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Volume 2 Issue 1 February 2011
Platelet Concentrates: A Promising Innovation In Dentistry
Dr. Kiran N K1, Dr. Mukunda K S2, Dr.Tilak Raj T N3
Senior Lecturer, 2Reader, 3Professor and Head of the Department, Department of
Pedodontics and Preventive Dentistry, Sri Siddhartha Dental College and Hospital, Tumkur, Karnataka.
Abstract: A recent Innovation in dentistry is the preparation and use of Platelet Concentrates (PRP, PRF), a concentrated suspension of growth factors found in platelets. These growth factors are involved in wound healing and are postulated as promoters of tissue regeneration. This article describes the methods of preparation, clinical application and safety concerns of PRP and also the evolution of second generation platelet concentrate, referred to as PRF. Key Words: Platelet rich plasma, growth factors, Platelets.
Journal of Dental Sciences & Research 2:1: Pages 50-61
Introduction : One of the last achievements in dentistry is the use of platelet concentrates for the improvement of reparation and regeneration of the soft and hard tissues after different surgical procedures. Post surgically, blood clots initiate the healing and regeneration of hard and soft tissues. Using platelet concentrates, is a way to
accelerate and enhance the body’s natural wound healing
mechanisms. A natural blood clot contains mainly red blood cells, approximately 5% platelets and less than 1% white blood cells1. It is now well known that platelets have many functions beyond that of simple hemostasis. Platelets
contain important growth factors
50 Journal of Dental Sciences and Research
of fibrin increasing collagen production. for increasing cell products used for the prevention and treatment of hemorrhages due to serious thrombopenia of the central origin. The study of these growth factors discovery platelets combined of their with extrusion to the by the adhesives. are blood platelet derived Concentrates: Volume 2 Issue 1 February 2011 plasma. which are a part of the natural healing process. using prepared plasma. Fibrin glue was originally described in 1970 and is formed by with It was donor polymerizing thrombin originally and fibrinogen calcium. Platelets contain important growth factors that. when added to wounded tissues or surgical potential sites. science Since medical several has recognized components in blood. the stability and quality of fibrin glue were low 2. It is now well known that platelets have many functions beyond that of simple hemostasis. Whitman et al have called PRP an “autologus alternative to fibrin glue”. The development of platelet concentrates as bioactive surgical additives that are applied locally to promote wound healing stems from the use 1990. initiating vascular in-growth. Platelet Evolution: In concentrates general. because of the low concentration of fibrinogen in 51 Journal of Dental Sciences and Research . and inducing cell differentiation3. Fibrin glue obtained through blood bank donations has been used for years as hemostatic agent and surgical adhesive. however. The important difference in composition between PRP and Fibrin Glue is the presence of a high concentration of platelets and accelerate healing. recruiting other cells to the site of injury.Platelet Concentrates that initiate and support wound healing. are responsible mitosis. to they have the has of led an development autologus platelet gel – PRP – to be used in various surgical fields. when secreted.
1. The present paper describes the preparation and uses of two commonly used platelet Volume 2 Issue 1 February 2011 Preparation of PRP: PRP can be prepared by two techniques. the credit of introducing platelet-rich plasma into contemporary oral surgery goes to Whitman et al who first advocated its use for oral surgical procedures in 1997 4. However. Platelet rich plasma was at 5. Transfusion System.Platelet Concentrates native concentration of fibrinogen in PRP4. With this technique. It is first centrifuged autologus platelet concentrate . Parker. patient's discarded. 52 Journal of Dental Sciences and Research . (Medtronic circulation The ELMD-500 Auto Electromedic. Blood is drawn into a collection bag containing citrate-phosphate-dextrose anticoagulant. The centrifugation speed is then reduced to 2. the term PRP is preferred to autologus platelet gel. Platelet Rich Plasma: Platelet rich plasma (PRP) is an autologus concentrate of human platelets in a small volume of separators: It requires large quantities of blood (450 to ml) be and generally in a plasma. the remaining PPP and RBCs can be returned or to can the be developed in the early 1970’s as a byproduct pheresis . General-purpose separators 2. plasma-rich growth factors (PRGFs) or a mere 5 requires operated hospital setting.400 rpm to get a final separation of about 30 ml of PRP from the RBCs. equipment improved 6 of multi-component Techniques and have through dramatically the 1990’s. Therefore. CO. General-purpose cell cell cell concentrates: Platelet-rich plasma (PRP) and Platelet rich Fibrin (PRF).600 rpm to separate RBCs from platelet-poor plasma (PPP) and PRP. Platelet-concentrating separators 1.
Technologies. Several studies have been performed to compare the efficacy of these systems (7-9) . 1. West Palm Beach. 2. topmost acellular plasma layer called PPP (40% of total volume). two such systems are approved by FDA and commercially available: Smart PreP (Harvest MA. USA). USA) and the namely bottom-most RBC layer (55% of total volume). cell Volume 2 Issue 1 February 2011 used and the speed and duration of centrifugation may differ with Platelet-concentrating different systems. and an intermediate PRP layer (5% of total volume) called the "buffy coat". Using a sterile syringe. A study conducted by Marx et al10 indicated that of all of the devices tested these 2 FDA cleared PRP devices produced greatest platelet concentrates and most important. which explains the red tinge of the final PRP processing of PRP is quite similar in most of the platelet-concentrating systems although the anticoagulant 53 Journal of Dental Sciences and Research . the Plymouth. This tube will now undergo a second centrifugation. 4. Inc.Platelet Concentrates USA) cell separator is widely used for 2. this technique. which is longer and faster than the first. which allows blood separation into three layers. The preparation and operator transfers PPP. The first centrifugation is called "soft spin". Currently. PRP and some RBCs into another tube without an anticoagulant. This allows the platelets (PRP) to settle at the bottom of the tube with a very few RBCs. Platelet System Concentrate (PCCS. FL. 3. release of therapeutic level of bioactive growth factors. called "hard spin". 3i Collection Implant Innovations. Venous blood is drawn into a tube containing an separators: It requires small quantity of blood and can be prepared by using certain equipments in a anticoagulant to avoid platelet activation and degranulation. dental clinic set up.
This PRP is then mixed with bovine thrombin and calcium chloride at the This the Calcium time results of in cell growth factor 5. gelling of platelet chloride concentrate. which is converted to fibrin and cross-linked11. 6. plasma. Platelet derived endothelial volume). Platelet activating factor -4 (PAF-4) The active secretion of these growth factors is initiated by the clotting begins process within 10 of blood and application. which contain the synthesized and pre-packed growth factors. 13) degranulation of the α granules in platelets. Basic fibroblast growth factor (bFGF) 7. Interleukin – 1 (IL-1) 6.Platelet Concentrates preparation. These platelets were: 1. More than 95% of the presynthesized growth factors are secreted within 1 hour. or wound. Mechanism of action of PRP: PRP works via the minutes after clotting. 5. Vascular Endothelial Growth Factor (VEGF) 4. Most of the PPP is removed with a syringe and discarded. nullifies the effect of the citrate anticoagulant used. PPP The (80% acellular of the Volume 2 Issue 1 February 2011 2. and thrombin helps in activating the fibrinogen. The growth factors which are released from activated . flap. The secreted growth factors immediately bind to the external surface of cell membranes of cells in the graft. is found at the top. and the remaining PRP is shaken well. Platelet derived growth factor (PDGF) 54 Journal of Dental Sciences and Research . within 10 minutes of clot initiation (12. Transforming growth factors beta 1 and beta 2 (TGF β 1 & 2) 3. PRP must be developed in an anticoagulated state and should be used on the graft. Therefore. flap. or wound via transmembrane receptors.
Blepharoplasty proliferation. osteoprogenitor cells in the host bone and in bone grafts12. and production. in XI the and risk thrombin.Platelet Concentrates transmembrane receptors in turn induce an activation of an Volume 2 Issue 1 February 2011 7. Periodontal/peridefects21 6. which causes the expression of (unlocks) a normal gene sequence of the cell such matrix as cellular Retrograde procedures 9. of life- surgeries threatening coagulopathies. sinus lift augmentation grafting(17. The preparation of PRP involves the isolation of PRP after which gel formation is accelerated using calcium chloride and bovine thrombin. Ablative surgeries of the Maxillo-Facial region 10. thus PRP growth factors act through the stimulation of normal healing. osteoid formation. it has found clinical applications in. synthesis etc. Hepatitis. Sanchez et al have elaborated on the potential risks associated with the use of PRP.15). Ridge Graftings20 5. Horizontal and vertical ridge augmentations19 4. Continuity defects12. just much faster(14.18) 3.16 2. Bovine 55 Journal of Dental Sciences and Research . Cyst enucleations/Periapical implant preservation However. collagen Safety concerns of PRP: Because it is an autogenous preparation. PRP is inherently safe and therefore free from concerns over transmissible diseases such as HIV. Clinical applications of PRP: Because PRP enhances Cruetzfeld-jacob disease 10 (CJD) 22 (“mad vow disease”) . Healing of Extraction wounds 8. 1. It has been discovered that the use of bovine thrombin may be associated with the development of antibodies to the factors resulting V. Endodontic surgeries and endogenous internal signal protein. West Nile fever.
autologous thrombin or perhaps extra-purified 23 immediately. Since. Its chief advantages include ease of preparation and lack of biochemical handling of blood.Platelet Concentrates thrombin preparations have been shown to contain factor V. thrombin. developed coagulopathies were not due to antibodies against bovine thrombin or human thrombin but instead due to antibodies that Preparation The preparation of PRF is very simple. which could result in the stimulation of the immune system when Volume 2 Issue 1 February 2011 been referred to as a secondgeneration platelet concentrate. Landesberg et al that have suggested methods of alternative The resultant product consists of the following three layers: • activating PRP need to be studied and made available to the dental community. Other preparation methods of PRP for include safer the required quantity of blood is drawn into 10-ml test tubes without an anticoagulant and centrifuged utilization of recombinant human thrombin. PRF is free from associated risks. which makes this preparation strictly autologus24. Blood is centrifuged using a tabletop centrifuge for 12 min at 2. Marx et al10 in their article stated that the second set of bleeding episodes in the patients who traditionally prepared PRP. Platelet rich Fibrin (PRF): Topmost layer consisting of acellular PPP • • PRF clot in the middle RBCs at the bottom PRF was first developed in France by Choukroun et al. The developed to bovine factor Va that was a contaminant thrombin in certain bovine commercial preparations.700 rpm. bovine thrombin is not used for the preparation. which has been shown to have several advantages over challenged with a foreign protein. It has 56 Journal of Dental Sciences and Research .
The conversion of fibrinogen into fibrin takes place slowly with small quantities of experimental trial. The elimination of these steps properties materials. PRF can also be used as a membrane.Platelet Concentrates Because of the absence of an anticoagulant. successful Therefore. preparation of PRF. the In an considerably reduces biochemical handling of blood as well as risks associated with the use of bovinederived thrombin. wound sealing and hemostasis. the affinity of squeezing out the fluids in the fibrin clot. and maturation. eliminates of redundant process adding several promoting growth advantages wound including bone graft anticoagulant as well as the need to neutralize it. Clinical trials suggest that the combination of bone grafts and growth factors contained in PRP and PRF may be suitable to enhance bone density. The addition of bovine-derived thrombin to healing. The results suggest that the growth factor content (PDGF and TGF-β) was comparable in both. PRF is in the form of a platelet gel and can be used in conjunction with bone grafts. growth physiologically available thrombin 57 Journal of Dental Sciences and Research . handling and improving of the graft promote conversion of fibrinogen to fibrin in PRP is also eliminated. before the clotting cascade is initiated. stabilization. speedy blood collection and immediate centrifugation. In this study. Another experimental study used osteoblast cell cultures to coagulate as soon as it comes in contact with the for glass surface. which offers osteoblasts to the PRF membrane appeared PRF over to has It be many superior22. is absolutely essential24. PRF can be obtained in the form of a membrane by investigate the influence of PRP and PRF on proliferation and differentiation of osteoblasts. blood begins to Volume 2 Issue 1 February 2011 factor content in PRP and PRF aliquots was measured using Elisa kits. advantages the PRP.
in that they show improved properties of PRF as compared with PRP. 7. favorable healing process is obtained due to this slow polymerization process. Reich RH. platelet-rich fibrin: Evolution of a second generation 58 Journal of Dental Sciences and Research . Munirathnam Naidu E.net. Appel TR. its many of advantages. Berge SJ. References: 1. Green DM. Available PRP at: different preparations of platelet concentrates for growth factor enrichment. Marx RE. Surgery. 62:484-88. Sunitha Raja V. University of Miami School of medicine. 3. In future.Platelet Concentrates present in the blood sample itself. Platelet-rich Plasma.plateletrich. Comparison of three on September 25. Clin Oral Implants Res 2002. J Oral Maxillofac Surg 2004. 5. von Linden JJ. Freymiller EG. 2. Berry RL. more histologic evaluations from other parts of the world are required to understand the benefits of this second- 62:489-96. 13:522-8. Evidence to support its use. Available at : http://www. and the material is being used widely in France. Division of Oral and Maxillofacial Central. Aghaloo TL. 6. Wiltfang et al findings from a series of 55:1294-9. clinical trials are encouraging. Literature pertaining to PRF is found in French. that a is physiologic very architecture to the Volume 2 Issue 1 February 2011 platelet concentrate.net accessed 2010.platelet-gel. Indian J Dent Res 2008. Whitmann DH. Potzsch B. Thus. Platelet gel: an alternative to fibrin glue with applications in oral and maxillofacial surgery. Muller J. The popularity of this material should increase considering The 25 Platelet-Rich Plasma: Ready or Not? J Oral Maxillofac Surg 2004. www. J Oral Maxillofac Surg 1997. Autologus Platelet Rich Plasma (Platelet Gel). 4. 19:42-6. generation platelet concentrate.
Kleis WK. Fennis JPM.Platelet Concentrates 8. 13:437-43. 59:1120. 59:1119. Buch R. P. 85:638. The Biology of Friadent-Schutze plasma Res kit. Kleis WK. Marx RE. Jacobson M. Schmitz JP. April 2001. Eichstaedt R. for D. Clin Implants 2003. Weibrich G. Clin Oral Implants Res 2002. The Oral Volume 2 Issue 1 February 2011 Radiol Endod 1998. Hitzler Harvest versus platelet-rich Oral WE. 10. J Oral Maxillofac Surg 2001. Sonnleitner DY. Int J Oral Maxillofac radiographic animal study on the use of autogenous scaffolds and platelet rich plasma. 11. PlateletRich Plasma: Growth factor Reynolds MA. 14:233-9. Kevy S. Stoelinga PJW. 12. Alveolar ridge and sinus platelet augmentation rich utilizing in enhancement for bone grafts. Rosen PS. Int J Oral Maxillofac Surg 2002. Marx RE. Preparation of growth factors enriched autologus platelet gel. 9. Carlson ER. The Smart system biology of platelet-rich plasma (letter to the editor). 62:489-96. Proceedings of the 27th Annual meeting of Service Biomaterials. J Oral Maxillofac Surg 2001. 13. Mandibular and Surg 2004. 15:879-82. Kassolis JD. Marx RE. JA. Curasan PRP kit vs. A Huemer Sullivan technique simplified producing Jansen reconstruction: A clinical platelet-rich plasma and platelet concentrates for intraoral bone grafting techniques: A Technical note. 16. 14. PCCS PRP system: Collection efficiency and platelet counts of two different methods for the preparation of plateletrich plasma. Weibrich G. Hafner PreP G. 31:281. J Oral Maxillofac platelet-rich plasma (letter to the editor). Oral Surg Oral Med Oral Pathol plasma combination with freeze dried 59 Journal of Dental Sciences and Research . Hollinger JO. Implants 200. et al. 17. 15.
Carlson NE. Garg AK. Kim SG. Oral Implantol 2001. 19. Dohan SL. J. Use of Particulate Dentin plaster of paris combination rich Gassling V. Platelet second rich Fibrin (PRF): A success of bone grafts around dental implants. 101:E37-44. osteoblast proliferation and differentiation in the cell culture. Int J Oral 60 Journal of Dental Sciences and Research . In Report of the 2nd International Symposium on growth factors (SyFac 2005). 18:93-103. R.Platelet Concentrates bone allograft. Acyl A. 25. Roach RB Jr. Par Wiltfang J. Kim YK. Sheridan PJ. 23. Platelet rich plasma vs platelet rich fibrin: Comparison content of and growth factor with/without platelet plasma in the treatment of bone defects around implants. 27:38. Diss A. using Proussaefs P et al. 21. J Periodont 2000. J Karpatkin platelet rich plasma gel. Maxillofac Volume 2 Issue 1 February 2011 Implants 2003. et al. Applications in Dentistry. Kupp LI. 20. Platelet rich plasma application in sinus graft surgery: Part I. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006. 133:1383. 56:11167. Lozada JL. et al. Sanchez AR. rich plasma: Clinical generation Part platelet I: and concentrate: Technological Concepts Platelet evolution. J Am Dent Assoc 2002. MO. Terheyden H. 18. Caplanis N. Int J Oral Maxillofac Implant 2002. J Oral Maxillofac Surg 1998. The use of platelet plasma to enhance the Simonpieri Girard rich Schoefler C. Risk Moses of M. back ground and processing techniques. 71:1654. Is platelet rich plasma the perfect enhancement factor? A current Review. 11:17. 24. Choukroun A. Landsberg M. 17:86. Chung CH. Case series. Dent Implantol Update 2000. 22.
9916373505 Fax no:08162-275536 E mail : drkirannk@gmail. Sri Siddhartha Dental College and Hospital. India Ph No. Karnataka.Kiran N K Senior Lecturer.Platelet Concentrates Address For Correspondance: Dr. Volume 2 Issue 1 February 2011 Agalakote. Department of Pedodontics and Preventive Dentistry.com 61 Journal of Dental Sciences and Research . Tumkur-502107.
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