Antimicrobial effect of platelet-rich fibrin: A systematic review of in vitro evidence-based studies.

This systematic review (SR) aimed to evaluate the antimicrobial potential of different types of platelet-rich fibrin (PRF) often used in regenerative treatments. An electronic search was performed in four databases and in Gray literature for articles published until January, 2023. The eligibility criteria comprised in vitro studies that evaluated the antimicrobial effect of different types of PRF. For the analysis of the risk of bias within studies, the modified OHAT (Office of Health Assessment and Translation) tool was used. For the evaluation of the results, a qualitative critical analysis was carried out in the synthesis of the results of the primary studies. Sixteen studies published between 2013 and 2021 were included in this SR. The antimicrobial effects of PRF variations (PRF, injectable PRF [I-PRF], PRF with silver nanoparticles [agNP-PRF], and horizontal PRF [H-PRF]), were analyzed against 16 types of bacteria from the oral, periodontal, and endodontic environments. All types of PRF showed significant antimicrobial action, with the antibacterial efficacy being more expressive than the fungal one. The I-PRF, H-PRF, and agNP-PRF subtypes improve antimicrobial activity. According to the OHAT analysis, no study was classified as having a high risk of bias. Evidence suggests that PRF variations have significant antimicrobial activity, with bacterial action being greater than fungal. Evolutions such as I-PRF, H-PRF, and agNP-PRF improve antimicrobial activity. Future studies analyzing the clinical effect of these platelets are fundamental. This SR was registered in INPLASY under number INPLASY202340016.

Does implant location influence the risk of peri-implantitis?

Peri-implantitis is characterized by nonreversible and progressive loss of supporting bone and is associated with bleeding and/or suppuration on probing. Peri-implant disease is considered as the main etiologic factor related to implant failure. Peri-implant disease has a pathogenesis similar to that of periodontal disease, both being triggered by an inflammatory response to the biofilm accumulation. Although the prevalence of peri-implantitis has been evaluated by several clinical studies with different follow-ups, there are currently little data on the impact of implant location and the prevalence of peri-implantitis. The aim of this review, therefore, was to summarize the evidence concerning the prevalence of peri-implantitis in relation to implant location and associated risk predictors. Even though most studies evaluating the prevalence of peri-implantitis in relation to implant location are cross-sectional or retrospective, they suggest that the occurrence of peri-implantitis is most prevalent in the anterior regions of the maxilla and mandible. Moreover, it seems that there is a higher prevalence of peri-implantitis in the maxilla than in the mandible.

Adopción/Adaptación para España de la Guía de Práctica Clínica de Nivel S3 de la Federación Europea de Periodoncia (EFP) - Tratamiento de la Periodontitis en Estadios I-III / Adoption/Adaptation for Spain of the Level S3 Clinical Practice Guideline of the European Federation of Periodontology (EFP) - Treatment of Periodontitis in Stages I-III

Resumen Antecedentes: La clasificación de la periodontitis recientemente introducida en el World Workshop de 2017, que incorpora estadios y grados de la enfermedad, tiene por objeto vincular la clasificación de la enfermedad con los enfoques preventivos y terapéuticos, ya que no solo describe su gravedad y el alcance, sino también el grado de complejidad y el riesgo de un individuo. Por lo tanto, es necesario contar con directrices clínicas basadas en la evidencia que ofrezcan recomendaciones para tratar la periodontitis. Objetivo: El objetivo del presente proyecto fue desarrollar una Guía de Práctica Clínica (CPG, por sus siglas en inglés, clinical practice guideline) de nivel S3 para el tratamiento de la periodontitis en los estadios I-III. Material y métodos: Estas CPG S3 se elaboraron bajo los auspicios de la Federación Europea de Periodoncia (EFP), siguiendo la orientación metodológica de la Asociación de Sociedades Médico-Científicas de Alemania y la estructura Grading of Recommendations Assessment, Development and Evaluation (GRADE). El proceso, riguroso y transparente, incluyó la síntesis de las investigaciones relevantes en 15 revisiones sistemáticas encargadas de manera específica, la evaluación de la calidad y la solidez de la evidencia, la formulación de recomendaciones específicas, así como lograr un acuerdo, sobre esas recomendaciones, por parte de expertos destacados y una amplia base de partes interesadas. Resultados: Estas CPG S3 abordan el tratamiento de la periodontitis (estadios I, II y III) utilizando un enfoque gradual preestablecido del tratamiento que, según el estadio de la enfermedad, debe ser incremental, incluyendo en cada caso diferentes intervenciones. Se llegó a un acuerdo sobre las recomendaciones relativas a las diferentes intervenciones, dirigidas a: i) cambios de comportamiento, control de biofilm supragingival, inflamación gingival y factores de riesgo; ii) instrumentación supragingival y subgingival, con y sin tratamientos coadyuvantes; iii) diferentes tipos de intervenciones quirúrgicas periodontales; y iv) el mantenimiento periodontal necesario para extender los beneficios a lo largo del tiempo. Conclusión: Esta Guía S3 informa a los clínicos, a los sistemas de salud, a los encargados de formular políticas sanitarias e, indirectamente, al público, sobre las modalidades disponibles y más eficaces para tratar la periodontitis y mantener una dentición sana durante toda la vida, de acuerdo con la evidencia disponible en el momento de su publicación.

Effectiveness of connective tissue graft substitutes for the treatment of gingival recessions compared with coronally advanced flap: a network meta-analysis.

OBJECTIVES: This study aimed to conduct a network comparison of the clinical effect of connective tissue graft (CTG) substitutes on the treatment of gingival recessions using coronally advanced flap. MATERIALS AND METHODS: An electronic search without language or dates restrictions was performed in five databases and in Grey literature for articles published until May, 2020. The eligibility criteria comprised randomized controlled trials (RCTs) that analyzed the clinical outcomes of CTG substitutes when compared with coronally advanced flap (CAF) for the treatment of Miller class I and II (Cairo RT I) gingival recessions. A pairwise and network meta-analysis were conducted for each periodontal parameters to assess and compare the outcomes among different treatment arms for the primary and secondary outcomes. This systematic review (SR) was registered in INPLASY under number INPLASY202060075. RESULTS: Twenty-seven studies were included in the present SR. All analyzed CTG substitutes showed superior results when comparing with CAF alone for all periodontal parameters. However, when compared in a network, the acellular dermal matrix (ADM) demonstrated the best treatment ranking of probability results, followed by platelet-rich fibrin (PRF), enamel matrix derivative (EMD), and xenogeneic collagen matrix (XCM) for root coverage (RC). CONCLUSION: This SR observed that the association of biomaterials increases the effectiveness of RC in comparison with CAF alone. Based on the treatment ranking, although all the biomaterials analyzed showed a positive effect for RC, the ADM demonstrated the best results. CLINICAL RELEVANCE: To know the effectiveness of CTG substitutes for the treatment of gingival recessions.

Clinical efficacy of xenogeneic and allogeneic 3D matrix in the management of gingival recession: a systematic review and meta-analysis.

OBJECTIVE: A systematic review and meta-analysis was thus conducted to answer the following focused question based on PICO strategy: Is there any 3D matrix biomaterial used for root coverage of human Miller class I and II defects equivalent with the connective tissue graft in localized defects of at least 2 mm and 3 mm? MATERIAL AND METHODS: The search on electronic database included MEDLINE, Cochrane Central Register of Controlled Trials, Clinical Trials.gov, Web of Science, and New Zealand/Australian Clinical Trials. Only randomized clinical trials (RCTs) that compared connective tissue graft (CTG) with at least one 3D matrix alone for root coverage in Class I and II Miller localized defects of at least 2 mm, with at least 6 months follow-up, were included in this systematic review. RESULTS: A total of 14 studies were included for meta-analysis (12 compared CTG with acellular dermal matrix allograft and 2 compared CTG with Xenogenic Collagen Matrix). Relative root coverage showed no significant difference among the materials, for either 2 or 3 mm minimal recessions. For keratinized tissue width, on 2 mm recessions, CTG showed superiority above other biomaterials, but on 3 mm recessions, it seemed to have the same results. The percentage of recessions with complete root coverage for both 2 and 3 mm recessions showed similar results for all biomaterials. CONCLUSIONS: With their limits, the present data concluded that CTG, acellular dermal matrix allograft, and xenogenic collagen matrix provided similar results for root coverage. CLINICAL RELEVANCE: To know if there is a 3D matrix with equivalent predictable results for root coverage, that we could avoid the morbidity of the connective tissue graft for these cases.

Prevalence of peri-implant diseases - a critical review on the current evidence.

The objective of this paper was to evaluate the current evidence reporting on the prevalence of peri-implantitis and to determine the influencing factors. An electronic search for articles published until February 2019 reporting on the prevalence of peri-implantitis was performed in MEDLINE. Included criteria were published in international peer-reviewed journals, written in English language, reported on the prevalence of peri-implantitis, included implants with a minimum follow-up of one year after functional loading and used a clear definition for peri-implantitis and/or peri-implant mucositis with a clear cutoff for bone level changes according to the case definitions of Sanz and Chapple and Berglundh et al. 2018. Included papers were anaylized for factors affecting the reported prevalences for peri-implantitis. Twenty-five papers were included in the present review and a wide range for the reported prevalence of peri-implantitis was seen. Case definitions for peri-implantitis with various thresholds for bone loss together with the type of reporting on patient- or implant-level were the most significant factors that lead to a large variety of the occurrence of the disease. Additionally, follow-up time and the evaluation in a certain "convenience" population may have influenced the prevalence values. In conclusion, it can be stated that a wide range for reporting the prevalence of peri-implantitis can be found and no real estimation of the global burden of the disease can be made. Applying accurate case definitions for peri-implantitis is the most important factor for reporting the prevalence and should be strictly followed in future reports.

Prevalence of peri-implant diseases - a critical review on the current evidence

Abstract The objective of this paper was to evaluate the current evidence reporting on the prevalence of peri-implantitis and to determine the influencing factors. An electronic search for articles published until February 2019 reporting on the prevalence of peri-implantitis was performed in MEDLINE. Included criteria were published in international peer-reviewed journals, written in English language, reported on the prevalence of peri-implantitis, included implants with a minimum follow-up of one year after functional loading and used a clear definition for peri-implantitis and/or peri-implant mucositis with a clear cutoff for bone level changes according to the case definitions of Sanz and Chapple and Berglundh et al. 2018. Included papers were anaylized for factors affecting the reported prevalences for peri-implantitis. Twenty-five papers were included in the present review and a wide range for the reported prevalence of peri-implantitis was seen. Case definitions for peri-implantitis with various thresholds for bone loss together with the type of reporting on patient- or implant-level were the most significant factors that lead to a large variety of the occurrence of the disease. Additionally, follow-up time and the evaluation in a certain "convenience" population may have influenced the prevalence values. In conclusion, it can be stated that a wide range for reporting the prevalence of peri-implantitis can be found and no real estimation of the global burden of the disease can be made. Applying accurate case definitions for peri-implantitis is the most important factor for reporting the prevalence and should be strictly followed in future reports.

Coronally advanced flap with or without porcine collagen matrix for root coverage: a randomized clinical trial.

OBJECTIVES: The objective of this study is to clinically evaluate the outcomes following treatment of single gingival recessions with either coronally advanced flap technique (CAF) alone or combined with a porcine collagen matrix graft (CM). MATERIALS AND METHODS: This is a randomized parallel design clinical trial, including forty patients with single Miller Class I or II gingival recession, with a depth ≥ 2 mm and located at upper canines or premolars. The patients were randomly assigned to receive either CAF or CAF + CM. The primary outcome variable was gingival recession reduction (Rec Red). RESULTS: Baseline recession depth was 3.14 ± 0.51 mm for CAF group and 3.16 ± 0.65 mm for CAF + CM group (p > 0.05). Both groups showed significant Rec Red (p < 0.05), up to 6 months. Rec Red for CAF + CM was 2.41 ± 0.73 mm and was 2.25 ± 0.50 mm for CAF alone (p > 0.05). Root coverage was 77.2 % in the CAF + CM group and 72.1 % in the CAF group (p > 0.05). Complete root coverage (CRC) was found in 40 % of the cases in the CAF + CM group and in 35 % of the sites treated with CAF. Keratinized tissue thickness (KTT) was 0.26 mm higher in CAF + CM group (p < 0.05). CONCLUSIONS: It can be concluded that CAF + CM does not provide a superior recession reduction when compared to CAF; however, it may offer a small gain in KTT after 6 months. CLINICAL RELEVANCE: CAF + CM can be suggested as a valid therapeutic option to achieve root coverage and some increase in soft tissue thickness after 6 months.