Platelet Rich Plasma is a simple, efficient, and minimally invasive method of obtaining a natural concentration of autologous growth factors and bio-active proteins. It has been used for years to restore, revive and regenerate damaged tissue in the body. PRP is now well established in the fields of dentistry, cosmetic surgery, plastic and maxillofacial surgery. These fields all well known to dentists.
The rationale for this wide spread use of PRP in the healing process of these varied fields of medicine and dentistry resides in the fact that platelets represent an easily obtainable reservoir of critical molecules involved in the tissue healing process. These molecules contribute to a well- orchestrated tissue healing symphony which proceeds through all three phases of tissue healing; the inflammatory, the reparative and the remodeling phases of wound healing.
Platelet Rich Fibrin is defined as an autologous leukocyte and platelet rich fibrin biomaterial that is obtained from the patients own blood and can be used for a variety of purposes and applications.
Platelet Rich Fibrin was first introduced in France by Choukroun in 2001. It was defined as a second- generation platelet concentrate comprised of autologous platelet and leukocyte fibrin biomaterial which accumulates platelets, immunity promoters and cytokines in the clot.
The Platelet Rich Fibrin forms a dense fibrin network that enables slower degradation rate and therefore a delayed release of growth factors to the surrounding tissue for healing and regeneration.
The release of growth factors from PRF has been reported up to 7 days for the majority of applications and sometimes longer.
Since 1990, medical science has recognized the components of blood, which are part of the natural healing process and when added to wounded tissue or surgical sites, have the potential to accelerate wound healing. Fibrin glue was first described in 1970 and is formed by polymerizing fibrinogen with thrombin and calcium. It was originally prepared using donor plasma however because of the low concentration of fibrinogen in plasma, the stability and quality was extremely low.
Platelet Rich Plasma was found to be an autologous modification of fibrin glue derived by concentrating platelets and when used in various applications had significant clinical success.
A normal blood clot contains 94% red blood cells, 5% platelets and 1% white blood cells while Platelet Rich Plasma contains 95% platelets.
Platelet Rich Fibrin was invented as an immune platelet concentrate collecting on a fibrin membrane containing all the constituents of a blood sample favorable to healing and immunity. PRF consists of a fibrin matrix polymerized in a tetra molecular structure with incorporation of platelets, leucocytes, cytokines and circulating stem cells. This material was used in conjunction with bone grafts and found to impart better healing to the graft while sealing the area, imparting hemostasis and overall better handling properties to the graft material.
Platelet Rich Fibrin was developed in France for specific use in oral and maxillofacial surgery. Today, PRF can be considered as a natural fibrin -based biomaterial, favorable to the development of micro-vascularization and epithelial cell migration. This can protect open wounds and accelerate healing. In cases of infectious wounds, this material contains leukocytes and promotes migration of other WBC’s to fight the infection.
PRF is routinely used in dental surgical procedures:
- Post enucleation of apical lesions
- Surgical removal of impacted third molars
- Impacted Canines
- Pre-prosthetic surgeries
- Graft Stabilization
- Cavities filled with PRF showed complete healing in half the normal time required
2021 there were 201,927 Dentists in the United States. Most have been trained in the use of Platelet Rich Fibrin.
In recent years, regenerative medicine is commonplace in the US and dentistry has extensively embraced the use of both PRP and PRF
The cost of regenerative therapy can be reduced by the combination of both PRP and PRF.
PRP has gained increasing popularity in the field of regenerative dentistry.
Regenerative Dentistry
- Regenerative endodontics (pulpotomy, apical surgery and apexification)
- Periodontics (treatment of infra-bony periodontal defects and periodontal plastic surgery)
- Oral and Maxillofacial surgery (tooth extractions, soft tissue and bone tissue surgery)
- Implant surgery
PRP in Endodontic Surgery
Regenerative endodontics aims to regenerate damaged/necrotic pulp-dentin tissues and root structures. PRP has been used widely in this application because of the ability to release a rich varied supply of healing and growth producing bio-substances. PRP supports cell growth and differentiation in the canal after disinfection. PRP promotes revascularization and is an effective modality in the regeneration of the compromised structural integrity.
There are many reports of single visit regenerative endodontic therapy involving the use of PRP.
The single visit has two advantages; it reduces the possibility of further bacterial contamination of the root canal and reduces the negative consequence of poor patient follow up.
It has also been found that PRP can serve as a successful scaffold for regenerative endodontic therapy.
Research has proven PRP to also be an effective scaffold in the treatment of necrotic immature teeth. In these patients, two clinical concepts are achieved.
First, the revitalization of necrotic tissue and second the active pursuit of pulp and dentin regeneration through the use of tissue engineering. The use of PRP allows immature pulp-less teeth to continue to grow and mature.
Studies are very promising to this date and ongoing so that standardized treatment protocols will be established.
PRP in Periodontal Regeneration Procedures
Regeneration of tooth supporting structures destroyed by periodontitis. This is the major goal. Periodontal regenerative surgery aims to regenerate alveolar bone, cementum and functional periodontal ligament. Once platelets are activated, they release their granules. In the granules are growth factors which contribute to chemotaxis, differentiation, metabolism and mobilization of cells involved in wound healing. During periodontal wound healing after the application of PRP, the concentrations of growth factors are significantly increased which then exert regulatory effects on the homeostasis of periodontal tissues and enhance the healing outcomes.
An important criterion for periodontal regeneration is the maintenance of a wound space to which the periodontal ligament can migrate. Because PRP possesses limited space potential it has been used with success mainly in combination with bone grafts or substitutes.
PRP in Oral and Maxillofacial Surgery
A number of studies have shown that PRP can significantly reduce postoperative pain and discomfort after tooth avulsion and can avoid the development of osteitis. In a study conducted on the effect of PRP on the healing of extraction sockets, the findings not only was postoperative pain less in the PRP group but there was clinically appreciable soft tissue healing in the PRP group when compared to controls.
Patients with third molar extractions showed treatment with PRP lead to pain reduction as well as improvement in swelling and the ability of mouth opening. Also, there was significant increase in the radiodensity over the baseline after tooth extraction and a decreased incidence of alveolar osteitis in the extraction socket.
PRP in Implant Dentistry
PRP has been utilized in dental implantology for stimulating new bone growth and peripheral nerve regeneration. Many studies have reported the beneficial effects of PRP on hard and soft tissue healing.
In a canine study, to access the effect of PRP on nerve innervation in the peri-implant bone, they demonstrated that PRP exhibited a significant effect on the diameter of the myelinated nerve fibers and might help to improve regeneration of nerve fibers.
PRP in Sinus-Floor Augmentation and Bone Remodeling
PRP has been added to graft materials for sinus floor augmentation. The beneficial use of PRP as an adjunct to bone material for sinus floor augmentation remains controversial but there are many studies stating there is significant advantages to the use of PRP. It has been reported that PRP can improve the regenerative potential of organic bovine bone by effectively enhancing bone formation and vascularization in the maxillary sinus floor. Also suggested that PRP might accelerate bone formation and regeneration by promoting angiogenesis.
Regenerative therapies have been emerging both in the field of medicine and dentistry. PRP is the vehicle that is driving new treatments. It is a concentrated source of growth factors and bio-active substances that when applied to an area of tissue damage can repair and regenerate tissues. PRP is a focus in regenerative dentistry as a treatment modality in different oral disorders. Clinical studies have been favorable and are ongoing into newer uses and applications. PRP/PRF are both going to be expanding in the field of regenerative dentistry into the future.
Juventix Regenerative Medical is an industry leader in the regenerative medical field. Our Platelet Rich Plasma Kits are FDA approved and designed for safety and effectiveness. They are cost effective and easy to use. Our kits provide consistency of concentrated product when obtained from the same source.
Juventix Regenerative Medical offers a patent pending LED Activator to active the platelets and begin the regenerative process. The activation, a critical step in the release of cytokines and growth factors, is accomplished with light and not with the addition of other chemicals such as Calcium Chloride or Thrombin.
Juventix Regenerative Medical supplies a Bio-Incubator that transforms the Platelet Rich Plasma to an Injectable Platelet Rich Fibrin. The PRF, commonly referred to as the “second generation of platelet products” has a broader range of clinical applications while providing outstanding outcomes.
RESTORE, REVIVE, REGENERATE- JUVENTIX REGENERATIVE MEDICAL
Regenerative Regards,
Dr. Robert McGrath
Studies
J Vet Dent 2019 Jun;36(2):109-123 PMID 31662059
Dent Clin North Am 2020 Apr;64(2):291-303 PMID 32111269
Ann Maxillofac Surg 2011 Jan-Jun;1(1): 53-57 PMID 23482459
Aust Dent J 2020 Jun; 65(2): 131-142 PMID 32145082
