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4 prp & prf.pptx
- 2. Contains restingplatelets 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 natureof 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
- 5. 8 ml autologouswhole 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 collectedwithout 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 preparationprocess 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 pooror 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
- 11. CELLS SIGNALING MOLECULES SCAFFOLDS 1. Mechanical stress 2.Vascularity 3. Infection Giannobile
- 12. Do PRP &PRF release growth factors? Do these growth factors affect regeneration?
- 13. PDGF-AB PDGF-AB ng/109 ml TGF-βTGF-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
- 14. Growth Factor Timepoint (hours) % of Max. EGF8 85.6 bFGF 2 82.3 PDGF-BB 4 82.4 TGF-β1 2 80.7 VEGF 4 80.4 Mathew J Swift
- 15. TGF-β1 ng/109 mlPDGF-AB ng/109 ml PLATELET CONCENTRATE COLLECTION SYSTEM (PCCS) 209.4 113.0 CURASAN –TYPE PRP KIT 70.2 275.4 Weibrich et al 2002
- 16.
- 17. TGF-β1 DOHAN ETAL 2006
- 18. PDGF-BB DOHAN ETAL 2006
- 19. ECM PROTEINS Fibronectin Vitronectin MATRICELLULARPROTEINS-TSP FIBRIN MESH 3D structure Platelet Leukocyte aggregation
- 20. LEUKOCYTES? Cytokines released Pro,anti-inflammatory MMP – 9, Serpin E1 Platelet leukocyte interactions Mechanisms Effects
- 21. FRANCIS J. HUGHES,WENDY TURNER, GEORGIOS BELIBASAKIS & GIANLUCA MARTUSCELLI 2006
- 22. P.Ducy et al1997 , J.B.Lian et al 2003, J.H. Hong 2005,Ishii et al 2003 , Nakashima et al 2002 , L.Ma 1996
- 23. FRANCIS J. HUGHES,WENDY TURNER, GEORGIOS BELIBASAKIS & GIANLUCA MARTUSCELLI 2006
- 24. Growth factor release? PRP- 8 hrs PRF- sustained release 1 week Fibrin, matrix proteins Affect osteoblast differentiation PRP- ?? PRF- qualified yes
- 26. VERTICAL OSSEOUS DEFECTS SINUSAUGMENTATION GBR ROOT COVERAGE
- 27. STUDIES MATERIALS & METHODS BMP-2 COLLAGEN- 1 OSTEOCALC IN WILTFANGJ 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 Newbone 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 DEFECTCLOSURE 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 BiITBIC 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 AREAOF 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 OFSTUDY 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 OSSEOUSFILL 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 inbone 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 AL2008 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
- 38. STUD IES MATER IALS & METHO DS PD REDU CTIO N(mm ) CAL GAIN( mm) RECES SION COVE RAGE( mm) BONE PRO BING (mm) DEFEC T BONE FILL (%) AREA WITH GRAY S(mm ) OUTC OME ASSES SMEN T Hanna et al 2004 ABB+P RPvs ABB 1.01 0.84 -0.15 Signifi cant +ve 1 year Ouyang & Qiao 2006 ABB+P RP vs ABB 1.3±0. 54 1.67± 0.34 1.68± 0.25 26.09 ±3.31 2.19± 0.03 Signifi cant +ve 1 year Piemont ese et al 2008 DFDBA +PRP vs DFDBA 1.7±0. 5 1.2±0. 3 Signifi cant +ve 1 year
- 39. STUDIE S MATERI ALS & METHOD S PD reducn (mm) CAL GAIN (mm) VRA GAIN(% ) DURATI ON OF STUDY OUTCOM E ASSESS MENT Okudaet al 2005 HA+PRP vs HA 1.0±0.4 1.4±0.5 24.8±6 1 year Significan t +ve Lekovic et al 2002 ABB+PRP vs ABB 1 year No significan t effects Demir et al 2007 BG+ PRP vs BG 1 year No additional benefits Harnack et al 2009 β-TCP + PRP vs β- TCP 1 year No additional benefits
- 40. STUDIE S MATERI ALS & METHO DS PD REDUCT ION CAL REDUCT ION DEFECT FILL OUTCO ME ASSESS MENT DURATION OF STUDY Lekovic etal 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 DURATIONOF 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 DURATIONOF 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 NOF 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 NOF 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 NOF 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 OFSTUDY 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
- 48. STUDIES MATERIAL S & METHODS Ti-MESH EXPOSUR E CLINICAL & RADIOGR APHIC ASSESSM ENT DURATIO NOF 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
- 50. STUDI ES MATER IALS & METHO DS RECES SION DEPTH GAIN (mm) KTW GAIN( mm) % ROOT COVER AGE Healin g index OUTCO ME ASSES SMENT DURAT IONOF STUDY (month s) Ver tic al Ho riz ont al Jankovi c 2007 CTG+P RP vs CTG 0.2 4± 0.1 1 - 0.74±0. 01 Enhanc ed in test vs control in 1st & 2nd wk Signific antly +ve 6 months Shepher d et al 2009 ADM + CPT & PRP vs ADM +CPT 0.3±1.0 20 Clinicall y significa nt 12 months Keceli 2008 CTG+P RP vs CTG No significa nt diff 12 months
- 51. STUD IES MATE RIALS & METH ODS RECE SSIO N DEPT H GAIN (mm) PD (mm) COMP LETE COVE RAGE CASE S (%) PSDL SOFT TISSU E CHAN GES OUTC OME ASSE SSME NT DURATIONOF STUDY V E RT IC AL H O RI Z O N TA L Cheun g WS 2004 PCG vs SCTG - 0. 36 -0.74 -5.5 Lower in PCG group at 1 month Superi or contou r & textur e matchi ng Better estheti c appear ance 8 months Huang LH 2005 CAF+P RP vs CAF - 0.1±0. 4 - 2.5±6. 9 No signific ant 6 months
- 52. Osseous defects • CALgain – 0.50 mm • New bone formation – 26%
- 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?
- 54. ROOT COVERAGE PROCEDURES SINUSAUGMENTATION VERTICAL OSSEOUS DEFECTS
- 56. STUDI ES MATE RIALS & METH ODS MEAN ROOT COVE RAGE COMP ETE ROOT COVE RAGE CASES GINGI VAL RECES SION( mm) WKT (mm) HEALI NG INDE X DURA TION OF STUD Y OUTC OME ASSES SMEN T Aleksic Z 2010, CAF+P RF vs CAF+C TG - 8.62% Enhan ced in PRF group 12 month s decrea sed postop erative discom fort and advanc ed tissue healing Jankov icS 2010 CAF+P RF vs CAF + EMD 2.1% 5% - 0.1±0. 2 - 0.43± 0.33 12 month s No clinical advant age of PRF over EMD
- 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
- 58. STUDI ES MATER IALS & METHO DS HISTOLOGIC ANALYSIS RADIO GRAPH IC ANALY SIS NO. OF IMPLA NTS LOST DURAT IONOF STUDY OUTCO ME ASSES SMENT BONE GAIN RESIDU AL BONE BONE GAIN Choukro un 2006 DFDBA + PRF vs DFDBA Histologic maturation of test at 4 mths same as control at 8 mths 8 months Positive Zhang Y 2011 Bio-oss + PRF vs Bio- oss 1.4% -1.5% 6 months No significa nt differen ce
- 59. STUDIE S MATERI ALS& METHO DS PD REDUCN (mm) CAL GAIN (mm) BONE FILL (%) OUTCO ME ASSESS MENT DURATI ON OF STUDY Thorat MK 2011 PRFvs OFD 1.00±0. 1 1.56±0. 01 18.26 Positive 9 months A.R. Pradeep 2011 PRF vs OFD All clinical and radiographic parameters showed statistically significant improvement in test vs control Positive 9 months VERTICAL OSSEOUS DEFECTS
- 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
- 67. 1. Is significantbone gain clinically relevant? 2. Evidence of supracrestal bone formation? 3. Evidence of true regeneration?
- 68. Patient related factors Post operative morbidity? Cost? Recombinant growth factors, gene therapy? Bone-Related Grafts, combination therapy
- 69. Sinus floor Significantimprovement in type C v-h?
- 70. Extraction sockets Labial bone- crestal margin Interdental bone? Vertical ridge augmentation ??
- 71. NBR, NTR phenomena? Cost,morbidity.
- 72. I. Inter-dental papilla II.Class 3 recessions III. Cost, esthetics, morbidity
- 73.
- 74.
- 75.