Platelet rich concentrates: A quick healer.

Sir,

Platelet rich plasma (PRP) has an extremely broad range of clinical applications in oral and maxillofacial surgery, periodontal surgery, otolaryngology, cardiovascular surgery, burns, wound healing, cosmetic surgery, orthopedic surgery etc., PRP has also been used in combination with mesenchymal stem cells to promote bone regeneration and can also be mixed with fat cells for breast reconstruction, and to correct painful adherent scars.[1] In contrary, some studies even suggest that PRP could even be harmful to tissue repair.[2]

There is still no consensus about the ideal platelet concentration that could optimize the tissue repair process.[2] The mechanism of action of growth factors is very complex, because each growth factor may have a different effect on the signal transduction of bone matrix mineralization. Growth factors may also interact with each other and consequently may form a cascade of different signal proteins with multiple pathways, which will ultimately lead to activation of gene expression followed by protein production. PRP is unique as it acts on multiple signal pathways at the same time.[3]

Platelet rich fibrin (PRF) has been vastly used in dentistry in treatment of periodontal regeneration, bone regeneration, dental implants, dental pulp regeneration. when used in periodontal regeneration PRF had two major benefits firstly the promotion of soft tissue healing as explained by the effect of PRF on progenitor proliferation and migration and secondly the induction of new alveolar bone formation as possibly facilitated by the fibrin mediated effect of PRF on runt-related transcription factor 2 (a key transcription factor associated with osteoblast differentiation) and matrix mineralization and also by the enhancing alkaline phosphatase activity. It also reduces expression of the matrix gla protein (a mineralization inhibitor), preferentially in alveolar bone osteoblast progenitors.[4]

Limitations of PRF are (1) the availability in larger quantity is limited, (2) PRF possesses the circulating immune cells and antigenic molecules that prevent its use as an allogenic material, (3) dehydration of PRF may inactivate the growth factors, (4) contamination of membrane during handling.[5]