Trombositten Zengin Materyaller ve Periodontolojideki Kullanımı

Abstract

Periodontal tedavinin amacı bireyin doğal dişlerini tüm yaşamı boyunca optimal fonksiyon, estetik ve rahatlık sağlayacak biçimde korumak ve sürdürmektir. Optimal periodontal tedavi, kaybolan periodonsiyumun rejenerasyonunu içermektedir. Geleneksel tedaviler sonucunda, ideal koşullar altında bile çoğu zaman uzun epiteliyal ataşman, sınırlı miktarda kemik, sement ve bağ dokusu oluşumu gerçekleşmektedir. Ancak son 20 yıldır, periodontal cerrahiyi takiben periodontal rejenerasyonu oluşturmaya yönelik çalışmalar yoğunlaşmıştır. Periodontal dokuların gelişimi ve rejenerasyonu için kritik olan faktör, uygun hücrelerin yara alanına çekilmesidir. Son zamanlarda periodontal rejenerasyonu sağlamak üzere taşıyıcı olarak da işlev gören biyolojik veya sentetik yapılar, otojen hücreler, aracı moleküller ve büyüme faktörleriyle birlikte kullanılmaya başlanmıştır. Doğal yara iyileşmesinde temel rol oynayan büyüme faktörü kompleksinin ana kaynağı trombositlerdir. Trombositler sadece pıhtı şekillendirerek lokal kan ve lenf kaybını önlemekle kalmaz aynı zamanda yara iyileşmesini başlatan büyüme faktörlerini ve sitokinleri içerir.

Son yıllarda geliştirilen trombositten zengin plazma (TZP) ve trombositten zengin fibrin (TZF) uygulamaları, doğal pıhtıdaki eritrosit/trombosit oranını tersine çevirerek, büyüme faktörlerinin konsantre halde cerrahi bölgesine uygulanmasını sağlamakta, yara iyileşmesini ve rejenerasyonu hızlandırmaktadır.

Bu derlemenin amacı; periodontal rejeneratif tedavide yeni bir yaklaşım olan trombosit kaynaklı ürünlerin etkinlik mekanizması, hazırlanışı ve periodontolojideki klinik kullanım alanları ile ilgili bilgi vermektir.

Keywords

• Trombosit, fibrin, rejenerasyon

References

1. Garret S. Periodontal regeneration around natural teeth. Ann Periodontol. 1996; 2: 621–66.
2. Rutherford RB, Ryan ME, Kennedy JE, Tucker MM, Charette ME. Platelet-derived growth factor and dexamethasone combined with a collagen matrix induce regeneration of periodontium in monkeys. J Clin Periodontol. 1993; 20: 537-44.
3. Shallhorn RG, McClain PK. Combined osseous composite grafting, root conditioning, and guided tissue regeneration. Int J Periodontics Restorative Dent. 1988; 8: 8–31.
4. Osborn JW, Price DG. An autoradiographic study of periodontal development in the mouse. J Dent Res. 1988; 67: 455-61.
5. McCauley LK, Somerman MJ. Biologic modifiers in periodontal regeneration. Dent Clin of North Amer (Part I). 1998: 361-87.
6. Lang NP. Focus on intrabony defects-conservative therapy. Periodontol. 2000; 22: 51-8.
7. Anusakthien O, Giannobile WV. Growth factor delivery to re-engineer periodontal tissues. Current Pharmaceutical Biotechnology. 2002; 3: 129-39.
8. Schmitz JP, Hollinger JO. The biology of plateletrich plasma. Letters to the Editor. J Oral Maxillofac Surg. 2001; 59: 1119-21.

9. Sanchez AR, Sheridan PJ, Kupp LI. Is plateletrich plasma the perfect enhancement factor? A current review. The International J Oral & Maxillofacial Implants. 2003; 18: 93-103.
10. Tambini K. Platelet Rich Plasma. UIC Dept OMFS Grand Rounds June 2001.
11. Grageda E. PlateletRich Plasma and bone graft materials: A review and a standardized research protocol. Implant Dentistry. 2004; 13(4): 301-9.
12. Man D, Plosker H, WinlandBrown JE. The use of autologous PlateletRich Plasma (Platelet Gel) and autologous PlateletPoor Plasma (Fibrin Glue) in cosmetic surgery. Plastic and Reconstructive Surgery. 2001; 107(1): 229-37.
13. Buza PW. Case studies Platelet Rich Plasma (Thrombograft PRP). Spacecoast Aromedical Institute. Erişim tarihi:12.05 2005. Erişim: http:/www.heartpumpur.com/prp_clinical_applications.htm.
14. Carter CA, Jolly DG, Worden Sr CE, Hendren DG, Kane CJM. PlateletRich Plasma gel promotes differentiation and regeneration during equine wound healing. Experimental and Molecular Pathology. 2003; 74: 244-55.
15. Ulutin O. The platelets. İstanbul 1976; 217-253. İ.Ü. Cerrahpaşa Tıp Fakültesi Sürekli Tıp Eğitimi Etkinlikleri Kanama ve Tromboza Eğilim Sempozyum Dizisi No: 36, 2003: 37-60.
16. Carlson NE, Roach RB Jr. Platelet-rich plasma: clinical applications in dentistry. J Am Dent Assoc. 2002; 133: 1383–6.
17. Tözüm TF, Demiralp B. Platelet-rich plasma: A promising innovation in dentistry. J Can Dent Assoc. 2003; 69: 664-664h.
18. Eppley BLMD, Woodell JE, Hıggıns JBS. Platelet quantification and growth factor analysis from PlateletRich Plasma: Implications for wound healing. Plastic and Reconstructive Surgery. 2004; 114(6): 1502-8.
19. Yu X, Hsieh SC, Bao W, Graves DT. Temporal expression of PDGF receptors and PDGF regulatory effects on osteoblastic cells in mineralizing cultures. Am J Physiol. 1997; 272(5Pt1): C1709-16.
20. Marx RE, Carlson ER, Eichstaed RM, Schimmele SR, Strauss JE, Georgeff KR. Platelet-rich plasma: growth factor enhancement for bone grafts. Oral Surg Oral Med Oral Pathol Radiol Endod. 1998; 85: 638–46.
21. Pierce GF, Tarpley J, Yanagihara D, Deuel TF. PDGF-BB, TGF-B1, and basic FGF in dermal wound healing: neovessel and matrix formation and cessation of repair. Am J Pathol. 1992; 140:1375–88.
22. Mustoe TA, Purdy J, Gramates P, Deuel TF, Thomasen A, Pierce GF. Reversal of impaired wound healing in irradiated rats by platelet-derived growth factor-BB: requirement of an active bone marrow. Am J Surg. 1989; 158:345-50.
23. Keskiner İ, Trombositten zengin plazma ve otojen kemik grefti uygulamalarının köpeklerde fenestrasyon tipi defektlerde incelenmesi (Tez). 2007.
24. Ferreira FC, Gomez MCC, Filho JS, Granjeiro JM, Simoes CMO, Magini RS. Platelet-rich plasma influence on human osteoblasts growth. Clin Oral Implants Res. 2005;16: 456-60.
25. -
26. Kocazeybek B, Arabaci U, Akdur H, Sezgic M, Erenturk S. Prospective evaluation of platelets prepared by single and random methods during 5 days of storage: aspects related to quality and quantity. Transfus Apher Sci. 2002; 26: 29-34.
27. Kassolis JD, Rosen PS, Reynolds MA. Alveolar ridge and sinus augmentation utilizingplatelet rich plasma in combination with freeze-dired bone allograft: Case series. J. Periodontol. 2000; 71: 1654-61.
28. Raghoebar GM, Schortinghuis J, Liem RSB, Ruben JL, Van Der Wal JE, Vissink A. Does platelet-rich plasma promote remodeling of autologous bone grafts used for augmentation of the maxillary sinus floor? Clin Oral Implants Res. 2005; 16: 349-56.
29. Manolagas SC. Birth and death of bone cells: basic regulatory mechanisms and implications for the pathogenesis and treatment of osteoporosis. Endocr. Rev. 2000; 21(2): 115-37.
30. Jakse N, Tangl S, Gilli R, Berghold A, Lorenzoni M, Eskici A, Haas R, Pertl C. Influence of PRP on autogenous sinus grafts. An experimental study on sheep. Clin Oral Implants Res. 2003; 14(5): 578-83.
31. Marx RE, Carlson ER, Eichstaedt RM, Schimmele SR, Strauss JE, Georgeff KR. Platelet-Rich Plasma: Growth factor enhancement for bone grafts. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998; 85: 638-46.
32. Han J, Meng HX, Tang JM, Li SL, Tang Y, Chen ZB. The effect of different platelet-rich plasma concentrations on proliferation and differentiation of human periodontal ligament cells in vitro. Cell Proliferation. 2007; 40: 241-52.
33. Graziani F, Ivanovski S, Cei S, Ducci F, Tonetti M, Gabriele M. The in vitro effect of different PRP concentrations on osteoblasts and fibroblasts. Clinical Oral Implants Research. 2006; 17: 212–9.
34. Gruber R, Karreth F, Frommlet F, Fischer MB, Watzek G. Platelets are mitogenic for periosteum-derived cells. Journal of Orthopaedic Research. 2003; 21: 941–8.
35. Kovacs K, Velich N, Huszar T, Fenyves B, Suba Z, Szabo G. Histomorphometric and densitometric evaluation of the effects of platelet-rich plasma on the remodeling of beta-tricalcium phosphate in beagle dogs. The Journal of Craniofacial Surgery. 2005; 16: 150-4.
36. You TM, Choi BH, Zhu SJ, Jung JH, Lee SH, Huh JY. Platelet-enriched fibrin glue and platelet-rich plasma in the repair of bone defects adjacent to titanium dental implants. The International Journal of Oral and Maxillofacial Implants. 2007; 22: 417-22.
37. Marx RE, Carlson ER, Eichstaedt RM, Schimmele SR, Strauss JE, Georgeff KR. Platelet-rich plasma: Growth factor enhancement for bone grafts. Oral Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontic. 1998; 85: 638–46.
38. Demir B, Sengun D, Berberoglu A. Clinical evaluation of platelet-rich plasma and bioactive glass in the treatment of intra-bony defects. Journal of Clinical Periodontology. 2007; 34: 709-15.
39. Simon D, Manuel S, Geetha V, Naik BR. Potential for osseous regeneration of platelet-rich plasma--a comparative study in mandibular third molar sockets. Indian Journal of Dental Research. 2004; 15: 133– 6.
40. Rullo R, Festa VM, Guida L, Laino G. Bone grafting with platelet-rich plasma in alveolar cleft. Case report. Minerva Stomatologica. 2007; 56: 63-71.
41. Griffin TJ, Cheung WS. Treatment of gingival recession with a platelet concentrate graft: a report of two cases. The International Journal of Periodontics and Restorative Dentistry. 2004; 24: 589–95.
42. Cheung WS, Griffin TJ. A comparative study of root coverage with connective tissue and platelet concentrate grafts: 8-month results. Journal of Periodontology. 2004; 75: 1678–87.
43. Dohan DM et al. Platelet-Rich Fibrin (TZF): second generation platelet concentrate. Part I: technological concepts and evolution. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod. 2006; 1: e37-44.
44. Dohan DM, de Peppo GM, Doglioli P, Sammartino G. Slow release of growth factors and thrombospondin-1 in Choukroun’s platelet-rich fibrin (PRF): a gold Standard to achieve for all surgical platelet concentrates Technologies. Growth Factors. 2009; 27(1): 63-9.
45. Choukroun J, Diss A, Simonpieri A, et al. Platelet-rich fibrin (PRF): A second-generation platelet concentrate. Part IV: Clinical effects on tissue healing. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006; 101: E56-60.
46. Dohan DM, Choukroun J, Diss A, Dohan SL, Dohan AJ, Mouhyi J, Gogly B. Platelet-rich fibrin (PRF): A second-generation platelet concentrate. Part II: Platelet-related biologic features. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006; 101 (3): e45-50.
47. Van Hinsbergh VW, Collen A, Koolwijk P. Role of fibrin matrix in angiogenesis. Ann NY Acad Sci. 2001; 936: 426-37.
48. Choukroun J, Diss A, Simonpieri A, Girard MO, Schoeffler C, Dohan SL, Dohan AJ, Mouhyi J, Dohan DM. Platelet-rich fibrin (PRF): a second generation platelet concentrate. Part IV: clinical effects on tissue healing. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006; 101(3): e56-60.
49. Dohan DM, Diss A, Odin G, Doglioli P, Hippolyte MP, Charrier JB. In vitro effects of Choukroun’s PRF (platelet-rich fibrin) on human gingival fibroblasts, dermal prekeratinocytes, preadipocytes, and maxillofacial osteoblasts in primary cultures. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009; 108: 341-52.
50. Wirthlin MR. The current status of new attachment therapy. J Periodontol. 1981; 52: 529-44.
51. Dohan DM, Rasmusson L, Albrektsson T. Classification of platelet concentrates: from pure platelet-rich plasma (P-PRP) to leucocyte-and platelet-rich fibrin (L-PRF). Trends Biotechnol. 2009; 27(3): 158-67.
52. Diss A, Dohan DM, Mouhyi J, Mahler P. Osteotome sinus flor elevation using Choukroun’s platelet-rich fibrin as grafting material: a 1-year prospective pilot study with microthreaded implants. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008; 105(5): 572-9.
53. Simonpieri A, Del Corso M, Sammartino G, Dohan Ehrenfest DM. The relevance of Choukroun’s Platelet-Rich Fibrin (PRF) and metronidazole during complex maxillary rehabilitations using bone allograft. Part II: implant surgery, prosthodontics and survival. Implant Dent. 2009; 18(3): 220-9.
54. M. Toffler, N. Toscano, D. Holtzclaw, M. Del Corso, and D. D. Ehrenfest, “Introducing Choukroun’s platelet rich fibrin (PRF) to the reconstructive surgery milieu.” The Journal of Implant and Advanced Clinical Dentistry. 2009; 1(6): 21–32.
55. Raja S, Munirathnam E. Platelet rich fibrin: Evolution of a second generation platelet concentrate. Indian J Dent Res. 2008; 19: 42-6.
56. Bajaj P, Nishanth S Rao, Agarwal E, Pradeep AR. Treatment of intrabony defect with platelet rich fibrin: Archives of Oral Sciences & Research, AOSR. 2011; 1(2): 90-4.