Clinical effect of platelet rich plasma in the treatment of periodontal intrabony defects.Systematic review and meta-analysis.
INTRODUCTION.Periodontal disease is a multifactorial and complex condition that affects the periodontium. It is characterized by the loss of collagen membrane with the subsequent destruction of the periodontal tissues.
1-3If not treated, the condition will lead to a premature loss of teeth.
2,4The main objectives of periodontal treatment are to eliminate the inflammatory process, prevent the progression of periodontal disease, maintain natural dentition in optimal health and function, and regenerate the lost periodontal tissues.1,5,6 The therapeutic modalities currently used to restore periodontal tissues, such as conventional open flap debridement (COFD), have shown limited potential to achieve the desired results. These techniques fail to regenerate the tissues affected by the disease. In addition, current regenerative procedures offer limited potential for complete periodontal restoration.
4,5One of the consequences of periodontal disease (periodontitis) is the appearance of periodontal intrabony defects (PID) (proximal and/or marginal bone loss). Various biomaterials, based on endogenous regenerative technology, have been used for treatment, in addition to using autogenous and allogeneic bone grafts. However, there is not any biomaterial considered as the gold standard yet for the treatment of PID.
3,5,7,8The key to tissue regeneration is to produce a cascade of coordinated curative events that can stimulate tissue formation. Such modulators include the use of growth factors (GFs), the application of extracellular matrix proteins, binding factors and the use of bone morphogenetic proteins.2,9,10 The potential role of GFs in periodontal regeneration is currently the focus of research. In recent years, there has been an increase in the scientific evidence that demonstrates their effectiveness in periodontal regeneration.
2,5,11-14GFs are present in platelet alpha granules, which upon release allow the multiplication and development of vascular endothelial cells, smooth muscle cells and fibroblasts. In addition, they induce multiple effects on cellular remodeling and modulate the inflammatory reaction in the healing and tissue regeneration processes.
1,2,5,10,14-18GFs include the platelet-derived growth factor (PDGF) and transforming growth factor β (TGF-β). These factors are the most studied in terms of periodontal regeneration. They are known to facilitate bone regeneration after bone grafting by increasing neoangiogenesis, cellular chemotaxis, mitosis, promoting stem cell proliferation and increasing osteoconduction.
1,2,10,14,19Other GFs, such as endothelial growth factor, vascular endothelial growth factor (VEGF), and type 1 insulin-growth factor, have been shown to have the potential to improve and accelerate the regeneration of hard and soft tissues.
1,5,10-15There is a growing interest in the use of platelet-rich plasma (PRP) for the treatment of PID since it is a concentrated s...