This article is adapted from a poster based on a literature review conducted by Arlene Cumming, a third year dental therapist student at the University of the Highlands and Islands.

figure 1

©Nicola Tree/Stone/Getty Images Plus

Summary

  • Plasma rich in growth factors (PRGF) is autologous, providing a biologic process that stimulates and accelerates tissue regeneration

  • This process has the potential to help aid elements of chronic periodontal disease alongside mechanical removal of plaque, usually completed by the dental hygienist/therapist (DT).

What is periodontal disease?

Periodontal disease is inflammatory destruction, initiated by oral pathogens which affect the supporting tooth structure, if the plaque is not removed by oral hygiene techniques or by mechanical intervention.

The severity of this disease ranges from mild, reversible inflammation, to chronic destruction of connective tissues, destroying the junctional epithelium, causing bone loss and the formation of a periodontal pocket, ultimately resulting in tooth loss.1

Ten to fifteen percent of the population will suffer from chronic periodontal disease (CPD).2

What is PRGF?

PRGF, a form of platelet concentrate, is an autologous process which stimulates tissue regeneration. It has been used increasingly in dentistry over the last decade, in areas such as implantology, oral surgery, and periodontics.

This process uses the patient's venous blood which, following a centrifugation process, separates the plasma from the red blood cells. Various growth factors are then derived from the platelets. PRGF provides stimulation and acceleration of tissue healing and regeneration,3 which is one of its many advantages. It utilises the body's natural organisms: PRGF promotes biologic processes like proliferation, migration, and differentiation.

Literature review

As PRGF is increasingly used in dental procedures, the aim is to establish if there are benefits in using PRGF in non-surgical periodontal treatment, to investigate if there is an improvement in the periodontal health, such as pocket depths (PD), clinical attachment levels (CAL) and wound healing.

PRGF is increasingly used in dental procedures. Even if the PRGF process is not added to the DT remit, DTs should know of it and feel confident to discuss it with patients.

The PRGF procedure is not currently in the remit of a DT4 nor in the protocols to treat CPD. Currently, DTs use guidelines from the Scottish Dental Clinical Effectiveness Programme5 and BSP,2 as well as looking at evidence-based practice to treat CPD. However, this advanced technology is being used in dental procedures such as implant placement; therefore, a DT should be aware of it so they can inform and discuss the process with the patient.

PRGF could become part of the DT remit in the future if more evidence supports its use in periodontal treatment.

Method

A database search was carried out from September to December 2020, using search engines. PubMed, Web of Science and the use of Knowledge Network were utilised as primary literature search tools using a search strategy.

Results

While there has been much research on PRGF and its benefits in CPD, few studies have considered PRGF in non-surgical periodontal treatment.

Five papers, spanning multiple countries, were included in this review. Although all the papers were looking at different aspects of PRGF in the treatment of CPD, they all showed positive results favouring its use. PRGF technology showed significant statistical difference in PD, gaining CAL, its aid against Porphyromonas gingivalis (P. gingivalis), and the aid in the healing of the periodontal ligaments.

Panda et al.6reported in their randomised control trial that in PD sites observed at six months: 90.9% reduced to <4 mm in patients that had had PRGF as well as scaling and root planing (SRP) compared to 59.1% in the SRP alone group.

Recommendations

  • Further studies into the benefits of the use of PRGF in non-surgical CPD treatment are required

  • DTs cannot use PRGF at present, but the dental world is constantly changing, and, with new studies, it may be included in non-surgical treatment for future patients

  • Even if the PRGF process is not added to the DT remit, DTs should know of it and feel confident to discuss it with patients. For example, PRGF may be part of the process when patients are going for implants or need to be referred for surgical CPD treatment

  • Being knowledgeable about PRGF, including its advantages and disadvantages, will enable informed discussions with patients

  • For this reason, there is justification for it to be further understood and taught to DT students

  • Dentistry is constantly advancing, and DTs should keep up to date, even if it is not in the current remit

  • The General Dental Council's Standard 7.3 states, 'You must update and develop your professional knowledge and skills throughout your working life'.7

Conclusion

The evidence so far suggests there is a potential use for PRGF in the treatment of CPD, alongside mechanical non-surgical treatment.

There was a range of benefits, from reduced PD, regaining CAL, benefits against P. gingivalis, and its use in healing the periodontal ligaments.

Limited research made it difficult to reach a definite answer to the question and most studies thus far have focussed on the surgical treatment of CPD.

Before this can become part of the daily DT remit, more comprehensive studies are required for PRGF intervention in non-surgical CPD treatment.