Autologous platelet concentrates for treating periodontal infrabony defects

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.