Background: The aim of this review was to evaluate the adjunctive effect of autologous platelet concentrates (APCs) for the treatment of furcation defects, in terms of scientific quality of the clinical trials and regeneration parameters assessment. Methods: A systematic search was carried out in the electronic databases MEDLINE, SCOPUS, CENTRAL (Cochrane Central Register of Controlled Trials), and EMBASE, together with hand searching of relevant journals. Two independent reviewers screened the articles yielded in the initial search and retrieved the full-text version of potentially eligible studies. Relevant data and outcomes were extracted from the included studies. Risk of bias assessment was also carried out. The outcome variables, relative to baseline and post-operative defect characteristics (probing pocket depth (PPD), horizontal and vertical clinical attachment loss (HCAL, VCAL), horizontal and vertical furcation depth (HFD, VFD) were considered for meta-analysis. Results: Ten randomized trials were included in this review. Only one study was judged at high risk of bias, while seven had a low risk, testifying to the good level of the evidence of this review. The meta-analysis showed a favorable effect regarding all outcome variables, for APCs used in adjunct to open flap debridement (p < 0.001). Regarding APCs in adjunct to bone grafting, a significant advantage was found only for HCAL (p < 0.001, mean difference 0.74, 95% CI 0.54, 0.94). The sub-group analysis showed that both platelet-rich fibrin and platelet-rich plasma in adjunct with open flap debridement, yielded significantly favorable results. No meta-analysis was performed for APCs in combination with guided tissue regeneration (GTR) as only one study was found. Conclusion: For the treatment of furcation defects APCs may be beneficial as an adjunct to open flap debridement alone and bone grafting, while limited evidence of an effect of APCs when used in combination with GTR was found.
1 January 2021 in Journal of Cranio-Maxillofacial Surgery
Background: To assess the changes in the inclination of the premolar and molar during a maxillary expansion with a micro-implant-assisted skeletal expander (MSE). Materials and Methods: A total of 21 patients (16 females, 5 males) with a mean age of 18.6 ± 4.5 (range 11.3–26.3 years) with a transverse maxillary deficiency were included in this study. They all received an MSE appliance for the maxillary skeletal expansion. The activation protocol consisted of about 0.5 mm expansion a day until a diastema was observed and continued with about 0.25 mm a day until the desired transverse relationship between the maxilla and mandible was achieved. OnDemand3D software was used for the measurements of the inclination change in the maxillary premolars and molars, pre- and post-expansion. Graphpad was used to compare the mean change in each tooth with the zero value (no change), and the p values of these changes with every tooth were calculated. Moreover, the changes and the mean values of all the teeth on the left and right sides were calculated separately. Results: A total of sixteen measurements were conducted for each patient. The first premolars tipped palatally after the expansion, while the second premolars and molars tipped buccally. The changes were significant for the molars and the left second premolar. Conclusions: The MSE induced some changes in the tooth inclination. The first premolars moved palatally, most likely due to perioral musculature and mastication force, while the first and second molars moved buccally. The second molar buccal movement is most likely due to the craniofacial rotation caused by the MSE as they were not subject to the expansion force.