Platelet Rich Plasma/Platelet Rich Fibrin
Platelet rich plasma (PRP) is a by-product of blood (plasma) that is rich in platelets. Until now, its use has been confined to the hospital setting. This was due mainly to the cost of separating the platelets from the blood and the large amount of blood needed to produce a suitable quantity of platelets. New technology permits doctors to harvest and produce a sufficient quantity of platelets from only 55 cc of blood, which is drawn from the patient while they are having outpatient surgery.
The concept of PRF (Platelet Rich Fibrin) is based on the centrifugation of whole blood without anticoagulants. Blood is drawn from the patient and then placed in a centrifuge. At the end of the process a fibrin clot containing platelets and white blood cells is obtained. This fibrin clot is called Platelet Rich Fibrin or PRF. It contains growth factors which will release gradually in the site where it is placed. The objective of the growth factors is to accelerate bone and soft tissue healing.
Why all the excitement about PRP?
PRP permits the body to take advantage of the normal healing pathways at a greatly accelerated rate. During the healing process, the body rushes many cells and cell-types to the wound in order to initiate the healing process. One of those cell types is platelets. Platelets perform many functions, including formation of a blood clot and release of growth factors (GF) into the wound. These growth factors; platelet derived growth factors (PDGF), transforming growth factor beta (TGF), and insulin-like growth factor (ILGF), function to assist the body in repairing itself by stimulating stem cells to regenerate new tissue. The more growth factors released and sequestered into the wound, the more stem cells are stimulated to produce new tissue. Thus, PRP permits the body to heal faster and more efficiently.
A subfamily of TGF, is bone morphogenic protein (BMP). BMP has been shown to induce the formation of new bone in research studies in both animals and humans. This is of great significance to the surgeon who places dental implants. By adding PRP, and BMP, to the implant site with bone substitute particles, the implant surgeon can now grow bone more predictably and faster than ever before.
PRP Has Many Clinical Applications
PRP can be used to aid bone grafting for dental implants. This includes onlay and inlay grafts, sinus lift procedures, ridge augmentation procedures, closure of cleft and/or lip, and palate defects. It can also assist in repair of bone defects created by removal of teeth, or small cysts and repair of fistulas between the sinus cavity and mouth.
PRP Also Has Many Advantages
- Safety: PRP is a by-product of the patient’s own blood, therefore, disease transmission is not an issue.
- Convenience: PRP can be generated in the doctor’s office while the patient is undergoing an outpatient surgical procedure such as the placement of dental implants.
- Faster healing: The supersaturation of the wound with PRP, and thus growth factors, produces an increase of tissue synthesis and faster tissue regeneration.
- Cost effectiveness: Since PRP harvesting is done with only 55 cc of blood in the doctor’s office, the patient need not incur the expense of the harvesting procedure in hospital or at a blood bank.
- Ease of use: PRP is easy to handle and actually improves the ease of application of bone substitute materials and bone grafting products by making them more gel-like.
Frequently Asked Questions About PRP
Is PRP safe? Yes. During the outpatient surgical procedure a small amount of your own blood is drawn out via the IV. This blood is then placed in the PRP centrifuge machine and spun down. In less than 15 minutes, the PRP is formed and ready to use.
Should PRP be used in all bone-grafting cases? Not always. In some cases, there is no need for PRP. However, in the majority of cases, application of PRP to the bone graft will increase the final amount of bone present, in addition to making the wound heal faster and more efficiently.
Will my insurance cover the costs? Unfortunately not. The cost of the PRP application (approximately $400) is paid by the patient.
Can PRP be used alone to stimulate bone formation? No. PRP must be mixed with either the patient’s own bone, a bone substitute material such as demineralized freeze-dried bone, or a synthetic bone product, such as BIO-OSS.
Are there any contraindications to PRP? Very few. Obviously, patients with bleeding disorders or hematologic diseases do not qualify for this in-office procedure. Check with your surgeon and/or primary care physician to determine if PRP is right for you.