Theoretical and Clinical Considerations for Autologous Blood Preparations: Platelet‐Rich Plasma, Fibrin Sealants, and Plasma‐Rich Growth Factors

Abstract

Introduction: Growth factors may play a prominent role in wound healing. Concentrating these mediators and applying them to healing osseous or soft tissue may accelerate the process and improve the quality of the healing tissues. Methods of collecting and concentrating autologous platelets have been developed. Platelet‐rich plasma (PRP) is a technique that concentrates platelets and releases their growth factors when applied to healing tissues. There are some positive data about the effects of PRP on hard‐ and soft‐tissue healing, but there is also some literature that shows minimal or no effect. Fibrin sealants undergo a different preparation procedure than PRP and tend to concentrate fibrinogen rather than platelets. They can be applied to either hard or soft tissue. Studies of these agents are also conflicting and some show positive results, whereas others show minimal effect. A third technique is plasma‐rich growth factors (PRGFs). Like PRP, this preparation concentrates platelets but differs from PRP in that no leukocytes are included. Studies support its use to improve hard‐ and soft‐tissue healing, but these articles are primarily case reports. Case Presentations: Pictures of two cases are shown in Figures 2 through 5. One shows the use of PRP with ridge augmentation, whereas the other demonstrates the use of PRP with root coverage. Conclusion: All of these agents, PRP, fibrin sealants, and PRGF, need additional study to determine the best indications to obtain a predictable wound healing benefit.

Platelet‐Poor and Platelet‐Rich Plasma Stimulate Bone Lineage Differentiation in Periodontal Ligament Stem Cells

“…Distinct platelet‐derived fractions have been designed 14 , 16 . These include platelet‐rich plasma (PRP), platelet‐poor plasma (PPP), and platelet‐rich fibrin, among others 16 , 17 . At the clinical level, they may be applied in the form of a gel on surgical wounds as an autologous source of biomolecules for the treatment of a wide range of tissue injuries 13,17‐19 .…”

“…These include platelet‐rich plasma (PRP), platelet‐poor plasma (PPP), and platelet‐rich fibrin, among others 16 , 17 . At the clinical level, they may be applied in the form of a gel on surgical wounds as an autologous source of biomolecules for the treatment of a wide range of tissue injuries 13,17‐19 . However, conflicting results regarding the clinical effectiveness of PRP in periodontal regeneration have been reported in the literature, probably because of wide variations in the protocols used to generate PRP, heterogeneity among clinical studies that evaluate different types of defects, and the absence of a biologic rationale to define the adequate concentrations of growth factors and other components present in platelet‐derived fractions 18–23 .…”

Platelet‐Rich Plasma–Assisted Guided Bone Regeneration for Ridge Augmentation: A Randomized, Controlled Clinical Trial

“…Resorbable or non‐resorbable membranes to block tissue ingrowth are often used as a guided bone regeneration technique to obtain a better result than graft alone. Biologics such as platelet‐derived growth factor, bone morphogenetic proteins, or autologous blood preparations may further augment the result 16 . More randomized, controlled, masked comparisons of biologics, membranes, graft materials, and augmentation techniques are needed to determine which materials and techniques give the most predictable results.…”

“…The use of autologous blood preparations may enhance bone grafting and ridge augmentation results 15,17‐19 . Platelet‐rich plasma (PRP) contains at least 60 different biologically active growth factors involved in the wound healing process that can stimulate cell proliferation, differentiation, chemotaxis, angiogenesis, and remodeling 16,19 . The concentration of growth factors is two to seven times higher in PRP than in normal blood clots 16 .…”

Advantages of Autologous Platelet‐Rich Fibrin Membrane on Gingival Crevicular Fluid Growth Factor Levels and Periodontal Healing: A Randomized Split‐Mouth Clinical Study

“…Platelet‐rich fibrin (PRF) is a second‐generation platelet concentrate first developed by Choukroun et al 24 as an autologous leukocyte and PRF biomaterial; it appears to improve and ease the use of this technique. It has been reported to have stimulant potential on cell chemotaxis and proliferation, and it is considered a novel therapeutic adjuvant in treatment of periodontal soft and hard tissues 25 , 26 . PRF has been shown to provide promising results in various surgical procedures, such as sinus‐floor augmentation during implant placement, 27 with a coronally displaced flap in multiple gingival recessions (GRs), 28 and in management of periodontal infrabony defects 29 and furcation defects 30 .…”