The Use of Platlet Rich Plasma in Oral Surgery
For many years, clinicians in various specialties of dentistry and medicine have been searching for materials that can accelerate and enhance bone and soft tissue healing, especially that of bone and soft tissue grafts. While bone morphogenic protein appeared to be a promising alternative for the enhancement and promotion of bone grafts and bone growth, the reality was this material was tremendously expensive to manufacture in even small quantities.
More recently, in both the oral surgical and the orthopedic literature, platelet-rich plasma has been shown to accelerate and enhance bone graft maturation and density. Platelet-rich plasma (PRP) is an autologous source of concentrated platelets. When it is combined with thrombin and calcium chloride, PRP leads to the release of platelet-derived growth factor (PDGF) and transforming growth factors beta-I and beta-2 (TGFB-1 and B-2). These growth factors have been shown to produce increased blood vessel formation, to stimulate the arrival of bone precursors and also to promote the differentiation toward mature osteoblasts, stimulating the deposition of collagen matrix, and inhibiting osteoblast formation and bone resorption.
Technology introduced in the last few years allows clinicians to withdrawal minimal amounts of the patient’s own blood (50-60 cc of blood), which are then centrifuged in a double-spin protocol which allows platelet-rich plasma to be prepared within about 15 minutes. When mixed with topical thrombin, the platelet-rich plasma forms a gel which can be mixed with and/or sprayed over bone grafts or sprayed underneath the tissue flap. This platelet-rich plasma has been shown to accelerate bone and soft tissue healing and to reduce the amount of postoperative swelling and discomfort associated with surgery. In fact, in patients where bone harvest sites are minimal, PRP can be mixed with bone substitutes in certain instances and successful grafting can occur. For example, in a study by Valentini, et al., twenty sinus augmentations were performed using Bio-Oss, and six months later, 57 implants were placed. The implant survival rate was 98.1%.
Currently, in my practice, where I have been using PRP for the past three years, I have found that block bone grafts that previously required 5-6 months of maturation time now require only 3-4 when PRP is used.
Additionally, I am often able to use bone shavings mixed with PRP to perform much of the onlay grafting that I was unable to perform without block bone grafts prior to this. Furthermore, PRP sprayed under the soft tissue prior to closure at the conclusion of the surgery has been very effective at promoting much more rapid healing and reducing patient discomfort. I have also found PRP to be very effective in promoting healing in those patients who heal poorly.
In short, PRP is a wonderful surgical adjunct and can be used to not only enhance healing of hard and soft tissue, but also shortens recovery times and promotes patient comfort.