Soft and hard-tissue changes after the placement of smart blood derivative platelet-rich fibrin into intrabony defects: A systematic review and meta-analysis with at least 9-month follow-up

The application of platelet-rich fibrin (PRF) is gaining popularity in the treatment of bony defects as an endogenous regenerative therapy. The fibrillar aggregation matrix is incorporated with cells, cytokines, and growth factors and is released with time when inserted into implant, oral and maxillofacial surgery, and periodontal surgeries to promote healing. This paper evaluates the wide application of PRF in the regeneration of intrabony defects. A literature search of PubMed, EBSCO, and Google Scholar databases was performed by two reviewers for articles, published from January 1, 2002, to December 31, 2016, followed by a manual search of several dental journals. Weighted mean differences (MDs) and 95% confidence intervals (CIs) were calculated for pocket probing depth (PPD), clinical attachment level (CAL), gingival margin level (GML), and defect fill evaluated from baseline to the end of follow-up. Nine randomized clinical trials were included showing overall standardized MD in two groups for CAL as 1.194 (93% CI: 0.919, 1.362, P = 0.0001); for PPD as 0.034 (95% CI: 0.820, 1.248, 0.0001); for GML as 0.244 (97% CI: −0.016, 0.472, P = 0.024); and for bone defect reduction as 1.789 (98% CI: 1.493, 2.084, P = 0.0001). The results of the meta-analysis seem to support the effectiveness of PRF in the treatment of intrabony defects. There was an overall reduction in PPD and gain in CAL and GML and defect resolution. This proves that the application of PRF in the regeneration of intrabony defects has a promising future but should be used with caution with the heterogeneity present in the studies for gingival margin level.