The use of platelet‐rich fibrin to enhance the outcomes of implant therapy: A systematic review

Abstract

ObjectiveTo assess the impact of platelet‐rich fibrin (PRF) on implant dentistry. The primary focused question was as follows: What are the clinical, histological, and radiographic outcomes of PRF administration for bone regeneration and implant therapy?MethodA systematic literature search comprised three databases: MEDLINE, EMBASE, and Cochrane followed by a hand search of relevant scientific journals. Human studies using PRF for bone regeneration and implant therapy were considered and articles published up to December 31, 2017 were included. Eligible studies were selected based on the inclusion criteria. Randomized controlled trials (RCT) and controlled clinical trials (CCT) were included.ResultsIn total, 5,963 titles were identified with the search terms and by hand search. A total of 12 randomized controlled trials (RCT) met the inclusion criteria and were chosen for data extraction. Included studies focused on alveolar ridge preservation after tooth extraction, osseointegration process, soft tissue management, bone augmentation, bone regeneration after sinus floor elevation and surgical peri‐implantitis treatment. Overall, the risk of bias was moderate or unclear. Nine studies showed superior outcomes for PRF for any of the evaluated variables, such as ridge dimension, bone regeneration, osseointegration process, soft tissue healing. Three studies failed to show any beneficial effects of PRF. No meta‐analysis could be performed due to the heterogeneity of study designs.ConclusionsThere is moderate evidence supporting the clinical benefit of PRF on ridge preservation and in the early phase of osseointegration. It remains unclear whether PRF can reduce pain and improve soft tissue healing. More research support is necessary to comment on the role of PRF to improve other implant therapy outcomes.

Platelet‐rich fibrin elicits an anti‐inflammatory response in macrophages in vitro

“…A controlled M1‐to‐M2 transition by the use of pro‐resolving agents might restrict the inflammatory response and consequently suppress the detrimental events induced by peri‐implantitis, as shown in mouse calvarial models . This mechanism might also explain the positive outcomes using PRF in conjunction with open flap debridement in patients with peri‐implantitis . The clinical evidence is still lacking and therefore the clinical translation of the present results should be interpreted with caution.…”

“…Since the introduction of PRF as an autologous temporary extracellular matrix of coagulated PRP, numerous attempts were made to support the use of PRF for clinical application. Despite the low number of randomized controlled clinical trials, individual studies underline the clinical potential of local application of PRF in regenerative dentistry, and particularly in implant dentistry . For example, a well‐designed clinical research provided the first insights into the potential of PRF in preserving the alveolar ridge after tooth extraction .…”

“…Macrophages tightly control the biomaterial‐host events during the osseointegration of dental implants . A recent systematic reviews by our group revealed that the use of PRF during implant placement increased implant stability during the early phases of osseointegration . As dental implants activate the immune system during the early stages of osseointegration, it is plausible that an M2 polarization by PRF may reduce the time lag for initiation of bone formation.…”

Platelet‐rich fibrin suppresses in vitro osteoclastogenesis

“…A recent systematic review by our group revealed that PRF increases the implant stability during the early phases of osseointegration. Because dental implants decrease the expression of osteoclast markers in cortical osteotomy defects after one month of healing, the use of PRF may further decrease osteoclastogenesis leading to a higher implant stability during the first months . Moreover, during GBR procedures a variety of other biomaterials are routinely used such as collagen membranes.…”

“…Platelet‐rich fibrin (PRF), an autologous preparation of coagulated plasma, was originally introduced to improve wound healing . Today, however, emerging evidence from randomized controlled trials suggests that PRF can preserve horizontal and vertical ridge dimension after tooth extraction . Further, preclinical studies support the use of PRF in bone regeneration.…”