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| Title |
Platelet-Rich Plasma (PRP) May Be Beneficial as an Adjunct to Graft Materials for the Treatment of Periodontal Intrabony Defects |
| Clinical Question |
For the treatment of periodontal intrabony defects, does platelet-rich plasma (PRP) have a significant additive effect when used in conjunction with bone grafts, as compared to bone grafting alone? |
| Clinical Bottom Line |
Within its limitations, PRP may be beneficial as an adjunct to graft materials for the treatment of periodontal intrabony defects, except in cases involving the use of GTR. |
| 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) 25048153 | Panda/2016 | Adult patients in 7 included studies | Systematic review of randomized trials | | Key results | The studies showed that there was a significant additive effect in treatment of intrabony defects when platelet-rich fibrin (PRF) was used as an adjunct with open flap debridement. Additionally, the platelet-rich plasma (PRP) can also provide a significant additive effect when used along with bone grafts. However, PRP was found to have no additional benefit when used in combination with GTR procedures.
| | #2) 27531202 | Hou/2016 | 15 RCTs reporting on 399 patients | Systematic review of randomized trials | | Key results | The included studies reported on the treatment of 524 periodontal intrabony defects treated in 399 patients (263 defects in intervention groups, 261 defects in control groups). Meta-analysis showed that there was a significantly greater clinical attachment level (CAL) gains and pocket depth (PD) reductions when PRP was used as an adjunct to treat periodontal intrabony defects compared to those who did not use PRP (CAL: WMD 0.76 mm, 95 % CI = 0.34 to 1.18 mm, P = 0.0004; PD: WMD 0.53 mm, 95 % CI = 0.21 to 0.85 mm, P = 0.001). However, when PRP was used along with GTR, it showed an insignificant additive effect on the treatment (CAL: WMD 0.08 mm, 95%CI = −0.30 to 0.46 mm, P = 0.67).
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| Evidence Search |
("platelet-rich plasma"[MeSH Terms] OR ("platelet-rich"[All Fields] AND "plasma"[All Fields]) OR "platelet-rich plasma"[All Fields] OR ("platelet"[All Fields] AND "rich"[All Fields] AND "plasma"[All Fields]) OR "platelet rich plasma"[All Fields]) AND (intrabony[All Fields] AND defect[All Fields]) |
Comments on
The Evidence |
Validity: The majority of studies included in Panda’s systematic review had a high level of evidence (RCTs with a high level of evidence score of “2”) and limited risk of bias (score of “low” to “moderate”), which indicate that the outcomes are likely to be reliable. However, most of the studies did not include sample size calculation and baseline comparison of the defect characteristics. For Hou’s study, 3 studies were classified as having a low risk of bias, 10 studies a moderate risk of bias, and 2 studies a high risk of bias. Hou’s meta-analysis also showed evidence of significant heterogeneity in results of the included studies. The meta-analysis revealed high I-squared values (54%-71%) for the mean differences in PD reduction and CAL gain.
Perspective: These systematic reviews aimed to assess the efficacy of PRP in the surgical treatment of periodontal intrabony defects based on randomized trials and reported that the use of PRP as an adjunct to a graft procedure yielded a significantly greater CAL gain and a PD reduction compared with the control treatment. Since both of these studies are systemic reviews/meta-analyses, they provide the highest level of evidence on this topic. |
| Applicability |
Obtaining a blood sample can potentially add unnecessary harm to the patient, and utilizing additional equipment such as a centrifuge is also a limiting factor in obtaining the autogenous PRP. Nonetheless, the use of PRP as an adjunct to a graft procedure yielded a significantly greater CAL gain and a PD reduction compared with the control treatment. However, clinicians should also be aware that the beneficial effect of PRP on the treatment of intrabony defects is negligible when used in combination with GTR procedures using membranes such as expanded polytetrafluoroethylene membrane (e-PTFE) and bio-absorbable collagen membrane (COL). |
| Specialty/Discipline |
(General Dentistry) (Oral Surgery) (Periodontics) |
| Keywords |
periodontal regeneration; platelet-rich plasma; intrabony defects; bone graft; chronic periodontitis treatment; guided tissue regeneration
|
| ID# |
3422 |
| Date of submission: |
12/05/2019 |
| E-mail |
true.kim.dds@gmail.com |
| Author |
Hyungjoo Kim, DDS |
| Co-author(s) |
Marcela Land, DDS |
| Co-author(s) e-mail |
marcelaland517@gmail.com |
| Faculty mentor/Co-author |
Angela Synatzske, DDS |
| Faculty mentor/Co-author e-mail |
angela.m.synatzske.mil@mail.mil |
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 | |
|
Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) |
post a comment |
by Claire Miles (San Antonio, TX) on 09/29/2022
I conducted a PubMed search on this topic on September 29, 2022. A more recent systemic review and meta analysis has been conducted that further supports this bottom line (PubMed ID: 33609186). Authors of this paper found that using PRF during open flap debridement, with or without bone grafting, led to significantly improved probing depths, clinical attachment loss, and radiographic bone fill than with OFD alone. Interestingly, the authors also proposed potential benefits of adding certain biomolecules to PRF (such as bisphosphonates)to improve clinical outcomes and create more individualized treatments | |
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