I NTRODUCTION
Platelet-rich plasma (PRP) is a novel technique employed for tissue regeneration that is widely employed in a variety of medical field such as otolaryngology, cardiology, orthodontics, periodontics, and oral and maxillofacial surgery. The PRP is commonly made up of combining PRP with additional component such as thrombin and calcium chloride and utilized in the form of gel. PRP made up of improved quantity of platelets as well as fibrinogen in its natural state.[ 1 , 2 ] Platelets are considered to be the first component which respond at a wound site during wound healing and they were serious to the start of the process. Platelets are significant source of growth factors, including platelet-derived growth factor, transforming growth factor-b (TGF-b) 1 and 2, and vascular endothelial growth factor and all of these are involved in the angiogenic cascade, which aids in the healing of hard and soft tissue wounds.[ 3 , 4 , 5 ]
PRP is a useful supplement to improve wound healing in a variety of dentistry and oral surgery procedures, particularly in aged patients. Patients who are above the age of 65 years are usually the ones who want to have these operations done. From a dental perspective, patients were considered special needs patients who require a specialized treatment plan; age is a key factor in diagnosing periodontal disease, which is the important origin of tooth loss. Furthermore, aged people are more prone to have systemic disorders, which might affect the coagulation and tissue repair responses to surgical treatment. In recent decades, elderly patients' quality of life has improved, resulting in an increase in demand for certain elective treatments and specialized strategies that meet their unique essentials in live time.[ 6 , 7 ]
PRP has been verified to be current healing aid in a variety of dentistry and oral surgical treatments. Ablative surgical methods, maxillary and mandibular reconstructions, and alveolar cleft surgical repair, periodontal defects such as infrabony procedures and periodontal surgery, in addition to osseointegrated implant implantation, are among them. In such treatments, the adhesive property of PRP allows for better graft handling, with additional predictable flap adaption and hemostasis, as well as predictable seal than primary closure alone.[ 8 , 9 , 10 , 11 , 12 , 13 , 14 ] The use of PRP in the case of avascular necrosis or bisphosphonate-related osteonecrosis of the jaw (BRONJ) caused by supplementary sources (e.g., radio-osteonecrosis) has recently been recommended, with the goal of improving wound healing and bone maturation.[ 15 , 16 , 17 , 18 , 19 , 20 , 21 ] There is no literature found to describe about knowledge regarding PRP among oral surgeons in Tamil Nadu. The present aim of the study was to evaluate the knowledge and awareness of PRP among oral surgeons in Tamil Nadu.
M ETHODOLOGY
An online questionnaire form was used to conduct a descriptive questionnaire study among oral surgeons in Tamil Nadu. With the help of Google Forms, which is generated from the Google site and web-based questionnaire form were created. Pretesting of questionnaire was done randomly for 10 oral surgeons. The questionnaire was finalized after equivocal and inappropriate questions were altered. To estimate the sample size, a pilot research was carried out. After conducting a pilot study, the final sample size was arrived and found to be 500 people. The primary sample size did not include the pretesting and pilot research samples. A structured questionnaire was framed related to the knowledge of PRP. A convenient sampling technique was employed. From August to November 2021, all participants answered surveys during a 4-month period. The questionnaires were completed by 500 participants and their responses were recorded in Google Forms, of which 500 were decided after eliminating the inaccuracies. An informed permission form was acquired from each participant in the survey after a brief introduction to the study's procedures. The information submitted was considered secret and participation was entirely voluntary. The inclusion criteria for the present study include those who completed Master of Dental Surgery (MDS) and those who are studying MDS in the branch of oral and maxillofacial surgery. The patient who were not willing to participate in the study and unable to give informed consent were excluded from the study.
R ESULTS
Among 500 study participants, 285 (57%) were males and 215 (43%) were females [ Table 1 ].
Table 1
Distribution of study participants according to gender
| Gender | Frequency (%) |
| Male | 285 (57.0) |
| Female | 215 (43.0) |
| Total | 500 (100.0) |
About of the 500 study participants, 216 (43.2%) were between the age group of 15 and 30 years, 182 (36.4%) were between the age group of 20 and 25 years, and 102 (20.4%) were between the age group of 25 and 30 years [ Table 2 ]. Four hundred and sixty six (93.2%) of the 500 survey participants had heard about PRP, while 34 (6.8%) had never heard of it [ Table 3 ].
Table 2
Distribution of study participants according to years of experience
| Years of experience | Frequency (%) |
| 15–20 | 216 (43.2) |
| 20–25 | 182 (36.4) |
| 25–30 | 102 (20.4) |
| Total | 500 (100.0) |
Table 3
Distribution of study participants according to correct response for the knowledge of platelet-rich plasma
| Responses | Frequency (%) |
| Yes | 466 (93.2) |
| No | 34 (6.8) |
| Total | 500 (100.0) |
Among the 500 study participants, 454 (90.6) had given the accurate responses in regard to the use of PRP in improving wound healing and bone maturation, whereas 46 (9.4) had given the incorrect responses [ Table 4 ].
Table 4
Distribution of study participants according to correct response related to the use of platelet-rich plasma in enhancing wound healing and bone maturation
| Responses | Frequency (%) |
| Yes | 454 (90.6) |
| No | 46 (9.4) |
| Total | 500 (100.0) |
Among the 500 study participants, 454 (90.6%) had known about the use of PRP in oral surgery whereas 46 (9.4%) had did not know about it [ Table 5 ].
Table 5
Distribution of study participants regarding the use of platelet-rich plasma in oral surgical procedures
| Responses | Frequency (%) |
| Yes | 454 (90.6) |
| No | 46 (9.4) |
| Total | 500 (100.0) |
Among the 500 study participants, 33 (6.6%) reported mandibular reconstruction, 84 (16.8%) reported surgical repair of the alveolar cleft, 367 (73.4%) of population responded to bone fracture, and 16 (3.2%) suggested osseointegrated implant implantation procedures [ Figure 1 ].
Among the 500 study participants, 40 (7.0%) were experienced regarding the use of PRP procedure Table 6 , whereas 466 (93%) never had previous history of any experience and all responded had awareness about the use of PRP in BRONJ.
Table 6
Distribution of study participants regarding previous experience in handling platelet-rich plasma procedure
| Responses | Frequency (%) |
| No | 466 (93.2) |
| Yes | 34 (6.8) |
| Total | 500 (100.0) |
D ISCUSSION
The current study was intended to assess the knowledge and awareness of PRP procedures among 500 oral surgeons. Initially, demographic and experience data were focused. Among the 500 patient, who participated 57% (285) were males and 215 (43%) were females. A PRP gel contains a higher concentration of platelets and fibrinogen concentration in its natural state.[ 1 , 2 ]
According to our study, 454 (90.6) had given the exact responses related to the use of PRP in enhancing wound healing and bone maturation. On supporting the above findings, our study showed that among the 500 study participants, 33 (6.6%) reported mandibular reconstruction, 84 (16.8%) reported surgical repair of the alveolar cleft, 367 (73.4%) of population responded to bone fracture, and 16 (3.2%) suggested osseointegrated implant implantation procedures.
PRP has been proposed for use in BRONJ surgery by some researchers. BRONJ is now recognized as a significant complication associated with bisphosphonates (BPs), common drugs used to treat a variety of pathologies linked by a change in bone turnovers such as bone osteoporosis, metastasis of the bone, related with multiple myeloma, solid tumor, and malignant hypercalcemia. BPs have anti-angiogenic activity as well as the ability to prevent bone resorption. As a result, BP-treated patients' bones are less vascularized and provided with less components required for wound healing.[ 22 ]
TGF-b1 and TGF-b2 are involved in connective tissue repair and bone regeneration and two further cytokines generated by PRP alpha granules. Their primary function is to promote fibroblast chemotaxis and cell synthesis of collagen and fibronectin by restricting collagen breakdown by reduced release of proteases and subsequently increasing protease inhibitors. TGF stimulates proliferation of mesenchymal stem cells and osteoblasts where resulting in bone regeneration, according to many in vitro and in vivo studies. TGF-b2 has been demonstrated to boost the activity of both osteoblasts and osteoclasts. By modulating the combined activity of osteoblasts and osteoclasts and increased activity of TGF-b2 may speed up bone regeneration.[ 23 ]
To improve bone healing, PRP treatment has been promoted as a supplement to conservative surgery. According to our study, all respondent has awareness about the use of PRP in BRONJ. The justification for using PRP in patients with BRONJ is established regarding the belief that the occurrence of a set of growth factors (typically suppressed by BPs) bone healing as an additional for stimulus and similar to physiological recovery, PRP's growth factors may help to increase wound healing of epithelial tissue, reduced tissue inflammation following surgery, and promote bone regeneration on affected region. Given the scarcity of Randomized control trials (RCTs) relevant to this topic, the majority of which have been accompanied using many graft materials and methodologies, data regarding PRP efficacy and efficiency is still debatable.
C ONCLUSION
PRP has been suggested for a variety of dentistry and oral and maxillofacial surgery applications. The simplicity with which these preparations can be made might be beneficial to dentists in a variety of procedures, and their safety may stimulate their broad acceptance. According to the findings of the current study, oral surgeons was aware of PRP as an auxiliary therapeutic technique for promoting wound healing and bone maturation.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
R EFERENCES
1. Carlson NE, Roach RB., Jr Platelet-rich plasma: Clinical applications in dentistry. J Am Dent Assoc. 2002;133:1383–6. doi: 10.14219/jada.archive.2002.0054.
2. Kao RT, Murakami S, Beirne OR. The use of biologic mediators and tissue engineering in dentistry. Periodontol. 2000;2009(50):127–53. doi: 10.1111/j.1600-0757.2008.00287.x.
3. Nikolidakis D, Jansen JA. The biology of platelet-rich plasma and its application in oral surgery: Literature review. Tissue Eng Part B Rev. 2008;14:249–58. doi: 10.1089/ten.teb.2008.0062.
4. El-Sharkawy H, Kantarci A, Deady J, Hasturk H, Liu H, Alshahat M, et al. Platelet rich plasma: Growth factors and pro- and anti-inflammatory properties. J Periodontol. 2007;78:661–9. doi: 10.1902/jop.2007.060302.
5. Anitua E, Andia I, Ardanza B, Nurden P, Nurden AT. Autologous platelets as a source of proteins for healing and tissue regeneration. Thromb Haemost. 2004;91:4–15. doi: 10.1160/TH03-07-0440.
6. Huttner EA, Machado DC, de Oliveira RB, Antunes AG, Hebling E. Effects of human aging on periodontal tissues. Spec Care Dentist. 2009;29:149–55. doi: 10.1111/j.1754-4505.2009.00082.x.
7. McCreary C, Ni Riordáin R. Systemic diseases and the elderly. Dent Update. 2010;37:604–7. doi: 10.12968/denu.2010.37.9.604.
8. 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. doi: 10.1016/s1079-2104(98)90029-4.
9. Fennis JP, Stoelinga PJ, Jansen JA. Mandibular reconstruction: A histological and histomorphometric study on the use of autogenous scaffolds, particulate corticocancellous bone grafts and platelet rich plasma in goats. Int J Oral Maxillofac Surg. 2004;33:48–55. doi: 10.1054/ijom.2003.0452.
10. Del Corso M, Vervelle A, Simonpieri A, Jimbo R, Inchingolo F, Sammartino G, et al. Current knowledge and perspectives for the use of platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) in oral and maxillofacial surgery part 1: Periodontal and dentoalveolar surgery. Curr Pharm Biotechnol. 2012;13:1207–30. doi: 10.2174/138920112800624391.
11. Plachokova AS, Nikolidakis D, Mulder J, Jansen JA, Creugers NH. Effect of platelet-rich plasma on bone regeneration in dentistry: A systematic review. Clin Oral Implants Res. 2008;19:539–45. doi: 10.1111/j.1600-0501.2008.01525.x.
12. Bae JH, Kim YK, Myung SK. Effects of platelet-rich plasma on sinus bone graft: Meta-analysis. J Periodontol. 2011;82:660–7. doi: 10.1902/jop.2010.100529.
13. Arora NS, Ramanayake T, Ren YF, Romanos GE. Platelet-rich plasma in sinus augmentation procedures: A systematic literature review: Part II. Implant Dent. 2010;19:145–57. doi: 10.1097/ID.0b013e3181cd706d.
14. Nikolidakis D, van den Dolder J, Wolke JG, Jansen JA. Effect of platelet-rich plasma on the early bone formation around Ca-P-coated and non-coated oral implants in cortical bone. Clin Oral Implants Res. 2008;19:207–13. doi: 10.1111/j.1600-0501.2007.01456.x.
15. Cetiner S, Sucak GT, Kahraman SA, Aki SZ, Kocakahyaoglu B, Gultekin SE, et al. Osteonecrosis of the jaw in patients with multiple myeloma treated with zoledronic acid. J Bone Miner Metab. 2009;27:435–43. doi: 10.1007/s00774-009-0047-9.
16. Curi MM, Cossolin GS, Koga DH, Araújo SR, Feher O, dos Santos MO, et al. Treatment of avascular osteonecrosis of the jaw in cancer patients with a history of bisphosphonate therapy by combining bone resection and autologous platelet-rich plasma: Report of 3 cases. J Oral Maxillofac Surg. 2007;65:349–55. doi: 10.1016/j.joms.2005.12.051.
17. Lee CY, David T, Nishime M. Use of platelet- rich plasma in the management of oral bisphosphonate-associated osteonecrosis of the jaw: A report of 2 cases. J Oral Implantol. 2007;33:371–82. doi: 10.1563/1548-1336(2007)33[371:UOPPIT]2.0.CO;2.
18. Bocanegra-Perez S, Vicente-Barrero M, Knezevic M, Castellano-Navarro JM, Rodrıguez-Bocanegra E, Rodrıguez-Millares J, et al. Use of platelet-rich plasma in the treatment of bisphosphonate-related osteonecrosis of the jaw. Int J Oral Maxillofac Surg. 2012;41:1410–5. doi: 10.1016/j.ijom.2012.04.020.
19. Adornato MC, Morcos I, Rozanski J. The treatment of bisphosphonate-associated osteonecrosis of the jaws with bone resection and autologous platelet-derived growth factors. J Am Dent Assoc. 2007;138:971–7. doi: 10.14219/jada.archive.2007.0294.
20. Mozzati M, Gallesio G, Arata V, Pol R, Scoletta M. Platelet-rich therapies in the treatment of intravenous bisphosphonate-related osteonecrosis of the jaw: A report of 32 cases. Oral Oncol. 2012;48:469–74. doi: 10.1016/j.oraloncology.2011.12.004.
21. Coviello V, Peluso F, Dehkhargani SZ, Verdugo F, Raffaelli L, Manicone PF, et al. Platelet-rich plasma improves wound healing in multiple myeloma bisphosphonate-associated osteonecrosis of the jaw patients. J Biol Regul Homeost Agents. 2012;26:151–5.
22. Yin G, Bai Y, Luo E. Angiogenic suppression of osteoclasts may play a role in developing bisphosphonate-related osteonecrosis of the jaw. Med Hypotheses. 2011;76:347–9. doi: 10.1016/j.mehy.2010.10.036.
23. Cochran DL, Wozney JM. Biological mediators for periodontal regeneration. Periodontol. 2000;1999(19):40–58. doi: 10.1111/j.1600-0757.1999.tb00146.x.