Autologous blood therapy in oral surgery

Within six months of March to September 2017, Manuel Neuer, the German national goalkeeper and world champion captain, has broken his foot three times: The entire German football community was worrying about his participation in the 2018 World Cup in Russia. It was only thanks to autologous blood therapy that the healing of the fractures accelerated and his comeback secured.

PRP therapy – derived from platelet-rich plasma and also called autologous blood therapy – has been applied in orthopedics and sports medicine, especially in the field of high-performance sports, since the end of 1990er and is now widely used throughout these disciplines. Although autologous blood and products made from it have been applied in the field of dental, oral and maxillofacial surgery since the 1960s, PRP therapy has only found its wide use in dental practices for a few years. And this is mainly thanks to the modern high-performance PRP enrichment methods, because PRP can be produced today within a few minutes using special PRP tubes and centrifugation protocols. The reasons for the increasing popularity of PRP therapy in dental practice are the same as in other medical fields: pain alleviation, accelerated tissue regeneration and shortened healing period.

This is how PRP therapy unfolds its effects

PRP application is based on the fact that platelets release growth factors upon stimulation, e.g. in the course of blood clotting, and thus promote the healing process. By targeted increase of the concentration of these growth factors in the areas to be treated, processes of wound healing and tissue regeneration can be considerably accelerated. This therapy thus makes use of the patient's own healing powers.

The reference range for peripheral blood platelet counts is 150.000/µl to 350.000/ µl. In PRP, this concentration increases by 3 to 8 times to more than one million platelets in a microliter. Such high platelet concentrations unleash a wealth of effects at the area to be treated, such as local recruitment and activation of immune and stem cells, induction of cell differentiation leading to increased tissue regeneration, increase of collagen synthesis, initiation of vascularization, stimulation of bone mineralization, etc.

For the production of PRP, 15 to 20 ml of the patient's own blood are taken. This blood is processed by centrifugation in the PRP tubes in such a way that the individual blood components are separated from each other and also concentrated. This process only takes about 10 to 15 minutes and can therefore be performed during an outpatient treatment. This body's own substance obtained is then applied precisely to the diseased or injured body part, e.g. by injection.

The bone morphogenetic proteins, BMP`s for short, are particularly noteworthy from a dental point of view among the growth factors released by platelets. Among other things, the BMP`s contribute to maintaining the balance between tissue formation and degradation in the musculoskeletal system and stimulate, for example, the differentiation of mesenchymal cells to osteoblasts. Thanks to this bone-forming effect, BMP's are also applied for other therapeutic purposes, such as for the healing of bone fractures, osteoporosis or other bone defects. For this reason, PRP therapy has proved to be very useful in oral surgery and is now routinely applied for tooth extraction, insertion of dental implant, jaw augmentation and healing of periodontal defects.

How effective is this therapy?

After tooth extraction, bone regeneration usually lasts about 16 weeks, and insufficient bone formation and dimensioning can lead to the fact that subsequent required reconstructive interventions cannot be performed. In a study conducted to this point, it was found that patients treated with PRP show a bone density already after one week of extraction, which was detectable in patients of control group only after 6 weeks. These results not only speak about high therapeutic efficacy, but also attested the potential that this method offers for a wide range of relevant medical problems.

This is especially true for problems associated with various complications during and after tooth extraction such as tooth root fracture, complicated extraction due to atypical root formation, ankylosis, inflammation of wounds, etc., and which mainly affect older patients. These complications can result in increased bone loss, which cannot be eliminated by complex reconstructive interventions. In this context, the PRP method acts as a simple, cost-effective and reliable adjuvant therapy to accelerate healing and bone formation and thus also to shorten waiting time for patients who require prostheses or dental implants.

PRP use in clinical applications

PRP has meanwhile been shown to be an effective remedy in many oral surgery interventions. One of the best examples of this is the treatment of periodontal bone pockets, where PRP application resulted in a significant reduction of probing depth and a clear improvement of bone regeneration in comparison to conventionally treated control probands. PRP therapy may also aid in bone grafting, which is used in cases of insufficient bone volume to anchor a dental implant. This therapy can also be applied successfully in other areas such as socket healing, augmentation of the sinus floor (sinus lift), onlay and inlay grafts, ridge augmentation, closure of lips and palate defects, repair of bone defects after tooth extraction or cyst removal and repair of fistula between the sinus cavity and the mouth.

The National Institute of Health found in one of its study in 2013 the following: "The growth factors in PRP might accelerate epithelial wound healing, decrease tissue inflammation after surgery, improve the regeneration of bone and soft tissues, and promote tissue vascularization." Today, after countless studies, all these points can only be answered in the affirmative.

Effects on the treatment of BRONJ

Bisphosphonate-related osteonecrosis of the jaws (BRONJ) occurs mainly in patients who have been treated with bisphosphonates during dental or orthodontic surgery. Bisphosphonates are inhibitors of bone resorption and are applied in the treatment of bone mets or osteoporosis. This inhibition is done by blocking osteoclast activity: As a result of the treatment, the growth factors bound to cell receptors can no longer have any effect on the cell, whereby apoptosis of osteoclasts is induced.

Since platelet-rich plasma contains many times higher concentrations of different growth factors, it speaks for itself that it could be used at least in the form of adjuvant therapy for the effective treatment of BRONJ. The regenerative PRP application has already been successfully demonstrated in several studies in the treatment of TMJ arthrosis and necrosis of the jaw.

Practical immediate benefits of PRP therapy

In addition to a number of the therapeutic benefits mentioned above, some practical benefits of this therapy should not be overlooked: It is a cost-effective, simple and quick treatment that can be carried out on an outpatient basis within a quarter of an hour and which also ensures a high willingness of patients to be treated with it. In medical practice, the approach of using only one puncture for both blood collection and administration of infusions or drugs has become established, in order to avoid unnecessary discomfort for the patient through multiple insertions, and is just as well applicable for PRP-preparation. The entire therapy accessories required for blood spinning and PRP collection are easy to use, simple to store due to small dimensions and can be reordered quickly after use.