Efficacy of platelet-rich plasma in oral surgery and medicine: an overview

Introduction Advancements in medicine demand less invasive therapies and faster recovery times for large-area skin damage caused by burns, large ulcers and tumours. To cover the wound and aid in the recovery process platelet-rich plasma is often used as adjuvant for skin grafting. Platelet-rich plasma is a growth factor–enriched with platelet concentrate–and is obtained from whole autologous blood by using density-gradient centrifugation. The platelet concentration of plateletrich plasma is four times higher than that of whole blood. Platelets when activated can induce the production of a variety of growth factors, such as platelet-derived growth factor, transforming growth factor Î2, epidermal growth factor and vascular endothelial growth factor. As such, plateletrich plasma contains not only high levels of platelets but also the full complement of clotting factors. Preparation of platelet-rich plasma is quick, simple and relatively inexpensive. Moreover, because platelet-rich plasma is prepared from the patient’s own blood, the risk of experiencing complications is minimal. The aim of this review is to discuss the efficacy of platelet-rich plasma in oral surgery and medicine. Conclusion Since platelet-rich plasma is a vehicle of mitogenic and chemotactic cytokines and growth factors, it shows to posses beneficial effects for several clinical applications and makes its use more attractive than the use of a single-recombinant growth factor. However, much of the existing published data on platelet-rich plasma have few laboratory studies documenting the content of the platelet-rich plasma, mechanism of action or shortand long-term outcomes. Introduction Advancements in medicine demand less invasive therapies and faster recovery times for large-area skin damage caused by burns, large ulcers and tumours. To cover the wound and aid in the recovery process, skin grafting is often used. The materials for skin grafting has gradually developed from autogenous skin, allogenous skin and even xenoskin to synthetic skin substitute, which was made using the ‘tissue-engineered skin’1,2. Currently, to continue to offer the best treatments available, the major avenues being explored are stem cells, gene therapy and autologous or bioengineered cytokines. However, these therapies are not yet ready for widespread clinical use3. So, intense research in regenerative medicine is towards accelerating the healing process using various biological agents such as growth factors (GFs) that may improve the biological activity of graft substitutes4 promoting the repair of skin wounds. Because platelet-rich plasma (PRP) is a GF–enriched with platelet concentrate–it could be promising in this effort. It is obtained from whole autologous blood by using density– gradient centrifugation. The platelet concentration of PRP is four times higher than that of whole blood5 and on activation, platelets can induce the production of a variety of GFs such, as platelet-derived GF (PDGF-AB), transforming GF β (TGF-β), epidermal GF (EGF) and vascular endothelial GF VEGF6,7. As such, PRP contains not only high level of platelets but also the full complement of clotting factors. Preparation of PRP is quick, simple and relatively inexpensive. Moreover, because PRP is prepared from the patient’s own blood, the risk of experiencing complications is minimal3. Biological properties of plateletrich plasma PRP is an autologous concentration of platelets in a small volume of plasma8,9. Platelets are a rich source of the complex group of proteins called GFs involved in natural wound healing and in regeneration of injured tissues. GFs are active signals for attracting stem cells into the site of injury and triggering proliferation of these cells. These GFs have been shown to be mitogenic for osteoblasts and to stimulate the migration of mesenchymal progenitor cells10. Chemotactic and mitogenic stimulation of these mesenchymal stem cells occurs and leads to an enhancement of bone repair and regeneration. Degranulation of platelets granules by proteins such as thrombin causes them to actively release these factors and to initiate all wound healing11. * Corresponding author Email: [email protected] 1 University of Ferrara, Resident, Maxillo-facial surgery specialist, Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, via Luigi Borsari 46, Ferrara, Italy 2 University of Valencia, Full Professor, University of Valencia Unidad de Estomatologia, Hospital Dr. Peset, Consultas Externa Jaun De Garay Sin 46017 Valencia, Spain 3 University of Milan-Bicocca, Assistant Professor, Neuroscience Department, via Cadore n°48, 20052, Monza (MB), Italy