Evaluation of injectable platelet-rich fibrin effect on the rate of canine retraction and alkaline phosphatase levels: An in-vivo study

Effectiveness of Platelet Rich Fibrin in Accelerating Canine Distal Movement: A Systematic Review of Randomized Controlled Trials

This review aimed at a systematic evaluation of the available literature on the effect of platelet-rich fibrin (PRF) in accelerating canine distal movement (CD). An elaborate search of the available literature on the effect of PRF on the acceleration of canine distal movement was conducted using appropriate search terms in PubMed, Scopus, Cochrane Central, and Google Scholar until April 2024. The risk of bias within the studies was assessed using the Cochrane risk of bias (RoB)-2 tool. Publication bias was assessed with a funnel plot, and a random effects model was used for quantitative synthesis. The certainty of the available evidence was assessed with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Following the systematic search, a total of 11 studies were included for the qualitative analysis, and three studies were included for quantitative synthesis. Most of the studies reported an increased rate of canine distal movement following administration of PRF. The overall pooled CD at one, two, three, four, and five months showed a significantly increased mean CD in i-PRF (p<0.00001; MD = 0.23; 95% CI: 0.14 to 0.32), and a significantly increased rate of CD was noted during the first and second months. The available studies had a moderate to low risk of bias and a moderate certainty of evidence. Hence, with a moderate certainty of evidence and a risk of bias, it can be concluded that PRF accelerates orthodontic tooth movement during the first two months.

Does the use of platelet-rich fibrin enhance the rate of orthodontic tooth movement? A systematic review and meta-analysis

Introduction

This review synthesizes the available evidence pertinent to the effect of platelet-rich fibrin on the rate of orthodontic tooth movement during comprehensive orthodontic treatment.

Method

This review followed the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Nine electronic databases were searched until January 2024 without restrictions, followed by a hand search of the reference lists. Controlled randomized split-mouth human studies assessing the effect of platelet-rich fibrin on the rate of orthodontic tooth movement were included. All relevant data from the included studies were extracted and pooled for qualitative and quantitative analysis. Risk-of-Bias was assessed using the Cochrane Risk of Bias tool. The certainty of the evidence was graded using the Grading of Recommendations, Assessment, Development, and Evaluation tool.

Results

From 515 studies, eleven randomized clinical trials were included for qualitative analysis and nine for quantitative analysis. The certainty of the evidence for these studies was low to moderate. The overall risk of bias for most studies was of some concern. The pooled estimate of the data from ten studies has a mean revealed difference of 1.31 (0.13-2.48) at a 95 % confidence interval with significant heterogeneity.

Conclusions

This systematic review suggest that platelet-rich fibrin enhances the orthodontic tooth movement rate, but the evidence quality was moderate. Further, based on the currently available evidence, the effectiveness of platelet-rich fibrin on the acceleration of orthodontic tooth movement could not be fully established.

Trial registration

PROSPERO: (CRD42021261836).

The 36-Month Survival Analysis of Conservative Treatment Using Platelet-Rich Plasma Enhanced With Injectable Platelet-Rich Fibrin in Patients With Knee Osteoarthritis

INTRODUCTION

Knee osteoarthritis (KOA) is a musculoskeletal disease that leads to pain, stiffness, and deformity of the load-bearing knee joints. Biologic products including platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) are now in the spotlight for the treatment of KOA owing to their role of disease-modifying potential effect. There are still limited studies on the survival rate of KOA treated with biological intervention. We conducted this study to evaluate the primary outcome as the survival rate of KOA treated with PRP enhanced with injectable PRF that helps avoid unnecessary surgical intervention.

METHODS

There were 368 participants who met the inclusion and exclusion criteria. Participants were informed about this prospective cohort study protocol and signed written consent forms. Each participant received one injection of 4 ml of PRP and 4 ml of injectable PRF (iPRF), the so-called "PRP enhanced with iPRF". Clinical assessment was evaluated with the visual analog scale (VAS) at the second, fourth, sixth, 12th, 18th, 24th, 30th, and 36th-month post-treatment. If the VAS pain score improved by more than 80% compared to the previous treatment, there was no need for a repeated dose. If the pain scores improved by 50% to 80% compared to the previous treatment, the participants were advised a repeated dose. However, if the pain scores improved by less than 50% compared to the previous treatment, the participants were advised to undergo surgical intervention instead of a repeated dose. The primary outcome was recorded as any surgical treatment (either arthroscopic knee surgery, unicondylar arthroplasty, or total knee arthroplasty) at any time point post-treatment. The secondary outcome was recorded as the interval (months) between first-to-second, second-to-third, and third-to-fourth injections.

RESULTS

The overall survival rate of knees that did not require surgical intervention during the 36-month follow-up was 80.18%. The mean number of injections was 2.52±0.07 times for overall participants. The mean interval time was 5.42±0.36, 8.92±0.47, and 9.58±0.55 months for the first-to-second, second-to-third, and third-to-fourth injections.

CONCLUSION

This study supports the usage of PRP enhanced with iPRF as a biologic modality for the treatment of KOA. This treatment modality provides a satisfactory survival rate at the 36-month follow-up. The longer interval between each injection supports the disease-modifying effect of PRP enhanced with iPRF.

The effect of submucosal injection of platelet-rich fibrin vs. platelet-rich plasma on orthodontic tooth movement in rabbits; 28 days follow-up

OBJECTIVE

This study aimed to compare between the effects of submucosal injection of platelet rich fibrin (i-PRF) versus platelet rich plasma (PRP) on orthodontic tooth movement (OTM) in a rabbit model over a 28-day follow-up period.

MATERIALS AND METHODS

Sixty-three rabbits were assigned into 3 equal groups. Group I animals were subjected to the OTM without any treatments and considered as the control. Whereas groups II and III were handled as group I and instead i-PRF and PRP were injected submucosally in the buccal vestibular mucosa next to the mandibular 1st premolar, respectively. The distance of OTM was consecutively measured clinically after 7, 14 and 28 days. Seven rabbits from each group were euthanized after 7, 14 and 28 days for histological evaluation. Two-way ANOVA followed by LSD post-hoc statistical tests were used for comparison.

RESULTS

After 28 days, the mean tooth movements were 4.36±0.04mm in the control group, 6.30±0.06mm in the group receiving PRP and, 6.85±0.09mm in the group receiving i-PRF. Statistical analysis for the values of teeth movements revealed highly significant differences between different groups (P=0.001) and between different time periods (P=0.001). Histological analysis showed that submucosal injection of PRP and i-PRF yielded significant differences in periodontal ligament width in compression and tension sides between different groups (P=0.001) and between different time periods (P=0.001).

CONCLUSION

Submucosal injection of either PRP or i-PRF is a minimally invasive and safe approach for accelerating OTM. In this rabbit model, the effect of i-PRF is significantly more pronounced than the effect of PRP.