Platelet-rich plasma as a promising innovation in dentistry

Sir, Guided bone regeneration is a well-accepted surgical technique utilized in implant dentistry to increase the quantity and quality of the host bone in areas of localized alveolar defects. The lack of predictability in regenerative bony procedures with various grafting materials suggests that enhancement in the osteoinductive properties of these materials are highly desirable. Platelet-rich plasma (PRP), has become a valuable adjunct in wound healing in clinical dentistry, which is generally prepared from the concentrated suspension of the growth factors found in platelets of the patient and used to deliver these growth factors in high concentration to sites requiring osseous grafting. [1] PRP is a new application of tissue engineering, biotechnology and a rapidly developing area for clinicians and researchers today. [2] Clinicians and scientists are investigating the use of PRP in dentistry as a way of enhancing the body's natural wound-healing mechanisms (like wise in surgical fields, including head and neck surgery, otolaryngology, cardio vascular surgery, oral and maxillofacial surgery, and periodontology). In real terms, PRP is just a volume of autologous plasma that has a platelet concentration above baseline. It is a storage vehicle for growth factors, especially, which primarily influence bone regeneration. Because of its novelty, there is a potential for misunderstanding, misuse, and application of what the practitioner may incorrectly think is PRP. Moreover, since this is an autologous preparation, any concerns regarding disease transmission and immunogenic reactions regarding allograftic and xenograftic preparations can be eliminated. [3] In oral implantology, the most important application of PRP would definitely be to accelerate autogenous grafts used for site preparations, sinus lifts, osseointegrations, ridge augmentations, etc., However, until date no positive clinical benefits have been documented in the literature citing these phenomenon's, with the use of PRP with non-vital bone substitutes. [4] Thus, the whole target of PRP remains applicable to basic osteo progenitor and stem cells. In addition, well-enhanced bone regeneration can be anticipated when PRP is used with mixtures of autogenous bone with recombinant human growth factors such as recombinant bone morphogenetic proteins. Though, early Results are very promising that there will be success when PRP is placed in the preparation site of a dental implant specifically in the maxilla, in areas of previous failures, in the osteoporotic women, etc. [1,5] Trisi and coworkers performed the first and most compelling study available on the use of PRP in combination with bone grafts. They propounded that grafts combined with PRP showed twice the graft maturity index calculated from a subjective radiographic assessment over the positive control sites i.e. cancellous cellular marrow grafts. [6] In general, healing proceeds by repair and regeneration after any surgical procedure; however, it does not fully restore the architecture or function of the affected unit. After surgery, platelets begin to form as table blood clot, releasing a variety of growth factors that induce and support healing and tissue formation. Several studies, including some dental research, have shown that platelet-derived growth factor, transforming growth factor- alpha and insulin-like growth factor I are found in PRP. [7,8,9,10] Administration of these growth factors may be combined with tissue regeneration techniques in the repair of intrabony defects, furcations and cyst cavities. A recently developed procedure can be used to create PRP, a concentrated suspension of growth factors that has been demonstrated to induce healing and regeneration of tissues, including those in the surgical area. Although the growth factors and the mechanisms involved are still poorly understood, the ease of applying PRP in the dental clinic and its beneficial outcomes, including reduction of bleeding and rapid healing, holds promise for further procedures. Conversely, clinical uses of PRP offers several advantages that mainly includes reduction in the frequency of intra-operative and post-operative bleeding at the donor and the recipient sites, facilitation of rapid soft-tissue healing, assistance in the initial stability of the grafted tissue at the recipient sites (as a result of its cohesive and adhesive nature), promotion of rapid vascularization of the healing tissue by delivering growth factors and in combination with bone replacement materials, induces regeneration. This short key note is an endeavor to draw the attention of clinicians and researchers to this newer aspect of clinical dentistry and tissue engineering where the authors expect some newer in vivo studies with larger parameters so as to establish concrete guidelines regarding the usage of PRP.