Platelet-Rich Fibrin as a New Approach in Treating Gingival Recession: Systematic Review and Meta-Analysis (original) (raw)

Journal of Dentistry, Oral Disorders & Therapy

include coronally advanced flap [3], laterally advanced flap [4], double papilla flap [5]. Others include autogenous grafts such as sub-epithelial connective tissue graft [6], free gingival graft [2], and the use of non-autologous substitutes including; acellular dermal matrix [7], Enamel Matrix Derivatives (EMD), Living Cellular Construct (LCC), and guided tissue regeneration [8]. The choice of surgical modality and material of choice is based on different factors such as degree of recession, location, width of keratinized tissue, gingival tissue biotype, esthetic demands, and patient's preference. CTG has been considered the golden standard for the treatment of GR due to its significant outcomes in complete RC, attachment gain, keratinized tissue gain, and overall long-term treatment stability [9,10]. On the other hand, the need for a second surgical site to harvest the CTG is a main disadvantage due to the increased risk of bleeding, pain, and swelling that leads to the need for other RC alternatives [10]. As a result, approaches have been proposed and showed approximately similar results to CTG based treatment and considered an alternative depending on the clinician's and patient's choices; these include: Guided Tissue Regeneration (GTR), Acellular Dermal Matrix Graft (ADMT), and biological materials e.g. Platelet Rich Fibrin (PRF), Platelet Rich Plasma (PRP), Enamel Matrix Derivatives (EMD), among others [10,11]. Platelet Rich Fibrin (PRF) is an autologous cicatricial matrix of fibrin that holds platelets, growth factors and cells within, and is capable of slow releasing them during its natural resorption. PRF membrane is prepared through the centrifugation of autologous blood in the absence of anticoagulants, which result in fibrin clot formation between the Platelet Poor Plasma (PPP) layer at the top and the red blood cells layer at the bottom of the centrifuge tube [12]. That clot is then pressed to release the serum and in turn forms a membrane [13]. A number of growth factors have been identified within the PRF membrane, which are Platelet-Derived Growth Factor (PDGF), Transforming Growth Factor-β1 (TGF-β1), Vascular Endothelial Growth Factor (VEGF), Epidermal Growth Factor (EGF), and Insulin-Like Growth factor-1 [14]. PRF preparation and application is safe, simple, and cost effective. It improves wound healing through the slow