Adjunctive therapy for root coverage with concentrated growth factor versus platelet-rich fibrin membranes: a systematic review and bayesian network meta-analysis

Objectives: To assess the differences between adjunctive therapy with Concentrated Growth Factor (CGF), Platelet-rich Fibrin (PRF) membranes, and available control groups in the clinical outcomes of root coverage.

Materials and methods: Randomized controlled clinical trials (RCTs) were identified in Pubmed/Medline, Scopus, and ISI Web of Science databases to assess the treatments after 6 months using a Bayesian random-effect network meta-analysis (NMA) framework regarding reduction in pocket depth (PD), clinical attachment loss (CAL), recession depth (RD), and width (RW), as well as, keratinized tissue width (KTW) and thickness (KTT) gain, and complete (CRC) and mean (MRC) root coverage percentages.

Results: Thirty-two RCTs were included, from which 27, 18, 12, eight, one, and one studies investigated PRF, connective tissue graft (CTG), flap alone, CGF, enamel matrix derivative (EMD), and dehydrated amniotic membrane, respectively. Thirty studies comprising CTG and flap-alone arms other than CGF and PRF were added to NMA. No significant difference has been found between CGF and PRF; however, CGF have a higher probability of being a better treatment than PRF in PD, CAL, and RW reduction and KTW gain, and PRF has a higher probability for being better in MRC, CRC, KTT gain, and RD reduction. PRF was significantly superior to flap-alone in terms of KTT gain and RD reduction. CGF had the highest probability of being the best treatment in PD and RW reduction, but in other outcomes, CTG was superior. PRF was significantly superior to flap-alone in terms of KTT gain and RD reduction.

Conclusions: Both adjunctive CGF and PRF demonstrated improvements regarding root coverage outcomes. Although there is no significant difference between PRF and CGF, these two membranes might have different impacts on different outcomes. Further studies are required for a more comprehensive conclusion, especially on CGF.

Clinical relevance: CTG is recommended for achieving ideal results in root coverage procedure. Since PRF and CGF both have a higher probability for being superior to flap alone, both could be suggested in cases which less than ideal outcomes are acceptable and minimization of patient discomfort is necessary.