Introduction
Methods
Focused question
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Population (P): patients with freshly extracted teeth.
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Intervention (I): socket or ridge preservation using platelet-rich fibrin (PRF) with or without biomaterials.
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Comparison (C): spontaneous healing, biomaterials without PRF.
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Outcomes (O): measurements of at least one of the following parameters: postoperative inflammation and pain, soft tissue healing, dimensional bone volume changes, bone quality.
Search strategy
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International Journal of Oral and Maxillofacial Implants;
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Clinical Implant Dentistry and Related Research;
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Clinical Oral Implants Research;
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Journal of Clinical Oral Investigations
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Journal of Implantology;
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Journal of Oral and Maxillofacial Surgery;
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International journal of oral and maxillofacial surgery.
Inclusion criteria
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English language
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Patient age 15–99 years
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Prospective controlled (CCTs) and/or randomized clinical studies (RCTs) in humans with either a split-mouth or parallel design with reasonable controls*
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Treatment of fresh sockets/ridge
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Treatment using either PRF (with or without biomaterials, i.e., bone substitute materials, collagen membranes as well as any other membrane of different origin) or spontaneous healing
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Treatment without any additional chemical or physical agents in/on the alveolus after extraction except suture materials
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Subject with and without anticoagulation intake.
Exclusion criteria
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Preclinical in vitro or animal studies;
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Third molar extraction;
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Combination with biomaterials without reasonable controls;
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Prospective randomized and/or controlled clinical studies (RCTs) in humans with either a split-mouth or parallel design without reasonable controls;
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Case reports, case series, cohort and retrospective studies;
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Immediate implantation;
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Inadequate methods or reporting of the study design and/or patients’ data.
Quality evaluation of included studies
Data extraction
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Primary outcomes: radiological and clinical evaluation of bone regeneration, dimensional bone-level change and histological assessment of bone regeneration.
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Secondary outcomes: healing period, pain management outcome and soft tissue regeneration.
Results
Study inclusion
Study designs
Study | Design | Number of patients | Test (n) | Control (n) | Manage | Case definition | Socket definition | Surgical procedure | Region/tooth | Healing time until implantation |
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Castro et al. [41] | Split mouth RCT | 21 (15 females, 6 males) | 21 | 21 | Not reported | Patients in need of at least three tooth extractions in the aesthetic zone were | Not reported | Tooth extractions were performed under local anesthesia and sterile conditions with a flapless approach | Premaxilla | 3 months |
Sharma et al. [54] | Split mouth RCT | 30 (16 females and 14 males) | 30 | 30 | 23.90 | Patients requiring extraction of bilateral mandibular molars except third molars | Not reported | Extraction of the tooth on both case and control side was done as atraumatic as possible in the same appointment | Not reported | Not reported |
Mourao et al. [56] | Parallel RCT | 32 (19 females and 13 males) | 16 | 16 | 37 | Patients requiring posterior tooth extraction (third molar exception) in the mandible or maxilla region were included | Not reported | All teeth were extracted using a minimally traumatic procedure. No vertical releasing incisions were performed. To avoid root and bony fractures, the molar teeth were sectioned using a multilaminated drill. Luxation of the teeth was performed using a periotome followed by removal using forceps | Molars and premolars | Not reported |
Canellas et al. [47] | Parallel RCT | 48 (27 females, 21 males) | 24 | 24 | 44.8 | Patients in good general health requiring a single, non-molar tooth extraction | Presence of buccal and palatal/lingual bone walls | Teeth were extracted using small levers without any osteotomy or mucoperiosteal flap, to minimize trauma | Incisors, canines and premolars | 3 months |
Srinivas et al. [48] | CCT split moth | 30 (not further specified) | Not reported | Not reported | Not reported | Healthy subjects with chronic periodontal conditions and who had teeth indicated for extractions | Not reported | Extraction of teeth was performed with emphasis on atraumatic extraction methods. A periosteal elevator was used to reflect the gingival tissues surrounding the tooth. Tooth was luxated from its socket using periotomes and/or luxators. Appropriate forceps were used depending on the availability of tooth structure to complete the extraction process in the maxilla or the mandible | Maxilla and mandible | Not reported |
Ahmed et al. [53] | Parallel RCT | 54 (22 females, 32 males) | Test 1:18, test 2: 18 | 18 | Not reported | Patients requiring extractions of maxillary or mandibular teeth and who desire replacement of teeth by dental implants | Not reported | Not reported | Not reported | Not reported |
Areewong et al. [55] | Parallel RCT | 36 (21 females and 15 males) | 18 | 18 | 50.67 | Healthy volunteers above 20 year of age, no systemic pathoses, that could disturb implant placement; Single rooted premolars and/or maxillary anterior teeth with an indication to extract and to be replaced with a dental implant | Intact surrounding alveolar bone (remaining bone at least two-third of root length) | A minimally traumatic extraction technique was performed. The periodontal ligaments were gently cut with a Piezotome. The tooth was carefully mobilized using forceps without flap reflection | Single rooted premolars and/or maxillary anterior teeth | 2 months |
Ustaoglu et al. [42] | Parallel RCT | 57 (29 females and 28 males) | Test1:19 Test2: 19 | 19 | Female: 35.9 Male:37.91 | Patients in need of single-rooted tooth extraction with the persistence of 50% or more of bone support (anterior or premolar teeth); demanded a single implant-supported prosthetic restoration in a premolar or anterior site | Persistence of 50% or more of bone support | The tooth was extracted using a flapless technique with as little trauma to the bone and soft tissue | Single-rooted tooth | Not reported |
Giudice et al. [40] | Split mouth RCT | 40 (12 females and 28 males) | 40 | 40 | 60.9 | Patient taking long-term oral antiplatelets and requiring at least four extractions of non-adjacent teeth | Not specified | Teeth extractions were performed as atraumatically as possible attempting to preserve the alveolar bone. Molars were sectioned with drills in two or three parts. Extraction sockets were carefully cleaned from any remains of granulation tissue. Flapless extractions were attempted, but if necessary flaps were elevated at the discretion of the Operator | All regions | Not reported |
Zhang et al. [49] | Parallel CCT | 28 (14 females and 14 males) | 14 | 14 | 34.6 | Patients with upper and lower mandibular molars diagnosed as fractured tooth or could not be retained for other reasons | Not reported | All patients were treated with the non‑flap minimally invasive extraction technology | Molars | 3 months |
Kumar et al. [43] | RCT Parallel/Split | 48 (not further specified) | Not reported | Not reported | 44.4 | Patients requiring tooth extraction | Not reported | All teeth were extracted atraumatically using periotomes and luxators without raising mucoperiosteal flap | All regions | Not reported |
Asmael et al. [58] | RCT split mouth | 20 males | 20 | 20 | 44.2 | Smoker patient with multiple teeth extraction | Not reported | Extraction in atraumatic manner | All regions | Not reported |
Clark et al. [39] | Parallel RCT | 45 enrolled 40 analyzed (22 females and 18 males) | Test 1:10 Test2:10 | Control1:10 Control2:10 | 58 | Patients with single-rooted tooth requiring extraction and replacement with a dental implant supported restoration | Teeth were excluded if they demonstrated a buccal dehiscence of more than 25% of the length of the tooth or presence of acute infection of endodontic origin | Non-traumatic tooth extraction was completed without the elevation of a mucoperiosteal flap | Not reported | 3.75 months |
Alzahrani et al. [44] | Parallel RCT | 24 (15 females and 9 males) | 12 | 12 | 37.8 | Subjects with at least one site bordered by minimum of one tooth, nonsmokers, teeth with root fracture, patients having teeth with hopeless periodontal prognosis, teeth with failed endodontic therapy or advanced carious lesion | Not reported | The teeth were extracted with minimal trauma and without flap elevation, using periotomes by single experienced periodontist | Not reported | Not reported |
Temmerman et al. [50] | Split moth RCT | 22 (15 females and 7 males) | 22 | 22 | 54 | Symmetrical bilateral (e.g., premolar versus premolar, incisor versus incisor) tooth extractions in the maxilla or mandible | Not specified | A flapless approach, as atraumatically as possible using periotomes, was used. Sites with loss of the buccal or palatal bone plate (< 50% of the initial height) were not excluded. Sockets were carefully cleaned using curettes | Incisors, canines and premolars | Not reported |
Marenzi et al. [57] | Split mouth RCT | 26 (17 females and 9 males) | 53 | Patients who needed bilateral paired dental extractions | All extraction sites were simple with alveolar walls preserved | The teeth were extracted in a nontraumatic manner without elevation of full-thickness flaps and preserving the buccal and lingual walls of the sockets | Canines, premolars and molars | Not reported | ||
Suttapreyasri et al. [45] | Split mouth RCT | 8 (5 women and 3 men) | 8 | 8 | 20.3 | Patients who are physically healthy, with no underlying systemic disease, as determined by medical history records. Need for symmetrical premolars extraction | Not reported | The tooth was gently luxated with an elevator and carefully extracted with extraction forceps, attempting to minimize the trauma to the bone circumscribing the alveolus | Premolars | Not reported |
Hauser et al. [46] | Parallel RCT | 23 (9 females and 14 males) | Test 1: 19 Test 2: 6 | 8 | 47.43 | Patients, who required the extraction of an upper or lower premolar before its replacement by a dental implant | Presence of the buccal and palatal/lingual bony walls evaluated clinically by measuring the thickness of the alveolar ridge and radiologically by a periapical radiograph, and residual periodontal attachment of at least 6 mm | A scalpel for the syndesmotomy; a buccal and palatal/lingual mucosal flap without discharge for the PRF-flap group; use of dental elevators, extraction with forceps, curettage, and socket filling with PRF membranes for PRF and PRF-flap groups; placement of the PRF membranes over the alveolar crest for the PRF-flap group; hemostasis by compression; and suture with a point cross | Premolars | 2 months |
Thakkar et al. [52] | RCT (not further defined) | 36 sites (Number of patients not defined) | Not reported | Not reported | Not reported | Patients between the age group of 20 and 55 years, requiring extraction of at least one maxillary or mandibular nonrestorable single‑rooted tooth | Not described | Periotomes and forceps were used with great care taken to maintain the buccal bone and the surrounding soft and hard tissues | Single rooted teeth | Not reported |
Yewale et al. [51] | Parallel RCT | 20 (9 females and 11 males) | Not reported | Not | 35 | Sites in maxilla were selected which where, single non restorable teeth and indicated for extraction | Intactness of buccal cortical plate was examined and assessed | Extraction was carried out atraumatically. Subsequent to atraumatic extraction, height of buccal and palatal bone plate was clinically inspected at mid buccal and mid lingual region with aid of periodontal probe. With #15 blade, intrasulcular incision was made elevating marginal gingiva and adjacent interdental papilla. Flap reflection was done by Periosteal elevator resulting in exposure of crestal bone around socket. This aided in direct visualization and measurement of crestal bone level. Bone curette was used to debride extraction socket if granulation tissue is present | Single rooted teeth | Not reported |
Evaluation of bias risk
Study | Random sequence generation | Allocation concealment | Blinding of participants and personnel | Blinding of outcome assessment | Incomplete outcome data |
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Castro et al. [41] | + | n.a | − | + | + |
Sharma et al. [54] | + | n.a | − | − | + |
Mourao et al. [56] | + | n.a | − | − | + |
Canellas et al. [47] | + | n.a | + | + | + |
Ahmed et al. [53] | − | n.a | − | − | + |
Areewong et al. [55] | + | n.a | − | − | + |
Ustaoglu et al. [42] | + | n.a | Participant - Personnel + | + | + |
Giudice et al. [40] | + | n.a | – | + | + |
Kumar et al. [43] | − | n.a | ? | − | + |
Asmael et al. [58] | − | n.a | − | − | − |
Clark et al. [39] | + | n.a | ? | + | + |
Alzahrani et al. [44] | − | n.a | − | − | + |
Temmerman al. [50] | + | n.a | − | − | + |
Marenzi et al. [57] | + | n.a | ? | ? | + |
Suttapreyasri et al. [45] | − | n.a | − | − | + |
Hauser et al. [46] | ? | n.a | − | ? | + |
Thakkar et al. [52] | + | n.a | − | − | + |
Yewale et al. [51] | + | n.a | − | + | + |
Selection | Comparability | Exposure | |
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Srinivas et al. [48] | |||
Zhang et al. [49] |
PRF preparation protocol
Study | PRF-type | Tube | RPM (RCF [×g]) | Centrifugation time (min) | Centrifuge |
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Castro et al. [41] | L-PRF | 9ml silica-coated plastic tubes without anticoagulant (BVBCTP-2, Intra-Spin, Intra-Lock) | 2700 rpm (RCFclot: 408 g) | 12 | Intra-Spin, Intra-Lock |
A-PRF + | 10-ml glass tubes without anticoagulant (DUO) for A-PRF + | 1300 rpm (RCFclot: 145 g) | 8 | DUO Process | |
Sharma et al. [54] | PRF | 6 ml intravenous blood was collected in a 10-ml sterile tube without anticoagulant | 3000 rpm | 10 | LabTech AVI-532-BL centrifugation machine |
Mourao et al. [56] | L-PRF | 10-ml red tubes (IntraSpin™, Biohorizons®) | 2700 rpm (708×g) | 12 | IntraSpin™, Biohorizons®, Birmingham, Alabama, USA |
Canellas et al. [47] | L-PRF | sterile, glass-coated plastic tubes | 2700 (708×g) | 12 | Intra-Lock, Boca Raton, Florida, USA |
Srinivas et al. [48] | L-PRF | 10 ml test tubes which were kept without an anticoagulant | 3000 rpm | 10 | Not reported |
Ahmed et al. [53] | L-PRF | Not reported | 3000 rpm | 10 | Not reported |
Areewong et al. [55] | L-PRF | Glass tube | 2700 rpm | 12 | IntraSpin, Intra-Lock, Nice, France |
Ustaoglu et al. [42] | L-PRF | 9 mL tubes | 2700 rpm | 12 | Intra-Spin System, L-PRF kit, Intra-Lock, Boca-Raton, FL, USA |
T-PRF | Grade IV sterile titanium tubes | 2800 rpm | 12 | Not reported | |
Giudice et al. [40] | A-PRF + | A-PRF + tubes | 1300 rpm | 8 | DUO centrifuge (Process for PRF, Nice, France); |
L-PRF | Red tubes | 2700 rpm | 18 | (Intra-Lock International, Boca Raton, Florida, USA | |
Zhang et al. [49] | L-PRF | test tubes without any anticoagulant | 400×g | 10 | Hettich® Universal 320 (Andreas Hettich GmbH & Co.KG, Tuttlingen, Germany) |
Kumar et al. [43] | PRF | Not reported | 3000 rpm | 10 | Not reported |
Asmael et al. [58] | PRF | Five or ten milliliters of intravenous blood was drawn in 10 mL glass vacuumed tube without anticoagulants | 3000 rpm | 10 | Centrifuge machine (Xiangtian, Jiangsu China) |
Clark et al. [39] | A-PRF | 01 mL sterile glass vacuum tube | 1300 rpm | 8 | Not reported |
Alzahrani et al. [44] | PRF | Not reported | 3000 (400×g) | 10 | Compact centrifuge (Hermle labortechnik, Germany) |
Temmerman et al. [50] | L-PRF | Plastic 10-mL tubes without anticoagulant | 2700 rpm | 12 | (IntraSpin™, IntraLock, Boca Raton, Florida, USA) |
Marenzi et al. [57] | L-PRF | 9-mL tubes | 2700 rpm | 12 | Intra-Lock, Boca-Raton, FL, USA |
Suttapreyasri et al. [45] | L-PRF | 10-mL glass tube | 3000 rpm | 10 | Hettich Zentrifugen centrifuge EBA 20 (Andreas Hettich GmbH& Co, KG, Tuttlingen, Germany |
Hauser et al. [46] | PRF | 8-mL tubes without anticoagulant | 2700 rpm | 8 | Not reported |
Thakkar et al. [52] | PRF | 10 ml syringe | 3000 rpm | 10 | Not reported |
Yewale et al. [51] | A-PRF + | 10-mL tubes without anticoagulants | 1300 rpm (208×g) | 8 | Not reported |
Primary outcomes
Bone regeneration
Study | n | Test | Control | Method | Results test | Results control | Statistical significance |
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Castro et al. [41] | 20 | L-PRF | Spontaneous healing | CBCT (thickness buccal bone 1 mm below the crest) after 3 months | 1.1 ± 0.3 mm | 1.1 ± 0.4 mm | No |
A-PRF+ | 0.9 ± 0.3 mm | No | |||||
CBCT (horizontal resorption 1 mm below the alveolar crest) after 3 months | Buccal: 1.6 ± 0.8 mm Palatal: 0.6 ± 0.7 mm | Buccal: 1,7 ± 1.0 mm Palatal: 0.5 ± 0.7 mm | No | ||||
Buccal: 1.6 ± 0.7 mm Palatal: 0.7 ± 0.8 mm | No | ||||||
CBCT (horizontal resorption 3 mm below the alveolar crest) after 3 months | Buccal: 1.5 ± 0.8 mm Palatal: 0.4 ± 0.4 mm | Buccal: 1.4 ± 0.8 mm Palatal: 0.3 ± 0.4 mm | No | ||||
Buccal: 1.2 ± 0.6 mm Palatal: 0.4 ± 0.7 mm | No | ||||||
CBCT (horizontal resorption 5 mm below the alveolar crest) after 3 months | Buccal: 1.0 ± 0.7 mm Palatal: 0.2 ± 0.4 mm | Buccal: 1.0 ± 0.6 mm Palatal: 0.1 ± 0.6 mm | No | ||||
Buccal: 0.8 ± 0.6 mm Palatal: 0.3 ± 0.6 mm | No | ||||||
CBCT (socket fill) after 3 months | 85.2 ± 22.9% | 67.9 ± 19.2% | Yes: p = 0.005 | ||||
83.8 ± 18.4% | Yes: p = 0.01 | ||||||
Histomorphometry (percent of bone volume/ tissue volume) | 47.7 ± 7.9% | 34.7 ± 6.9% | Yes: p < 0.05 | ||||
54.5 ± 5.6% | Yes: p < 0.05 | ||||||
Micro-CT (percent of bone volume/ tissue volume) | 43.4 ± 8.7% | 35.0 ± 8.2% | No: p = 0.09 | ||||
50.7 ± 4.5% | Yes: p < 0.001 | ||||||
Sharma et al. [54] | 30 | PRF | Spontaneous healing | Digital panoramic radiographs (grayscale value) after 16 weeks | 91.980 | 88.689 | No: 0.668 |
Canellas et al. [47] | 45 | L-PRF | Spontaneous healing | CBCT (bone loss 1 mm below the alveolar crest) after 3 months | 0.93 ± 0.9 mm | 2.27 ± 1.2 mm | Yes P < 0.0001 |
CBCT (bone loss 3 mm below the alveolar crest) after 3 months | 0.85 ± 0.8 mm | 1.67 ± 1.1 mm | Yes p < 0.005 | ||||
CBCT (bone loss at the buccal bone wall) after 3 months | 0.70 ± 0.7 mm | 1.39 ± 1.2 mm | Yes P < 0.02 | ||||
CBCT (horizontal bone loss at 5 mm below the crest) after 3 months | 0.67 ± 0.5 mm | 1.08 ± 1.0 mm | No P = 0.094 | ||||
CBCT (vertical bone loss at the palatal/ lingual wall) after 3 months | 0.67 ± 0.9 mm | 1.24 ± 1.15 mm | No P = 0.064 | ||||
CBCT (new bone formation) after 3 months | 190.90 ± 169.90 mm3 | 44.87 ± 200.20 mm3 | Yes P = 0.009 | ||||
Histomorphometry (percentage of new bone formation after 3 months) | 55.96 ± 11.97% | 39.69 ± 11.13% | Yes p = 0.00001 | ||||
Srinivas et al. [48] | 30 | PRF | Spontaneous healing | CBCT (bone density) | 24 h: 319.79 ± 95.472 3 months: 564.76 ± 94.856 | 24 h: 194.82 ± 78.986 3 months: 295.87 ± 87.217 | 24 h: Yes P < 0.001 3 moths: Yes P < 0.001 |
CBCT (Bone hight) | 24 h: 13.93 ± 3.56 mm 3 months: 12.28 ± 3.84 mm | 24 h: 14.68 ± 4.32 mm 3 months: 12.78 ± 3.82 mm | 24 h: No P = 0.466 3 moths: No P = 0.615 | ||||
Ahmed et al. [53] | 54 | PRF | Spontaneous healing | Radiographic analysis (bone hight reduction, crest to tip of the root taking adjoining tooth as a guide) after 16 weeks | 0.17 ± 0.44 mm | 2.12 ± 0.69 mm | Yes p < 0.001 |
Radiographic analysis (bone width reduction) after 16 weeks | 0.47 ± 0.36 mm | 1.71 ± 0.49 mm | Yes p < 0.001 | ||||
Radiographic analysis (bone density change using gray scale histogram) after 16 weeks | 0.44 ± 1.21 | 1.45 ± 0.51 | Yes P = 0.006 | ||||
Areewong et al. [55] | 38 | PRF | Spontaneous healing | Histomorphometric: new bone formation ratio after 8 weeks | 31.33 ± 18% | 26.33 ± 19.63% | No P = 0.431 |
Zhang et al. [49] | 28 | PRF | Spontaneous healing | CBCT after 3 months (reduction of the buccal alveolar) | 1.6000 ± 1.46416 mm | 2.8000 ± 1.81487 mm | No |
CBCT after 3 months (reduction of the height of the lingual/palatal alveolar crest) | 1.0000 ± 0.70711 mm | 2.0500 ± 1.29180 mm | No | ||||
CBCT after 3 months (reduction of the width of the alveolar crest) | 1.0500 ± 0.77862 mm | 2.0760 ± 1.67149 mm | No | ||||
Histomorphometric analysis after 3 months (osteoid) area/tissue area) | 9.7624 ± 4.0121% | 2.8056 ± 1.2094% | Yes P < 0.01 | ||||
Kumar et al. [43] | 48 | PRF | Spontaneous healing | Clinical measurement using measured using metal callipers (average loss of alveolar width) after 6 months | 3 ± 0.8 mm | 3.3 ± 0.61 mm | No |
Clinical measurement using measured using metal callipers (average loss of alveolar height) after 6 months | 3 ± 0.64 mm | 3 ± 0.83 mm | No | ||||
Radiological measurement (degree of alveolar fill) after 6 months | 73.76 ± 0.14% | 74.3 ± 0.13% | No | ||||
Clark et al. [39] | 45 | Test 1: A-PRF Test 2: A-PRF + FDBA | Control1: spontaneous healing Control 2: FDBA | Clinical measurement using alginate impression and a periodontal probe (loss ridge height reduction) after 15 weeks | Test 1: A-PRF: 1.8 ± 2.1 mm Test 2: A-PRF + FDBA: 1.0 ± 2.3 mm | Control 1: 3.8 ± 2.0 mm Control 2: 2.2 ± 1.8 mm | Test 1 vs. control 1: Yes P < 0.05 Test 2 vs. control 2: No |
Clinical measurement using alginate impression and a metal callipers (Loss of ridge width (coronal)) after 15 weeks | Test 1: A-PRF: 2.8 ± 1.2 mm Test 2: A-PRF + FDBA: 1.9 ± 1.1 mm | Control 1: 2.9 ± 1.7 mm Control 2: 2.5 ± 1.1 mm | Test 1 vs. control 1: No Test 2 vs. control 2: No | ||||
Clinical measurement using alginate impression and a metal callipers (Loss of ridge width (middle)) after 15 weeks | Test 1: A-PRF: 1.8 ± 1.8 mm Test 2: A-PRF + FDBA: 1.7 ± 1.2 mm | Control 1: 1.8 ± 1.3 mm Control 2: 1.5 ± 1.2 mm | Test 1 vs. control 1: No Test 2 vs. control 2: No | ||||
Clinical measurement using alginate impression and a metal callipers (Loss of ridge width (apical)) after 15 weeks | Test 1: A-PRF: 1.8 ± 1.5 mm Test 2: A-PRF + FDBA: 1.6 ± 1.5 mm | Control 1: 1.5 ± 1.6 mm Control 2: 1.2 ± 1.3 mm | Test 1 vs. control 1: No Test 2 vs. control 2: No | ||||
Micro-CT analysis of bone cores (bone mineral density) after 15 weeks | Test 1: A-PRF: 493 ± 70 mg/cm3 Test 2: A-PRF + FDBA: 521 ± 58 mg/cm3 | Control 1:487 ± 64 mg/cm3 Control 2: 551 ± 58 mg/cm3 | Test 1 vs. control 1: No Test 2 vs. control 2: No | ||||
Histomorphometric analysis (percentage of vital bone) after 15 weeks | Test 1: A-PRF:46% ± 18% Test 2: A-PRF + FDBA: 29% ± 14% | Not reported | Test 1 vs. control 1: No Test 2 vs. control 2: No | ||||
Alzahrani et al. [44] | 24 | PRF | Spontaneous healing | Clinical Cast analysis (reduction of alveolar ridge width) | Week 1: 2.09 ± 0.84 mm Week 4: 5.22 ± 0.80 mm Week 8: 8.58 ± 1.73 mm | Week 1: 3.26 ± 2.21 mm Week 4: 9.79 ± 6.02 mm Week 8: 13.54 ± 6.57 mm | Week 1:No P = 0.141 Week 4:Yes P = 0.012 Week 8:Yes P = 0.036 |
Radiolographic analysis (mean radiographic bone fill) | Week 1: 74.05 ± 1.66% Week 4: 81.54 ± 3.33% Week 8: 88.81 ± 1.53% | Week 1: 68.82 ± 1.07% Week 4: 74.03 ± 1.22% Week 8: 80.35 ± 2.61% | Week 1: Yes P = 0.012 Week 4:Yes P = 0.00 Week 8: Yes P = 0.017 | ||||
Temmerman et al. [50] | 22 | PRF | Spontaneous healing | CBCT after 3 months (Vertical resorption, lingual) | 0.4 ± 1.1 mm | 0.7 ± 0.8 mm | No |
CBCT 3 months (Vertical resorption, buccal) | 0.5 ± 2.3 mm | 1.5 ± 1.3 mm | Yes P = 0.0002) | ||||
CBCT 3 months (Horizontal width reduction 1 mm below the crest) | 22.84 ± 24.28% | 51.92 ± 40.31% | Yes P = 0.0004 | ||||
CBCT 3 months (Horizontal width reduction 3 mm below the crest) | 6.16 ± 6.16% | 14.51 ± 19.6% | Yes p = 0.007 | ||||
CBCT 3 months (Horizontal width reduction 5 mm below the crest) | 2.91 ± 4.54% | 4.4 ± 4.89% | Yes P = 0.02 | ||||
CBCT 3 months (socket fill) | 8.1 ± 3.1 mm 94.7 ± 26.9% | 6.2 ± 3.9 mm 63.3 ± 31.9% | Yes, P = 0.005 Yes, P = 0.0004 | ||||
Suttapreyasri et al. [45] | 8 | PRF | Spontaneous healing | Clinical socket dimension measurements after 8 weeks (mesial-distal [M-D] and buccal-lingual [B-L]) were measured from the inner socket orifice at the midpoint of the extraction site, a UNC-15 periodontal probe (Hu-Friedy, Chicago, IL) | M-D: 1.76 ± 1.36 mm B-L: 3.31 ± 0.09 mm | M-D 2.17 ± 1.65 mm B-L: 3.92 ± 0.64 mm | M-D: no B-L: no |
Cast analysis buccal contour change after 8 weeks | Upper part: 1.96 ± 1.10 mm Middle part: 1.79 ± 0.90 mm Lower part: 0.5 ± 0.72 mm | Upper part: 2.59 ± 0.7 mm Middle part: 1.61 ± 0.43 mm Lower part: 0.56 ± 0.38 mm | Upper part: no Middle part: no Lower part: no | ||||
Cast analysis lingual contour change after 8 weeks | Upper part: 1.59 ± 0.64 mm Middle part: 0.42 ± 0.39 mm Lower part: 1.78 ± 0.57 mm | Upper part: 1.03 ± 0.57 mm Middle part: 1.78 ± 0.47 mm Lower part: 0.39 ± 0.35 mm | Upper part: no Middle part: no Lower part: no | ||||
Radiographic Resorption of Marginal Bone Levels at Mesial of the Extraction Site after 8 weeks | 2.22 ± 0.51 mm | 2.86 ± 0.65 mm | No | ||||
Radiographic Resorption of Marginal Bone Levels at distal of the Extraction Site after 8 weeks | 2.08 ± 0.09 mm | 2.10 ± 0.50 mm | No | ||||
Hauser et al. [46] | 23 | PRF | Spontaneous healing | Clinical measurements of the alveolar crest Width loss after 8 weeks | 0.48% | 3.68% | Yes P < 0.05 |
Radiographical analysis of the vertical linear Measurements on Superimposable Radiographs after 8 weeks | Mesial: 1.21 ± 0.4 mm Distal: 0.76 ± 0.25 mm | Mesial: 0.77 ± 0.17 mm Distal: 2.07 ± 0.81 mm | Mesial: yes Distal: no | ||||
Micro CT (bone volume/Tissue Volume) after 8 weeks | 0.281 ± 0.037 | 0.249 ± 0.037 | No | ||||
Thakkar et al. [52] | 36 sites | demineralized freeze‑dried bone allograft (DFDBA) mixed with PRF, covered by a collagen membrane | Demineralized freeze‑dried bone allograft (DFDBA), covered by a collagen membrane | calibrated radiographs (Ridge width reduction from baseline to 180 days) | 0.75 ± 0.49 mm | 1.3611 ± 0.70 mm | Yes (p = 0.005) |
Ridge height reduction (from baseline to 180 days) | 1.38 ± 0.50 mm | 1.08 ± 0.428 mm | No | ||||
Yewale et al. [51] | Sybograf plus (70% HA and 30% βTCP) mixed with A-PRF + , covered by a Collagen sponge (Collasponge ™) | Sybograf plus (70% HA and 30% βTCP), covered by a Collagen sponge (Collasponge ™) | CBCT after 6 months: horizontal width at 1 mm | 2.123 ± 0.76 mm | 1.83 ± 0.8 mm | No | |
CBCT after 6 months: horizontal width at 3 mm | 1.689 ± 0.84 mm | 0.596 ± 1.08 mm | Yes (p = 0.041) | ||||
CBCT after 6 months: horizontal width at 5 mm | 0.97 ± 1.28 mm | 0.59 ± 1.59 mm | No |
Secondary outcomes
Pain assessment
Study | n | Test | Control | Results test | Results control | Statistics |
---|---|---|---|---|---|---|
Mourao et al. [56] | 32 | L-PRF | Spontaneous healing | 7 days: 4 ± 1.15 | 7 days: 5.12 ± 1.08 | Yes (p = 0.0128) |
Ustaoglu et al. [42] | 57 | L-PRF | Spontaneous healing | Day 1: 3.30 ± 2.07 Day 2: 0.48 ± 0.92 | Day 1:5.11 ± 1.60 Day 2 | Day 1: yes (P = 0.047) Day 2: No |
T-PRF | Spontaneous healing | Day 1: 3.29 ± 1.85 Day 2: 0.47 ± 0.62 | Day 1: yes (P = 0.047) Day 2: No | |||
T-PRF vs. L-PRF No | ||||||
Kumar et al. [43] | 48 | PRF | Spontaneous healing | Day 1: 0% of the patients | Day: 1 18.1% of the patients | Not reported |
Asmael et al. [58] | 20 | PRF | Spontaneous healing | 48 h After Extraction: 0.65 | 48 h After Extraction: 1.8 | No |
Temmerman et al. [50] | 22 | L-PRF | Spontaneous healing | Day 3: 2,81 | Day 3: 3,52 | Yes P = 0.03 |
Marenzi et al. [57] | 26 | L-PRF | Spontaneous healing | 3.2 ± 0.3 | 4.5 ± 0.7 | Yes P < 0.0001 |
Yewale et al. [51] | 20 | Sybograf plus (70% HA and 30% βTCP) mixed with A-PRF + , covered by a Collagen sponge (Collasponge ™) | Sybograf plus (70% HA and 30% βTCP), covered by a Collagen sponge (Collasponge ™) | Pain frequency after 10 days: Mild:2 Moderate:8 | Pain frequency after 10 days: Mild:3 Moderate: 7 | No |
Soft tissue regeneration
Study | n | Test | Control | Method | Results test | Results control | Statistics |
---|---|---|---|---|---|---|---|
Sharma et al. [54] | 30 | PRF | Spontaneous healing | The Landry wound healing index (mean ± SD) | Day 3: 3.43 ± 0.504 Day 7: 3.93 ± 0.254 Day 14: 4.83 ± 0.379 | Day 3: 3.17 ± 0.379 Day 7: 3.73 ± 0.082 Day 14: 4.3 ± 0.46 | Day 3: yes p = 0.025 Day 7: yes P = 0.039 Day 14: yes p = 0.00 |
Mourao et al. [56] | 32 | L-PRF | Spontaneous healing | Wound healing index (mean ± SD) | Week 1: 3.81 ± 0.65 Week 2: 4.75 ± 0.44 | Week 1: 3.18 ± 0.54 Week 2: 4.5 ± 0.51 | Week 1: Yes p = 0.0138 Week 2: No |
Srinivas et al. [48] | 30 | PRF | Spontaneous healing | Wound healing index after 7 days | 3.8 ± 0.40 | 3.0 ± 0.53 | Yes P < 0.001 |
Ahmed et al. [53] | Spontaneous healing | Wound healing index | Very good 94.1% | Very good in 86.7% | Not reported | ||
Ustaoglu et al. [42] | 57 | L-PRF | Spontaneous healing | The Landry wound healing index (mean ± SD) | Week 1: 3.58 ± 0.63 Week 2: 4.59 ± 0.51 | Week 1: 3.21 ± 0.66 Week 2: 4.38 ± 0.49 | Week 1: no Week 2: no |
Spontaneous healing | Complete wound epithelization (%) | Week 1: 54.9 Week 2: 100 | Week 1: 10.1 Week 2: 40.7 | Week 1: yes P = 0.047 Week 2: yes P = 0.041 | |||
T-PRF | Spontaneous healing | The Landry wound healing index (mean ± SD) | Week 1: 3.69 ± 0.51 Week 2: 4.71 ± 0.50 | Week 1: 3.21 ± 0.66 Week 2: 4.38 ± 0.49 | Week 1: no Week 2: no | ||
Spontaneous healing | Complete wound epithelization (%) | Week 1: 70.1 Week 2: 100 | Week 1: 10.1 Week 2: 40.7 | Week 1: yes P = 0.047 Week 2: yes P = 0.041 | |||
Giudice et al. [40] | 40 | A-PRF + | Spontaneous healing | Wound healing index (mean) | Week 1: 1 Week 2: 0.25 | Week 1: 1.05 Week 2: 0.33 | No |
L-PRF | Spontaneous healing | Wound healing index (mean) | Week 1: 0.95 Week 2: 0.15 | Week 1: 1.05 Week 2: 0.33 | No | ||
Asmael et al. [58] | 20 | PRF | Spontaneous healing | Percentage of epithelization after 1 week | 52.7% | 51.3% | No |
The Landry wound healing index (mean) after 1 week | 3.45 | 4.2 | Yes P = 0.0035 | ||||
15 Marenzi et al. [57] | L-PRF | Spontaneous healing | Wound healing index (mean ± SD) | Day 3: 4.8 ± 0.6 Day 7: 4.5 ± 0.5 Day 14: 4.2 ± 0.2 Day 21: 4.1 ± 0.1 | Day 3: 5.1 ± 0.9 Day 7: 4.9 ± 0.3 Day 14: 4.3 ± 0.3 Day 21: 4.2 ± 0.2 | Day 3: No p = 0.197 Day 7: yes p = 0.05 Day 14: yes p = 0.01 Day 21: yes p = 0.0002 |