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| Title |
Leukocyte Platelet Rich Fibrin Is More Effective Than Natural Healing in Reducing Vertical and Horizontal Alveolar Ridge Resorption After Tooth Extraction |
| Clinical Question |
In systemically healthy patients requiring alveolar ridge preservation after extraction, does the use of leukocyte platelet rich fibrin (L-PRF) as a socket grafting material alone reduce the vertical and horizontal alveolar ridge resorption compared to natural healing? |
| Clinical Bottom Line |
For patients requiring alveolar ridge preservation after a tooth extraction, leukocyte platelet rich fibrin is more effective than natural healing in reducing vertical and horizontal alveolar ridge resorption. This is supported by a systematic review that included 68 patients in two randomized controlled trials and one split-mouth trial in which L-PRF significantly outperformed natural healing. However, another split-mouth trial of only 8 patients showed no difference between L-PRF and natural healing. |
| 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) 30058532 | Dragonas/2018 | 76 adult patients in 4 included studies | Systematic review of randomized trials | | Key results | Three out of four included trials showed significantly favorable outcomes for post-extraction vertical and horizontal ridge dimensions when using L-PRF compared to natural healing. One study found no differences between the two groups. The studies showed heterogeneity in terms of surgical protocol and outcomes assessment; therefore the investigators were unable to perform a meta-analysis. | |
| Evidence Search |
(("platelet-rich fibrin"[MeSH Terms] OR ("platelet-rich"[All Fields] AND "fibrin"[All Fields]) OR "platelet-rich fibrin"[All Fields] OR "l prf"[All Fields]) OR (("leukocytes"[MeSH Terms] OR "leukocytes"[All Fields] OR "leukocyte"[All Fields]) AND ("platelet-rich fibrin"[MeSH Terms] OR ("platelet-rich"[All Fields] AND "fibrin"[All Fields]) OR "platelet-rich fibrin"[All Fields] OR ("platelet"[All Fields] AND "rich"[All Fields] AND "fibrin"[All Fields]) OR "platelet rich fibrin"[All Fields]))) AND ((((("alveolar process"[MeSH Terms] OR ("alveolar"[All Fields] AND "process"[All Fields]) OR "alveolar process"[All Fields] OR ("alveolar"[All Fields] AND "ridge"[All Fields]) OR "alveolar ridge"[All Fields]) AND ("preservation, biological"[MeSH Terms] OR ("preservation"[All Fields] AND "biological"[All Fields]) OR "biological preservation"[All Fields] OR "preservation"[All Fields])) OR (socket[All Fields] AND ("preservation, biological"[MeSH Terms] OR ("preservation"[All Fields] AND "biological"[All Fields]) OR "biological preservation"[All Fields] OR "preservation"[All Fields]))) OR (alveolar[All Fields] AND socket[All Fields] AND ("preservation, biological"[MeSH Terms] OR ("preservation"[All Fields] AND "biological"[All Fields]) OR "biological preservation"[All Fields] OR "preservation"[All Fields]))) OR (ridge[All Fields] AND ("preservation, biological"[MeSH Terms] OR ("preservation"[All Fields] AND "biological"[All Fields]) OR "biological preservation"[All Fields] OR "preservation"[All Fields]))) |
Comments on
The Evidence |
Validity: The studies included in the systematic review were all randomized controlled trials with strict inclusion and exclusion criteria. The protocol for preparation of the L-PRF was followed closely in each study. Temmerman et al. (2016) used a split mouth RCT design and evaluated results using CBCT. Hauser et al. (2013) used periapical radiographs and clinical measurements for analysis and included alternate surgical techniques to test the usefulness of L-PRF. Finally, Alzahrani et al. (2017) used cast and radiographic analysis to measure the effect on the alveolar ridge. However, the placement technique and numbers of L-PRF membranes were not specified in all of the studies. Therefore, there is need for a standardization in protocol for L-PRF moving forward.
Perspective: L-PRF provides a simple solution for socket preservation, especially for clinicians who routinely use IV sedation (which facilitates the collection of blood for the L-PRF membrane). The real usefulness of this method will be determined after it is fully compared to bone grafting materials.
|
| Applicability |
Preserving alveolar ridge height and width is important when planning for future dental implants. L-PRF is an enticing option for alveolar ridge preservation due to its cost effectiveness and optimal handling properties. While the included studies do establish a difference in outcomes for L-PRF versus natural healing, L-PRF will need to be compared to other proven methods of preserving alveolar ridge width and height. |
| Specialty/Discipline |
(General Dentistry) (Oral Surgery) (Periodontics) |
| Keywords |
L-PRF, leukocyte platelet rich fibrin, alveolar ridge preservation
|
| ID# |
3337 |
| Date of submission: |
11/12/2018 |
| E-mail |
vieth@uthscsa.edu |
| Author |
Michael Vieth, DDS |
| Co-author(s) |
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| Co-author(s) e-mail |
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| Faculty mentor/Co-author |
Richard S. Finlayson, DDS |
| Faculty mentor/Co-author e-mail |
finlaysonr@uthscsa.edu |
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) |
post a rationale |
| None available | |
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Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) |
post a comment |
| None available | |
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