Platelet-rich Plasma Combining With Demineralized Freeze-dried Bone Allografts For Periodontal Regeneration In The Treatment Of Intrabony Defects:a Meta-analysis

Treatment of the periodontal bone defects which is caused by periodontitis is difficult.The scaling and root planing can only delay the progress of the disease but can not really get the regeneration of periodontal tissue.So,how obtaining the regeneration of periodontal tissue is so hot in recently years.The regeneration of periodontal tissue include the regeneration of periodontal ligament,alveolar bone and cementum.At present,the methods which are usually used to treat of the regeneration of periodontal tissue are including bone grafting,guided tissue regeneration and a various of growth factors and so on.Among those,bone grafting and growth factor are obtained more and more attention.Demineralized freeze-dried bone allografts(DFDBA)is a allogenic bone,which contains a variety of bone growth factors and bone formation of protein and other differentiation factors.Some studies had shown that the application of DFDBA in the treatment of periodontitis resulted in regeneration of periodontal tissue which including regeneration of new bone,formation of the periodontal ligament and cementum.Platelet-rich plasma(PRP)is a platelet derivatives which obtain from the patient’s own blood,and it is a new type of tissue engineering material,that can effectively promote periodontal wound healing and periodontal tissue regeneration.So,PRP combined with DFDBA on the regeneration of periodontal intrabony defects gets a lot of attention.PURPOSE The aim of the meta-analysis is to assess the influence of PRP combined with DFDBA on the regeneration of periodontal intrabony defects by means of evaluating clinical and radiographic outcomes in prospective human clinical trials.METHOD The following databases such as PubMed 、The Cochrane Library、EMbase、CNKI、Wan fang and VIP data were searched on computer from inception to December,2016.According to the inclusion and exclusion criteria,two reviewers independently extracted the data,assessed the methodological quality of the included studies.RevMan 5.2 was applied for meta analysis.RESULTS Six papers were obtained and which including 142 patients with periodontitis and 205 periodontal bone defect sites.Six articles showed that there was no significant difference in probing depth decrease between the PRP combine with DFDBA and the PRP or DFBDA alone group[MD=0.35,95%CI(–0.09,0.79),P=0.12].But there was a significant difference in clinical attachment loss increase between the two group[MD= 0.68,95%CI(0.41,0.94),P<0.00001].Three articles(94 patients with periodontitis and 127 periodontal bone defect sites)were included for evaluating bone filling.There was a significant difference in the distance from the cemento-enamel junction(CEJ)to the vertical bone defect(BD)(CEJ-BD)[MD=0.71,95%CI(0.46,0.95),P<0.00001]between the two group.and there was also a significant difference in the distance from the alveolar crest to the vertical bone defect(AC-BD)[MD=0.64,95%CI(0.41,0.87),P<0.00001]between the two group.However there was no significant difference in the distance from the cementoenamel junction(CEJ)to the alveolar crest(AC)(CEJ-AC)[MD=0.03,95%CI(-0.10,0.16),P=0.68]between the two group.CONCLUSION Within the limitations of the meta analysis,when PRP combined with DFDBA is superior to PRP or DFDBA alone in the clinical attachment loss and bone filling,but there was no significant difference in probing depth.However given the limited sample size and quantity of included studies,the above conclusion still needs to be further proved by conducting more high-quality and large-scale RCTs.