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Is the use of platelet-rich fibrin effective in the healing, control of pain, and postoperative bleeding in the palatal area after free gingival graft harvesting? A systematic review of randomized clinical studies

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Abstract

Objective

A systematic review (SR) was conducted to answer the following focused question based on PICO strategy: In patients who were submitted to harvesting palatal free gingival graft, could platelet-rich fibrin (PRF) application in comparison with another method improve the healing, pain, and control of postoperative bleeding in the palatal area in randomized clinical trials?

Methods

A SR was conducted according to the PRISMA guidelines. The MEDLINE (PubMed), Scopus, Embase, and Web of Science databases were searched, and hand searches were made, covering the period up to August 2020, for randomized clinical trials (RCTs) reporting the effect of PRF membrane in postoperative palatal healing management compared with any other methods. The risk of bias (RoB) of the studies included was assessed by using the RoB 2 tool.

Results

The electronic search strategy identified 150 articles. After title screening and abstract reading, 141 studies were excluded, and 9 full-text publications were comprehensively evaluated. Finally, 8 articles were included in the systematic review. Six studies showed that the PRF membrane was effective in improving wound healing during the first 2 weeks. As regards patient-centered outcomes, five studies showed that PRF promoted less postoperative pain. Finally, five studies that evaluated bleeding showed that the PRF membrane improved control of postoperative bleeding. RoB was classified as low in 4 studies, 3 with some concerns, and only one study did not describe the outcome data, and as this was missing, it was not possible to verify the protocol of data analysis for this study; therefore, it was classified as having high RoB.

Conclusion

Within the limitations of this study, the collective evidence emerging from this SR may support the use of PRF membrane in the palatal area after free gingival graft harvesting. The results of this review must be interpreted with caution, due to the low number of RCTs included and high degree of heterogeneity among the PRF protocols. Further well-designed RCTs with accurate protocol and standard PRF parameters are required in order to gain clear understanding of the influence of PRF on wound healing and patient-centered outcomes.

Clinical relevance

The use of PRF membrane for the protection of the palatal donor site following free gingival graft harvesting procedures improves wound healing and patients’ quality of life.

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References

  1. Tavelli L, Ravidà A, Lin G-H, del Amo F, Tattan M, Wang HL (2019) Comparison between subepithelial connective tissue graft and de-epithelialized gingival graft: a systematic review and a meta-analysis. J Int Acad Periodontol 21:82–96

    PubMed  Google Scholar 

  2. Zucchelli G, Mele M, Stefanini M, Mazzotti C, Marzadori M, Montebugnoli L, de Sanctis M (2010) Patient morbidity and root coverage outcome after subepithelial connective tissue and de-epithelialized grafts: a comparative randomized-controlled clinical trial. J Clin Periodontol 37:728–738

    PubMed  Google Scholar 

  3. Tavelli L, Barootchi S, Avila-Ortiz G et al (2020) Peri-implant soft tissue phenotype modification and its impact on peri-implant health: a systematic review and network meta-analysis. J Periodontol:19–0716

  4. Wessel JR, Tatakis DN (2008) Patient outcomes following subepithelial connective tissue graft and free gingival graft procedures. J Periodontol 79:425–430

    Article  PubMed  Google Scholar 

  5. Del Pizzo M, Modica F, Bethaz N et al (2002) The connective tissue graft: a comparative clinical evaluation of wound healing at the palatal donor site - a preliminary study. J Clin Periodontol 29:848–854

    Article  PubMed  Google Scholar 

  6. Brasher WJ, Rees TD, Boyce WA (1975) Complications of free grafts of masticatory mucosa. J Periodontol 46:133–138

    Article  PubMed  Google Scholar 

  7. Farnoush A (1978) Techniques for the protection and coverage of the donor sites in free soft tissue grafts. J Periodontol 49:403–405

    Article  PubMed  Google Scholar 

  8. Burkhardt R, Hämmerle CHF, Lang NP (2015) Self-reported pain perception of patients after mucosal graft harvesting in the palatal area. J Clin Periodontol 42:281–287

    Article  PubMed  Google Scholar 

  9. Kızıltoprak M, Uslu MO (2020) Comparison of the effects of injectable platelet-rich fibrin and autologous fibrin glue applications on palatal wound healing: a randomized controlled clinical trial. Clin Oral Investig 24:4549–4561

    Article  PubMed  Google Scholar 

  10. Rossmann JA, Rees TD (1999) A comparative evaluation of hemostatic agents in the management of soft tissue graft donor site bleeding. J Periodontol 70:1369–1375

    Article  PubMed  Google Scholar 

  11. Tavelli L, Ravidà A, Saleh MHA, Maska B, del Amo FSL, Rasperini G, Wang HL (2019) Pain perception following epithelialized gingival graft harvesting: a randomized clinical trial. Clin Oral Investig 23:459–468

    Article  PubMed  Google Scholar 

  12. Yen CA, Griffin TJ, Cheung WS, Chen J (2007) Effects of platelet concentrate on palatal wound healing after connective tissue graft harvesting. J Periodontol 78:601–610

    Article  PubMed  Google Scholar 

  13. Escobar M, Pauletto P, Benfatti CAM, Cruz ACC, Flores-Mir C, Henriques BAPC (2020) Effect of cyanoacrylate tissue adhesive in postoperative palatal pain management: a systematic review. Clin Oral Investig

  14. Choukroun J, Diss A, Simonpieri A et al (2006) Platelet-rich fibrin (PRF): A second-generation platelet concentrate. Part IV: Clinical effects on tissue healing. Oral Surgery. Oral Med Oral Pathol Oral Radiol Endodontol 101:56–60

    Article  Google Scholar 

  15. Mannava Y, Nayak SU, Kamath DG, Dash T (2018) Platelet-rich fibrin as palatal bandage: a case report. Indian J Public Heal Res Dev 9:65–68

    Article  Google Scholar 

  16. Patarapongsanti A, Bandhaya P, Sirinirund B et al (2019) Comparison of platelet-rich fibrin and cellulose in palatal wounds after graft harvesting. J Investig Clin Dent 10:e12467

    Article  PubMed  Google Scholar 

  17. Miron RJ, Fujioka-Kobayashi M, Bishara M, Zhang Y, Hernandez M, Choukroun J (2017) Platelet-rich fibrin and soft tissue wound healing: a systematic review. Tissue Eng Part B Rev 23:83–99

    Article  PubMed  Google Scholar 

  18. Femminella B, Iaconi MC, Di Tullio M et al (2016) Clinical comparison of platelet-rich fibrin and a gelatin sponge in the management of palatal wounds after epithelialized free gingival graft harvest: a randomized clinical trial. J Periodontol 87:103–113

    Article  PubMed  Google Scholar 

  19. Ozcan M, Ucak O, Alkaya B, Keceli S, Seydaoglu G, Haytac M (2017) Effects of platelet-rich fibrin on palatal wound healing after free gingival graft harvesting: a comparative randomized controlled clinical trial. Int J Periodontics Restorative Dent 37:e270–e278

    Article  PubMed  Google Scholar 

  20. Samani MK, Saberi BV, Tabatabaei SMA, Moghadam MG (2017) The clinical evaluation of platelet-rich plasma on free gingival graft’s donor site wound healing. Eur J Dent 11:447–454

    Article  PubMed  PubMed Central  Google Scholar 

  21. Alpan AL, Cin GT, Lektemur Alpan A, Torumtay Cin G (2020) PRF improves wound healing and postoperative discomfort after harvesting subepithelial connective graft from palate: a randomized controlled trial. Clin Oral Investig 24:425–436

    Article  Google Scholar 

  22. Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol 62:1006–1012

    Article  Google Scholar 

  23. Schardt C, Adams MB, Owens T et al (2007) Utilization of the PICO framework to improve searching PubMed for clinical questions. BMC Med Inform Decis Mak 15:7–16

    Google Scholar 

  24. Shea BJ, Hamel C, Wells GA, Bouter LM, Kristjansson E, Grimshaw J, Henry DA, Boers M (2009) AMSTAR is a reliable and valid measurement tool to assess the methodological quality of systematic reviews. J Clin Epidemiol 62:1013–1020

    Article  PubMed  Google Scholar 

  25. Greenhalgh T, Peacock R (2005) Effectiveness and efficiency of search methods in systematic reviews of complex evidence: audit of primary sources. Br Med J 331:1064–1065

    Article  Google Scholar 

  26. Sterne JAC, Savović J, Page MJ et al (2019) RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ 366:1–8

    Google Scholar 

  27. Bahammam MA (2018) Effect of platelet-rich fibrin palatal bandage on pain scores and wound healing after free gingival graft: a randomized controlled clinical trial. Clin Oral Investig 22:3179–3188

    Article  PubMed  Google Scholar 

  28. Sousa F, Machado V, Botelho J, Proença L, Mendes JJ, Alves R (2020) Effect of A-PRF application on palatal wound healing after free gingival graft harvesting: a prospective randomized study. Eur J Dent 14:63–69

    Article  PubMed  PubMed Central  Google Scholar 

  29. Ustaoğlu G, Ercan E, Tunali M (2016) The role of titanium-prepared platelet-rich fibrin in palatal mucosal wound healing and histoconduction. Acta Odontol Scand 74:558–564

    Article  PubMed  Google Scholar 

  30. Sharma V, Kumar A, Puri K, Bansal M, Khatri M (2019) Application of platelet-rich fibrin membrane and collagen dressing as palatal bandage for wound healing: a randomized clinical control trial. Indian J Dent Res 30:881–888

    Article  PubMed  Google Scholar 

  31. Sullivan HC, Atkins JH (1968) Freeutogenous gingival grafts. 1. Principles of successful grafting. Periodontics 6:5–13

    PubMed  Google Scholar 

  32. Marucha PT, Kiecolt-Glaser JK, Favagehi M (1998) Mucosal wound healing is impaired by examination stress. Psychosom Med 60:362–365

    Article  PubMed  Google Scholar 

  33. Zucchelli G (2000) Mounssif I (2015) Periodontal plastic surgery. Periodontology 68:333–368

    Article  Google Scholar 

  34. Zucchelli G, Mounssif I, Mazzotti C, Montebugnoli L, Sangiorgi M, Mele M, Stefanini M (2014) Does the dimension of the graft influence patient morbidity and root coverage outcomes? A randomized controlled clinical trial. J Clin Periodontol 41:708–716

    Article  PubMed  Google Scholar 

  35. Wyrębek B, Górski B, Górska R (2018) Patient morbidity at the palatal donor site depending on gingival graft dimension. Dent Med Probl 55:153–159

    Article  PubMed  Google Scholar 

  36. Soileau KM, Brannon RB (2006) A histologic evaluation of various stages of palatal healing following subepithelial connective tissue grafting procedures: a comparison of eight cases. J Periodontol 77:1267–1273

    Article  PubMed  Google Scholar 

  37. Miron RJ, Moraschini V, Fabbro D et al (2020) Use of platelet-rich fibrin for the treatment of gingival recessions: a systematic review and meta-analysis. Clin Oral Investig 24:2543–2557

    Article  PubMed  Google Scholar 

  38. Annunziata M, Oliva A, Buonaiuto C, di Feo A, di Pasquale R, Passaro I, Guida L (2005) In vitro cell-type specific biological response of human periodontally related cells to platelet-rich plasma. J Periodontal Res 40:489–495

    Article  PubMed  Google Scholar 

  39. Shanmugam M, Kumar TS, Arun R et al (2010) Clinical and histological evaluation of two dressing materials in the healing of palatal wounds. J Indian Soc Periodontol 14:241–244

    Article  PubMed  PubMed Central  Google Scholar 

  40. Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, Schünemann HJ, GRADE Working Group (2008) Rating Quality of Evidence and Strength of Recommendations : GRADE : An Emerging Consensus on Rating Quality of Evidence and Strength of Recommendations RATING QUALITY OF EVIDENCE OF RECOMMENDATIONS GRADE : of evidence an emerging and consensus of on rati. Br Med J 336:924–926

    Article  Google Scholar 

  41. Dohan Ehrenfest DM, Pinto NR, Pereda A, Jiménez P, Corso MD, Kang BS, Nally M, Lanata N, Wang HL, Quirynen M (2018) The impact of the centrifuge characteristics and centrifugation protocols on the cells, growth factors, and fibrin architecture of a leukocyte- and platelet-rich fibrin (L-PRF) clot and membrane. Platelets 29:171–184

    Article  PubMed  Google Scholar 

  42. Miron RJ, Pinto NR, Quirynen M, Ghanaati S (2019) Standardization of relative centrifugal forces in studies related to platelet-rich fibrin. J Periodontol 90:817–820

    Article  PubMed  Google Scholar 

  43. Miron R, Choukroun J, Ghanaati S (2018) Controversies related to scientific report describing g-forces from studies on platelet-rich fibrin: necessity for standardization of relative centrifugal force values. Int J Growth Factors Stem Cells Dent 1:80–89

    Article  Google Scholar 

  44. Ehrenfest DMD (2010) How to optimize the preparation of leukocyte- and platelet-rich fibrin (L-PRF, Choukroun’s technique) clots and membranes: introducing the PRF Box. Oral Surgery, Oral Med. Oral Pathol. Oral Radiol. Endodontology 110:275–278

    Google Scholar 

  45. Dohan Ehrenfest DM, de Peppo GM, Doglioli P, Sammartino G (2009) Slow release of growth factors and thrombospondin-1 in Choukroun’s platelet-rich fibrin (PRF): a gold standard to achieve for all surgical platelet concentrates technologies. Growth Factors 27:63–69

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Periodontology and Oral Implantology, Dental Research Division, University of Guarulhos, SP, Guarulhos, Brazil

    Jonathan Meza-Mauricio, Camila Pinheiro Furquim, Belen Retamal-Valdes & Marcelo Faveri

  2. Department of Periodontology, School of Dentistry, Universidad Cientifica del Sur, Lima, Peru

    Antonella Geldres & Gerardo Mendoza-Azpur

  3. Department of Periodontology, Dental Research Division, School of Dentistry, Veiga de Almeida University, Rua Ibiturana, 108, Maracanã, Rio de Janeiro, Brazil

    Vittorio Moraschini

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  1. Jonathan Meza-Mauricio
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Correspondence to Jonathan Meza-Mauricio.

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Meza-Mauricio, J., Furquim, C.P., Geldres, A. et al. Is the use of platelet-rich fibrin effective in the healing, control of pain, and postoperative bleeding in the palatal area after free gingival graft harvesting? A systematic review of randomized clinical studies. Clin Oral Invest 25, 4239–4249 (2021). https://doi.org/10.1007/s00784-021-03933-5

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