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Sometimes gums aren’t perfect. And even if they are initially, sometimes they don’t stay perfect, as in the case of receding gums. Gingival recession can result in hypersensitivity and can leave roots vulnerable to root caries and bone degeneration.
Soft or hard tissue augmentation, such as grafting can correct many of these kinds of issues. Tissues used in grafting can originate from a number of sources. But many practitioners believe that the patient is their own best donor for these procedures.1
To enhance the odds of success, clinicians may use guided tissue regeneration to augment both soft and hard tissues. This technique involves the placement of biocompatible barrier membranes, which may be resorbable or nonresorbable.
Barriers are often placed in conjunction with growth factors. This is said to encourage predictable regeneration, while helping to eliminate pathogenic proliferation.1
Growth Factors
Platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) are the most common types of growth factor available for oral surgery. Some studies indicate that in comparison with PRP, PRF is released more gradually for a stronger, more durable effect on proliferation and regeneration.2–5
Other studies show that PRP offers better growth factor release in the short term, while PRF is more effective at delivering a steady release of growth factor over long periods.
More recently, advanced PRF (A-PRF) and an injectable liquid form of PRF (i-PRF) has been found to release significantly higher growth factor than either of the other two over a 10-day period. Dentists must decide what product works best in their hands.2,6,7
Growth factors are derived from patient blood draws, in which plasma is separated from red blood cells through centrifuging. The platelet-poor plasma is pipetted off, leaving the PRP, located just above the white blood cells. PRP concentrates the platelets, in which the growth factors in the blood are stored. The PRP can then be used with a membrane to help regenerate bone and soft tissue.1
In the case of PRF, blood is spun into components of plasma, red blood cells, and white blood cells (leukocytes) and platelets. The last of these, which becomes the PRF, becomes a highly concentrated, platelet-rich gel, also known as a “buffy coat,” which is chockful of growth factors. It can be used in various oral surgery procedures to promote healing, without the addition of anticoagulants. But because anticoagulants aren’t used, it must be processed quickly, before clotting starts. Once the PRF clots form, they can be used as membranes or plugs.2
Some practitioners prefer this method as a way to avoid palatal tissue removal, which leaves the patient with two surgical sites. Patient-derived platelet-rich protein on a collagen sponge contained in a collagen membrane, can stimulate growth of not only naturally occurring gum tissue but also bone tissue.2,8
Speedy Healing
Growth factors offer normal healing, but at an accelerated rate. When growth factors are released into a wound, they stimulate stem cells capable of regenerating tissues. Such a procedure is cost effective and safe, as the growth factors are autologous.2
To help ensure successful procedures of this nature, good isolation and evacuation can be paramount. With a system such as Isolite, surgery sites, in which grafting tissues, barrier membranes and growth factors are used, are kept free of contaminants, debris and oral fluids, thanks to easy isolation of the field and continuous evacuation. And because the system centers around a flexible, transparent mouthpiece, comfort, visibility and safety are all enhanced.
While there appears to be general agreement that more research needs to be done, there is also a consensus that growth factors such as PRP are a major asset to oral surgery success.1
Written by Rebecca Stone
REFERENCES
1. Stone R. Change agents. Mentor. 2017; 8(6):32–36.
2.Stone R. Skin in the game.Mentor. 2017; 8(11):20–24.
3.Wang M, Li J, Liu J, Lin X, Xu W. The comparison of platelet-rich fibrin and platelet-rich plasma in releasing growth factors and their effects on the proliferation and differentiation of adipose tissue-derived stem cells in vitro. Hua Xi Kou Qiang Yi Xue Za Zhi. 2012; 30:641–644,649.
4.Schar MO, Diaz-Romero J, Kohl S, Zumstein MA, Nesic D. Platelet-rich concentrates differentially release growth factors and induce cell migration in vitro. Clin Orthop Relat Res. 2015; 473:1635–1643.
5.Preeja C, Arun S. Platelet-rich fibrin: Its role in periodontal regeneration. Saudi J Dent Res. 2014; 5:117–122.
6.Kobayashi E, Fluckiger L, Fujioka-Kobayashi M, et al. Comparative release of growth factors from PRP, PRF, and advanced-PRF. Clin Oral Investig. 2016; 20:2353–2360.
7.Miron RJ, Fujioka-Kobayashi M, Hernandez M, et al. Injectable platelet rich fibrin (i-PRF): opportunities in regenerative dentistry? Clin Oral Investig. 2017; 21: 2619–2627.
8.Kranz R, Gwosdow A. Recovering from recession — with far less pain. Massachusetts Society for Medical Research. 2010. Available at: whatayear.org/05_10.php. Accessed May 6, 2019.
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