Highlighted review: Autologous platelet concentrates for treating periodontal infrabony defects

Massimo Del Fabbro, Lorena Karanxha, Saurav Panda, Cristina Bucchi, Jayakumar Nadathur Doraiswamy, Malaiappan Sankari, Surendar Ramamoorthi, Sheeja Varghese, Silvio Taschieri

Plain language summary: Autologous platelet concentrates for treating periodontal infrabony defects 

Review question 
Does the addition of autologous platelet concentrates (APC) improve surgical treatment outcomes of bone defects in gum disease? 

Background 
Teeth are maintained in their position by soft and hard tissues (gums and surrounding bone). Gum disease or periodontitis, is an inflammatory condition of all these tissues caused by the bacteria present in the dental plaque.

If left untreated, gum disease can cause teeth to loosen and eventually lead to tooth loss. The destruction of jaw bone around teeth (called the alveolar bone) during gum disease, can be horizontal (where the whole level of bone around the root is reduced) or vertical, forming a bone defect within the bone (infrabony defect).

There are several available surgical treatments for infrabony defects, including:
1. open flap debridement in which the gum is lifted back surgically in order to clean the deep tartar;
2. bone graft in which a portion of natural or synthetic bone is placed in the area of bone loss;
3. guided tissue regeneration in which a small piece of membrane‐like material is placed between the bone and gum tissue in order to keep the gum tissue from growing into the area where the bone should be; and
4. the use of enamel matrix derivative, a gel‐like material which is placed in the area where bone loss has occurred and promotes its regeneration.

In order to accelerate the healing process, autologous platelet concentrates have been recently used. They are concentrates of the platelets of patient's own blood containing growth factors that are thought to promote tissue regeneration.

The aim of this review was to assess if the addition of APC brings any benefits in the treatment of infrabony defects when combined with different surgical treatments. 

Study characteristics 
Authors from Cochrane Oral Health carried out this review and the evidence is up to date to 27 February 2018. We included 38 studies and a total of 1042 infrabony defects. We considered four different types of surgical treatments and compared each technique with the same one when APC was added.

Overall we considered these comparisons: open flap debridement with APC versus without APC; open flap debridement and bone graft with APC versus without APC; guided tissue regeneration with APC versus without APC; and enamel matrix derivative with APC versus without APC. 

Key results 
There is very low‐quality evidence that the addition of APC to two types of treatment: open flap debridement and open flap debridement with bone graft, may bring some advantages in the treatment of infrabony defects. However, for the other two types of treatment, guided tissue regeneration and enamel matrix derivative, there is insufficient evidence of a benefit. 

Quality of evidence 
We judged the quality of the evidence to be very low due to problems with the design of the studies. 

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Citation: Del Fabbro  M, Karanxha  L, Panda  S, Bucchi  C, Nadathur Doraiswamy  J, Sankari  M, Ramamoorthi  S, Varghese  S, Taschieri  S. Autologous platelet concentrates for treating periodontal infrabony defects. Cochrane Database of Systematic Reviews 2018, Issue 11. Art. No.: CD011423. DOI: 10.1002/14651858.CD011423.pub2.