Platelet Rich Plasma
Platelet Rich Plasma (PRP) is a substance that is a by-product of blood (plasma) that is rich in platelets. Up until recently, its use has been solely confined to use in hospitals. This was due to the cost of separating the platelets from the blood and the large amount of blood needed to produce an appropriate amount of platelets. New technology allows the doctor to harvest and produce an adequate amount of platelets from only 20 cc of blood drawn from the patient while they are having outpatient surgery.
Why all the excitement about PRP?
PRP allows the body to take full advantage of the normal healing pathways at a greatly accelerated rate. While your body goes through the healing process, it rushes numerous cells and cell-types to the wound in order to initiate the correct healing process. One of those cell types are the platelets. Platelets have several functions, including the release of growth factors (GF) into the wound and the formation of blood clots. These GF (platelet derived growth factors PGDF, transforming growth factor beta TGF, and insulin-like growth factor ILGF) function to help the body in repairing itself by stimulating the stem cells to regenerate new tissue. The more growth factors that are released into the wound, the more stem cells that are stimulated to produce new host tissue. Therefore, it’s obvious that PRP allows the body to heal quickly and efficiently.
A subfamily of TGF, is bone morphogenic protein (BMP). BMP has been proven to encourage the formation of new bone in research studies that have been done on animals and humans. The results of these research studies is greatly significant to the oral surgeon who places dental implants. By adding PRP, and thus BMP, to the implant sites that have been substituted with bone particles, the implant surgeon can now grow bone more quickly and predictably.
PRP has many clinical applications
- Used for bone grafting for dental implants. This includes sinus lift procedures, onlay and inlay grafts, ridge augmentation procedures, and closures of cleft, lip and palate defects.
- Used in the repair of bone defects created by removal of teeth or small cysts.
- Used in the repair of fistulas between the mouth and sinus cavity.
PRP is a by-product of the patient’s own blood, therefore, disease transmission is not an issue.
PRP can be created right in the doctor’s office while the patient is undergoing an outpatient surgical procedure.
The supersaturation of the wound with PRP, and thus growth factors, produces an increase of tissue synthesis and therefore faster tissue regeneration.
Since PRP harvesting is done with only 20 cc of blood in the doctor’s office, the patient won’t need to incur the expense of the harvesting procedure in the hospital or at the 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.
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 fifteen minutes, the PRP is formed and ready to use.
Should PRP be used in all bone grafting cases?
Not always. In some instances, there is not a need for the use of PRP. However, in the majority of cases, the application of PRP to the 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 $500) has to be paid directly 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 synthetic bone product, such as BIO-OSS, or a bone substitute material such as demineralized freeze-dried bone.
Can PRP be used alone to accelerate healing of tooth extraction sites?
Yes. PRP used in tooth extraction sites accelerates soft tissue healing and increases bone attachment and periodontal attachment in teeth with bone loss due to the impacted wisdom teeth.
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 option for you.
Bone Morphogenic Protein (BMP)
Success in bone grafting surgery can be affected adversely by several things. The patient’s age and conditions that can inhibit bone forming, such as diabetes, smoking, and chronic steroid use can make it more difficult in obtaining graft bone. When a patient is an older adult, has undergone multiple operations or has some metabolic problem that does not let them fuse well or heal, that’s when we need some assistance in the process.
Bone Morphogenic Protein (BMP) is a recently developed purified substance that speeds up the bone growth and minimizes the need for harvesting a patient’s bone or using bone substitutes. Innovations in molecular biology have resulted in purified forms of these substances — a family of bone morphogenic proteins (BMP) that have showed exponential increases in bone growth. To encourage bone growth, BMP still requires a unique mechanical structure and a substrate to hold it in it’s place. The approved form begins as a powder that is regenerated and absorbed into a collagen sponge. The sponge is then placed into the host site and allowed to form new bone into which implants can be placed. BMP is useful in cases requiring larger amounts of bone when patients do not wish to undergo multiple bone grafting procedures.