Wound healing in dentistry is one indicator of a successful procedure. Poor wound healing results in complications such as infections for the patients, which leads dentists to explore treatment, therapies, and procedures that encourage fast recovery while minimizing complications for their patients.
Platelet-rich plasma is a treatment that relies on the body's natural healing mechanism to trigger tissue regeneration and recovery, with minimal, if any, side effects to the patients.
At Northridge Dentist, we are at the forefront of providing the best services and embracing new technology and techniques to improve our customer's experience. Read on to find out more about platelet-rich plasma and its applications in dentistry.
Defining Platelet Rich Plasma
The body has its healing mechanism through platelets, white blood cells, and growth factors that promote cell regeneration, growth, and repair. When in the right concentration, these factors will allow wound healing without needing medication.
Sometimes, however, the body does not produce sufficient wound healing factors to facilitate natural recovery and will need a boost through platelet-rich plasma therapy. Such would be the case for people with conditions that predispose them to low platelet counts. These conditions could cause a low platelet count by causing an increased platelet breakdown or reducing the production of platelets. The conditions include:
- Immune thrombocytopenia due to autoimmune disorders which cause the body to attack platelets
- Bacterial infections of the blood
- Thrombotic thrombocytopenic purpura (a condition where the body forms small clots throughout the body, leading to a decline in the body's platelet count)
- Some medications such as anticonvulsants
- Some types of anemia
- Viral infections like HIV
- Chemotherapy and radiation treatments
- Heavy alcohol intake
Older people also have a reduced production of platelets, which increases the time it takes to recover from surgical procedures.
Even in the right concentration, wound healing takes a long time, especially when the tissues involved include bone tissues.
Platelet-rich plasma is a concentration of platelets from a small amount of plasma generated from the patient's blood. The human blood is composed of plasma on which red blood cells, white blood cells, and platelets are suspended.
Platelets or thrombocytes are responsible for blood clotting and wound healing. Thrombocytes contain dense granules, lysosomes, and o-granules, which are critical to their function. During a vascular injury, platelets become activated, leading to the release of coagulation factors from the granules.
Doctors generate platelet-rich plasma (PRP) by separating blood components and concentrating platelets through centrifugation.
The process separates your blood into distinct layers, with the topmost layers containing a rich supply of platelets, cytokines, and growth factors. Cytokines regulate inflammation, stem cell migration, angiogenesis, and cell proliferation.
Platelets are the main components of PRP in addition to inflammatory cells and proteins. These proteins are sources of growth factors, which promote cell recruitment, proliferation, and tissue regeneration and healing.
PRP therapy has wide acceptance and application in sports injuries and facial restoration. Recent decades have seen a wide acceptance among dentists due to the accelerating factors it presents to wound healing.
Other advantages that make platelet rich plasma therapy an excellent choice among dentists include:
- PRP utilizes your blood, therefore, reducing the risk of disease transmission or allergic reactions
- The generation of PRP is convenient as the doctor can generate it during your outpatient surgical procedure (it takes around 15 minutes to have the PRP ready for use)
- Platelet-rich plasma therapy promotes faster wound healing, therefore, shortens recovery time.
- It is a cost-effective procedure as it does not require elaborate procedures similar to those in blood banks.
- Platelet-rich plasma is easy to handle and use for applications in different dental procedures.
Platelet-rich plasma therapy is a safe procedure since it utilizes your blood and cells. However, if you have a bleeding disorder or a hematologic disorder, you want to discuss other options with your dentist. Another disadvantage with PRP is the lack of insurance coverage, so you have to pay out of your pocket. You might also experience pain and infection at the iniection site.
History of Platelet Rich Plasma
Ancient civilizations triggered healing by intentionally creating inflammation, a concept that Dr. G. Hackett utilized in the 1950s to strengthen tendons, ligaments, and herniated regions. He noted the appearance of fresh tissue cells and bones in weak areas he triggered using injections and subsequent relief from his patients’ disorders. He theorized that triggering inflammation could lead to relief from chronic pain and problems in the musculoskeletal system.
His theories would form the basis for developing other technologies such as platelet rich plasma, which instead of using irritants to trigger healing, employed the body's natural healing mechanisms.
The application of platelet-rich plasma in medicine began in the 1970s in the field of hematology. Hematologists used the term to describe plasma whose platelet count was above the basal count of the blood. They used platelet-rich plasma in treating thrombocytopenia.
The 1980s saw an increase in platelet-rich plasma during surgical procedures to facilitate wound closure, reduce inflammation, and facilitate new cell growth. Dentists also embraced its use in the 1990s for periodontal and maxillofacial surgery. Later on, its use in bone grafting, fractures, and repair of connective tissue increased. Research shows that PRP is effective at improving burn, post-surgical, and acne scars.
Other practitioners in the medical field have embraced the use of platelet-rich plasma for cardiac surgery, plastic surgery, and sports injuries. Fields such as gynecology and urology also use PRP for different treatments.
The use of PRP remains controversial in some circles amidst calls for wider research and human trials to understand the benefits and potential side effects arising from the therapy.
Existing research and clinical trials indicate that platelet-rich plasma is safe as long as the preparation is done in a sterile environment. Poor sterilization of the preparation environment and tools could lead to cross-infection and increase the risk of allergic reactions.
Most of the existing studies have been done on animals and a few comparative studies on patients. These animal studies have been successful with clinicians witnessing repair and rejuvenation of injured areas soon after treatment with PRP. Platelet-rich plasma therapy is considered an elective procedure that the patient can opt-out of. As such, insurance companies have yet to include it in their coverage. The lack of conclusive evidence of the effectiveness of PRP therapy also dissuades insurance companies from offering coverage fo the procedure.
Preparation of Platelet Rich Plasma
One of the major concerns with platelet-rich plasma is the lack of standardization in the preparation method. Generally, all commercial systems apply the principle of differential centrifugation. However, they can use single or double spin centrifugation to achieve a platelet-rich plasma with between 2 and 5% higher platelet concentrations compared to the basal platelet level. The preparation method also varies across different fields, which is why there lacks enough objective research on the effectiveness of PRP therapies across different fields.
Despite these differences, the preparation process follows common steps. The first step in the process involves collecting the patient's blood, preferably using plastic syringes or siliconized tubes. These materials do not activate the platelets in the patient's blood.
Blood draws are typically performed on cubital veins (the superficial veins in the upper limbs) to prevent trauma. The amount of blood for PRP is usually 10 to 60 ml depending on the type and extent of surgery. Anticoagulants such as sodium citrate are added into the blood after its collection.
After drawing the required blood, it is centrifuged for ten minutes at 1200 rpm to separate platelets without damaging or activating them. The centrifuge machine’s speed will also vary depending on the manufacturer and the number of spins the machine employs.
The single centrifugation method (a soft-spin technique) allows the separation of blood into three layers. The top and middle layers above the red blood layer contain the required platelets and growth factors.
The two are aspirated together using a pipette and placed into a separate tube, then mixed with calcium chloride solution to induce coagulation. The coagulated product is used on the injury site.
Different clinicians apply different methods, speeds, and centrifugation counts to produce platelet rich plasma; therefore, the preparation method might vary based on the preparation equipment used and the manufacturer’s instructions. After the first centrifugation, the doctor can conduct additional spins to produce an even higher concentration of platelets and other components.
Most dentists use commercial systems with different centrifugation speeds and accommodate blood volumes of up to 60 ml. These differences in speed and centrifugation process affect the concentration of platelets and leukocytes derived from the blood. Factors such as the platelets’ size and the basal platelet count of the patient will affect the final concentration of platelets in platelet-rich plasma.
Other factors that affect the concentration of platelet-rich plasma yield include:
- The draw of blood (the longer it lasts, the higher the activation of platelets, which lowers the final platelet count)
- Temperature during processing
- The anticoagulants used
The method of preparation results in different concentrations and types of platelet-rich plasma. These concentrations fall into four groups, as follows:
- Pure PRP, which is poor in leukocytes (also called leukocyte-poor PRP), shows a lower fibrin density after its activation. These platelet concentrates can be used as liquids, like an injection or activated gel forms like the one used during a sinus lift graft surgery.
- Leucocyte and PRP (L-PRP), which contains leukocytes, but has a lower density fibrin network after activation. As with pure PRP, L-PRP can be used in liquid form or as a gel. The preparations of these concentrates have more standardizations and protocols than pure PRP, which seeks to minimize blood These preparations are ideal for use in dental applications as they are inexpensive to make. They are in a volume and shape that allows ease in combination with surgical procedures. They offer a slow release of growth factors over a more extended period. They can also be prepared in large quantities.
- Pure platelet-rich fibrin does not have leucocytes and has a higher density fibrin network. These cannot be handled in liquid form; therefore, they cannot be injected. However, they can be used as solid materials in their applications. These preparations are expensive, making them inconvenient to use. They are incredibly complicated to use in daily oral surgical procedures. However, they present improved skin wound healing as fibrin glue substitutes in surgical procedures.
- Leukocyte rich fibrin and platelet-rich fibrin have both leukocytes and a high-density fibrin network. These concentrates can only be handled as solid materials during their application.
Other classifications are suggested using different parameters, but the above classification is the most widely accepted among dental professionals.
Applications of Platelet Rich Plasma in Dentistry
Whitman and Marx are credited as the pioneers of applying platelet-rich plasma therapy in dentistry, which began in the 1990s. Their success in implementing platelet-rich plasma therapy in wound healing led to its wider use by more dentists.
They, however, experienced challenges in collecting and preventing coagulation of the collected blood. To prevent coagulation, they would use anticoagulants, which reduce the effectiveness of platelet-rich plasma. Earlier preparations also took time, lengthening the length of the procedure.
Dentists have embraced using platelet rich plasma for different applications. They can make platelet rich plasma within a short time while the patient undergoes an oral procedure. Processing of the platelet-rich plasma involves placing a patient's blood into a centrifugal machine, which spins the blood rapidly.
The rapid spinning motion leads to the separation of various components. The platelet-rich plasma derived from the process has a platelet concentration 3 to 5 times higher than that of your normal blood. That concentration can be injected into the injured tissue or used together with other treatment materials such as bone grafts to facilitate healing.
The top uses of platelet-rich plasma in dentistry include sinus lift grafting, ridge augmentation, closure of cleft lip and palate defects, repair of fistulas, and Crano-facial repairs.
Resorption of the jawbone is a natural result of missing teeth. In such cases, your jawbone is insufficient to support dental implants, and you will have to choose another procedure or have a bone graft.
Bone grafting will replace the bone lost from your bone, from other species such as cows, or through synthetic bone materials. Sinus lift grafting is usually necessary where the bone grafting procedure is required for teeth on the upper jaw, behind the cheeks.
When the previous tooth extends to the sinus, the loss of that tooth leaves a thin layer of bone, which cannot support a dental implant.
A sinus lift graft involves the placement of bone graft on the sinus floor under the sinus membrane. After healing, the bone graft will form part of the jaw that supports the implant. A sinus lift graft recovery before a dental implant placement takes several months to allow sufficient bone regeneration.
Apart from its application in bone grafting for dental prosthesis, PRP therapy allows for repairing cleft palate deformities and ridge augmentation.
Dentists also use platelet-rich plasma on tooth extraction sites to accelerate bone formation and healing. Speedy healing after a dental extraction is crucial in reducing jawbone loss and facilitates the use of prosthesis. If your dentist uses PRP therapy during tooth extraction, you will be ready for implant placement after two to four months, unlike the regular four to six months waiting time in the absence of PRP therapy.
Dental Implant Procedures
PRP has shown great promise after its use in dental implant procedures for accelerated healing. Like in bone grafting, PRP therapy triggers bone regeneration and soft-tissue growth, facilitating faster placement of the crown after implant placement.
Most studies indicate that PRP triggers bone regeneration within two weeks of its application, making for faster implant adherence. Patients whose implants were dipped in platelet-rich plasma had their bone begin to regenerate two weeks after the procedure. The presence of a richer concentration of platelets triggered the implant to fuse faster with the patient’s bone (PRP accelerates Osseointegration).
Oronasal fistulas are abnormal pathways between the roof of the mouth and either of the sinus cavities. These cavities develop due to:
- Congenital abnormalities
- Trauma during surgical repair such as cleft repair
- Oral abscesses
- Procedures such as tooth extraction or implant placement on the upper jaw
- Buildup bacterial in the mouth
- Failed root canal
Such bacteria or abscesses can result in infections that could spread to the tooth pulp or the jawbone. Oral fistulas cannot repair themselves and require surgery to correct. Dentists can use PRP therapy during fistula repair to promote new bone tissue formation to close the fistula.
Dry socket is a common condition in 25 to 30% of patients who undergo malar extraction. It results in severe pain, especially on the first and third days after the extraction.
The development of a dry socket after an extraction is a significant concern for dentists. They seek to carry out procedures that minimize their occurrence or prescribe medication to handle such pain. Dry socket prevention also contributes to lesser chances of the patient developing an infection or jaw necrosis.
While anyone can experience a dry socket, some groups are at higher risks of the condition, including:
- Patients older than 30
- Women on oral contraceptives
- Post-menopausal women
- Patients with inflamed gums (pericoronitis)
- Teeth grinding
These conditions reduce circulation to the mouth, leading to lower wound healing capabilities. After tooth extraction, patients who receive PRP therapy have lower incidences of dry socket and reduced pain compared to those who receive standard treatment without PRP therapy.
Since PRP may contain white blood cells in addition to platelets, it prevents bacterial infections and promotes faster healing. These white blood cells also prevent the dissolution of established clots, which makes the healing process easier.
Platelet-rich therapy is a promising field with many possible applications in dental procedures. It offers many advantages, such as convenience and fewer side effects compared to medications.
Most of you probably know of sportsmen and women who have had PRP injections or people with tendon and ligament problems receive these injections and recover from the condition. However, you might feel uncertain when considering the same therapy for oral procedures.
Speaking to your dentist is usually the best approach so that you can learn more about the procedure, its applications, and your eligibility.
Preparation for PRP therapy will depend on your circumstances, but you need to let your dentist know about any medication you are taking that could affect the effectiveness of platelets.
People with hematologic conditions also need to consult with their doctors on their suitability for this therapy to ensure that it does not pose any unnecessary risks.
In general, PRP therapy is a safe procedure since it utilizes the patient’s blood and components. The only complications that could arise are linked to the blood draw, the injection used, and the sterility of the equipment used to draw and prepare the blood.
Remember that you will be paying for the procedure from your pocket; therefore, you must discuss the cost with your dentist and adjust your finances to accommodate the treatment. One therapy will cost from $400.
Find a Northridge Dentist Near Me
Advances in medical technology enable healthcare professionals to understand how our bodies work and to develop better treatment options that bring more good than harm to patients.
Dental procedures, including oral and implant surgeries, require significant recovery time. Wound healing in these instances is of crucial importance in measuring these procedures’ success.
Dentists seek to shorten the recovery time between treatments, which also reduce the risk of developing infections, for instance, bacterial infections of the blood due to delayed wound healing.
Therefore, they employ procedures like PRP therapy, which trigger the body’s natural healing mechanisms by concentrating wound healing factors to the surgical site. Northridge Dentist is an open-minded dental practice that seeks to bring the best treatments to our patients.
Our team consists of dental professionals updated with the current happening in the dental world and procedures that we can embrace for our patients’ benefits. In addition to adopting new technologies and treatment methods, we inform our patients to understand what treatment involves.
Call us at 818-875-0216 to schedule your consultation.