Clinical controversies in oral and maxillofacial surgery: part onePlatelet-rich plasma: ready or not?
Section snippets
Platelet-rich plasma with autogenous bone
Only a few studies to date have evaluated the effect of combining PRP with autogenous bone, and the results vary. The most noteworthy study is the article by Marx et al.2 In this study, 88 patients with mandibular continuity defects were randomized to be reconstructed with autogenous cancellous bone grafts with or without the addition of PRP. Subjectively evaluated radiographs determined that the degree of maturation of the grafts was significantly greater with the addition of PRP (1.6 to 2.2
Platelet-rich plasma with anorganic bone mineral
Can PRP promote improved bone healing when combined with anorganic bone mineral? Because PRP is postulated to exert its effect on living cells, Marx believes that PRP is “unlikely to significantly promote bone substitutes and other non-cellular graft materials.”14 Nevertheless, several studies have looked at PRP combined with anorganic bovine bone (Bio-Oss; Osteohealth, Shirley, NY), and the results are again conflicting.
Two studies evaluated the use of PRP with Bio-Oss in a rabbit calvarial
Platelet-rich plasma with organic bone matrix
PRP has been combined with organic bone matrix, such as freeze-dried, demineralized bone powder. There are a few studies in this category, and again the results are mixed.
Shanaman et al22 performed alveolar ridge augmentation on 3 patients, primarily using freeze-dried demineralized bone (combined with small amounts of autogenous bone in 2 cases). The graft was mixed with PRP and protected with a barrier. Core samples for histology were obtained at the time of implant placement. Although there
Platelet-rich plasma when used alone
When PRP has been placed into bone defects without other grafting materials, the results are again inconclusive. Anitua28 reported improved epithelialization and bone density when PRP was placed into extraction sockets. Similarly, Mancuso et al29 showed a lower rate of alveolar osteitis, less pain, and more dense radiographic bone healing when PRP was placed into third molar extraction sockets. However, Farrell et al30 found no enhanced bone formation when inferior border mandibular defects in
Discussion
Why are there such conflicting data in the literature to date? The particular animal models used may play a role. It is certainly possible that a higher concentration of platelets may aid in human wound healing, whereas other animal species may heal extremely well even without additional platelets, making it more difficult to show a benefit of PRP in these models. The techniques used to sequester the platelets and prepare the PRP in the various studies may influence the success. Some isolation
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Evaluation of bone regeneration in periapical osseous defects with and without platelet rich plasma, combined calcium sulfate and autologous bone graft – A comparative study
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