Autologous platelet concentrates for treating periodontal infrabony defects.,Evidence-Based Dentistry

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Autologous platelet concentrates for treating periodontal infrabony defects.
Evidence-Based Dentistry Pub Date : 2019-06-28 , DOI: 10.1038/s41432-019-0031-8
Carlos Fernando de Almeida Barros Mourão ₁

Affiliation

Data sources Medline, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Oral Health's Trials Register, LILACS BIREME Virtual Health Library, the US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform. Searches were conducted with no limitations on the language or date of publication.Study selection Parallel and split-mouth randomised controlled trials (RCTs) conducted on patients with infrabony defects requiring surgical treatment were considered. Studies needed to compare a specific surgical technique with and without the use of with autologous platelet concentrates (APC).Data extraction and synthesis Two reviewers independently extracted data and assessed risk of bias with data being analysed using standard Cochrane methodology. Changes in probing pocket depth (PD), clinical attachment level (CAL) and radiographic bone defect filling (RBF) were the primary outcomes assessed. Changes in PD and CAL were reported as mean difference (MD) millimeters and 95% confidence intervals with RBF as MD percentage change (5). Data was organised in four groups related to specific surgical techniques, 1. APC + Open Flap Debridement (OFD) versus OFD, 2. APC + OFD + Bone Grafting (BG) versus OFD + BG, 3. APC + Guided Tissue Regeneration (GTR) versus GTR, and 4. APC + Enamel Matrix Derivative (EMD) versus EMD.Results Thirty eight RCTs evaluating 1402 defects were included. Twenty-two trials used a split-mouth design and sixteen a parallel approach. Most studies (36) had a high overall risk of bias with two having an unclear risk. Twelve studies (510 infrabony defects) were included for the comparison between APC + OFD versus OFD alone providing evidence of an advantage in using APC globally from split-mouth and parallel studies for all three primary outcomes.PD (MD) = 1.29 mm (95%CI; 1.00 to 1.58 mm); CAL (MD) = 1.47 mm (95% CI; 1.11 to 1.82 mm); RBF (MD) = 34.26% (95% CI; 30.07% to 38.46%).Seventeen studies (569 infrabony defects) were included for the comparison between APC + OFD + BG versus OFD + BG. When all follow-ups, as well as 3 to 6 months and 9 to 12 months are considered, there is very low-quality evidence of an advantage in using APC from both split-mouth and parallel studies for all three primary outcomes; PD (MD) = 0.54mm (95% CI; 0.33 to 0.75 mm); CAL (MD) = 0.72 mm (95% CI; 0.43 to 1.00 mm); and RBF (MD) 8.10% (95% CI 5.26% to 10.94%)For the comparison APC + GTR versus GTR alone seven studies (248 infrabony defects) were included Considering all follow-ups, there is very low-quality evidence of a probable benefit for APC for both PD (MD) = 0.92 mm (95% CI; -0.02 to 1.86 mm) and CAL (MD) 0.42 mm (95% CI; -0.02 to 0.86 mm). As confidence intervals are wide there is a possibility of a slight benefit for the control. For 3 to 6 months and a 9 to 12 months follow-up no benefits were evidenced, except for CAL at 3 to 6 months MD = 0.54 mm (95% CI; 0.18 to 0.89 mm). No RBF data were available.Only two studies (75 infrabony defects) were included in the comparison of APC + EMD versus EMD. There was insufficient evidence of an overall advantage of using APC for all three primary outcomes: A survival rate of 100% for the treated teeth was reported in all studies for all groups, while no complete pocket closure was reported. It was not possible to perform a quantitative analysis regarding patients' quality of life. Conclusions For two types of treatment, open flap debridement and open flap debridement with bone graft there is very low-quality evidence that the adjunct of APC when treating infrabony defects may improve probing pocket depth, clinical attachment level, and radiographic bone defect filling. There was insufficient evidence of an advantage in using APC for GTR or EMD.

中文翻译：

自体血小板浓缩液可用于治疗牙周骨下层缺损。

数据来源Medline，Embase，Cochrane对照试验中心注册（CENTRAL），Cochrane口腔健康试验注册，LILACS BIREME虚拟卫生图书馆，美国国家卫生研究院正在进行的试验注册（ClinicalTrials.gov）和世界卫生组织国际临床试验注册平台。进行搜索时没有语言或出版日期的限制。研究选择考虑了对患有下颌骨缺损需要手术治疗的患者进行的平行和双口随机对照试验（RCT）。需要进行研究以比较使用和不使用自体血小板浓缩液（APC）的特定手术技术。数据提取和合成两名审阅者独立提取数据，并使用标准Cochrane方法分析数据，评估偏倚风险。评估囊袋深度（PD），临床附着水平（CAL）和放射照相的骨缺损填充（RBF）的变化是评估的主要结果。PD和CAL的变化被报告为平均差异（MD）毫米和95％置信区间，RBF为MD百分比变化（5）。数据分为与特定手术技术有关的四组，分别为1. APC +皮瓣清创术（OFD）与OFD，2。APC + OFD +骨移植（BG）vs OFD + BG，3. APC +引导组织再生（GTR））相对于GTR，以及4. APC +搪瓷基体衍生物（EMD）与EMD。结果包括38个RCT，评估了1402个缺陷。22项试验使用裂口设计，而16项采用并行方法。大多数研究（36）的总体偏倚风险很高，其中两项风险尚不清楚。十二项研究（510骨下缺陷）包括在APC + OFD与单独的OFD之间的比较中，提供了通过口裂和平行研究在全球使用这三种主要结果的APC的优势的证据.PD（MD）= 1.29 mm（95 ％CI； 1.00至1.58mm）；CAL（MD）= 1.47毫米（95％CI; 1.11至1.82毫米）; RBF（MD）= 34.26％（95％CI; 30.07％to 38.46％）。APC + OFD + BG与OFD + BG的比较包括17项研究（569个骨内缺损）。如果考虑所有的随访，以及3到6个月和9到12个月，仅有非常低质量的证据表明，对所有三个主要结局使用分口研究和平行研究的APC均具有优势；PD（MD）= 0.54mm（95％CI; 0.33至0.75 mm）; CAL（MD）= 0.72毫米（95％CI; 0.43至1.00毫米）; 和RBF（MD）8.10％（95％CI 5.26％至10.94％）比较APC + GTR与GTR相比，纳入了7项研究（248枚骨下缺损）。 PD（MD）= 0.92 mm（95％CI; -0.02至1.86 mm）和CAL（MD）0.42 mm（95％CI; -0.02至0.86 mm）对APC可能带来的好处。由于置信区间很宽，因此对于控制可能会有一点好处。在3到6个月以及9到12个月的随访中，除CAL在3到6个月时MD = 0.54 mm（95％CI； 0.18到0.89 mm）外，没有发现任何益处。没有可用的RBF数据。在APC + EMD与EMD的比较中仅包括两项研究（75个骨骼下缺陷）。没有足够的证据表明使用APC可以实现所有三个主要结局的总体优势：在所有组的所有研究中，治疗牙齿的存活率均报告为100％，而没有完全闭合袋的报道。无法对患者的生活质量进行定量分析。结论对于两种类型的治疗，即开放式皮瓣清创术和带骨移植的开放式皮瓣清创术，有非常低质量的证据表明，APC辅助治疗骨下缺损可改善探查袋深度，临床附着水平和影像学上的骨缺损充盈。没有足够的证据表明使用APC进行GTR或EMD具有优势。

更新日期：2019-06-28

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