Mixing PRP and Bio-Oss?

There is a great review of PRP in the April edition of Compendium. Link and info below. Click Here for the Pubmed Review in Compendium Toscano N, Holtzclaw D. Surgical considerations in the use of platelet-rich plasma. Compend Contin Educ Dent. 2008 Apr;29(3):182-5. Platelet-rich plasma is an autologous source of platelet-derived growth factors that enhance surgical soft- and hard-tissue wound healing. Surgeons should be aware of its mechanisms of action and benefits, as well as the controversy regarding its use.

There is really no specific ration. If you use PRP for your xenografts, then you can use PRP to mix the BioOss instead of saline. After, and while you pack the graft, you can additionally spray the grafted area with PRP. Checking the patient's hemoglobin is not necessary. PRP is a byproduct of platelets, and if you use the correct centrifuge, it should generally concentrate platelets to approximately 5 times the patients platelet count. The normal value for patient's platelets is 150K-400K, and the average platelet concentrate would be roughly 1million platelets. In the healthy patient, without any risks for thrombocytopenia, no lab test is necessary prior to preparing PRP.

Regarding PRP one has to basically understand that:1. PRP is a source of growth factors i.e signalling molecules. these molecules can and will act only on the living cells. so it is inconsequential to use Biooss or any other graft that does on carry its own living cells in combination with PRP. PRP can thus be effective only when it is used in combination with autogenous bone (i.e grafts that contain cells). one even while using with autogenous bone one has to keep in mind that as the growth factors act on all the cells in the vicinity you need to isolate the grafted site from the overlying epithelium and the connective tissue otherwise these tissues may actually take over the place of the bone. 2. if u intend to use the biooss as a carrier for PRP then its altogether a different question and opens up a big debate. 3. One has to understand the basic wound healing here: As the platelets live probably for 24-48hrs max. the action of the growth factors released from the PRP is for a short duration, but this heavy load of Gf's released from the PRP in the initial stages of healing brings about faster recruitment of the Macrophages which in turn keep release the cytokines necessary for wound repair. it to bring about the faster and increased recruitment of macrophages that the PRP is/ has to be used. hope this helps regards

There is a very unique PRP study conducted by Dr. Schiroli (Saint Martino Hospital) 2 years ago. It compares B-TCP alone (Cerasorb) to B-TCP w/PRP, Autogenous Bone, DFDBA and BioOss. The histological evaluations displayed significantly more mature bone formation for the sites treated with B-TCP & PRP, followed by Autogenous Bone. The 2 sites filled with DFDBA and BioOss displayed decreasing amounts/volume of bone formation in the order mentioned.

One has to understand that adding PRP to Biooss or any graft which has no living cells will not give any benefit regarding bone formation.PRP in order to be effective needs cells to act upon therefore mixing it with a non vital grafting material makes no sense. The only beneficial side effect will be faster soft tissue healing.

in our group we use bio oss mixed with PRGF as a gold standard in sinus floor elevation procedures (tatum technique), and we saw that it makes a lot of sense basically because the prgf is a very good carrier for the bio material and that makes you dont waste to much material , then you need less material, for example to fill a sinus with just bio oss you will need like 35% more material than if you mixed mith PRGF and last and not less important if you read a little bit of Dr, Anitua you will see in his studies that the bone tissue regeneration is increased in the first periods of regeneration ( to explain it easier) and the soft tissue regeneration is much faster and nice with prgf.

Even if there are no living cells in the biomaterial(Bio-Oss), doesn't prp help the host bone to regenerate into the graft material?

One must be specific with their use of materials. PRP is excellent for soft tissue assistance. Bio-Oss is excellent for long term bone growth maintenance. It works well for a sinus. demineralized and mineralized freeze dried bone helps for individual sockets. A product like Exatech, a mix, works very well for ridge width augmentations. BMP, ie Infuse, works very well where a facial plate is missing. Using combinations of products can also help. PRP with Bio-oss generally will not help promote bone, but may help if soft tissue closure is a challenge. Hope this summary helps