2. Contains resting platelets at a
concentration of at least 106/ul.
The PRP may or may not be activated
prior to use; the term “PRP” does not
indicate that activation has occurred.
Petrungaro P S 2001
PRP is a fraction of plasma that
provides a rich source of growth factors
and may enhance the initial stabilization
and revascularization of the flaps and
grafts. Petrungaro 2001
3. • the nature of a matrix itself, in theory providing a
construct for tissue regeneration as well as
degradable (autologous), biologic, from which
growth factors are slowly released.
• Non-thrombinized autologous graft material
4.
5. 8 ml autologous whole
blood
Platelet-poor plasma and
buffy coat
Platelet-
poor plasma
Platelet-rich
plasma
Erythrocytes
2400 rpm for 10 minutes
3600 rpm for 15 minutes
Weibrich 2003
10% CaCl2+bovine
thrombin
6. blood is collected without
anticoagulant
Centrifuged (3000 rpm
10mins)
three parts quickly appear
in the tube
clot can be transformed
into a membrane by
compression between two
sterile gauzes
using a specific tool for
clot collection and
membrane standardization
Coagulation
starts during the
centrifugation
Choukroun et al
2000
7. 1. PRF preparation process creates a gel-like matrix,
that contains high concentration of non-activated
functional intact platelets contained within a fibrin
matrix that release a relatively constant
concentration of growth factors over a period of 7
days. Carroll 2005
2. It can be squeezed to form a membrane and can
be used as fibrin bandage serving as a matrix to
accelerate the healing of wound edges. Gabling
2009, Vence 2009
3. Chair-side preparation of PRF is quite easy, fast
and simplified process minus artificial biochemical
modification than PRP, which takes more time.
Dohan 2006
4. This procedure produces an inexpensive
autologous fibrin membrane in approximately 1
min and hence no cost for membrane and bone
graft to the patients.
8. Leukocyte poor or pure platelet-rich
plasma (P-PRP)
Leukocyte & platelet-rich plasma (L-PRP)
Leukocyte poor or pure platelet rich
fibrin(P-PRF)
Leukocyte and platelet-rich fibrin (L-PRF)-
Choukroun’s PRF
Dohan Ehrenfest 2009
9. 1. Effect – Something that is produced by an agency
or cause
2. Efficacy -It is the extent to which an intervention
does more good than harm when delivered under
optimal conditions
3. Effectiveness -It is the extent to which planned
outcomes are achieved as a result of an
intervention intended to achieve the desired effect,
under ordinary circumstances (not controlled
circumstances such as in laboratory).
4. Efficiency - It is the ratio of the output to the
inputs of any system.
Flay 1986; Last 1988
12. Do PRP & PRF release growth factors?
Do these growth factors affect regeneration?
13. PDGF-AB PDGF-AB
ng/109 ml
TGF-β TGF-β1
ng/109 ml
PRP vs
Unconcentrate
d plasma PRP vs
Unconcentr
ated
plasma
KAWASE ET
AL 2003
440.6±211.8% 256.7 346.6±111.
3%
198.7
27. STUDIES MATERIALS
&
METHODS
BMP-2 COLLAGEN-
1
OSTEOCALC
IN
WILTFANG J
2004
Autograft+P
RP (+1, +2
conc)
+collagen
lyophilisat in
various
combin in 6
groups
Inc in 2 wks
–collagen &
(+1)PRP
group
Inc at2 wks
in all
collagen
groups
Inc at 2 wks
in collagen
groups &
autogenous
bone + PRP
Inc in 4 wks
– collagen
&(+2) PRP
group
Pigs- critical
size defects
IHC at
2,4,12&26
wk
28. STUDIES MATERIALS
& METHODS
CP
RESORPTION
New bone formation
SOFFER E
2006 - Rabbits
Ceramic
particles (CP)
vs
Autogenous
platelet
lysates(APL) +
CP vs
CP+APL±Thro
mbin(THR)
+APL grps-
increased
APL+CP in calvaria-
decreased
APL+CP in femur -
increased
+THR grps -
decreased
Duration of
study -2
months
Critical size
defects in
calvaria &
femur
+THR in femur –
decreased
29. STUDIES MATERIALS &
METHODS
DEFECT CLOSURE
Pryor et al 2005 Sprague-Dawley rats
Contralateral critical-
size defects
No significant
difference between
test and control
PRP+ACS vs ACS
4th ,8th week
Torres et al 2010 Rabbits –calvarial
defects
Test group produced
twice the
vertical bone volume
PRP+ABB vs ABB
6 weeks
30. STUDIES MATERIA
LS &
METHODS
BiIT BIC BoIT OUTCOME
ASSESSM
ENT
Sánchez
2005
Mesial and
distal 3-
wall peri-
implant
defects
Significant difference between
treatment groups
Low
regenerative
potential
Dogs
DFDB+PRP
vs DFDB
vs NT
1 ,2 and 3
months
31. STUDIES MATERIA
LS &
METHODS
TOTAL
AREA OF
BONE
FILL
% OF
BONE
FILL
DURATIO
N OF
STUDY
OUTCOME
ASSESSM
ENT
Grageda E
2005
sheep Significant
increase in
test
No
significant
difference
6 months No significant
effect of PRP
in
combination
with allograft
in max sinus
augmentation
DFDBA +
CCFDBA +
PRP vs
DFDBA +
CCFDBA
32. STUDIES MATERIALS
& METHODS
DURATION
OF STUDY
OUTCOME
ASSESSMEN
T
de
Vasconcelos
Gurgel BC
2007
Mongrel dogs no
differences
were
observed for
all
parameters
3 months PRP does
not exert
additional
effects
PRP vs GBR
vs
PRP+GBR vs
control
Kazakos K
2011
Rabbits + critical
size defects
3 months does not
enhance
bone healing
process
Membrane vs
Membrane +
PRP
33. STUDIES MATERIALS &
METHODS
OSSEOUS FILL Outcome
assessment
Simon BI 2009 Dogs By 3 weeks in
PRFM containing
sites
PRFM alone may
be the best graft
for ridge
preservation
procedures
PRFM ,
Membrane
DFDBA &
untreated
control
Clinical &
histological
evaluation at
10days,2,3,6
and 12 weeks
34. Increase in bone related proteins in sites
treated with PRP ?
• Yes
Quantity n quality of new bone form??
Quantity
Significant new bone formation
Quality
Remaining graft particle
35. SUAID ET AL 2008
Mongrel dogs
Histomorphometric analysis after 1month
Results
Parameters Difference between test and
control (mm)
Length of new cementum 0.99±0.16
Sulcular+ junctional epithelium -0.45±0.25
New C/T attachment adjacent
to root without cementum
formation
0.06±0.1
Bone position -0.11±0.39
40. STUDIE
S
MATERI
ALS &
METHO
DS
PD
REDUCT
ION
CAL
REDUCT
ION
DEFECT
FILL
OUTCO
ME
ASSESS
MENT
DURATION
OF STUDY
Lekovic
et al
2003
PRP+
ABB+GT
R vs
OFD
1.58±0.
05
1.61±0.
11
ver
tica
l
hor
izo
ntal
Significa
ntly
Positive
6 months
2.7
5±
0.3
8
2.2
0±
0.3
5
Camargo
PM et al
2002
PRP+AB
B+GTR
vs GTR
buc
cal
ling
ual
buc
cal
ling
ual
buc
cal
ling
ual
Not
determin
ed
6 months
2.4
7±
0.5
2.4
±0.
51
1.3
6±
0.1
5
1.3
9±
0.0
4
1.7
5±
0.0
8
1.8
4±
0.1
1
Camargo
PM et al
2005
PRP+AB
B+GTR
vs OFD
2.2
2±
0.3
2.1
2±
0.3
3.0
5±
0.5
2.8
8±
0.4
3.4
6±
0.9
3.4
2±
0.0
Not
determin
ed
6 months
41. STUDIES MATERIALS &
METHODS
OUTCOME
ASSESSMENT
DURATION OF STUDY
Mauro et al
2003
GTR + PRP No additional
benefits
1 year
Yassibag-
Berkman 2007
β-TCP vs β-TCP
+ PRP /β-TCP +
PRP +
membrane
No additional
benefits
1 year
Dori et al 2008 ABB+ EMD
+PRP vs ABB+
EMD
No additional
benefits
1 year
Dori et al 2008 β-TCP +GTR+
PRP vs β-
TCP+GTR
No additional
benefits
1 year
42. STUDIES MATERIALS &
METHODS
OUTCOME
ASSESSMENT
DURATION OF
STUDY
Christgau et al
2006
PRP+ β-TCP+
GTR vs β-TCP+
GTR
No additional
benefits
12 months
Dori et al 2007 PRP+ABB+GTR vs
ABB+GTR
No additional
benefits
12 months
Dori et al 2007 ABB+PRP+GTR vs
ABB+GTR
No additional
benefits
12 months
Keles et al 2006 GTR+PRP vs
BG+GTR
No additional
benefits
12 months
Camargo et al
2009
ABB+GTR+PRP vs
ABB+GTR
No additional
benefits
12 months
43. STUDIES MATERIALS
& METHODS
CT
ANALYS
IS
OPG
ANALYSIS
DURATIO
N OF
STUDY
OUTCOM
E
ASSESS
MENT
NEW
BONE
FORMATIO
N
Graziani
et al
2005
PRP +
autologous
BG+
fibrinogen
cryo
precipitate
6.27
mm
mineralizatio
n as early as
3 months
postoperativ
ely
6
MONTHS
POSITIVE
44. STUDIES MATERIAL
S &
METHODS
HISTOMO
RPHOMET
RIC
ANALYSIS
IMPLANT
S
DURATIO
N OF
STUDY
OUTCOME
ASSESSM
ENT
Rodriguez
A 2003
PRP+anorg
anic
deproteiniz
ed bovine
BG+
immediate
implant
placement
viable new
bone
formation
in close
approximat
ion to the
xenograft
Lost= 5/70
in 15
patients
36 months Significantly
positive
Mazor Z
2004
PRP+autolo
gous
BG+immed
iate
implant
placement
no clinical
evidence of
crestal
bone loss
around the
implants
both
clinically
and
radiographi
6 months Significantly
positive
45. STUDIES MATERIAL
S &
METHODS
CT
ANALYSIS
HISTOMO
RPHMETR
IC
ANALYSIS
DURATIO
N OF
STUDY
OUTCOME
ASSESSM
ENT
NEW BONE
FORMATIO
N NEW
BON
E
RES
ORP
TIO
N
RAT
E
Philippart P
2003
PRP+rhTF+
autologous
BG
success
rate of
grafting
90.3%
6 months Positive
Philippart P
2005
PRP+rhTF+
autologous
BG+
inorganic
xenograft
6mt
hs-
0.5
6& 10
months
Positive
10m
ths-
2
46. STUDIES MATERIALS
& METHODS
HISTOMORP
HOMETRIC
ANALYSIS
DURATION
OF STUDY
OUTCOME
ASSESSMEN
T
NEW
BONE
%
GRAF
T
RESO
RPTIO
N
RATE
(%)
Wiltfang J
2003
beta-TCP +
PRP vs beta-
TCP
about
8-
10%
higher
Not
enhan
ced
6 months Regeneration
small extent
Kassolis JD
2005
FDBA + PRP
vs FDBA +
membrane
Non
signifi
cantly
higher
6.8 ±
4.5
0.84±
0.11
6 months Positive
Torres J 2009 ABB +PRP vs
ABB
Signifi
cantly
increa
6months Positive
47.
48. STUDIES MATERIAL
S &
METHODS
Ti-MESH
EXPOSUR
E
CLINICAL
&
RADIOGR
APHIC
ASSESSM
ENT
DURATIO
N OF
STUDY
OUTCOME
ASSESSM
ENT
Shanaman
R 2001,
PRP+
allograft
gains in
both
vertical
and
horizontal
component
s
Positive
Brugnami F
2011
Autologous
BG+PRP vs
Autologous
BG
enough
bone width
and height
6 months Positive
Torres J
2010
ABB +Ti-
mesh +
PRP vs ABB
+ Ti-mesh
28.5% in
control
,none in
test group
Bone
augmentati
on higher
in test
group
6 months Not
significant
53. Root coverage
• % of root coverage in general –
no significant effect on
improvement of root coverage
• How many studies talk of 100%
coverage and stability of results?
57. STUDIES MATERIAL
S &
METHODS
RADIOGR
APHIC
ANALYSIS
NO. OF
IMPLANT
S LOST
DURATIO
N OF
STUDY
OUTCOME
ASSESSM
ENT
BONE GAIN
Mazor et al
2009
PRF
+immediat
e implant
7mm –10mm None 6 months Positive
Toffler M
2010
Osteotome
sinus
elevation +
PRF
7mm-
13mm
None 6 months Positive
Simonpieri
A 2011
L-PRF+
immediate
implant
placement
8.5 - 12
mm
NONE 72 months Positive
61. Del Fabbro 2011
PRP may exert a positive adjunctive
effect when used in combination with
graft materials, but not with GTR, for
the treatment of intrabony defects.
No significant benefit
of platelet concentrates was found for
the treatment of gingival recession.
J Periodontol 2011 ;82:1100-1111
62. Kotsovilis S 2010
Diverse outcomes (positive and
negative) have been reported for the
efficacy of PRP combined with various
therapeutic bioactive
agents/procedures, reflecting the
limited and heterogeneous data
available and possibly suggesting
that the specific selection of
agents/procedures combined with
PRP could be important.
J Periodontol Res 2010;45:428-443
63. Plachkova AS 2008
They found evidence for beneficial
effects of PRP in the treatment of
periodontal defects.
Evidence for beneficial effects of PRP in
sinus elevation appeared to be weak.
No conclusions could be drawn about
other applications of PRP in dentistry.
Clin Oral Implants Res 2008;19:539-545
64. Arora NS 2010
No obvious positive effects of PRP
on healing of bone graft material in
maxillary sinus augmentation
procedures were noted, the
handling of the particulate bone
grafts was improved.
Implant Dent 2010 Apr 19(2):145-57
65. Martinez-Zapata MJ 2009
PRP improves the gingival
recession but not the clinical
attachment level in chronic
periodontitis.
Transfusion 2009;49:44-56
66.
67. 1. Is significant bone gain clinically
relevant?
2. Evidence of supracrestal bone
formation?
3. Evidence of true regeneration?
