of Cranio-Maxillofacial Surgery, Inselspital, Bern University Hospital, , University of Bern, ; Bern, Switzerland
                [4 ]GRID grid.49470.3e, ISNI 0000 0001 2331 6153, Department of Oral Implantology, , University of Wuhan, ; Wuhan, China
                [5 ]GRID grid.260975.f, ISNI 0000 0001 0671 5144, Division of Oral Bioengineering, Institute of Medicine and Dentistry, , Niigata University, ; Niigata, Japan
                [6 ]Department of Prosthetic Dentistry, University Iuliu Hatieganu, Cluj-Napoca, Romania
                [7 ]GRID grid.10388.32, ISNI 0000 0001 2240 3300, Department of Periodontology, Operative and Preventive Dentistry, , University of Bonn, ; Bonn, Germany
                [8 ]Division Private practice, West Bowmanville Family Dental, Bowmanville, Ontario Canada
                [9 ]Independent researcher, Rome, Italy
                [10 ]GRID grid.258333.c, ISNI 0000 0001 1167 1801, Department of Periodontology, , Kagoshima University Graduate School of Medical and Dental Sciences, ; Kagoshima, Japan
                [11 ]GRID grid.10420.37, ISNI 0000 0001 2286 1424, Department of Oral Biology, , University of Vienna, ; Vienna, Austria
                [12 ]GRID grid.11804.3c, ISNI 0000 0001 0942 9821, Department of Periodontology, , Semmelweis University, ; Budapest, Hungary
                [13 ]GRID grid.411173.1, ISNI 0000 0001 2184 6919, Department of Oral Surgery, School of Dentistry, , Fluminense Federal University, ; Rua Mario dos Santos Braga, 30, Centro, Niteroi, Rio de Janeiro, Brazil
                [14 ]GRID grid.214458.e, ISNI 0000000086837370, Department of Periodontics and Oral Medicine, , University of Michigan, ; Ann Arbor, Michigan USA
                Author information
                © The Author(s) 2021

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                : 7 August 2020
                : 2 February 2021
                Funded by: Universität Bern
                Custom metadata
                © Springer-Verlag GmbH Germany, part of Springer Nature 2021

                intrabony defect,platelet-rich fibrin,l-prf,advanced-prf
                intrabony defect, platelet-rich fibrin, l-prf, advanced-prf


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