Rolul terapiei cu plasmă îmbogățită în trombocite (PRP) în stomatologia pediatrică: aplicații, beneficii și perspective viitoare

1. Introduction

Pediatric dentistry is a field constantly evolving with advancements aimed at improving patient care and clinical outcomes. Among these innovations, regenerative therapies have garnered considerable attention, with platelet-rich plasma (PRP) being at the forefront. PRP therapy, an autologous treatment involving the concentration of platelet-rich plasma from the patient’s own blood, has shown promise in accelerating healing, reducing inflammation, and promoting tissue regeneration.

In pediatric dental practice, PRP is being increasingly utilized in various clinical applications, including post-surgical healing, dental trauma management and bone regeneration. Additionally, its role in the treatment of craniofacial clefts, particularly cleft lip and palate, has been the subject of growing interest. Despite its growing use, the standardization of protocols and further clinical evidence are required to establish PRP as a routine part of pediatric dental care.

This article aims to provide an overview of the biological principles behind PRP, its applications in pediatric dentistry and its potential role in the management of craniofacial clefts, along with the benefits and challenges associated with its use.

2. Platelet-rich plasma: biological basis and preparation

Platelet-rich plasma is derived from whole blood, which is processed to concentrate the platelets and growth factors. The preparation of PRP involves the separation of blood components through centrifugation, resulting in a plasma rich in platelets that is then reintroduced into the treatment site. PRP contains a high concentration of platelets, which are rich in growth factors, such as platelet-derived growth factor (PDGF), transforming growth factor-beta (TGF-b) and vascular endothelial growth factor (VEGF), all of which play crucial roles in tissue healing and regeneration^(1-4).

The process of creating PRP is relatively simple and can be done in-office with minimal equipment. The blood sample is typically drawn from the patient, and after centrifugation, the concentrated platelet-rich plasma is extracted and ready for use. The major advantage of PRP is that it is derived from the patient’s own blood, minimizing the risk of immune rejection or disease transmission, making it a safe and reliable treatment option.

There are different types of PRP preparations based on platelet concentration, the presence or absence of white blood cells, and the method of application. The ideal preparation depends on the clinical indication, and further research is necessary to determine the most effective protocols for pediatric patients.

3. Clinical applications of PRP in pediatric dentistry

Platelet-rich plasma therapy has shown promising results in various clinical scenarios within pediatric dentistry, due to its regenerative capabilities and minimally invasive nature. The following subsections outline its current and potential uses.

3.1. Post-surgical healing enhancement

Post-surgical recovery in pediatric patients presents unique challenges, particularly when dealing with tissue healing and minimizing complications. PRP therapy has emerged as a promising adjunct to enhance recovery after various dental surgeries, including tooth extractions, cleft lip and palate surgeries, and bone grafting procedures.

The healing process in pediatric patients can be complex due to the rapid turnover of tissues and the need for careful management of scarring and inflammation. PRP has been shown to improve tissue regeneration by providing a concentrated source of growth factors directly at the site of injury. Studies have demonstrated that PRP can significantly reduce postoperative swelling, bruising and pain while enhancing wound healing and reducing the formation of scar tissue. One study by Choukroun et al.⁽⁴⁾ suggested that PRP may accelerate the healing of soft tissue in oral surgery, improving both functional and aesthetic outcomes in pediatric patients.

The use of PRP in pediatric dental surgeries not only accelerates tissue healing, but also helps in reducing the need for prolonged post-surgical care and minimizes complications, thus improving the overall patient experience. Additionally, its autologous nature ensures safety and reduces the risk of adverse reactions⁽²⁾.

3.2. Management of dental trauma

Dental trauma is one of the most common reasons for emergency visits in pediatric dentistry. Whether it involves fractured teeth, avulsions, or soft tissue injuries, prompt and effective management is crucial. Platelet-rich plasma has shown promising results in the treatment of dental trauma, particularly in accelerating the healing of soft tissue injuries and supporting the regeneration of damaged periodontal tissues.

In cases of dental trauma where soft tissue injuries are present, PRP application can reduce bleeding, accelerate tissue regeneration, and improve overall healing times. For example, in traumatic dental avulsions, PRP has been used to promote the healing of the periodontal ligament, which is crucial for successful tooth replantation. Several studies^(1-3) have indicated that the application of platelet-rich plasma to the periodontal ligament helps stimulate tissue regeneration, supporting faster healing and a reduced risk of complications like ankylosis or root resorption.

PRP’s ability to enhance soft tissue healing also extends to the management of oral mucosal injuries and the prevention of infections, making it a valuable tool in emergency pediatric dentistry.

3.3. Pulp therapy and regenerative endodontics

For young permanent teeth with incomplete root formation, PRP serves as a scaffold in regenerative endodontic procedures, stimulating root maturation and apical closure. It supports the reestablishment of pulp vitality by promoting cell differentiation and angiogenesis.

3.4. Support in bone grafting procedures (bone regeneration and cleft management)

Bone regeneration is another key area where platelet-rich plasma has been widely studied and applied. Pediatric patients who suffer from bone loss due to trauma, congenital defects or surgical interventions may benefit from the application of PRP to enhance the regenerative process. Platelet-rich plasma accelerates osteogenesis by stimulating the differentiation of mesenchymal stem cells into osteoblasts, which play a critical role in bone formation.

In pediatric dental treatments, PRP is often used in conjunction with bone grafts to improve the success rate of bone regeneration procedures. Its ability to enhance osteoconductivity and osteoinduction is particularly useful in the reconstruction of alveolar bone defects, such as those seen in children with cleft lip and palate. Studies by Kawamoto et al.⁽³⁾ have demonstrated that PRP can increase bone density and improve the integration of bone grafts in pediatric patients, thus promoting better long-term outcomes.

The use of platelet-rich plasma in pediatric bone regeneration not only accelerates healing but also reduces the need for additional surgical interventions, making it an attractive option for pediatric dentists managing complex cases.

3.5. Adjunct in periodontal therapy

Though less commonly applied in children, PRP has shown potential as an adjunctive therapy in cases of aggressive periodontitis or localized bone loss, by promoting regeneration of periodontal structures.

4. PRP in the management of craniofacial clefts

Craniofacial clefts, particularly cleft lip and palate, are among the most common congenital malformations, requiring complex surgical and orthodontic interventions throughout childhood. The primary goals in cleft management include restoring normal function (speech, mastication, breathing), achieving favorable facial esthetics, and ensuring proper growth and development of craniofacial structures.

Recent research has highlighted the potential role of platelet-rich plasma as an adjunctive therapy in the surgical management of craniofacial clefts. PRP’s concentration of autologous growth factors – particularly platelet-derived growth factor (PDGF), transforming growth factor-beta (TGF-b) and vascular endothelial growth factor (VEGF) – makes it an attractive option to enhance tissue healing and bone regeneration in this delicate patient population.

In alveolar bone grafting procedures, particularly secondary alveolar bone grafting (SABG) performed in the mixed dentition phase, PRP has been utilized to augment autogenous bone grafts. Several studies, including those by Lee et al.⁽⁵⁾ and Marukawa et al.⁽⁶⁾, have reported that platelet-rich plasma may improve the quality and quantity of new bone formation, facilitate faster osseous healing, and reduce the incidence of postoperative complications such as graft resorption and oronasal fistula formation.

Moreover, during primary palatoplasty, the application of PRP at the surgical site has been associated with improved soft tissue healing, reduced dehiscence, and enhanced vascularization of the palatal flaps. Although data in the pediatric cleft population remain limited, preliminary findings suggest that platelet-rich plasma may contribute to better long-term functional and aesthetic outcomes.

However, it is important to emphasize that results have been variable across studies, with some systematic reviews⁽⁷⁾ suggesting that, while PRP has positive biological effects, the magnitude of clinical benefit in craniofacial cleft repair remains to be fully validated. Thus, its use should be considered complementary to, rather than a replacement for, established surgical techniques.

In conclusion, platelet-rich plasma appears to be a promising adjunct in the comprehensive management of craniofacial clefts, offering potential benefits in promoting wound healing and enhancing bone graft success. Nevertheless, well-designed, multicenter randomized controlled trials are necessary to establish standardized protocols and confirm its efficacy in cleft surgery.

5. Advantages, limitations and future perspectives of PRP in pediatric patients

5.1. Advantages

The use of platelet-rich plasma in pediatric dentistry offers numerous benefits that align with the fundamental principles of child-centered care.

• Autologous and biocompatible: PRP is derived from the child’s own blood, eliminating the risk of immunological reactions or disease transmission, and ensuring excellent biocompatibility⁽²⁾.
• Accelerated healing: growth factors released from activated platelets significantly enhance the speed and quality of tissue regeneration, reducing recovery times post-intervention.
• Reduced postoperative complications: PRP minimizes local inflammation, swelling and discomfort, which is especially valuable in young, anxious patients⁽⁴⁾.
• Minimally invasive: the process is relatively simple, requires minimal manipulation, and integrates seamlessly into standard surgical protocols.
• Cost-effective in the long term: although PRP pre­pa­ra­tion may require specialized equipment, its po­ten­tial to reduce complications, re-interventions, and healing times translates into reduced overall treat­ment costs.

5.2. Limitations

Despite its clinical potential, the application of platelet-rich plasma in pediatric dentistry is not without challenges.

• Limited evidence in pediatrics: most clinical data come from adult studies; pediatric-specific evidence remains scarce and mainly anecdotal or based on case series⁽⁸⁾.
• Small blood volume available: in very young patients, the limited volume of autologous blood that can be safely collected may restrict PRP yield.
• Technical variability: differences in centrifugation protocols, platelet concentrations, and activation techniques can lead to inconsistent results between cases and among practitioners⁽⁸⁾.
• Need for trained personnel: the preparation and application require trained staff and appropriate sterile equipment, which may not be available in all pediatric dental settings⁽⁹⁾.
• Regulatory and ethical considerations: the use of biologics in children requires careful ethical review and adherence to institutional and regulatory guidelines, especially in research settings.

5.3. Future perspectives

The future of PRP in pediatric dentistry looks promising⁽⁹⁾, with several avenues for development.

• Personalized PRP protocols: tailoring PRP preparation based on patient-specific factors (age, systemic health, surgical needs) could optimize outcomes.
• Combination with biomaterials: investigations are ongoing into combining PRP with bioactive scaffolds, stem cells and newer biomaterials to enhance regenerative potential.
• Expanded applications: beyond bone and soft tissue healing, PRP may find future roles in pulp regeneration, orthodontic movement facilitation and the management of periodontal defects in children.
• High-quality research: well-designed, multicenter randomized controlled trials with long-term follow-up are needed to validate the efficacy and cost-effectiveness of PRP across various pediatric dental procedures.

6. Conclusions

The incorporation of platelet-rich plasma into pediatric dental practice represents a promising advancement in the pursuit of regenerative, minimally invasive, and patient-centered care. The autologous nature of PRP, along with its rich concentration of bioactive proteins and growth factors, offers a compelling adjunct to conventional surgical and conservative approaches. In procedures such as bone regeneration, soft tissue healing and the therapeutic management of craniofacial clefts, PRP provides enhanced healing, reduced morbidity, and improved overall outcomes – particularly valuable in children whose tissues are in dynamic developmental phases.

While initial results and clinical experience support the safety and efficacy of platelet-rich plasma in pediatric dentistry, further high-quality, evidence-based studies are essential to define standardized protocols, indications and long-term benefits. In particular, clinical trials targeting specific conditions – such as alveolar cleft reconstruction, post-trauma management and soft tissue healing – will help validate the role of PRP as a routine tool in pediatric dental treatment.

The integration of platelet-rich plasma into therapeutic strategies should be approached with a balanced perspective, acknowledging its biological potential while respecting the individual physiological characteristics and medical needs of pediatric patients. As research and technology evolve, the synergy between regenerative medicine and pediatric dentistry is expected to yield innovative approaches that will reshape the future of dental care for children.

Autor corespondent: Diana-Monica Preda E-mail: diana_monica_preda@yahoo.com

CONFLICT OF INTEREST: none declared.

FINANCIAL SUPPORT: none declared.

This work is permanently accessible online free of charge and published under the CC-BY.