Platelet concentrates: Regenerating the lost tissues.

Sir,

One of the recent promising innovations in dentistry is the use of platelet concentrates for the accelerated repair and regeneration of the soft and hard tissues. The use of platelet concentrates enhances the body's natural wound healing mechanisms. There has been considerable interest among the medical practitioners to develop some type of biologic glue that could achieve hemostasis and help in wound sealing. In the recent times, several new approaches have been developed to prepare them. They are based on autologous whole blood obtained immediate pre-operatively, which is then processed immediately into autologous concentrated platelet-rich plasma (PRP) or platelet rich fibrin (PRF). PRP is an autologous modification of fibrin glue[1] and is an autologous concentrate of human platelets in a small volume of plasma. This is achieved by the use of differential centrifugation in a conventional auto-transfusion machine. When this PRP is combined with thrombin and calcium chloride, platelet gel is created.[2] This product is a rich source of growth factors and is effective in accelerating significant tissue repair and regeneration. PRP works through the degranulation of the granules in platelets, which contain the synthesized and pre-packed growth factors. The two most important growth factors are platelet-derived growth factor, and transforming growth factor-β. Because PRP enhances osteoprogenitor cells in the host bone and in bone grafts, it has found clinical applications in bone defects, sinus lift augmentation, horizontal and vertical ridge augmentations, ridge preservation, periodontal/peri-implant defects, cyst enucleations/periapical surgeries, healing of extraction wounds, endodontic surgeries, ablative surgeries of the maxillo-facial region and blepharoplasty. PRF was first developed in France by Choukroun et al.[3] and is a second generation platelet concentrate. This technique requires neither anticoagulant nor bovine thrombin. PRF occurs in the form of platelet gel and promotes bone growth and maturation, promotes healing of wound and can be used in conjunction with the bone graft materials and can accelerate regeneration of tissues. PRF is considered a useful biomaterial and a number of authors have shown its importance in the treatment of periodontal defects, furcation and gingival recession.[45] Though, the material is widely used by the clinicians all over the world because of its ease of preparation and cost effectiveness, more future long-term clinical trials are required to establish and understand its role completely.