| With the extension of life expectancy has greatly promoted the development process of Medical Science and prosthetic dentistry.The traditional ways of repairing will no longer satisfy the needs of life.Therefore,Implant denture gain greater promotion.We have found that the bone mass at the edentulous ridge has become one of the most important reasons to decide the success of implant denture in the clinical work.After extraction many factors have to be considered for clinicians,such as the absorption of missing teeth alveolar bone,the shape and quality of residual alveolar ridge,the proportion of cortical bone and cancellous bone and the height,width,thicknes of the edentulous jaw.In order to obtain adequate bone mass and improve the success rate of implant denture,clinicians often apply the method of site preservation after extraction,namely at the same time clinicians take certain measures to reduce the alveolar ridge absorption,so as to guarantee sufficient bone mass when implanting.Platelet-rich fibrin(PRF)is also known as Choukroun,s PRF,which was a new generation of platelet concentrates.PRF was first extracted and applied in oral and maxillofacial surgery by the French scholar Choukroun in 2001.PRF contains a large number of platelets,leukocyte,growth factors and cytokines,which make PRF become the new biological material in promoting the soft and hard tissue regeneration.The existing researches indicate that PRF will releasea large amount of growth factors and inflammatory factors when they were applicated in the surgical site.Therefore,we can expect to see that PRF can promote tissue healing and anti-infection effect.Unfortunately,some studies have not find the effect of PRF in promoting tissue healing is obvious,ttheir actual effect in oral surgery for promoting tissue healing and regeneration is still controversial.The healing of extraction sockets accompanied by hard and soft tissue healing process.In order to reduce alveolar bone dimensional changes,several techniques aiming at enhancing the regeneration process in the extraction socket have been adopted.Therefore,the extraction sockets is the excellent model to study the effect of platelet rich fibrin on tissue healing.Objective: The aim of this systematic review was to assess if the use of platelet rich fibrin may be beneficial to the healing of extraction sockets,so as to provide reliable scientific basis for the choice of treatment in clinical work.Methods : Pub Med / MEDLINE(December 2000-2015),EMBASE(December 2000-2015),the Cochrane Central Register of controlled trials(the Cochrane Central Register of controlled trials,December 2000-2015),EBSCO(December 2000-2015),ScienceDirect(December 2000-2015),Chinese biomedical literature disc database(CBMdisc),CNKI(CNKI),VIP Chinese science and technology periodical database(WEB version),Wanfang database were searched using a combination of specific search terms.Hand searching of the relevant journals and the bibliographies of reviews were also performed.Prospective comparative studies evaluating the effect of platelet rich fibrin onfresh extraction sockets were included.Further included,at least 10 patients receiving treatment(at least 5 groups),followed up for at least 1 week.The subjective experiences of patients were the result variables of postoperative swelling,postoperative pain,the quality of life of patients.The result variables of objective measurement were used to assess soft and hard tissue healing by the clinical observation,imaging,histology and histomorphometry index.A methodological study quality assessment was made.Meta analysis was performed by RevMan 5.3 software.Use fixed effect model to estimate the combined effect and the effect of the volume was expressed by 95% confidence interval(CI).Dichotomous outcomes apply the relative risk(RR)or odds ratio(OR)to express the effect size effect analysis;continuous outcomes selecte weighted mean difference(WMD)or standardized mean difference(SMD).Results: The initial search identified 716 articles,14 articles were included.In 912 patients,a total of 1148 teeth were extracted,the control groups were573,the experimental groups were 575.2 literatures were high qualities,the qualities of 6 literatures are medium,6 literatures were low qualities.All of the articles could use meta-analysis.The results of them showed:(1)Eight studies about the occurrence rate of postoperative dry sockets could use meta-analysis.The results are RR=0.20,95%CI(0.12,0.35),P<0.00001,illustrating that filling PRF could effectively reduce the incidence of dry socket.(2)There were three articles that studied the postoperative pain value changes.The results of meta-analysis showed that SMD=-0.04,95% CI(-0.91,0.34),P=0.80,indicating that it was not a positive impact that the extractionsockets filled with PRF to alleviate postoperative pain.(3)Four articles were related to the adjacent periodontal pocket depth changes.The results of meta-analysis were that SMD=1.16,95% CI(0.72,1.60),the combined effect of the amount of test Z=5.13,P < 0.00001.It showed that filling PRF in the sockets could reduce the adjacent periodontal pocket depth.(4)There were three articles which used gray value to measure bone density.The results of meta-analysis showed that SMD=0.30,95% CI(-0.06,0.66),the combined effect of the amount of test Z=1.64,P = 0.10.There were no statistically significant differences between both groups.It showed that the extraction socket filled with PRF cannot increase the density of bone tissue.(5)There were two studies which used tatic phase radionuclide imaging analysis of techne-tium(TC)99m methylene diphosphonate absorption value to measure bone density.The results were that SMD=0.03,95% CI(-0.44,0.51),the combined effect of the amount of test Z=0.13,P = 0.89.It showed that the differences between two groups in bone density were not statistically significant.Conclusion:(1)There is limited evidence that the use of platelet rich fibrin is associated with the reduction of the incidence of dry socket in the first post-operative week,while there is not enough evidence to prove the reduction of patients' pain perception.(2)There is suggestion(but not clear evidence)of the beneficial effect of platelet rich fibrin on soft tissue healing after teeth extraction.(3)There is limited histological evidence of better bone quality as well as histomorphometric evidence of greater bone formation in the first 3months after teeth extraction,when using platelet rich fibrin.(4)A positive effect of platelet rich fibrin in accelerating bone healing is only suggested but could not be clearly demonstrated by radiographic assessment. |
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