Is autologous platelet concentrate beneficial for post-extraction socket healing? A systematic review
The aim of this systematic review was to assess if the use of autologous platelet concentrates may be beneficial to the healing of extraction sockets. Medline, Embase and Cochrane Central Register of Controlled Trials were searched using a combination of specific search terms. Hand searching of the relevant journals and of the bibliographies of reviews was also performed. Prospective comparative studies evaluating the effect of a platelet concentrate on fresh extraction sockets were included. Outcome variables related to hard and soft tissue healing, aesthetics and postoperative discomfort were considered. A methodological study quality assessment was made. The initial search yielded 425 articles, eight were finally included. 207 tooth extractions (104 tests and 103 controls) in 115 patients were evaluated. The articles provided a broad range of variable outcomes to assess the regenerative potential of platelet concentrate and its possible benefits to the treatment. Favourable effects on hard and soft tissue healing and postoperative discomfort reduction were often reported. A large heterogeneity was found regarding study design, sample size, surgical techniques and methods for preparing platelet concentrates. Standardization of experimental design is needed in order to detect the true effect of platelet concentrates in regenerative procedures of extraction sockets.
Available from: Mariano Tia
- "The growth factors (particularly platelet-derived growth factors (PDGF), transforming growth factors (TGF-í µí»½), and vascular endothelial growth factors (VEGF)) and the other molecules (fibrinogen, fibronectin, and vitronectin) contained in platelets (í µí»¼-granules) give to these products the ability to modulate many phases of the healing process like the hemostasis and the neoangiogenesis . The clinical results of these products are interesting but remain quite mixed and controversial in the literature, depending on the kind of preparation    . Platelet concentrates are classified into 4 main families depending on their leukocyte and fibrin content: pure platelet-rich plasma (P-PRP), leukocyte-and platelet-rich plasma (L-PRP), pure platelet-rich fibrin (P- PRF), and leukocyte-and platelet-rich fibrin (L-PRF) . "
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ABSTRACT: The aim of this study was to evaluate the effects of leukocyte- and platelet-rich fibrin (L-PRF) on the pain and soft tissue healing after tooth extractions. Twenty-six patients (9 males and 17 females) were treated with multiple extractions (2 to 8), with a total of 108 extractions. This was an exploratory single blinded randomized clinical trial with a split-mouth design. The pain after the surgery was assessed in each patient by the VAS scale (1 to 10) at intervals of 24-48-72-96 hours. The soft tissue healing was clinically evaluated at 3, 7, 14, and 21 days after surgery by the same examiner surgeon, using the modified Healing Index (4 to 12). The mean value of postextraction pain was 3.2 ± 0.3 in the experimental sides and 4.1 ± 0.1 in the control sides. After 7 days from the extractions, the values of modified Healing Index in the experimental and control groups were, respectively, 4.8 ± 0.6 and 5.1 ± 0.9. The use of L-PRF in postextraction sockets filling can be proposed as a useful procedure in order to manage the postoperative pain and to promote the soft tissue healing process, reducing the early adverse effects of the inflammation.
Available from: PubMed Central
- "PRP contains high concentrations of growth factors that stimulate different biological functions such as chemotaxis, angiogenesis, cell proliferation and differentiation, all of which facilitate healing (1-3); so when the platelets release growth factors, they trigger a process of tissue regeneration. In addition to growth factors, granulation tissue in wounds treated with PRP contains intra- and extra-platelet components that could also contribute to tissue regeneration (4,5). "
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ABSTRACT: Dental retentions have a high prevalence among the general population and their removal can involve multiple complications. The use of platelet rich plasma has been proposed in an attempt to avoid these complications, as it contains high growth factors and stimulates diverse biological functions that facilitate the healing of soft and hard tissues.
Objectives: To evaluate the available scientific evidence related to the application of platelet-rich plasma in the post-extraction alveoli of a retained lower third molars.
Material and Methods: A systematic review of published literature registered in the Medline, EMBASE, Cochrane and NIH databases. The following categories were included: human randomized clinical studies. Key search words were: platelet rich plasma; platelet rich plasma and oral surgery; platelet rich in growth factors and third molar.
Results: Of 101 potentially valid articles, seven were selected, of which four were rejected as they failed to meet quality criteria. Three studies fulfilled all selection and quality criteria: Ogundipe et al.; Rutkowski et al.; Haraji et al. The studies all measured osteoblast activity by means of sintigraphy, and also registered pain, bleeding, inflammation, temperature, numbness as perceived by the patients, radiological bone density and the incidence of alveolar osteitis.
Conclusions: Scientific evidence for the use of PRP in retained third molar surgery is poor. For this reason randomized clinical trials are needed before recommendations for the clinical application of PRP can be made.
Key words:Platelet rich plasma, lower third molar surgery, postoperative.
Available from: Otacilio Luiz Chagas Junior
- "Hence the study showed that topical application of PRP gel has a beneficial effect in enhancing socket healing after third molar surgery. Fabbro et al. (2011) conducted a systematic review of the prospective comparative studies that investigated the effect of platelet-rich plasma on the healing of the post-extraction alveolus. "
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ABSTRACT: Platelet-rich plasma (PRP) is rich in growth factors, target-specific polypeptides that play a role in cell proliferation and differentiation and can thus encourage wound repair. This study sought to assess the effects of PRP on new bone formation in a sample of 25 patients with clinical indications for extraction of all four impacted third molars with similar orientation, depth, and root morphology. Immediately after extraction, sockets on one side received PRP, whereas those on the other side (control) did not. Patients underwent 6 months of clinical and radiographic follow-up. Periapical radiographs were scanned and bone repair was assessed by image histogram analysis. The radiographic densities of the extraction sockets were compared to the densities of the distal surfaces of the adjacent teeth, with the difference between both serving to distinguish the PRP and control sides. Results showed that healing of PRP-treated sockets was significantly different from that of control sockets at 1-, 3-, and 6-month follow-up, in mandibular and maxillary sockets alike. The results of this sample suggest that PRP provides a safe and effective means of speeding alveolar bone repair.
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