Effect of platelet concentration in platelet-rich plasma on peri-implant bone regeneration
Introduction
Platelets contain a variety of autologous growth factors, including platelet-derived growth factor (PDGF), transforming growth factors β1 and β2 (TGF-β1 and TGF-β2), insulin-like growth factor (IGF), epidermal growth factor (EGF), and epithelial cell growth factor (ECGF), as well as a growth factor for hepatocytes [5]. In 1998, Marx et al. [7], [8] found that platelet-rich plasma (PRP) had a positive effect on bone regeneration, since it was a source of autologous growth factors. In 44 patients who underwent reconstruction of the mandible following resection, they demonstrated that the use of PRP in combination with autologous bone transplant led to increased bone regeneration and bone density. The use of PRP to support the osseointegration of endosseous dental implants also resulted in significantly increased bone regeneration in animal experiments [4], although there are some contradictory results [12].
This study analyzed the effect of PRP on peri-implant bone regeneration in a rabbit model and focused on the possible influence of the platelet concentration in the PRP.
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Animal model
After receiving approval from our animal care committee, 20 male New Zealand white rabbits, weighing 3293 ± 259 g, aged 9–12 months, were used for this study. The animals were kept in individual cages in the institution’s animal care center and fed water and standard diet ad libitum.
PRP production
For the self-production of PRP, the Platelet Concentrate Collection System (PCCS System, 3i®, West Palm Beach, FL, USA) was used. After collecting 30 ± 2 ml of whole blood from the marginal auricular vein or the
Intravital fluorochrome staining
Transmission light microscopy was used to compare the implant position in the spongy bone of the epiphysis with respect to the metaphysis and the medullary cavity of the diaphysis of the femur, which lacks spongy bone. For the most part, regeneration was limited to the part of the implant in contact with spongy bone for both the control and PRP-treated groups. Therefore, only the fluorochrome staining in the area of spongy bone was evaluated histomorphometrically.
In the 4-week specimens (n =
Discussion
The fluorochrome staining method used in this study is an established method. The morphometrically determined bone surface areas can be used as a measure of bone regeneration [6], [11], [14].
The extent of the difference in fluorochrome staining between the test and control groups at intermediate platelet concentrations suggests an increase in peri-implant bone regeneration of about 90% with the use of concentrated PRP, which might be a clinically relevant difference. In their miniature pig
Conclusions
From the combined data on the biological effect of PRP, it can be concluded that PRP seems to be able to activate the osseous regeneration processes under optimized conditions. However, we do not fully understand the conditions necessary for it to stimulate osseous regeneration. The stimulatory effect of PRP in vitro on the proliferation of osteoblasts seems to start in vivo in the second week, can be evaluated statistically significant from the third week, and still exists in the fourth week.
Acknowledgements
The authors thank Ms. A.H. Loos of the Institute of Medical Biometry, Epidemiology and Informatics at the Johannes Gutenberg University of Mainz for her help with the statistical analysis. This study was supported by Nobel Biocare® Deutschland GmbH, Wankelstrasse 9, D-50996 Köln, Germany, and by 3i®, West Palm Beach, FL, USA, by providing the self-tapping Branemark® titanium screw implants and the Platelet Concentrate Collection System® for this study free of charge.
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