**2. Materials and methods**

A structured literature search (**Figure 2**) was performed on PUBMED (October 2015–February 2016) using MESH terms "Platelet-rich fibrin" and "Platelet-rich plasma" according to the

**Figure 2.** Flow-chart of literature search strategy and results.


following search strategy: "Platelet-rich fibrin" [All Fields] NOT "Platelet-rich plasma" [All Fields]. Results were limited by: Seniority (5 years since publication), Language (English), Availability (Full-text) and Species (Human). Inclusion criteria were: (a) randomized clinical trials (RCTs) using (b) Choukroun's L-PRF (not PRF) in (c) Oro-Maxillo-Facial procedures. Initial search resulted in 62 articles, 19 of which met the inclusion criteria (**Table 2**). Five articles were excluded due to quality/availability lack of randomization. Due to the high het-

L-PRF: A "Super" Biomaterial for Naturally Guided Hard/Soft Tissue Bioengineering and Regeneration...

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Periodontal tissue regeneration has been defined as the formation of new cementum, alveolar bone, and a functional periodontal ligament on a previously-diseased tooth-supporting root surface. Due to limited intrinsic regenerative potential, IBDs are a common and challenging sequel of periodontal disease. Meta-analyses demonstrated that, treatment with conservative open flap debridement, produces an Average Clinical Attachment (CAL) gain of 2.0 mm [9]. While about 1.5 mm may be attributed to newly formed bone; bone-fill does not implicate the regeneration of new attachment to the root [9]. In this context, L-PRF appears promising for regeneration of the whole periodontal attachment system (**Figure 3A** and **B**). Five RCTs addressing the prospective application of L-PRF in the treatment of Periodontal IBD were found. The identified studies allowed for the following comparisons: (a) L-PRF/Open flap surgery vs. Open flap surgery [10–12], (b) L-PRF/Bio-Oss® constructs (Bio-Oss®, Geistlich Pharma North America, Inc.) vs. L-PRF [13] and (c) L-PRF/DFDBA constructs vs. DFDBA (Demineralized Freeze-Dried Bone Allograft) [14]. All patients included in those studies were periodontally stable and systemically healthy individuals who presented: similar bilateral IBD of at least 5 mm probing depth, located in vital asymptomatic teeth with no furcation involvement. Studies evaluating the addition of L-PRF to conventional open flap procedure reported the biomaterial notably improving both, clinical and radiographic parameters of IBDs, after 9 [11, 12] and 12 months [10]. A significant increase in probing depth (PD) reduc-

Gingival Margin Stability [(GMS) *less post-treatment gingival recession*], bone defect fill and percentage bone defect fill were noticed in all L-PRF-treated sites vs. controls [10–12]. Interestingly, higher patient acceptance was also associated with use of L-PRF. Most probably, this is attributed to the accelerated wound healing and pain-inhibitory properties [10, 11]. The presented PD reduction and CAL gain values were superior to previously-reported values in meta-analysis performed for open flap surgery [9], suggesting the additional benefits of L-PRF over the conventional approach. Treatment with L-PRF/particulate bone-graft substitutes (Bio-Oss® [13] and DFDBA [14]) provided additional statistically-significant benefits, in terms of PD reduction, CAL gain and bone defect fill vs. graft substitutes, after 6 months. Nonetheless, the absence of "simultaneously-run" L-PRF-alone control renders it difficult to

erogeneity, results are presented in a narrative format.

**3.1. L-PRF in the treatment of periodontal intrabony defects (IBDs)**

**3. Results and discussion**

tion, CAL gain, post-treatment.

**Table 2.** Summary of clinical literature (RCTs) on L-PRF use in dentistry.

following search strategy: "Platelet-rich fibrin" [All Fields] NOT "Platelet-rich plasma" [All Fields]. Results were limited by: Seniority (5 years since publication), Language (English), Availability (Full-text) and Species (Human). Inclusion criteria were: (a) randomized clinical trials (RCTs) using (b) Choukroun's L-PRF (not PRF) in (c) Oro-Maxillo-Facial procedures. Initial search resulted in 62 articles, 19 of which met the inclusion criteria (**Table 2**). Five articles were excluded due to quality/availability lack of randomization. Due to the high heterogeneity, results are presented in a narrative format.
