The effect of platelet rich fibrin in secondary alveolar bone graftting in cleft lip and palate patients: a randomised prospective study

Abstract

Cleft lip, alveolus and palate is the most common congenital abnormality in the world. In Malaysia, it is reported one in seven hundred live births are diagnosed with cleft. The treatment process involves secondary alveolar bone grafting (SABG) harvesting from iliac crest which will be performed at the age of eight to twelve years old or when there is unerupted permanent canine. The problem that arises post-operative SABG is the loss of bone due to resorption. Therefore, our aims for this study are to assess the efficacy of SABG with the combination of platelet rich fibrin (PRF) or platelet rich plasma (PRP), and to assess the effectiveness of PRF in facilitating bone healing and enhancing periodontal healing post-operative SABG. This study involved systematic review and randomised control trial (RCT). Systematic review was performed on four articles whereas RCT involved nineteen patients, both unilateral and bilateral clefts, in the age group of eight to twelve years or patients with unerupted permanent canine, where nine patients in the PRF group (with the usage of PRF) and ten patients in the membrane group (with the usage of resorbable pericardium membrane). In systematic review, we evaluated bone height, bone density and bone volume. Evaluation of RCT involved one day pre-operatively as baseline, up to six months post-operatively. In RCT, we evaluated clinical assessment on tooth mobility, gingival recession, periodontal pocketing, and canine eruption while radiographic evaluation was on bone height, bone volume and bone density. Local post-operative complications of the recipient site and donor site was also studied, involving pain score, wound breakdown, wound dehiscence, fistula, hematoma, and scar. Our result in systematic review showed both PRF/PRP group and control group achieved successful outcome. In RCT, there was no statistically significant result between PRF group and resorbable pericardium membrane group in clinical, radiological and local post-operative complications, however significant difference was seen with better bone volume in membrane group. In conclusion, PRF/PRP is equally as effective as the control group.