Tissue Engineering – BMP and PRP

Bone Morphogenetic Protein (BMP)

Bone Morphogenetic Protein is a naturally occurring protein that induces bone formation. Commonly, there is not enough bone present for implant placement. Attempting to place an implant at a site with insufficient bone can lead to unfavorable results. This technique utilizes recombinant DNA technology to isolate BMP, which is delivered in an absorbable collagen sponge to the surgical site. BMP is the most effective option that is available today for increasing bone availability for implant placement. It is not necessary for every bone grafting case, but for optimal results it may be recommended by us.

BMP causes significant swelling and occasionally bruising. This is to be expected and is not a concern.  The swelling tends to decrease within two weeks.

Several contraindications exist with BMP. These include the use in children, a current pregnancy or a history of BMP placement.

Platelet Rich Plasma (PRP) is exactly what its name suggests. The substance 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 (thousands) and the large amount of blood needed (one unit) to produce a suitable quantity of platelets. New technology permits the doctor to harvest and produce a sufficient quantity of platelets from only 55 cc of blood 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 GF (platelet derived growth factors PGDF, 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 sequestered into the wound, the more stem cells stimulated to produce new host tissue. Thus, one can easily see that 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 animals and humans. This is of great significance to the surgeon who places dental implants. By adding PRP, and thus BMP, to the implant site with bone substitute particles, the implant surgeon can now grow bone more predictably and faster than ever before.

PRP and BMP have many clinical applications:

• Bone grafting for dental implants. This includes onlay and inlay grafts, sinus lift procedures, ridge augmentation procedures, and closure of cleft, lip and palate defects.
• Repair of bone defects creating by removal of teeth or small cysts.
• Repair of fistulas between the sinus cavity and mouth.

PRP also has many advantages:

• Safety: PRP is a by-product of the patients own blood; therefore, disease transmission is not an issue.
• Convenience: PRP can be generated in the doctors office while the patient is undergoing an outpatient surgical procedure, such as placement of dental implants.
• Faster healing: The supersaturation of the wound with PRP, and thus growth factors, produces an increase of tissue synthesis and thus faster tissue regeneration.
• Cost effectiveness: Since PRP harvesting is done with only 55 cc of blood in the doctors office; the patient need not incur the expense of the harvesting procedure in hospital or at the 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 fifteen 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 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? Most cases are considered medically necessary and completed along with the bone grafting. We will work with you and submit necessary documentation to your insurance carrier.
• Can PRP be used alone to stimulate bone formation? No. PRP must be mixed with either the patients own bone, allogeneic bone or xenogeneic bone.
• 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.