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CLINICAL UTILIZATION OF PLATELET-RICH PLASMA IN DENTISTRY 1

Clinical Utilization of Platelet-rich Plasma in Dentistry

Anna Rusnak

Scott Sonnier

Lamar Institute of Technology Dental Hygiene Program


CLINICAL UTILIZATION OF PLATELET-RICH PLASMA IN DENTISTRY 2

Abstract
Platelet-rich plasma (PRP) is blood plasma that contains a high concentration of platelets, growth

factors and cytokines (small cell signaling proteins). PRP is made from the patients own blood

at the time of the procedure and helps promote healing of injured tissue. The use of PRP allows a

patient to use the healing factors that are found in their own blood at a faster rate. PRP therapy

has been used for many years in orthopedics and by high profile athletes to promote healing after

surgeries and injuries. There are many promising uses for PRP in dentistry such as; promoting

healing and helps with inflammation after oral and periodontal surgeries, helps heal and manage

bisphosphonate osteonecrosis of the jaw by promoting new bone formation, reduces microbial

activity after oral and periodontal surgeries, and healing of cleft lip and cleft palate surgeries.

The PRP can be made at the dental office at the time of the patients visit by simply taking a

blood sample at the beginning of the procedure and using an in-office centrifuge to extract the

PRP from the whole blood sample.

Keywords: Platelet-rich plasma(PRP), Dental procedures, Periodontal surgery, Bisphosphonate

osteonecrosis of the Jaw, Antimicrobial, Surgical healing, Bone regeneration, Oral surgery,

Tooth extraction, Implant surgery


CLINICAL UTILIZATION OF PLATELET-RICH PLASMA IN DENTISTRY 3

Clinical Uses of Platelet-rich Plasma in Dentistry

Platelet-rich plasma (PRP) can be defined as a high concentration of autologous platelets

contained in a small volume of autologous plasma (Anderson, Bright & Buchanan 2017). PRP

contains over 30 growth factors that are used to begin and accelerate the wound healing process

and can be used in many medical situations inside and outside of dentistry. Some examples

outside of dentistry are the use of PRP by orthopedic surgeons to get pro-athletes back into the

game faster by speeding up their healing time and it can also help prevent scarring after plastic

surgery. In dentistry, platelet-rich plasma is used to promote healing in many everyday

procedures and complex oral surgeries, such as, wisdom tooth extraction, facial reconstruction,

cleft lip and palate, implant placements, and managing bisphosphonate osteonecrosis of the jaw

(BRONJ) (Albanese, Licata, Polizzi & Campisi, 2013).

Platelet-rich plasma was first used during open heart surgery in 1977 and has become

increasingly popular ever since. It is used by high profile doctors, such as, Dr. Arun Garg, who

specializes in implants and has written many dental textbooks. PRP is also used by many doctors

locally and across the United States because of its low cost, ease of procedure, and high benefit

to the patient.

Is PRP safe for every patient? Research shows the only group of patients to avoid the use

of PRP in is those with precancerous cells or cancerous lesions. This is because their blood may

be infected with cancer cells and facilitate metastases, new areas of growth. PRP should also be

avoided in patients with blood clotting disorders. There are very few clinical studies available

that show contraindications. Platelet-rich plasma is an autogenic process that uses the patients

own blood to heal their own body which is the reason it is so safe and widely used.
CLINICAL UTILIZATION OF PLATELET-RICH PLASMA IN DENTISTRY 4

Platelet-rich plasma can be easily made in the dental office by following a simple

procedure. A small sample of blood is collected from the patient using an intravenous needle

with the amount of blood needed depending upon the procedure. Next, the blood sample is spun

at a high speed using a centrifuge to separate the red blood cells (RBC) from the white blood

cells (WBC). Using this method two layers of blood cells are formed inside the tube. The bottom

layer contains RBCs and the top layer contains the platelets and WBCs. The top layer, which is

used in the procedure, is easily separated from the bottom layer using surgical scissors while the

bottom layer is then discarded (Dhurat & Sukesh, 2014). The top layer can contain up to

1,000,000,000/1 L of concentrated platelets in one sample tube. The usual platelet concentration

in a normal blood sample is only 150,000 to 350,000/1 L (Albanese, Licata, Polizzi,& Campisi,

2013).

The procedure of making PRP in the dental office is quick from start to finish. The

procedure begins with the dentist or nurse starting an IV in the patients hand or arm. For those

patients who are undergoing IV conscious sedation the same IV line can be used for collecting

the blood sample and administering the sedation drugs. The amount of blood needed varies

depending on the procedure and how much PRP the dentist needs for the treatment area. The

blood sample is collected using vacuum tubes and immediate taken to the centrifuge where it is

spun for a few minutes, the exact time depends on the speed and setting of the centrifuge. The

sample is ready to use immediately after it is finished spinning in the centrifuge. When finished

the PRP is very thick and is separated from the rest of the blood sample using the previously

explained technique. The thick consistency allows PRP to be manipulated into different shapes to

fit the area of the procedure. The approximate time from start to finish is between twenty to forty

minutes therefore this time efficient method is convenient for most practices.
CLINICAL UTILIZATION OF PLATELET-RICH PLASMA IN DENTISTRY 5

Platelet-rich plasma has many important roles in dentistry today and the technology while

not new in other fields of medicine is relatively new to dentistry. The way PRP is prepared and

used varies between all dental specialties and offices. The common aspect is that PRP is safe and

effective as it can improve the outcome of many dental procedures.

The use of platelet-rich plasma helps with inflammation, healing, and pain after oral

surgeries, such as extractions. Enhanced soft tissue healing in patients treated with PRP

decreases common complications, such as dry sockets and bone inflammation. Studies have also

shown reduction in postoperative pain in patients treated with PRP. The regrowth of bone and

bone density after extraction is also improved (Albanese, Licata, Polizzi,& Campisi, 2013).

Platelet-rich plasma can be used during implant surgery by coating the implant body with

the PRP before placement within the bone. This procedure has been shown to improve soft tissue

healing and bone regeneration around the implant body, therefore decreasing the likelihood of

the implant failing (Albanese, Licata, Polizzi & Campisi, 2013).

Some studies have proposed the use of PRP in bisphosphonate osteonecrosis of the jaw

(BRONJ) surgery. BRONJ is a complication related to the use of bisphosphonates as they are

used in the treatment of osteoporosis and other bone disorders and inhibit osteoclast and bone

resorption. Patients who take these drugs have poor vascularity in their bones and the poor

vascularity prevents wound healing. The theory of how platelet-rich plasma stimulates bone

healing in patients with BRONJ is that the PRP contains the growth factors that are usually

repressed by the bisphosphonate drug (Albanese, Licata, Polizzi & Campisi, 2013).

Platelet-rich plasma has been shown to have antimicrobial benefits when used in

conjunction with oral and periodontal surgeries. PRP achieves this antimicrobial activity by

generating oxygen metabolites that include superoxide, hydrogen peroxide, and hydroxyl free
CLINICAL UTILIZATION OF PLATELET-RICH PLASMA IN DENTISTRY 6

radicals. The oxygen metabolites bind with and internalize microorganisms killing them. The

platelets with PRP release antimicrobial peptides at site of surgery and studies have shown that it

can be effective against microorganisms such as Staphylococcus aureus, Enterococcus faecalis,

Candida albicans, Streptococcus agalactie and Streptococcus oralis (Dargo, Bortolin &

Vassena, 2013).

The application of PRP during cleft lip and cleft palate surgeries has been shown to

reduce the number of surgeries by up to four procedures. PRP accomplishes this by promoting

vascularity, increasing soft tissue healing, and guarding against infections that are usually seen

after these types of surgeries (El-Anwar, Nofal, Khalifa & Quriba 2016).

Platelet-rich plasma is a new promising technology in the field of dentistry that is safe,

convenient, and effective for the patient. The usually cost to the patient is $300 to $500 per

procedure. PRP has been shown to be successful when used to promote healing in many

everyday procedures and complex oral surgeries. By decreasing infection, prompting healing of

hard and soft tissues and decreasing inflammation of pain. This treatment is safe for the patient

because it comes from the patients own body and eliminates possibility of disease transmission.

This simple procedure can be done in any dental office with the proper equipment and is widely

used in specialty offices, such as periodontal and oral surgery offices (Anderson, Bright &

Buchanan 2017).
CLINICAL UTILIZATION OF PLATELET-RICH PLASMA IN DENTISTRY 7

References

Albanese, A., Licata, M. E., Polizzi, B., & Campisi, G. (2013). Platelet-rich Plasma (PRP) in

Dental and Oral Surgery: From the Wound Healing to Bone Regeneration. Immunity &

Ageing: I & A, 10, 23. http://doi.org/10.1186/1742-4933-10-23

Anderson, H., Bright, N., Buchanan, C. (2017) Platelet-Rich Growth Factors in

Dentistry. Access ADHA. (February 2017 issue) pg. 14-17.

www.adha.org ISSN 1050-0758

Dargo, L., Bortolin, M., & Vassena, C., (2013). Antimicrobial Activity of Prue Platelet-rich

Plasma Against Microorganisms Isolated From Oral Cavity. BMC Microbiology. Doi:

10.1186/1471-2180-13-47 http://www.biomedicalcentral.com/1471-2180/13/47

Dhurat, R., & Sukesh, M. (2014). Principles and Methods of Preparation of Platelet-Rich

Plasma: A Review and Authors Perspective. Journal of Cutaneous and Aesthetic

Surgery, 7(4), 189197. http://doi.org/10.4103/0974-2077.150734

El-Anwar, M. W., Nofal, A. F., Khalifa, M., & Quriba, A. S. (2016). Use of Autologous Platelet-

rich Plasma in Complete Cleft Palate Repair. Laryngoscope, 126(7), 1524-1528.

doi:10.1002/lary.25868 http://eds.a.ebscohost.com.libproxy.lamar.edu