A Prospective Study Involving the Use of Platelet Rich Plasma in Enhancing the Uptake of Bone Grafts in the Oral and Maxillofacial Region

Abstract

Platelet-rich plasma (PRP) is an autologous product that contains highly concentrated number of platelets in a small volume of plasma, derived from whole blood by gradient density centrifugation. It has been speculated that local growth factors in human platelets (insulin-like growth factor, IGF; transforming growth factor, TGF-b; platelet derived growth factor, PDGF) would enhance healing of grafts and also counteract resorption. The aim of this study was to evaluate efficacy of PRP on early healing after autogenous bone grafting. Of the twenty patients selected ten were treated with autogenous bone graft and PRP (PRP group) and other ten with autogenous bone graft alone (non-PRP group). PRP group consisted of two benign tumor of mandible, one post surgical defect, two unilateral alveolar cleft, one bilateral alveolar cleft with skeletal class III malocclusion, one maxillary hypoplasia, one oronasal fistula, one recurrent tumor of mandible, one multiple impacted mandibular teeth. Non-PRP group consisted of seven benign tumor of jaw, one keratocyst odontogenic tumor, one orbital blow out fracture, one residual traumatic defect. Biopsies were taken in the native bone, PRP treated grafted bone, grafted bone without PRP at 3 months to assess the maturity of bone. Radiographic imaging was performed by panoramic radiography at 3 and 6 months to evaluate bone opacity of grafted bone on comparison with native bone and computerized tomography at 6 months to evaluate grafted bone morphologically and to measure bone density in Hounsfield units. Microscopic results showed that significantly more matured bone was formed at PRP treated sites as that of native bone and immature bone in controls after 3 months of healing. Bone opacity of PRP treated bone grafts was close to that of native bone than that of non-PRP treated bone grafts on panoramic radiograph at 3 and 6 months. There was graft loss in three cases and graft resorption in one case of non-PRP treated bone grafts at 6 months. In PRP group the compact bone was clearly differentiated from cancellous bone as in native bone and thick in five cases, thin in five cases. In non-PRP group the compact bone was thin as a whole. Comparing native bone group and PRP group the CT value of PRP treated bone graft was more or less close to native bone group and comparing native bone group and non-PRP group CT value was low in non-PRP treated bone graft. Whereas when comparing PRP and non-PRP group CT value was higher in PRP group. Autologous PRP was a safe, biocompatible, effective, source for growth factors and carries no risk of transmissible diseases. It enhances and accelerates bone regeneration of autogenous bone grafts.

Pooled thrombin-activated platelet-rich plasma: a substitute for fetal bovine serum in the engineering of osteogenic/vasculogenic grafts

“…In the literature, a significant and dose‐dependent increase in the proliferation rate of ASCs was reported when using tPRP instead of FBS as a culture medium supplement in monolayer cultures (Kocaoemer et al ., ; Kinzebach et al ., ; Amable et al ., ; Atashi et al ., ). Moreover, PRP has been investigated in both preclinical (Malhotra et al ., ) and clinical (Kumar et al ., ) studies as a potential enhancement or replacement of allogenic and autologous bone grafts in bone defects. Both, however, have so far delivered inconsistent results, possibly due to the lack of standardization of the preparation and application of PRP.…”

Immediate iliac bone graft reconstruction of post ablative defect of benign mandibular pathology - a systematic review

“…[ [33][34][35][36][37] On the other hand, other studies in the review got comparable or even better result despite not utilizing PRP. [23,26] Therefore it may be difficult to ascribe the outcome to any beneficial effect of PRP as claimed by the authors.…”

How Should We Evaluate Outcomes for Use of Biologics in the Knee?

“…44 In addition, radiographs can be used to detect signs of bone healing such as the degree of incorporation of bone grafts with biologic augmentation. 45 While radiographs are an inexpensive, widely available, and noninvasive tool for outcomes assessment, they do not provide a detailed assessment of soft tissue changes and thus likely have a limited role in assessing outcomes following biologic treatments. Plain radiographs may be most useful for long-term outcome studies of the effect of biologic treatment as a modifier of osteoarthritis disease progression.…”

“…Human clinical studies have evaluated structural outcomes on T1-and T2-weighted MRI images, particularly after ACL reconstruction with PRP augmentation. 38,40,[45][46][47][48] Clinical studies evaluating bone-graft integration into the reconstruction tunnels and ligament maturation after ACL reconstruction are numerous. 2 A systematic review 49 evaluated four studies (one level I randomized controlled trial, 50 two level II studies, 38,48 and one case-control study 46 ) to see if PRP or autologous platelet concentrations had any effect on graft integration into reconstruction tunnels, as determined on T1-or T2-weighted MRI scans.…”