The objective of the study was to compare the treatment outcomes of periodontal furcation defects by using platelet‐rich fibrin (PRF) with other commonly utilized modalities. The eligibility criteria comprised randomized controlled trials (RCTs) comparing the clinical outcomes of PRF with those of other modalities for the treatment of furcation defects. Studies were classified into 11 categories in 3 different groups as follows: Group I (addition of PRF): (1) open flap debridement (OFD) alone versus OFD/PRF, (2) OFD/bone graft (OFD/BG) versus OFD/BG/PRF; Group II (comparative studies to PRF): (3) OFD/BG versus OFD/PRF, (4) OFD/collagen membrane versus OFD/PRF, (5) OFD/PRP versus OFD/PRF, (6) OFD/rhBMP2 versus OFD/PRF; and Group III (addition of biomaterial/biomolecule to PRF): OFD/PRF versus … (7) OFD/PRF/BG, (8) OFD/PRF/amniotic membrane (AM), (9) OFD/PRF/metformin, (10) OFD/PRF/bisphosphonates, (11) OFD/PRF/statins. Weighted means and forest plots were calculated for the reduction of probing pocket depth (PPD), gain of vertical and horizontal clinical attachment levels (VCAL and HCAL), gain in vertical and horizontal bone levels (VBL, HBL), and radiographic bone fill (RBF). From 45 articles identified, 21 RCTs reporting on class II furcations were included. The use of OFD/PRF and OFD/BG/PRF statistically significantly reduced PPD and improved VCAL and HCAL when compared to OFD or OFD/BG, respectively. The comparison between OFD/PRF alone versus OFD/BG, OFD/CM, OFD/PRP, or OFD/rhBMP2 led to similar outcomes for all investigated parameters, including a reduction in PPD, VCAL/HCAL gain, and RBF. The additional incorporation of a BG to OFD/PRF only mildly improved outcomes, whereas the addition of AM improved clinical outcomes. The addition of small biomolecules such as metformin, bisphosphonates, or statins all led to significant improvements in PPD, VCAL, and HCAL when compared to OFD/PRF alone. Noteworthy, a very high heterogeneity was found in the investigated studies. The use of PRF significantly improved clinical outcomes in class II furcation defects when compared to OFD alone, with similar levels being observed between OFD/PRF and/or OFD/BG, OFD/CM, OFD/PRP, or OFD/rhBMP2. Future research geared toward better understanding potential ways to enhance the regenerative properties of PRF with various small biomolecules may prove valuable for future clinical applications. Future histological research investigating PRF in human furcation defects is largely needed. The use of PRF in conjunction with OFD statistically significantly improved PPD, VCAL, and HCAL values, yielding comparable outcomes to commonly used biomaterials. The combination of PRF to bone grafts or the addition of small biomolecules may offer additional clinical benefits, thus warranting future investigation.

中文翻译：

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使用富含血小板的纤维蛋白进行牙周再生。分叉缺陷：荟萃分析的系统评价


该研究的目的是比较使用富血小板纤维蛋白（PRF）与其他常用方法治疗牙周分叉缺损的结果。资格标准包括比较 PRF 与其他分叉缺陷治疗方式的临床结果的随机对照试验 (RCT)。研究被分为 3 个不同组中的 11 个类别，如下： 第一组（添加 PRF）：(1) 单独开皮瓣清创 (OFD) 与 OFD/PRF，(2) OFD/骨移植 (OFD/BG) 与 OFD /BG/PRF；第二组（与 PRF 的比较研究）：(3) OFD/BG 与 OFD/PRF，(4) OFD/胶原膜与 OFD/PRF，(5) OFD/PRP 与 OFD/PRF，(6) OFD/rhBMP2 与 OFD/PRF OFD/PRF；第三组（在 PRF 中添加生物材料/生物分子）：OFD/PRF 与……(7) OFD/PRF/BG，(8) OFD/PRF/羊膜 (AM)，(9) OFD/PRF/二甲双胍，( 10) OFD/PRF/双膦酸盐，(11) OFD/PRF/他汀类药物。计算加权平均值和森林图，以减少探查袋深度（PPD）、垂直和水平临床附着水平的增益（VCAL和HCAL）、垂直和水平骨水平的增益（VBL、HBL）以及放射线骨填充（径向基函数）。从确定的 45 篇文章中，纳入了 21 篇报告 II 类分叉的随机对照试验。与 OFD 或 OFD/BG 相比，OFD/PRF 和 OFD/BG/PRF 的使用在统计学上显着降低了 PPD，并改善了 VCAL 和 HCAL。单独的 OFD/PRF 与 OFD/BG、OFD/CM、OFD/PRP 或 OFD/rhBMP2 之间的比较导致所有研究参数的相似结果，包括 PPD、VCAL/HCAL 增益和 RBF 的降低。在 OFD/PRF 中额外加入 BG 仅略微改善了结果，而添加 AM 则改善了临床结果。 与单独使用 OFD/PRF 相比，添加二甲双胍、双膦酸盐或他汀类药物等小生物分子均可显着改善 PPD、VCAL 和 HCAL。值得注意的是，调查研究中发现了非常高的异质性。与单独使用 OFD 相比，PRF 的使用显着改善了 II 类分叉缺陷的临床结果，在 OFD/PRF 和/或 OFD/BG、OFD/CM、OFD/PRP 或 OFD/rhBMP2 之间观察到相似的水平。未来的研究旨在更好地了解利用各种小生物分子增强 PRF 再生特性的潜在方法，可能对未来的临床应用有价值。未来的组织学研究非常需要调查人类分叉缺陷中的 PRF。 PRF 与 OFD 结合使用在统计上显着改善了 PPD、VCAL 和 HCAL 值，产生与常用生物材料相当的结果。 PRF 与骨移植物的结合或添加小生物分子可能会提供额外的临床益处，因此值得未来的研究。