Table 3.
Articles extracted from the SRs included in this study, which were included in the meta-analysis
| Authors, year | SRs included that cited | Protocol applied | Follow-up | Design | Weight (%) | Conclusions* |
|---|---|---|---|---|---|---|
| Aroca et al., 2009 | Del Fabbro et al., 2011; Chambrone and Tatakis, 2015, Luo et al., 2015, Moraschini and Barboza, 2016; Castro et al., 2017 (5 articles) | Hardware: EBA 20, Hettich GmbH and Co KG, Tuttlingen, Germany; Setting: 3000 r.p.m./10 min. (Tube type: NR); (named: fibrin clot, PRF); 4 membranes prepared (but is not clearly described if the authors applied the four membranes in situ) | 6 months | RCT Split-mouth not blind (miller Class I and II) | 13.16 | Multiple gingival recessions indicated that MCAF surgery alone or in combination with PRF are effective procedures to cover denuded roots. No additional benefit in terms of mean root coverage or short-term wound healing for the treatment of multiple gingival recessions (PRF group) |
| Jankovic et al., 2010 | Chambrone and Tatakis, 2015; Moraschini and Barboza, 2016; Amine et al., 2017; Castro et al., 2017; Chambrone et al., 2019 (5 articles) | Hardware: NR; Setting: 3000 r.p.m. (approximately 400G)/10 min. (Tube type: NR); (named: PRF); 1 membrane | 12 months | RCT Split-mouth Not blind (Miller Class I and II) | 13.16 | Both techniques proved to be clinically successful in the treatment of GR. Minor advantages of PRF membrane use as graft material are related to advanced tissue healing during the 1st week postsurgery and a decrease in patient discomfort during the early wound healing period. The study did not succeed in demonstrating any clinical advantage of the use of PRF compared to EMD in coverage of GR (MCAF) |
| Jankovic et al., 2012 | Valenzuela and Oliva, 2014; Chambrone and Tatakis, 2015; Moraschini and Barboza, 2016; Amine et al., 2017; Castro et al., 2017 (5 articles) | Hardware: NR; Setting: 3000 r.p.m. (approximately 400G)/10 min. (Tube type: NR); (named: PRF); 1 membrane | 6 months | RCT Split-mouth single-blind (miller Class I and II) | 13.16 | Clinical implications and advantages of PRF membrane as a graft material are related to avoidance of a donor site surgical procedure, advanced tissue healing for the first 2 weeks postsurgery, and a major decrease in patient discomfort during the early wound-healing period. A high level of observed clinical parameter equivalence between CTG and PRF groups powerfully supports the clinical value of PRF use |
| Padma et al. 2013 | Luo et al., 2015; Moraschini and Barboza, 2016; Amine et al., 2017; Castro et al., 2017; Li et al., 2019 (5 articles) | Hardware: NR; Setting: 3000 r.p.m./10 min. (Tube type: NR); (named: PRF); 1 membrane | 6 months | RCT split-mouth Not blind (Miller Class I and II) | 13.16 | CAF surgery alone or in combination with PRF are effective procedures to cover denuded roots. The data obtained from a combination of CAF-PRF after a period of 6 months showed additional benefits along with mean root coverage in the treatment of miller’s class I and II gingival recessions when compared with the CAF technique alone |
| Thamaraiselvan et al., 2015 | Moraschini and Barboza, 2016; Amine et al., 2017; Castro et al., 2017; Li et al., 2019 (4 articles) | Hardware: NR; Setting: 3000 r.p.m./10 min. (Following original technique, Choukroun et al. 2001*); (Tube type: NR); (named: fibrin clot, PRF); 1 membrane | 6 months | RCT parallel Single-blind (Miller Class I and II) | 10.54 | The ease of applying PRF in the dental clinic and its beneficial outcomes, including reduction of bleeding and rapid healing, holds promise even though the mechanisms involved are still poorly understood |
| Eren and Atilla, 2014 | Moraschini and Barboza, 2016; Amine et al., 2017; Castro et al., 2017 (3 articles) | Hardware: Nüve Laboratory Equipments, NF200, Ankara, Turkey; Setting: 400G/12 min. (Glass-coated plastic tube); (named: fibrin clot, PRF); 1 membrane (thickness of 1 mm; PRF membrane was doubled by placing one part onto the other) | 6 months | RCT split-mouth Single-blind (Miller Class I and II) | 7.89 | A clinical advantage of PRF as a graft material is related to avoidance of a donor site and a major decrease in patient discomfort after operation. Due to these features, it could be concluded that CAF + PRF technique may represent an alternative to the traditional CAF + SCTG technique |
| Tunali et al., 2015 | Moraschini and Barboza, 2016; Castro et al., 2017; Chambrone et al., 2019 (3 articles) | Hardware: EBA 20, Hettich GmbH and Co KG, Tuttlingen, Germany; Setting: 2700 r.p.m./12 min. (Prepared according to the protocol developed by Choukroun et al. in 2001 - Process Protocol*); (Glass tube); (named: L-PRF, autologous PRF); 1 membrane | 12 months | RCT Split-mouth Single-blind (Miller Class I and II) | 7.89 | L-PRF membrane, in combination with a CAF procedure, is safe and effective for the treatment of Miller Class I and II gingival recession defects, without the significant morbidity or potential clinical difficulties associated with donor-site surgery |
| Gupta et al., 2015 | Castro et al., 2017; Li et al., 2019 (2 articles) | Hardware: RC-4, REMI Laboratories, Mumbai, India; Setting: 2700 r.p.m./12 min. (Glass tube); (named: PRF clot, PRF membrane); 1 membrane (1 mm area of RBC layer as the leukocytes and platelets are found to be concentrated at the junction of PRF clot and RBC layer) | 6 months | RCT Parallel Not blind (miller Class I and II) | 5.26 | It can be safely concluded that CAF alone and in combination with PRF membrane is a highly predictable procedure for the treatment of miller Class I and Class II gingival recessions. However, PRF provided an additional advantage of earlier healing and quicker attainment of optimal gingival tissue thickness which was maintained throughout the follow-up period. As adequate gingival tissue thickness is a known predictive factor for long-term stability of soft tissue recession coverage; it can be inferred that the use of PRF in conjunction with CAF can prove to be a superior choice for the treatment of such defects. PRF being an autologous material might possess both regenerative capacities as well as resorption potential. |
| Keceli et al., 2015 | Castro et al., 2017; Chambrone et al., 2019 (2 articles) | Hardware: Mikro 22 R Hettich Centrifugal Machine, Tuttlingen, Germany; Setting: NR (Tube type: NR); (named: L-PRF); 1 membrane | 6 months | RCT split-mouth Single-blind (Miller Class I and II) | 5.26 | PRF does not develop the primary outcome like obtained with CAF + CTG. It might have positively, albeit weakly, an important clinical variable in recession treatment, by the activity of growth factors and the fibrin matrix constituent. However, this finding is still not sufficient to advocate the true clinical effect of PRF |
| Öncü et al., 2017 | Chambrone et al., 2019 (1 article) | Hardware: PC-02, Process; Setting: 2700 r.p.m./12 min (Glass-coated plastic tube); (named: fibrin clot, PRF); 1 membrane | 6 months | RCT split-mouth (multiple gingival recession) (Miller Class I and II) | 2.63 | Control and test were effective. PRF avoids a donor site, which means a major decrease in postoperative discomfort |
| Bozkurt et al., 2015 | Li et al., 2019 (1 article) | Hardware: Medifuge, Silfradentsr, S. Sofia, Italy; Setting: CGF (30′′ acceleration, 2’ 2700 r.p.m., 4’ 2400 r.p.m., 4’ 2700 r.p.m., 3’ 3000 r.p.m., and 36′′ deceleration and stop)/14:06 min. (Glass-coated plastic tube); (named: CGF); 1 membrane (thickness of 1 mm) | 6 months | RCT split-mouth RCT split-mouth (Miller Class I and II) | 2.63 | CGF + CAF was not superior to CAF alone in providing a consistent reduction in the baseline recession |
| Kuka et al., 2017 | Li et al., 2019 (1 article) | Hardware: Hettich EBA 20 centrifuge, Tutlingen, Germany; Setting: 3000 r.p.m./10 min. (Following De Sanctis and Zucchelli technique, 2007*); (Tube type: Glass-coated plastic tube); (named: PRF); 1 membrane | 12 months | RCT split-mouth (only Miller Class I) | 2.63 | CAF + PRF and CAF approaches were successful in root coverage of multiple Miller class I gingival recessions. Clinically, the CAF + PRF procedure resulted in better soft tissue healing. PRF might be an alternative to different grafting materials for the treatment of multiple gingival recessions |
| Dixit et al., 2018 | Li et al., 2019 (1 article) | Hardware: NR; Setting: 2700 r.p.m./12 min. (Tube type: NR; only 6 mL); (named: PRF); 1 membrane | 6 months | RCT split-mouth (Miller Class I and II) | 2.63 | Single tooth gingival recessions by CAF indicated that only benefit of the addition of PRF appears to be a significant increase in the thickness of gingiva which may improve the predictability and long-term maintenance of achieved soft tissue root coverage |
The weight of each work was evaluated proportionally appear in other SRs; *Reported by authors[2]. PRF – Platelet-rich in fibrin; L-PRF – Leukocyte- platelet-rich in fibrin; CAF – Coronally advanced flap; GR – Gingival recession; SCTG – Subepithelial connective tissue graft; CGF – Concentrated growth factor; EMD – Enamel matrix derivative; SR – Systematic review; RCT – Randomized controlled trials; MCAF – Modification CAF. Articles referred (protocols): Choukroun J, Adda F, Schoeffler C, Vervelle A. An opportunity in perioimplantology: The PRF [in French]. Implantodontie 2001;42:55-62. (The L-PRF was prepared according to the protocol developed by Choukroun et al. in 2001 (Process Protocol)); Dohan Ehrenfest DM, Choukroun J, Diss A, Dohan SL, Dohan AJ, Mouhyi J, et al. Platelet-rich fibrin (PRF): A second-generation platelet concentrate. Part I: Technological concepts and evolution. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;101:37-44. (The blood was quickly collected, and the tubes were immediately centrifuged at 2,700 rpm for 12 min 5 using a Hettich Universal 320 table centri- fuge (Hettich Instruments) at room temperature); De Sanctis M, Zucchelli G. Coronally advanced flap: A modified surgical approach for isolated recession-type defects: Three-year results. J Clin Periodontol 2007;34:262-8 (protocol used 3000 r.p.m. × 10 min.); Tatakis DN, Chambrone L, Allen EP, Langer B, McGuire MK, Richardson CR, et al. Periodontal soft tissue root coverage procedures: A consensus report from the AAP regeneration workshop. J Periodontol 2015;86:S52-5. (use of glass-coat plastic tube), RPM – Revolutions per minute; NR – Not Reported; G – Gravitational force; CTG – Connective tissue graft; RBC – Red blood cells