Socket Preservation, Platelet Rich Plasma (PRP), Bone Grafting

• Preserving Your Jaw Bone after Extraction
• Platelet Rich Plasma
• Why all the excitement about PRP?
• PRP Has Many Clinical Applications
• PRP Also Has Many Advantages
• Frequently Asked Questions About PRP
• Tooth Extraction and Bone Grafting Procedure

Preserving Your Jaw Bone after Extraction

Removal of teeth is sometimes necessary because of pain, infection, bone loss, or due to a fracture in the tooth. The bone that holds the tooth in place (the socket) is often damaged by disease and/or infection, resulting in a deformity of the jaw after the tooth is extracted. In addition, when teeth are extracted the surrounding bone and gums can shrink and recede very quickly, resulting in unsightly defects and a collapse of the lips and cheeks.

These jaw defects can create major problems in performing restorative dentistry whether your treatment involves dental implants, bridges, or dentures. Jaw deformities from tooth removal can be prevented and repaired by a procedure called socket preservation. Socket preservation can greatly improve your smile’s appearance and increase your chances for successful dental implants.

Several techniques can be used to preserve the bone and minimize bone loss after an extraction. In one common method, the tooth is removed and the socket is filled with bone or bone substitute. It is then covered with gum, artificial membrane, or tissue, which encourages your body’s natural ability to repair the socket. With this method, the socket heals, eliminating shrinkage and collapse of the surrounding gum and facial tissues. The newly formed bone in the socket also provides a foundation for an implant to replace the tooth. If your dentist has recommended tooth removal, be sure to ask if socket preservation is necessary. This is particularly important if you are planning on replacing the front teeth.

Platelet Rich Plasma

Platelet rich plasma (PRP) is a by-product of blood (plasma) that is rich in platelets. Until now, its use has been confined to the hospital setting. This was due mainly to the cost of separating the platelets from the blood and the large amount of blood needed to produce a suitable quantity of platelets. New technology permits doctors to harvest and produce a sufficient quantity of platelets from only 55 cc of blood, which is drawn from the patient while they are having outpatient surgery.

Why all the excitement about PRP?

PRP permits the body to take advantage of the normal healing pathways at a greatly accelerated rate. During the healing process, the body rushes many cells and cell-types to the wound in order to initiate the healing process. One of those cell types is platelets. Platelets perform many functions, including formation of a blood clot and release of growth factors (GF) into the wound. These growth factors; platelet derived growth factors (PDGF), transforming growth factor beta (TGF), and insulin-like growth factor (ILGF), function to assist the body in repairing itself by stimulating stem cells to regenerate new tissue. The more growth factors released and sequestered into the wound, the more stem cells are stimulated to produce new tissue. Thus, PRP permits the body to heal faster and more efficiently.

A subfamily of TGF, is bone morphogenic protein (BMP). BMP has been shown to induce the formation of new bone in research studies in both animals and humans. This is of great significance to the surgeon who places dental implants. By adding PRP, and BMP, to the implant site with bone substitute particles, the implant surgeon can now grow bone more predictably and faster than ever before.

PRP Has Many Clinical Applications

PRP can be used to aid bone grafting for dental implants. This includes onlay and inlay grafts, sinus lift procedures, ridge augmentation procedures, closure of cleft and/or lip, and palate defects. It can also assist in repair of bone defects created by removal of teeth, or small cysts and repair of fistulas between the sinus cavity and mouth.

PRP Also Has Many Advantages

• Safety: PRP is a by-product of the patient’s own blood, therefore, disease transmission is not an issue.
• Convenience: PRP can be generated in the doctor’s office while the patient is undergoing an outpatient surgical procedure such as the placement of dental implants.
• Faster healing: The supersaturation of the wound with PRP, and thus growth factors, produces an increase of tissue synthesis and faster tissue regeneration.
• Cost effectiveness: Since PRP harvesting is done with only 55 cc of blood in the doctor’s office, the patient need not incur the expense of the harvesting procedure in hospital or at a blood bank.
• Ease of use: PRP is easy to handle and actually improves the ease of application of bone substitute materials and bone grafting products by making them more gel-like.

Frequently Asked Questions About PRP

Is PRP safe?

Yes. During the outpatient surgical procedure a small amount of your own blood is drawn out via the IV. This blood is then placed in the PRP centrifuge machine and spun down. In less than 15 minutes, the PRP is formed and ready to use.

Should PRP be used in all bone-grafting cases?

Not always. In some cases, there is no need for PRP. However, in the majority of cases, application of PRP to the bone graft will increase the final amount of bone present, in addition to making the wound heal faster and more efficiently.

Will my insurance cover the costs?

Unfortunately not. The cost of the PRP application (approximately $400) is paid by the patient.

Can PRP be used alone to stimulate bone formation?

No. PRP must be mixed with either the patient’s own bone, a bone substitute material such as demineralized freeze-dried bone, or a synthetic bone product, such as BIO-OSS.

Are there any contraindications to PRP?

Very few. Obviously, patients with bleeding disorders or hematologic diseases do not qualify for this in-office procedure. Check with your surgeon and/or primary care physician to determine if PRP is right for you.

Tooth Extraction and Bone Grafting Procedure

1- Dr. Sehgal is shown here drawing a patient’s blood in preparation for tooth extraction and bone grafting.
2- A vial of the patient’s blood is obtained.
3- It is put into a special machine called a centrifuge that will separate the blood in under 15 minutes.
4- The blood is now separated and Dr. Kapoor or Dr. Sehgal can retrieve the Platelet Rich Plasma and fibrin.
5- Platelet rich fibrin
6- The platelet rich fibrin is flattened prior to usage and some of the platelet rich plasma is also retrieved from the vial.
7- The before picture of the patient’s broken tooth that required to be extracted.
8- The tooth has been removed and the Platelet Rich Plasma has been inserted along with the bone grafting material.
9- Dr. Kapoor or Dr. Sehgal then stitch up the area and you will be schedule in 2 weeks for a follow up visit.