A major medical revolution
THE BOOSTER TO HEAL, REPAIR AND REJUVENATE
Tissue regeneration with PRP (Platelet-Rich Plasma),
PRF (Platelet-Rich fibrin), Bone Morphogenetic Protein (BMP2)
and stem cells
REGENERATIVE DENTISTRY
THE BOOSTER TO CICATRISE, REPAIR, REJUVENATE hard and soft tissues
"INSANITY IS DOING THE SAME THING OVER AND OVER AND EXPECTING A DIFFERENT RESULT".
The PRF or Platelet-Rich Fibrin or Plasma Rich in Fibrin appeared a few years after the PRP.
It was Dr. Schleicher and Dr. Joseph Choukroun (anaesthesiologist in Nice) who introduced autologous platelet concentrate without the use of antiplatelet agents in the management of postoperative pain.
Dr. Joseph Choukroun's starting point was the development of a medical treatment protocol introducing autologous platelet concentrates without the use of antiplatelet agents that could be used in superficial necrotizing wounds.
These autologous platelet concentrates activate the process of blood vessel formation, called angiogenesis, and thus the regeneration and healing of damaged tissue.
FRP does not contain any anticoagulants, antiplatelet agents or other blood by-products. Thus, it exploits the ability of fibrin to create a reticulated lattice that traps blood platelets and scar cells.
Thus, FRP induces, over a longer period of time and in a persistent manner, the multiplication and differentiation of fibroblasts and osteoblasts that participate in the fabrication of new soft tissues (gum) and hard tissues (bone).
PRP (also known as Platelet Rich Plasma) and PRGF (also known as Plasma Rich in Growth Factor) are the first generations of autologous platelet blood concentrates containing growth factors.
Professor Arun K. Garg has described and reported on the protocols for PRP recovery. He realized the great therapeutic potential in surgical techniques of this platelet concentrate, extracted by a simple blood test on the patient.
Applications in the USA in the field of oral surgery, especially in dental implant placement and pre-implant surgeries such as bone fillers and sinus lifts.
PRP was developed before PRGF or Plasma Rich in Growth Factor.
This one was developed by Dr. Anuita in 1999. Both of these autologous platelet concentrates contain blood by-products of animal origin: anticoagulants or anti-platelet aggregation agents. They allow for easier handling during the protocol by giving the practitioner more time to inject the PRP into the operated biological tissues.
The criticism of these medical techniques is the need to use high speed centrifugation for their manufacture.
This technique allows to obtain mainly blood platelets, which does not hinder their efficiency, in most cases.
However, based on this deficiency of the technique, another autologous platelet concentrate without the use of antiplatelet agents has been developed in France by Dr. Joseph Choukroun.
REGENERATIVE DENTISTRY IS A MAJOR MEDICAL REVOLUTION
In the common sense, the term “regeneration” designates the whole of the phenomena of repair of a tissue or an organ until the recovery of its initial integrity. The organism replaces or restores a tissue or organ of the body, injured or amputated, in its original form and function.
The term “healing” is more restrictive, since it designates a modality of regeneration in the broadest sense: either, by the phenomenon of regeneration, a repair of a tissue or an organ, but not necessarily ad integrum; or, by the phenomenon of consolidation, the reconciliation of separate elements that were previously united.
Regenerative medicine” aims at stimulating regeneration phenomena in order to replace damaged or amputated tissues or organs with functional organs or tissues as close as possible to their initial integrity.
The use of “platelet growth factors” and stem cells is a major component of regenerative medicine.
Regenerative dentistry” is the correspondence of regenerative medicine to the field of dentistry. This specialty has expanded considerably thanks to the new surgical techniques of dental implant placement and bone and gum grafting. The regeneration of oral cavity tissues is a widely studied subfield of oral surgery since the reconstruction of bone (hard tissue) and gingival and mucosal tissues (soft tissue) largely depends on the reconstruction of dental arches by dental implants and implant-supported dental prostheses.
The introduction of autologous platelet blood concentrates and the concept of providing growth factors in supra-physiological concentrations is a major medical revolution because it considerably improves surgical techniques and medical therapeutics in many fields of medicine and dentistry.
In oral regenerative surgery: the use of PLATELET-RICH PLASMA – PRP and PLATELET-RICH FIBRIN – PRF optimizes the results, especially in surgical implantology techniques: the placement of dental implants and surgical therapies by bone fillers with biomaterials, as well as bone and gum grafts
In aesthetic medicine and“rejuvenation“: the injection of PRP or PRF into the skin, forces the tissues to regenerate to bring about a “rejuvenation” of the face. It is a protocol indicated to plump up the face, or to stimulate hair growth if the patient has enough hair bulbs left.
Scar reduction: based on the same biological model of regeneration.
Joint pain: when joints have been prematurely worn down by repeated work or trauma, pain can be tempered or even completely eradicated with PRP or PRF injections that induce tissue healing of joint tissues.
REGENERATIVE DENTISTRY: THE USE OF PRP AND PRF
The last two decades have seen the development of new medical protocols using the patient’s own biology and the human body’s ability to regenerate itself. They increase the success of surgical techniques such as reconstructions with pre-implant bone fillers: in addition to biomaterials, autologous blood concentrates are used for therapeutic purposes as PRP (Platelet-Rich Plasma) Platelet Rich Plasma) and PRF (Platelet-Rich Fibrin or Fibrin Rich Plasma).
Autologous blood concentrate is obtained by a simple blood test performed by the practitioner in the dental office. By centrifugation of the patient’s blood, a blood platelet concentrate is obtained containing a number of growth factors, including Bone Morphogenetic Protein (BMP2) and Stem Cells.
The use of these growth factors, leukocytes and stem cells is a new paradigm in medicine, surgical techniques and dentistry. It is an operative time that stimulates tissue regeneration, in general, and bone healing, following surgery.
Regenerative dentistry is an additional operative time during surgical techniques. This therapy promotes the natural regeneration of the tissues of the oral cavity. It optimizes bone and gum healing by providing supra-physiological quantities of biological growth factors, inducing growth and tissue healing, contained in the patient’s blood.
This is a new medical paradigm: to provoke (we say induce) the regeneration of the patient’s damaged biological tissues, using their own scar cells, rather than repairing them with exogenous materials. Autologous blood concentrates collected from the patient are reinjected immediately. Thanks to the popularity of PRP and PRF, the concept of “regenerative medicine and dentistry” was born.
PRP® was the first generation of autologous platelet concentrates and PRF® is currently the second generation.
Both are called “autologous” because they are derived from the patient’s own blood. The first continent is an antiplatelet agent and the other is not. The “growth factors” they contain accelerate and potentiate the healing of injured gums and bone structures. This is the very principle of tissue regeneration: to reintroduce blood platelets and healing plasma group cells into wounds during surgical techniques or into damaged tissue in supra-physiological quantities. These include molecular factors that cause tissue regeneration and thus healing or rejuvenation.
Physicians have seen an acceleration in the use of PRP and PRF, particularly in the last five years. However, PRP has been known for about 20 years in the United States through the publications of Professor Arun K. Garg , co-discoverer of this technique.
Although there is an early mention of FRPs in the medical literature dating back to 2001, it was not until the years 2012 to 2014 that academics focused on FRPs. Today, more than five hundred scientific papers report the potential of FRP-induced tissue regeneration
In dental surgery, this supply of growth factors is called oral regenerative surgery. These contributions have sometimes taken the place of biomaterials in certain surgical techniques
- Unlike PRP, FRP does not contain blood by-products, such as anticoagulants, especially of animal origin, and is therefore not considered a drug. FRP is therefore a natural blood autograft that requires only one centrifugation, unlike PRP which requires two.
- The fibrin in PRP is a rigid macromolecule with tetra-molecular junctions;
- The fibrin of the FRP is a tri-molecular junction molecule that gives it a natural and physiological structure, identical to that of the scar of an injured tissue.
This difference is crucial: the fibrin in FRP delivers growth factors over a longer period of time than in PRP. Thus, healing is optimized over several days.
Since the discovery of the potential of FRPs, researchers have made numerous improvements in surgical techniques to optimize tissue healing.
FRP is used in dental and oral surgery to induce regeneration of gingival and bone tissue. The extremely satisfactory clinical results of these surgical therapies have thus helped popularize regenerative dentistry.
YOU ARE UNIQUE!
CLINICAL CASES OF TISSUE RESOPTION
CLINICAL OUTCOME OF REGENERATIVE DENTISTRY
STEM CELLS TO STIMULATE HEALING OF BONE GRAFTS
In oral regenerative surgery, stem cells are not used or are used very rarely. They are reserved for more complex cases in a hospital setting. Furthermore, strict legislation governs these protocols, which sometimes differ radically from country to country. In Switzerland, for example, certain techniques are permitted while they are prohibited elsewhere, for purely sovereign reasons.
Mesenchymal stem cells stimulate the healing of surgical techniques. They come mainly from :
- Bone marrow,
- Autologous fat,
- Umbilical cord blood collected after a baby is born.
- Peripheral blood,
Bone marrow stem cell harvesting requires surgery in the operating room under anesthesia. The transplant physician uses a special hollow needle and syringe. It takes bone marrow samples from the upper part of the pelvic bones or from the upper part of the tibia, below the knee. This operation is performed several times to extract several millimeters of bone marrow.
After the procedure, the body needs four to six weeks to recreate the extracted bone marrow.
The bone marrow undergoes a centrifugation protocol to recover stem cells that can then be injected into the graft or the grafted area to encourage osteogenesis.
The fatty tissue contains stem cells. Plastic surgeons use this source in the case of lipostructures, especially those of the face. Indeed, the addition of fat allows both a volumetric restructuring of the face, but also the import of undifferentiated scar cells.
Although used for the past 20 years, this protocol is new, especially for injection in adult patients. Stem cell transplantation from the patient’s own peripheral blood or bone marrow is more common.
Stem cells from the patient’s own peripheral blood are the most commonly used source for autologous blood factor transplantation. These cells are contained in the bone marrow which will release them into the bloodstream. In some hospital techniques, hematopoiesis is stimulated with a drug administered to the patient. This stimulates the passage of more hematopoietic stem cells from the bone marrow into the bloodstream than is normally the case.
The classic technique consists of taking a simple blood sample and concentrating the blood products by centrifugation.
BMPS OR BONE MORPHOGENETIC PROTEINS (BMP2)
Bone Morphogenetic Proteins (BMPss) play an important role in the development of bone and cartilage. They are proteins belonging to the family of growth factors interacting with cytokines or metaboligenic inducers. That is to say, it leads to the formation of bone and cartilage. BMPs are now seen as a dominant set of morphogenetic signals that orchestrate the tissue structure of the human body.
Like many other BMP family proteins, BMP-2 plays a role in ossification processes, making it of interest in pre-implant bone grafting protocols. However, due to the scarcity of dental clinical studies on them, and their current non-approval for medical marketing in France and Switzerland, BMP2s are not exploited in dental surgery as they usually are in the USA.
IMPORTANT: It should be noted that all chapters concerning the use of PRP (Platelet Rich Plasma) and stem cells in regenerative medicine protocols are written for general information purposes. Indeed, the legislation of some countries, such as France, does not yet accept these innovative protocols. While many other countries have already validated them, such as Switzerland, as well as all therapies based on stem cells, especially in the USA. The use of certain techniques is for the moment reserved for the hospital environment. The legislation for their use in curative protocols seems to be more flexible, both in France and in Switzerland. These techniques are, in any case, much discussed because the advantages are unquestionable. Numerous pioneering practitioners are working to ensure that advances in legislation are symmetrical with those in science and their therapeutic applications, both curative and aesthetic.
