Platelet Rich Plasma (PRP) in Dental and Oral Surgery: Gum Problems and Periodontitis
Periodontitis is one of the most common infectious diseases in the world and is associated with some chronic diseases such as heart disease and diabetes.
What are periodontal diseases?
The word periodontal literally means "around the tooth". Periodontitis, also known as gum disease, is a serious bacterial infection that destroys the gums and surrounding tissues in the mouth.
If the infection is not treated, the disease progresses and the underlying bone around the teeth disintegrates and is no longer able to hold the teeth in place.
Usually tooth loss is not painful, so it is possible to have it and not even notice it.
What causes periodontitis?
As with many other oral health diseases, bacteria and plaque buildup are often the cause. In fact, plaque buildup (which contains many types of bacteria) is the most common cause of gum disease. Other factors that contribute to gum disease include:
> Lifestyle choices
> A nutrient-poor diet
> Smoking/use of smokeless tobacco
> Autoimmune or systemic diseases
> Hormonal changes in the body
> Bruxism (incessant clenching of the teeth)
> Certain medications
Types of tooth loss
The different types of periodontal disease are often classified according to the stage at which the disease has progressed at the time of examination:
Gingivitis. In gingivitis, the mildest form of tooth loss, the gums are likely to be red, swollen and sore, bleeding easily with daily brushing and flossing. Treatment by a dentist and proper, consistent home care will help resolve the problems associated with gingivitis.
Mild periodontitis. Untreated gingivitis leads to mild periodontitis. This stage of gum disease shows signs of gingival pockets (the gums pull back from the teeth, deepening the gap between the teeth and gums) and early bone loss around the teeth. Immediate dental treatment is necessary to prevent further erosion of the bone and damage to the gums.
Moderate to advanced periodontitis. The most advanced stage of gum disease shows significant bone loss, deepening of the gum pockets, and possible recession of the gums around the teeth. Teeth may become loose and require extraction.
What are the treatment methods for periodontitis?
The difficulty in the treatment of inflammatory periodontitis is that known standard methods (antibacterial therapy and local treatments) do not always lead to positive results and a long remission period, thus improving the quality of treatment for patients with periodontitis. New innovative treatment methods need to be introduced into the dental practice. Despite the numerous methods proposed (use of osteoplastic materials, targeted tissue regeneration techniques, etc.), the problem of periodontal treatment remains acute, so a comprehensive introduction of new technologies into dental practice is necessary to improve the quality of care of patients with periodontitis
One of these methods today is the method of injection with plasma obtained from the patient's own blood, called Platelet-Rich Autoplasm (PRP). The great interest in PRP is mainly due to the fact that platelets contain numerous growth factors and cytokines that promote the regeneration of damaged tissue. Due to these factors, platelet plasma injected into the tissue leads to the formation of new capillaries, normalization of hemodynamics, tissue aeration and metabolism.
PRP therapy is an injectable method for local stimulation of tissue regeneration processes. It serves not only to relieve inflammation, but also initiates the process of natural regeneration of the color, shape and structure of the oral mucosa
The use of platelet-rich plasma (PRP) today offers one of the few ways to modulate and improve wound healing and fight infections without the use of drugs
The advantage of PRP therapy is that platelet-rich plasma can accelerate the regeneration of bone, cartilage and epithelium, as the regeneration process is universal and differs only in duration. Another advantage of PRP treatment is the improvement of microcirculation and metabolism, which stimulates local immunity. Moreover, platelet-derived growth factors cannot cause cancer as they are not mutagenic.
At the same time, the process of bone consolidation, collagen matrix formation and bone formation is carried out with the participation of bone morphogenetic collagen proteins, activating local immunity.The use of autoplasm excludes the possibility of infection and allergic reactions.
The material for PRP therapy is autoplasm, which contains platelets, hormones, proteins and vitamins in natural concentration.
The use of platelet-rich plasma is currently one of the few ways to modulate and improve wound healing and fight infections without the use of drugs
Blood consists of the intercellular substance (plasma), a clear pale yellow fluid (55% of blood mass) and its suspended components (45%). The three main types are red blood cells (RBCs), white blood cells (white blood cells) and platelets (thrombocytes)
The use of platelet-containing autoplasm is a way to stimulate and improve tissue regeneration.
Autoplasm enriched with platelets and fibrin is an endogenous source of growth factors obtained from the separation of whole blood by density gradients. In performing this function, platelets have been found to secrete special proteins called growth factors, which are biologically active molecules. They send out special signals that are picked up by receptors on damaged cells.
To obtain platelet plasma, this method uses a special PRP tube and a centrifuge with special centrifugation modes. Blood is taken from the patient in a tube (on average 9 to 36 ml) immediately before centrifugation, since autoplasm with a high platelet concentration can only be isolated from fresh, non-conjugated blood.
Centrifugation divides the blood into fractions using the separating gel: The lower part of the tube contains the red blood cell mass, and the upper part contains the platelet-rich plasma.
During the first 10 minutes, the platelets secrete about 70% of the growth factors they contain. The complete release of growth factors occurs within one hour. The platelets then synthesize additional growth factors for about 8 days before they die. Therefore, the PRP production must be immediately before use and must not be activated in advance.
Advantages of PRP therapy for periodontitis
- Elimination of unpleasant odors from the mouth;
- Elimination of bleeding;
- Significant reduction of tooth mobility (and thus the risk of tooth loss);
- Pain relief, prevention of periodontal diseases;
- rapid closure and healing of cavities after tooth extractions;
- Restoration of the natural color and correct anatomical shape of the gums
- prevent further spread of periodontal disease;
- Ensuring osseointegration of implants;
- almost complete reduction of the risk of allergies or rejection of the implant;
- Improvement of the patient's quality of life.
- High tolerance
PRP therapy does not introduce foreign proteins or synthetic substances into the patient's body, which can cause an allergic reaction in allergic patients. The only foreign substance that can cause an allergic reaction in a patient is the anticoagulant used to obtain the treatment substrate. Therefore, before prescribing the procedure, it is necessary to determine whether the patient has had a previous allergic reaction to the drug to be used.
- Minimum number of contraindications and possible side effects
The introduction of autoplasm does not cause cell mutations that can cause the growth of benign and malignant tumors. Since the plasma is completely non-toxic, kidney and liver damage, the development of dysbacteriosis and the occurrence of other serious complications from the injection are completely excluded. With proper pre-cleaning of the oral cavity and compliance with the rules of asepsis, the risk of local inflammation is also practically reduced to zero.
Direct contraindications to the administration of autoplasm injections are only bleeding problems and/or bleeding sequelae manifested by a decreased platelet count below 100,000/μl and anemia (hemoglobin below 90 g/l), as well as intolerance to anticoagulants and coagulants.
In addition, caution and a discriminating approach are recommended when prescribing the procedure to patients with coagulation disorders, febrile patients, people with oncopathology, and active herpetic and other viral infections. Relative contraindications include the use of heparin-based medications on the day of PRP administration.
In all other cases, platelet-rich plasma can be administered without restriction.
- Exceptional efficacy
PRP treatment of patients with periodontal disease strengthens gum tissue and prevents the development of periodontitis, which in turn helps prevent tooth loosening and tooth loss.
PRP therapy is very effective in periodontitis treatment
The injections of autoplasm accelerate the healing of implants and prevent their rejection. They also greatly shorten the healing time after extensive maxillofacial surgery, including osteoplasty and sinus inlay.
PRP is essential for dental extractions in diabetics - the injection of platelet-rich plasma ensures rapid wound healing and prevents the formation of abscesses.
Platelet rich plasma is an autologous plasma volume with a 4-5 fold increase in platelet concentration and is a proven source of growth factors such as PDGF, TGF, IGF, VEGF, EGF, platelet derived angiogenesis factor and platelet factor IV . The positive influence of PRP on bone healing is attributed to the angiogenic, proliferative and differentiating effects of PDGF and TGF in high concentration
The use of PRP technology, in addition to supporting bone healing during extensive bone augmentation procedures, is recommended for all patients with impaired wound healing, such as heavy smokers, diabetics, especially with known wound healing and osteoporotic diseases.
What are the disadvantages of the treatment method with PRP?
Although the treatment effect occurs quickly, it does not last long - about 3-4 months. Of course, provided that the patient strictly adheres to the rules of hygiene. Therefore, it is strongly recommended to repeat the treatment at least every six months to maintain the good condition of the gums. It is also important that the plaque is removed at regular intervals.
The complexity of the procedure lies in the fact that each patient is different, so it is essential to take into account the state of health, blood clotting levels and the number of certain cells in the blood in order to obtain a plasma that is actually of maximum benefit for the treatment.
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