The Dental Applications of Platelet Rich Plasma
The use of platelet rich plasma (or “PRP therapy”) to accelerate healing gained widespread acceptance in the fields of sports medicine and orthopedic surgery during the 1990s. Now, PRP therapy has proven valuable when used in conjunction with dental implant procedures and tooth extraction, contributing to faster tissue and bone growth. PRP therapy is currently being used to reduce post-operative pain, promote tissue repair, and reduce healing times in a variety of different disciplines.
How it Works
PRP therapy allows patients to take advantage of the body’s natural capacity for healing, but at a greatly accelerated rate. During the body’s healing process, it sends different cell types, including platelets to the site of trauma to initiate healing.
In PRP therapy, the patient’s own blood is drawn out and then spun rapidly, resulting in a concentration of platelets. When this heavily concentrated portion of the blood is isolated it contains three to five times the number of growth factors found in normal blood.
Whereas platelet counts in normal blood range from 150,000/1L to 350,000/1L, platelet rich plasma has a concentration of at least 1,000,000/1L. Such a high concentration of platelets is particularly useful in producing highly differentiated cells, the combination of which are critical to rebuilding tissue – and especially bone. There is also a significant increase in vascularity in the healing tissue.
One highly relevant growth factor boosted by PRP is bone morphogenetic protein (BMP). There is much clinical evidence, both through animal and human-based studies, that indicates that BMP is a significant factor in the formation of new bone. The correlation between PRP and BMP is useful for dentists placing implants as it helps grow new bone at a much quicker rate than traditional methods for bone regeneration.
How it Helps
The evidence pointing to the efficacy of PRP therapy is compelling. In one study evaluating the healing times of patients following tooth extractions, it was found that patients treated with PRP therapy healed nearly six times faster than patients in the control group. These findings are significant, not only because they reveal the potential of PRP therapy to reduce the patient’s pain and suffering, but also because they offer a solution to several significant medical problems.
This is especially true in regards to problems associated with slow or improper healing following a tooth extraction, specifically in older patients. Poor healing can result in an excessive loss of bone that may prove either untreatable or fixable only through expensive reconstructive surgery. PRP therapy offers a technique for expedited healing that is simple, cost-effective, and reliable.
The reliability factor, in particular, is of great use to board certified maxillofacial surgeons, to allow their patients to heal and return to “full function” quicker while also reducing the wait time required by patients in need of prostheses or dental implants.
PRP Clinical Applications
PRP has proven to be effective in aiding several oral and maxillofacial surgical procedures. There is also evidence showing PRP therapy as a promising aid in periodontal regenerative therapy. PRP therapy helps in bone grafting, a procedure used to improve the outcome of dental implant surgery.
The treatment can be used for both onlay and inlay grafts, sinus lift procedures, ridge augmentation procedures, and closure of cleft, lip and palate defects. PRP can also be used in the repair of bone defects in the wake of tooth or cyst removal and the repair of fistulas between the sinus cavity and the mouth.
Implications for the Treatment of BRONJ
BRONJ stands for bisphosphonate-related osteonecrosis of the jaw. Bisphosphonates are widely used drugs for the treatment of osteoporosis, bone metastasis, and other pathologies joined by the same alteration of bone turn-over. The use of bisphosphonates limits the abilities of certain facial bones to heal, as the bisphosphonates repress various growth factors (GFs).
Seeing as PRP therapy is proven to boost GFs, it makes for a plausible theory that PRP therapy could be suited to treat BRONJ. As reported by the National Institute of Health in a 2013 study, “The growth factors in PRP might accelerate epithelial wound healing, decrease tissue inflammation after surgery, improve the regeneration of bone and soft tissues, and promote tissue vascularization.”
Immediate Advantages of PRP Application
As a medical treatment, the use of PRP comes with a multitude of implicit benefits. Obtaining the PRP from the patient is quick and cost-effective, for starters. Some oral surgeons simply use the same IV to both draw blood for the PRP and sedate the patient, thereby limiting the number of uncomfortable needle sticks.
The tools needed for spinning blood and obtaining PRP are simple and small enough that they can be stored and used within the confines of the oral surgeon’s office; there’s generally no need for involving a lab.
Furthermore, the quantity of blood required to generate PRP is only 55 cubic centimeters (cc). This small amount of blood can be harvested within the doctor’s office, so there’s no need to incur the expense of using a hospital or blood bank. Finally, since the patient’s own blood is sufficient for obtaining usable PRP, there is no risk of any disease transmission.
In the dental profession, as well as in the broader medical field, there is tremendous value placed on fast healing. The faster a patient heals following surgery, the lower the risk of infection and other complications. In recent years, the amount of blood needed to create PRPs decreased from one full unit to only 55 cc making the treatment a much more viable option. Meanwhile, new opportunities are being researched for the application of this promising and sustainable medical technology.
More randomized controlled trials (RCTs) will better define the potential of PRPs. Since the application of PRPs is natural and safe, there are few constraints on future testing. In fact, the wide variety of PRP tests in a host of scenarios is one of the reasons why many scientific consensuses around the subject have been somewhat elusive.
Nonetheless, significant evidence continues to mount on many fronts pointing to the safety and efficacy of PRP therapy in multiple dental and maxillofacial procedures.
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