What is PRP in periodontology anyway?

PRP is an autologous blood product with an increased platelet concentration and corresponding release of biologically active factors. In periodontology, PRP is not discussed as a substitute for standard therapy, but as a possible addition to regenerative procedures. The decisive factor is therefore not the mere existence of PRP, but the clinical context: what defect morphology is present, what regenerative concept is used and how standardized is the treatment actually?

For which indications is PRP relevant in periodontal disease?

The most robust discussion on PRP does not take place in general periodontitis therapy, but primarily in the case of residual deep pockets with intrabony defects in a surgical-regenerative context. The EFP S3 guideline recommends regenerative periodontal surgery for intrabony defects of 3 mm or more. For residual deep pockets without this context, the basis remains the structured staged treatment of periodontitis and not just any PRP short circuit.

What do meta-analyses show for intrabony defects?

Here it becomes more concrete. The meta-analysis by Roselló-Camps et al. found small to moderate benefits for PRP in attachment level and radiographic bone level, but no significant benefit in probing depth reduction. The pooled effects were 0.58 mm CAL gain and 0.76 mm bone level benefit, while the PPD change was not statistically clear. This is a signal, but not a breakthrough.

The meta-analysis by Hou et al. was somewhat more favorable for PRP and showed an average of 0.76 mm additional CAL gain and 0.53 mm additional PD reduction. At the same time, the additional benefit in subgroups with guided tissue regeneration was not significant.

What happens if you don't just read the positive studies?

Then the picture becomes much more sober. In a randomized study, Harnack et al. found no additional benefit of PRP over beta-TCP in intrabony defects. Döri et al. also showed no significant improvement with PRP in the 5-year data if EMD plus natural bone mineral had already been used. Yilmaz et al. also reported that PRP plus bovine-derived xenograft performed clinically similar to platelet-poor plasma plus xenograft.

Is PRP already standard in non-surgical periodontal therapy?

No. The evidence is too inconsistent for this. In more recent reviews on non-surgical therapy, autologous platelet concentrates as a whole or PRF/i-PRF directly are often examined, not just classic PRP. Although the meta-analysis by Lipovec et al. found additional effects of around 0.6 mm PPD reduction and 1.1 mm CAL gain after six months compared to NSPT alone, it also reported high heterogeneity and an unclear to high risk of bias. This is interesting, but not yet a clean standard.

The more recent RCT by de Oliveira Alves et al. on i-PRF also shows that this restraint makes sense: both groups improved after SRP, but without any significant additional benefit from the injectable concentrate. So anyone who sells non-surgical PRP across the board as a proven routine is faster in marketing than in evidence.

Why does the evidence on PRP in periodontal disease remain so inconsistent?

Because very different methods are often lumped together under the PRP label. Differences in blood collection, tube system, centrifugation protocol, activation, platelet concentration, defect morphology, accompanying materials and surgical technique make the studies difficult to compare. It is precisely this heterogeneity that is named as a central problem in the systematic reviews themselves. This is not a detail, but the reason why PRP is still an additional option rather than a core guideline.

What role do PRP tubes play in standardized PRP protocols?

More than many people want to admit. PRP tubes are not just accessories, they are part of the pre-analysis and therefore part of the reproducibility. If blood collection, tube system and preparation routine are not properly standardized, clinical results become difficult to compare. This does not mean that a particular tube automatically guarantees better therapy results. Precisely this statement would be too far-reaching from a technical point of view and unnecessarily risky in terms of advertising law. The only thing that is technically correct is that standardized PRP protocols do not begin in the centrifuge.

A practical page on PRP tubes can be found here: prpmed.en → PRP tubes Vi PRP-PRO