• Richard J Miron, Vittorio Moraschini, Massimo Del Fabbro, Adriano Piattelli, Masako Fujioka-Kobayashi, Yufeng Zhang, Nikola Saulacic, Benoit Schaller, Tomoyuki Kawase, Raluca Cosgarea, Soren Jepsen, Delia Tuttle, Mark Bishara, Luigi Canullo, Meizi Eliezer, Andreas Stavropoulos, Yoshinori Shirakata, Alexandra Stähli, Reinhard Gruber, Ondine Lucaciu, Sofia Aroca, Herbert Deppe, Hom-Lay Wang, and Anton Sculean.
• Department of Periodontology, University of Bern, Bern, Switzerland. richard.miron@zmk.unibe.ch.
• Clin Oral Investig. 2020 Aug 1; 24 (8): 2543-2557.

ObjectivesThe aim of this systematic review and meta-analysis was to compare the use of platelet-rich fibrin (PRF) with other commonly utilized treatment modalities for root coverage procedures.Materials And MethodsThe eligibility criteria comprised randomized controlled trials (RCTs) comparing the performance of PRF with that of other modalities in the treatment of Miller class I or II (Cairo RT I) gingival recessions. Studies were classified into 5 categories as follows: (1) coronally advanced flap (CAF) alone vs CAF/PRF, (2) CAF/connective tissue graft (CAF/CTG) vs CAF/PRF, (3) CAF/enamel matrix derivative (CAF/EMD) vs CAF/PRF, (4) CAF/amnion membrane (CAF/AM) vs CAF/PRF, and (5) CAF/CTG vs CAF/CTG/PRF. Studies were evaluated for percentage of relative root coverage (rRC; primary outcome), clinical attachment level (CAL), keratinized mucosa width (KMW), and probing depth (PD) (secondary outcomes).ResultsFrom 976 articles identified, 17 RCTs were included. The use of PRF statistically significantly increased rRC and CAL compared with CAF alone. No change in KMW or reduction in PD was reported. Compared with PRF, CTG resulted in statistically significantly better KMW and RC. No statistically significant differences were reported between the CAF/PRF and CAF/EMD groups or between the CAF/PRF and CAF/AM groups for any of the investigated parameters.ConclusionsThe use of CAF/PRF improved rRC and CAL compared with the use of CAF alone. While similar outcomes were observed between CAF/PRF and CAF/CTG for CAL and PD change, the latter group led to statistically significantly better outcomes in terms of rRC and KTW. In summary, the use of PRF in conjunction with CAF may represent a valid treatment modality for gingival recessions exhibiting adequate baseline KMW.Clinical RelevanceThe data indicate that the use of PRF in conjunction with CAF statistically significantly improves rRC when compared with CAF alone but did not improve KMW. Therefore, in cases with limited baseline KMW, the use of CTG may be preferred over PRF.

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