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Platelet-rich fibrin might not provide a benefit in healing and complications after third-molar extraction
JADA+ CONTENT
This review does not in any way substitute for professional advice and should not be regarded as clinical guidance. As always, any evidence should be carefully considered by clinician and patient to ensure that in their views, all potentially desirable consequences outweigh all potentially undesirable consequences.
JADA+ CLINICAL SCANS
Romina Brignardello-Petersen, DDS, MSc, PhD
PLATELET-RICH FIBRIN MIGHT NOT PROVIDE A BENEFIT IN HEALING AND COMPLICATIONS AFTER THIRD-MOLAR EXTRACTION
Al-Hamed FS, Tawfik MA, Abdelfadil E, Al-Saleh MA. Efficacy of platelet-rich fibrin after mandibular third molar extraction: a systematic review and metaanalysis [published online ahead of print February 1, 2017]. J Oral Maxillofac Surg. http://dx.doi.org/10.1016/ j.joms.2017.01.022. Key words. Surgery; complications; extraction; healing; platelet-rich fibrin; third molar; systematic review. Clinical relevance. Platelet-rich fibrin (PRF) is an intervention that may reduce complications and enhance healing after third-molar extractions, making the postoperative period less problematic for patients. However, the administration of PRF may be difficult and time consuming. Therefore, clinicians should consider the evidence about the potential benefits of PRF when deciding whether to use it. Study summary. The authors conducted a systematic review (SR) to determine the effects of PRF on healing and complications after third-molar extractions. They searched for clinical trials comparing PRF with natural socket healing in 3 electronic databases and 4 oral and maxillofacial journals up to November 2015 and found 6 studies.* The studies included 335 third-molar extractionsy among 183 participants.z The researchers found inconsistent results for postoperative pain,§ swelling,{ trismus,# and periodontal pocket depth. Researchers in 4 studies assessed bone healing, and none of them found statistical differences between PRF and natural healing up to 3 months after third-molar extraction.
Strengths and limitations. There are some concerns about the methods the authors used to conduct this SR. Although the authors used appropriate selection criteria for including studies to answer the clinical question and conducted the searches among the most relevant sources, they did not describe the processes of the study selection and quality assessment of the included studies with enough detail for us to judge whether this SR had a low risk of bias. The authors judged that the included studies had unclear or high risk of bias, which also raises concerns about the confidence we can have in this evidence. Owing to the diverse characteristics of the studies, the authors could not perform meta-analyses. Although this was the correct choice, it makes it harder to interpret the results. The results were inconsistent across trials for all outcomes that are important to patients. Considering all the limitations in the SR process and of the included studies, we have low certainty in the lack of benefit of PRP versus natural healing on healing and complications after third-molar extraction. n http://dx.doi.org/10.1016/j.adaj.2017.03.024 Copyright ª 2017 American Dental Association. All rights reserved.
Address correspondence to Dr. Brignardello-Petersen at e-mail [email protected]. Disclosure. Dr. Brignardello-Petersen did not report any disclosures. * Five randomized clinical trials and 1 nonrandomized clinical trial conducted in India, Cyprus, Turkey, and Iran. Five were split-mouth studies. y Researchers in 3 trials used a triangular flap, and researchers in 2 trials used an envelope flap; researchers in 3 trials performed osteotomies; and researchers in 5 trials prescribed perioperative antibiotics and nonsteroidal anti-inflammatory drugs. z Mean age across trials, 26 years; 56% female. § Researchers in 1 study at low risk of bias found statistically significantly less pain with PRF after 1 day, whereas researchers in 1 study at high risk of bias found no statistically significant differences. Researchers in a third study with a high risk of bias found statistically significant differences after 7 days. { Researchers in 1 study with an unclear risk of bias found statistically significantly less swelling with platelet-rich fibrin (PRF) after 1 day, whereas researchers in another study at high risk of bias found no statistically significant differences between PRF and natural healing. # Researchers in 2 studies found statistically significant differences between PRF and natural healing in trismus, but the researchers in 1 study found benefit and those in the other found harm.
JADA 148(6) http://jada.ada.org
June 2017 e73
This review does not in any way substitute for professional advice and should not be regarded as clinical guidance. As always, any evidence should be carefully considered by clinician and patient to ensure that in their views, all potentially desirable consequences outweigh all potentially undesirable consequences.
JADA+ CLINICAL SCANS
Romina Brignardello-Petersen, DDS, MSc, PhD
PLATELET-RICH FIBRIN MIGHT NOT PROVIDE A BENEFIT IN HEALING AND COMPLICATIONS AFTER THIRD-MOLAR EXTRACTION
Al-Hamed FS, Tawfik MA, Abdelfadil E, Al-Saleh MA. Efficacy of platelet-rich fibrin after mandibular third molar extraction: a systematic review and metaanalysis [published online ahead of print February 1, 2017]. J Oral Maxillofac Surg. http://dx.doi.org/10.1016/ j.joms.2017.01.022. Key words. Surgery; complications; extraction; healing; platelet-rich fibrin; third molar; systematic review. Clinical relevance. Platelet-rich fibrin (PRF) is an intervention that may reduce complications and enhance healing after third-molar extractions, making the postoperative period less problematic for patients. However, the administration of PRF may be difficult and time consuming. Therefore, clinicians should consider the evidence about the potential benefits of PRF when deciding whether to use it. Study summary. The authors conducted a systematic review (SR) to determine the effects of PRF on healing and complications after third-molar extractions. They searched for clinical trials comparing PRF with natural socket healing in 3 electronic databases and 4 oral and maxillofacial journals up to November 2015 and found 6 studies.* The studies included 335 third-molar extractionsy among 183 participants.z The researchers found inconsistent results for postoperative pain,§ swelling,{ trismus,# and periodontal pocket depth. Researchers in 4 studies assessed bone healing, and none of them found statistical differences between PRF and natural healing up to 3 months after third-molar extraction.
Strengths and limitations. There are some concerns about the methods the authors used to conduct this SR. Although the authors used appropriate selection criteria for including studies to answer the clinical question and conducted the searches among the most relevant sources, they did not describe the processes of the study selection and quality assessment of the included studies with enough detail for us to judge whether this SR had a low risk of bias. The authors judged that the included studies had unclear or high risk of bias, which also raises concerns about the confidence we can have in this evidence. Owing to the diverse characteristics of the studies, the authors could not perform meta-analyses. Although this was the correct choice, it makes it harder to interpret the results. The results were inconsistent across trials for all outcomes that are important to patients. Considering all the limitations in the SR process and of the included studies, we have low certainty in the lack of benefit of PRP versus natural healing on healing and complications after third-molar extraction. n http://dx.doi.org/10.1016/j.adaj.2017.03.024 Copyright ª 2017 American Dental Association. All rights reserved.
Address correspondence to Dr. Brignardello-Petersen at e-mail [email protected]. Disclosure. Dr. Brignardello-Petersen did not report any disclosures. * Five randomized clinical trials and 1 nonrandomized clinical trial conducted in India, Cyprus, Turkey, and Iran. Five were split-mouth studies. y Researchers in 3 trials used a triangular flap, and researchers in 2 trials used an envelope flap; researchers in 3 trials performed osteotomies; and researchers in 5 trials prescribed perioperative antibiotics and nonsteroidal anti-inflammatory drugs. z Mean age across trials, 26 years; 56% female. § Researchers in 1 study at low risk of bias found statistically significantly less pain with PRF after 1 day, whereas researchers in 1 study at high risk of bias found no statistically significant differences. Researchers in a third study with a high risk of bias found statistically significant differences after 7 days. { Researchers in 1 study with an unclear risk of bias found statistically significantly less swelling with platelet-rich fibrin (PRF) after 1 day, whereas researchers in another study at high risk of bias found no statistically significant differences between PRF and natural healing. # Researchers in 2 studies found statistically significant differences between PRF and natural healing in trismus, but the researchers in 1 study found benefit and those in the other found harm.
JADA 148(6) http://jada.ada.org
June 2017 e73