Does PRP enhance bone integration with grafts, graft substitutes, or implants A systematic reviewReport as inadecuate




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BMC Musculoskeletal Disorders

, 14:330

Orthopedics and biomechanics

Abstract

BackgroundSeveral bone implants are applied in clinical practice, but none meets the requirements of an ideal implant. Platelet-rich plasma PRP is an easy and inexpensive way to obtain growth factors in physiologic proportions that might favour the regenerative process. The aim of this review is to analyse clinical studies in order to investigate the role of PRP in favouring bone integration of graft, graft substitutes, or implants, and to identify the materials for which the additional use of PRP might be associated with superior osseo- and soft tissues integration.

MethodsA search on PubMed database was performed considering the literature from 2000 to 2012, using the following string: -Bone Substitutes-Mesh OR -Bone Transplantation-Mesh OR -Bone Regeneration-Mesh OR -Osseointegration-Mesh AND -Blood Platelets-Mesh OR -Platelet-Rich Plasma-Mesh. After abstracts screening, the full-texts of selected papers were analyzed and the papers found from the reference lists were also considered. The search focused on clinical applications documented in studies in the English language: levels of evidence included in the literature analysis were I, II and III.

ResultsLiterature analysis showed 83 papers that fulfilled the inclusion criteria: 26 randomized controlled trials RCT, 14 comparative studies, 29 case series, and 14 case reports. Several implant materials were identified: 24 papers on autologous bone, 6 on freeze-dried bone allograft FDBA, 16 on bovine porous bone mineral BPBM, 9 on β-tricalcium phosphate β-TCP, 4 on hydroxyapatite HA, 2 on titanium Ti, 1 on natural coral, 1 on collagen sponge, 1 on medical-grade calcium sulphate hemihydrate MGCSH, 1 on bioactive glass BG and 18 on a combination of biomaterials. Only 4 papers were related to the orthopaedic field, whereas the majority belonged to clinical applications in oral-maxillofacial surgery.

ConclusionsThe systematic research showed a growing interest in this approach for bone implant integration, with an increasing number of studies published over time. However, knowledge on this topic is still preliminary, with the presence mainly of low quality studies. Many aspects still have to be understood, such as the biomaterials that can benefit most from PRP and the best protocol for PRP both for production and application.

KeywordsPRP Implant integration Platelets Bone Regenerative medicine AbbreviationsRCTRandomized controlled trials

FDBAFreeze-dried bone allograft

BPBMBovine porous bone mineral

β-TCPβ-tricalcium phosphate

HAHydroxyapatite

TiTitanium

MGCSHMedical-grade calcium sulphate hemihydrate

BGBioactive glass

GFsGrowth factors

PRPPlatelet-rich plasma

PCBMParticulate cancellous bone and marrow

GTRGuided tissue regeneration

PRGFPlasma rich in growth factors.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2474-14-330 contains supplementary material, which is available to authorized users.

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Author: Alice Roffi - Giuseppe Filardo - Elizaveta Kon - Maurilio Marcacci

Source: https://link.springer.com/







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