Platelet Rich Plasma
Platelet rich plasma (PRP) is a part of blood that has been concentrated and is rich in platelets. It’s use was initially in hospital setting and newer technology allows us to harvest and concentrated enough quantity of platelets from only a small amount of blood drawn from the patient prior to outpatient surgery.
PRP speeds the normal healing process. During this process, the body produces many cells of specific types (often called growth factors) in the area of the wound in order to initiate healing. One of those cell types is platelets which perform many functions: formation of a blood clot and release of growth factors into the wound. These growth factors (platelet derived growth factors PGDF, transforming growth factor beta TGF and insulin-like growth factor ILGF) assist the body in repairing itself by stimulating stem cells to regenerate new tissue. The more growth factors released into the wound, the more stem cells stimulated to produce new host tissue. So PRP permits the body to heal faster and more efficiently. This process is short lived.
BMP (Bone Morphogenic Protein) is one of the growth factors that is released with PRP placement and it has been shown to stimulate the formation of new bone in humans. This is potentially helpful since needing more bone is common in dental implant placement. By adding PRP and thus stimulating some BMP production, to the potential implant site the implant surgeon can stimulate soft tissue healing (which is where PRP seems to exibit it’s primary effect) and some bone growth stimulation.
Since PRP is a by-product of your own blood, disease transmission is not an issue. It can be generated in the doctor’s office during an outpatient surgical procedure, such as placement of dental implants. The biggest advantage of PRP is that it produces an increase of tissue growth and thus faster tissue regeneration.
PRP was one of the first significant growth factor, healing stimulants. Professionally I have used it since 1999, published a paper on it in 2001 and provided it as a service for a number of years. My opinions are based on my professional experience, what other implant surgeons say at conferences and most importantly what the research shows. I found the blood draw painful for patients, as the needle required is large and I found it seemed to make a small initial difference in soft tissue healing and little difference in bone healing. At the time it became more commonly used, it was the best thing we had. Although some claim addition of PRP to a bone graft will increase the final amount of bone present, I found it made little difference compared to not using it. It does make the wound heal faster and more efficiently. Currently there are products on the market that either
- Grow bone much better (BMP) or
- Somewhat better (PDGF/Gem 21)
PDGF or platelet derived growth factor is described elsewhere and my opinion is that it affects soft tissue as well and bone more so, with no trauma to the patient, at a similar cost to provide it.
I would encourage anyone that is considering having PRP for a dental implant procedure, to look at the research. It is clear to me that the mixed results for bone growth, make it a 3rd tier choice and I have currently stopped providing this procedure.