Platelet-rich plasma: evidence to support its use

Background Authors were assigned the task to develop case definitions for periodontitis in the context of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. The aim of this manuscript is to review evidence and rationale for a revision of the current classification, to provide a framework for case definition that fully implicates state-of-the-art knowledge and can be adapted as new evidence emerges, and to suggest a case definition system that can be implemented in clinical practice, research and epidemiologic surveillance. Methods Evidence gathered in four commissioned reviews was analyzed and interpreted with special emphasis to changes with regards to the understanding available prior to the 1999 classification. Authors analyzed case definition systems employed for a variety of chronic diseases and identified key criteria for a classification/case definition of periodontitis. Results The manuscript discusses the merits of a periodontitis case definition system based on Staging and Grading and proposes a case definition framework. Stage I to IV of periodontitis is defined based on severity (primarily periodontal breakdown with reference to root length and periodontitis-associated tooth loss), complexity of management (pocket depth, infrabony defects, furcation involvement, tooth hypermobility, masticatory dysfunction) and additionally described as extent (localized or generalized). Grade of periodontitis is estimated with direct or indirect evidence of progression rate in three categories: slow, moderate and rapid progression (Grade A-C). Risk factor analysis is used as grade modifier. Conclusions The paper describes a simple matrix based on stage and grade to appropriately define periodontitis in an individual patient. The proposed case definition extends beyond description based on severity to include characterization of biological features of the disease and represents a first step towards adoption of precision medicine concepts to the management of periodontitis. It also provides the necessary framework for introduction of biomarkers in diagnosis and prognosis.

https://onlinelibrary.wiley.com/doi/epdf/10.1111/jcpe.12945

Staging and grading of periodontitis: Framework and proposal of a new classification and case definition.

Platelet-rich fibrin (PRF) belongs to a new generation of platelet concentrates geared to simplified preparation without biochemical blood handling. In this initial article, we describe the conceptual and technical evolution from fibrin glues to platelet concentrates. This retrospective analysis is necessary for the understanding of fibrin technologies and the evaluation of the biochemical properties of 3 generations of surgical additives, respectively fibrin adhesives, concentrated platelet-rich plasma (cPRP) and PRF. Indeed, the 3-dimensional fibrin architecture is deeply dependent on artificial clinical polymerization processes, such as massive bovine thrombin addition. Currently, the slow polymerization during PRF preparation seems to generate a fibrin network very similar to the natural one. Such a network leads to a more efficient cell migration and proliferation and thus cicatrization.

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Platelet-rich fibrin (PRF): a second-generation platelet concentrate. Part I: technological concepts and evolution.

Platelet-rich plasma (PRP) has been utilized in surgery for 2 decades; there has been a recent interest in the use of PRP for the treatment of sports-related injuries. PRP contains growth factors and bioactive proteins that influence the healing of tendon, ligament, muscle, and bone. This article examines the basic science of PRP, and it describes the current clinical applications in sports medicine. This study reviews and evaluates the human studies that have been published in the orthopaedic surgery and sports medicine literature. The use of PRP in amateur and professional sports is reviewed, and the regulation of PRP by antidoping agencies is discussed.

Platelet-Rich Plasma From Basic Science to Clinical Applications

Background:Grafting the floor of the maxillary sinus has become the most common surgical intervention for increasing alveolar bone height prior to the placement of endosseous dental implants in the posterior maxilla. Outcomes of this procedure may be affected by specific surgical techniques, simultaneous versus delayed implant placement, use of barrier membranes over the lateral window, selection of graft material, and the surface characteristics and the length and width of the implants. Rationale:The primary objective of this systematic review was to determine the efficacy of the sinus augmentation procedure and compare the results achieved with various surgical techniques, grafting materials, and implants. Focused Question: In patients requiring dental implant placement, what is the effect on implant survival of maxillary sinus augmentation versus implant placement in the non-grafted posterior maxilla? Search Protocol: MEDLINE, the Cochrane Oral Health Group Specialized Trials Register, and the Database...

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Effect of Maxillary Sinus Augmentation on the Survival of Endosseous Dental Implants. A Systematic Review

Background: Alveolar bone regeneration is frequently necessary prior to placement of implants. Efforts to improve wound healing have focused on factors that may enhance bone formation following guided bone regeneration (GBR) techniques alone or in combination with bone replacement graft materials. Recent reports suggest that platelet-rich plasma (PRP), presumably high in levels of peptide growth factors, may enhance the formation of new bone when used in combination with autogenous graft material. Methods: In this report, the clinical and radiographic results are presented on 15 consecutively treated patients using autologous PRP in combination with freeze-dried bone allograft (FDBA) for sinus elevation and/or ridge augmentation. FDBA and PRP (0.5 g/2cc PRP) were mixed and placed as a composite graft material. A gel formed by mixing autologous thrombin-rich plasma with PRP (1:4 ratio) was used to cover the graft material. Core biopsies of grafted areas were obtained in several patients as part of implant ...

Alveolar Ridge and Sinus Augmentation Utilizing Platelet‐Rich Plasma in Combination With Freeze‐Dried Bone Allograft: Case Series

Theuseofdental implantshas revolutionized the treatment of partially and fully edentulous patients today. Implants have becomea treatment approach formanaging a broad range of clinical dilemmas due to their high level of predictability and their ability to be used for a wide variety of treatment options. While in many cases dental implants have been reported to achieve long-term success, they are not immune fromcomplications associated with improper treatment planning, surgical and prosthetic execution, material failure, and maintenance. Included in the latter are the biologic complications of peri-implant mucositis and peri-implantitis, inflammatory conditions in the soft and hard tissues at dental implants. It is the purpose of this paper to review the current knowledge concerning peri-implant mucositis and peri-implantitis to aid clinicians in their diagnoses and prevention. It is recognized that new information will continue to emerge, and as such, this document represents a dynamic endeavor that will evolve and require further expansion and reevaluation.

Peri-implant mucositis and peri-implantitis: A current understanding of their diagnoses and clinical implications

A retrospective clinical evaluation of patients consecutively treated from multiple centers was performed. The treatment of these patients utilized the bone-added osteotome sinus floor elevation (BAOSFE) procedure with immediate implant fixation. The BAOSFE method employs a specific set of osteotome instruments to tent the sinus membrane with bone graft material placed through the osteotomy site. A total of 174 implants was placed in 101 patients. Implants were of both screw and cylinder shapes with machined, titanium plasma-sprayed, and hydroxyapatite surfaces from various manufacturers. The 9 participating clinicians used autografts, allografts, and xenografts alone or in various combinations, and the type of graft was selected by the individual clinicians. The choice of graft material did not appear to influence survival rates. Loading periods varied from 6 to 66 months. The survival rate was 96% or higher when pretreatment bone height was 5 mm or more and dropped to 85.7% when pretreatment bone height was 4 mm or less. The most important factor influencing implant survival with the BAOSFE was the preexisting bone height between the sinus floor and crest. This short-term retrospective investigation suggests that the BAOSFE can be a successful procedure with a wide variety of implant types and grafting procedures. (INT J ORAL MAXILLOFAC IMPLANTS 1999;14:853‐858)

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The Bone-Added Osteotome Sinus Floor Elevation Technique: Multicenter Retrospective Report of Consecutively Treated Patients

In 2014, the American Academy of Periodontology Board of Trustees charged a Task Force to develop a clinical interpretation of the 1999 Classification of Periodontal Diseases and Conditions to address concerns expressed by the education community, the American Board of Periodontology, and the practicing community that the current Classification presents challenges for the education of dental students and implementation in clinical practice. The Academy announced that an update to the 1999 Classification would commence in 2017. The present focused update addresses three specific areas of concern with the current classification: attachment level, chronic versus aggressive periodontitis, and localized versus generalized periodontitis.

Paul S. Rosen

Papers

Alveolar Ridge and Sinus Augmentation Utilizing Platelet‐Rich Plasma in Combination With Freeze‐Dried Bone Allograft: Case Series

Peri-implant mucositis and peri-implantitis: A current understanding of their diagnoses and clinical implications

The Bone-Added Osteotome Sinus Floor Elevation Technique: Multicenter Retrospective Report of Consecutively Treated Patients

American Academy of Periodontology Task Force report on the update to the 1999 classification of periodontal diseases and conditions

A review on alveolar ridge preservation following tooth extraction.