08 April 2020

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Platelet-rich plasma (PRP): use in oral surgery

Giulia Palandrani

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Platelet-rich plasma (PRP)  is a concentration of platelets derived from the centrifugation of autologous whole blood. It is extensively used to promote soft and hard tissue healing and to significantly reduce wound healing time. Platelets are among the first cells to respond at a wound site, they have important procoagulant effects and are a rich source of different growth factors, such as platelet-derived growth factor (PDGF), transforming growth factor-b (TGF-b) 1 and 2, and vascular endothelial growth factor (VEGF).
These factors are involved in initiating and sustaining the healing process by accelerating bone repair, promoting fibroblast proliferation, and increasing tissue vascularity Recently, PRP has been used to promote healing also in dental practice and oral surgery . This narrative review  describes the different uses of , PRP  in dental and oral surgery and discuss its efficacy, efficiency and risk/ benefit ratio.  

Materials and methods  
An extensive search of bibliographical databases included: MEDLINE; EMBASE; the Cochrane Library and Best Evidence ; the ISI Web of Science ; PubMed ; Lilacs ; the Cochrane Central Register of Controlled Trials and CINAHL.
The following keywords were used: PRP, Piastrinic Gel, PRF, Oral surgery, Dental surgery, Periodontal surgery, Oral medicine, Wound Healing, ONJ, BRONJ. Articles published in English from 2007 to December 2012 were considered ,all RCTs and literature reviews were considered, case reports were used for the BRONJ session only, studies based on in vitro trials were excluded . A total of 68 articles were considered.  

Results
The use of PRP   in dental surgery
This review of the literature suggests that the use of PRP  in the alveolar socket after tooth extractions  shows an improvement in soft tissue healing but there is insufficient evidence which supports the efficacy of PRP in improving bone regeneration in the long run. Not univocal results were obtained regarding the improvement of post operative pain with the use of platelet-rich plasma. The combination of PRP  application with other biomaterials such as autogenous bone or bone substitutes seems to be promising as regards sinus lifting, but the results depend on the material used. Promising results have also been obtained in implant surgery, using PRP  on its own as a coating material.       

The use of PRP  in periodontal surgery
The letterature is controversial about this topic. Many studies revealed that PRP   may exert positive adjunctive effect when used in combination with graft materials for the treatment of intrabony defects. Other authors show different results with no significant benefits regarding the additional use of PRP  to graft materials in the treatment of intra osseous periodontal defects.

The use of PRP   in BRONJ surgery.
Some researchers have proposed the use of PRP in BRONJ surgery in order to enhance bone healing. 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. The results of the studies selected showed that the combination of necrotic bone curettage and PRP  application has demonstrated successful outcomes and minimal invasivity in the treatment of refractory BRONJ .  

The risk/benefit ratio and the use of PRP  
Platelet-rich plasma is an autologous preparation, utilizing the patient’s own blood in a significantly small quantity. For this reason, it is safe and there have been no published references relating to the risk of infections, immunogenic reactions or any other adverse effects which exist with allografts or xenografts.

The only disadvantages of PRP  is  that the patient have to be subjected to a venipuncture and blood drawing procedure, and the clinician has to buy the PRP-processing system with high costs.  

Conclusions  
The scientific evidence regarding the efficacy and efficiency of PRP   is still controversial.   This Review of the literature suggests that:
 - the use of PRP  in the alveolar socket after tooth extractions improve soft tissue healing;
 - Platelet-rich plasma (PRP) has revealed better results in periodontal therapy in association with other materials than when it is used alone;  
- the combination of PRP  with other biomaterials seems to be favorable as regards sinus lifting even if the choice of material used is critical in this field;
- the combination of necrotic bone curettage and PRP  application seem to be encouraging for the treatment of refractory BRONJ.
However, further RCTs are required to support the use of PRP in current practice.  

For additional informations: Platelet-rich plasma (PRP) in dental and oral surgery: from the wound healing to bone regeneration. Immunity & Ageing