Do autologous platelet concentrates (APCs) have a role in intra‐oral bone regeneration? A critical review of clinical guidelines on decision‐making process

Abstract

In the past decades, personalized regenerative medicine has gained increased attention. Autologous platelet concentrates (APCs) such as PRP, PRGF, and L‐PRF, all serving as a source of a large variety of cells and growth factors that participate in hard and soft tissue healing and regeneration, could play a significant role in regenerative periodontal procedures. This narrative review evaluated the relative impact of APCs in alveolar ridge preservation, sinus floor augmentation, and the regeneration of bony craters around teeth, both as a single substitute or in combination with a xenograft. L‐PRF has a significant beneficial effect on alveolar ridge preservation (<alveolar bone resorption, >bone quality). The data for PRGF are less convincing, and PRP is controversial. L‐PRF can successfully be used as a single substitute during transcrestal (≥3.5 mm bone gain) as well as 1‐stage lateral window sinus floor elevation (>5 mm bone gain). For PRGF and especially PRP the data are very scarce. In the treatment of bony craters around teeth, during open flap debridement, L‐PRF as a single substitute showed significant adjunctive benefits (e.g., >PPD reduction, >CAL gain, >crater depth reduction). The data for PRP and PRGF were non‐conclusive. Adding PRP or L‐PRF to a xenograft during OFD resulted in additional improvements (>PPD reduction, >CAL gain, >bone fill), for PRGF no data were found. Autologous platelet concentrates demonstrated to enhance bone and soft tissue healing in periodontal regenerative procedures. The data for L‐PRF were most convincing. L‐PRF also has the advantage of a greater simplicity of production, and its 100% autologous character.

L-PRF Secretome from Both Smokers/Nonsmokers Stimulates Angiogenesis and Osteoblast Differentiation In Vitro

“…This study demonstrated that L-PRF secretome (LPRFS) derived from L-PRF membranes from smokers and nonsmokers similarly stimulates angiogenesis and bone differentiation in vitro. L-PRF is a source of growth factors and biomolecules for stimulating tissue wound healing in vitro and in vivo [3,10]; however, most previously reported evidence includes L-PRF derived from nonsmoker healthy donors. L-PRF has been proven effective in treating periodontal defects and sinus lift procedures evaluated through clinical and radiographic parameters.…”

“…L PRF clot enriched in leucocytes and platelets is obtained from the middle portion of the tube, removing the erythrocytes. This L-PRF clot can be compressed to get membranes or plugs at the wound receptor site [3]. There is growing in vitro and in vivo evidence that supports the application of L-PRF derived from nonsmokers to stimulating wound healing during both medical and dental conditions, including the treatment of leg ulcers, periodontal defects, sinus lift surgery, alveolar ridge preservation, and as an adjuvant in gingival graft procedures for gingival recession treatment [2][3][4][5][6].…”

“…This L-PRF clot can be compressed to get membranes or plugs at the wound receptor site [3]. There is growing in vitro and in vivo evidence that supports the application of L-PRF derived from nonsmokers to stimulating wound healing during both medical and dental conditions, including the treatment of leg ulcers, periodontal defects, sinus lift surgery, alveolar ridge preservation, and as an adjuvant in gingival graft procedures for gingival recession treatment [2][3][4][5][6]. These beneficial effects may be linked to the impact of L-PRF on cell proliferation, migration, angiogenesis, bone differentiation, and inhibition of osteoclast activity [7][8][9].…”

Human versus Rat PRF on Collagen Membranes: A Pilot Study of Mineralization in Rat Calvaria Defect Model

“…The plasma fraction containing the platelets and leukocytes undergoes coagulation, and the resulting yellow clot is removed while serum is squeezed out, ending up with PRF membranes [1]. PRF membranes have a broad spectrum of clinical applications ranging from dentistry [3][4][5][6][7][8][9] to other disciplines, such as healing diabetic ulcers [10], cartilage and joint repair [11], and even pterygium surgery [12]. In dentistry, for instance, a typical application of PRF membranes is in filling extraction sockets, not only for alveolar ridge preservation but also for the improvement of bone regeneration [13,14].…”

Leukocytes within Autologous Blood Concentrates Have No Impact on the Growth and Proliferation of Human Primary Osteoblasts: An In Vitro Study

“…Over the last 20 years, regenerative medicine has undergone a remarkable transformation with the introduction of autologous blood concentrates in the medical and dental fields [1][2][3]. These concentrates have evolved from first-generation platelet-rich plasma (PRP) [4,5] plasma rich in growth factors (PRGF) to second-generation platelet-rich fibrin (PRF) [6].…”