ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title The Addition of Platelet Rich Fibrin (PRF) to Open Flap Debridement (OFD) Aids in The Treatment of Chronic Periodontitis with Intrabony Defects
Clinical Question In patients with chronic periodontitis, does the addition of platelet-rich fibrin (PRF) to open flap debridement (OFD) aid in the resolution of intrabony defects (vertical alveolar bone loss)?
Clinical Bottom Line Platelet-rich Fibrin (PRF) is obtained from a centrifuged blood sample taken from the patient. The addition of PRF to OFD aids in the treatment of chronic periodontitis in patients with intrabony defects by decreasing probing depths, raising clinical attachment levels, and displaying radiographic bone-fill.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 22348695Pradeep/201290 patients with intrabony defectsRandomized Clinical Trial
Key resultsOver a nine month time period, 3-wall intrabony defects in patients with chronic periodontitis were treated with PRF + OFD, platelet rich plasma (PRP) + OFD, or OFD alone. The sites treated with PRF + OFD displayed a greater reduction in probing depth (3.77 +/- 1.19 mm), greater gain in clinical attachment levels (3.17 +/- 1.29 mm), and greater mean bone fill (55.41% +/- 11.39%) than the control sites treated with OFD alone.
#2) 21513477Sharma/201142 patients with chronic periodontitisRandomized Controlled Trial
Key resultsThis study compared PRF with open-flap debridment (OFD) or OFD alone. The 3-wall intrabony defects that received PRF + OFD was significantly greater in probing depth reduction (4.55 +/- 1.87mm), attachment level gain (3.31 +/- 1.76 mm), and mean radiographic fill (48.26% +/- 5.72%) than the intrabony defects receiving OFD alone. The difference in periodontal attachment level was not statistically significant. All patients displayed an uneventful wound healing process.
Evidence Search ("bone regeneration"[MeSH Terms] OR ("bone"[All Fields] AND "regeneration"[All Fields]) OR "bone regeneration"[All Fields]) AND PRF[All Fields]
Comments on
The Evidence
Validity: In the Pradeep RCT, the study was double blinded and controlled. All three patient groups were similar at the start and there was sufficient completion rate. Groups were treated equally apart from the assigned treatment. Follow-up and patient compliance was adequate and recall bias was not an influence. In the Sharma RCT, the study was double blinded and controlled. All of the sites were similar at the start and thirty-five of the forty-two patients completed the study. Variables were controlled to treat the patient groups equally, and compliance and follow up was sufficient. Perspective: The ultimate goal of chronic periodontitis treatment is periodontal regeneration. PRF displays great promise of regenerating lost tissue through hard and soft tissue healing induction and the creation of favorable healing architecture. The Pradeep study is a great example of OFD with the addition of PRF resulting in reduced probing depths, clinical attachment level gain, and increased radiographic fill. It is worth noting the PRP + OFD group displayed slightly greater mean bone fill than the PRF + OFD group. Placement of the PRF in the Sharma study showed similar resolution of attachment levels, probing depths, and radiographic fill. A stent was used to replicate probing position used in the pre-operative assessment. As PRF is obtained from the patient’s own blood, this additive could be an invaluable tool in tissue regeneration. Long term trials with histologic analysis to demonstrate regenerative properties, as well as multiple case reports will help to verify these conclusions and validate clinical efficacy.
Applicability Potential patient harm can result from obtaining a blood sample, and a centrifuge is a limiting factor in obtaining the autogenous PRF. However, patients with intra bony defects may benefit from the addition of PRF to bone matrix. The growth factor is autogenous, and the patient is unlikely to have a response/reaction to its addition. It is a simple procedure and cost effective, making it an ideal fibrin concentrate additive.
Specialty/Discipline (General Dentistry) (Oral Surgery) (Periodontics)
Keywords Periodontal regeneration; Platelet-rich Fibrin; Intrabony Defects; Bone Graft; Chronic Periodontitis Treatment; Open Flap Debridement
ID# 2905
Date of submission: 04/15/2015spacer
E-mail kingw@livemail.uthscsa.edu
Author William Travis King
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Kevin M. Gureckis, DMD & Jane Chadwick, DDS
Faculty mentor/Co-author e-mail gureckis@uthscsa.edu; janechadwick@gmail.com
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