Prp-soft Tissue Coverage

VOLUME 39 • NUMBER 6 • JUNE 2008 473

QUINTESSENCE INTERNATIONAL

Patients are placing increasing value on

esthetic and functional outcomes of dental

treatment. Gingival recession can compro-

mise both esthetics and function and is a

common condition, with reported prevalence

as high as 50% to 88% in adults.1 Traditional

root-coverage procedures include the sub-

epithelial connective tissue graft,2 coronally

advanced flap,3 semilunar flap,4 laterally posi-

tioned flap,5 double papilla flap,6 and the

epithelialized gingival graft.7

Recently, dermal allografts8,9 and guided

tissue regeneration (GTR)10–12 have been

introduced as alternative treatment options.

Today, the subepithelial connective tissue

graft procedure is still considered the gold

standard for root coverage with mean per-

cent root coverage varying between 65%

and 98% and complete root coverage

achieved in 0% to 90% of cases.13,14 The

Role of platelet-rich plasma in soft tissue root-coverage procedures: A reviewJill D. Bashutski, DDS1/Hom-Lay Wang, DDS, MSD2

The aim of this article was to review the current evidence on the role of platelet-rich plasma

(PRP) in enhancing root-coverage techniques and discuss the rationale for its use in these

applications. Sound biologic rationale and a multitude of basic science research support

the use of PRP to promote soft tissue healing, although evidence of its role in enhancing

periodontal applications, especially root coverage, is limited. Current scientific research

has yet to elucidate all of the mechanisms by which PRP can affect soft tissue healing and

assess its capacity to stimulate regeneration. Furthermore, clinical evidence on the use of

PRP in root-coverage procedures is extremely limited, with only 2 randomized controlled

trials published as of May 2007. A pertinent review of medical and dental literature relating

to PRP and its role in wound healing and enhancement of root-coverage procedures was

performed. Preliminary reports in this area suggest that the potential benefits of PRP in

root-coverage procedures may be improved esthetics, decreased patient morbidity, and

accelerated wound healing. An appropriate assessment of the effects of PRP and its pos-

sible use in enhancing root-coverage procedures cannot be made at this time because of

inadequate clinical evidence. (Quintessence Int 2008;39:473–483)

Key words: platelet-rich plasma, regeneration, root coverage, soft tissue grafts

1Resident, Department of Periodontics and Oral Medicine,

School of Dentistry, University of Michigan, Ann Arbor,

Michigan.

2Professor and Director of Graduate Periodontics, Department

of Periodontics and Oral Medicine, School of Dentistry,

University of Michigan, Ann Arbor, Michigan.

Correspondence: Dr Hom-Lay Wang, Professor and Director of

Graduate Periodontics, Department of Periodontics and Oral

Medicine, University of Michigan School of Dentistry, 1011

North University Avenue, Ann Arbor, MI 48109-1078. Fax: 734-

936-0374. E-mail: [email protected]

Bashutski.qxd 4/15/08 2:13 PM Page 473

474 VOLUME 39 • NUMBER 6 • JUNE 2008


Bashutski/Wang

disadvantages of this technique include the

need for a donor site and occasional unsatis-

factory tissue contour and esthetics.13–15 In

addition, complications that may arise using

this technique include excessive bleeding at

the donor site and infection and/or slough-

ing at the receptor site.13–15

The coronally advanced flap procedure

has a wide range of clinical success, with an

average root coverage of 75% to 99% and

complete root coverage in 23% to 95% of

cases.16–19 The coronally advanced flap proce-

dure has an advantage over the subepithelial

connective tissue graft in that it does not

require a second surgical site; however, this is

at the expense of gaining tissue thickness.

Similarly, root-coverage procedures utilizing

GTR can achieve an average of 74% reces-

sion depth coverage, with complete coverage

in 41% of cases.20

Providing soft tissue coverage of denuded

root surfaces presents a unique challenge in

that these surfaces are avascular, which com-

plicates the healing process. Also, if soft tis-

sue grafting is employed, it can be difficult to

stabilize the graft against the tooth surface,

resulting in sloughing and even occasional

failure of the graft.15 While traditional root-

coverage procedures have adequately

addressed the challenge of covering exposed

roots, other factors such as esthetic accept-

ability, patient morbidity, and postsurgical

healing time for these grafts are sometimes

suboptimal. More important, root coverage

using these techniques primarily results in tis-

sue repair, not regeneration.21 As a result, new

approaches to root coverage currently involve

incorporating growth factors into previously

employed techniques to enhance the healing

response and possibly promote regeneration.

Most recently, enamel matrix derivative,

platelet-derived growth factor, and platelet-rich

plasma (PRP) have been studied for these

purposes. Although data are emerging on the

ability of these factors to affect wound healing

and root coverage, more long-term research is

needed to fully evaluate their clinical utility.

This article reviews current information on the

use of PRP in soft tissue healing and root-cov-

erage procedures, focusing on the biologic

rationale behind its use and summarizing per-

tinent studies on the subject.

The search strategy included an electronic

search of the Medline (PubMed) database for

medical and dental literature published in the

English language through May 2007. Key

search terms included root coverage, coronal-

ly advanced flap, connective tissue graft, gin-

gival recession, platelet-rich plasma, and PRP.

In addition, the bibliographies of several key

papers22–24 were also reviewed and pertinent

references included. The search resulted in a

total of 4 clinical studies, all of which are pre-

sented in the body of this article.

PLATELET-RICH PLASMA

Platelet-rich plasma is essentially an increased

concentration of autologous platelets sus-

pended in a small amount of plasma after

centrifugation. Several systems have been

developed to isolate PRP, all with varying

platelet and growth factor yields (for a detailed

review, see Roukis et al25). Briefly, a small vol-

ume (about 50 mL) of the patient’s blood is

obtained and centrifuged at varying speeds

until it separates into 3 layers: platelet-poor

plasma, platelet-rich plasma, and red blood

cells. The PRP is isolated and stored with a cit-

rate-based anticoagulant until the end of the

surgical procedure. Immediately before appli-

cation, topical bovine thrombin and 10% cal-

cium chloride are added to activate the clot-

ting cascade, producing a platelet gel. The

whole process takes approximately 12 min-

utes26 and produces a platelet concentration

of 3 to 5 times that of native plasma.26,27

Because the platelets are autologous, they

are able to secrete bioactive growth factors

upon activation and subsequent degranulation

of their alpha granules. These growth factors

are also present at increased concentrations in

PRP and are involved in key stages of wound

healing and regenerative processes including

chemotaxis, proliferation, differentiation, and

angiogenesis.28 In addition to growth factors,

platelets release numerous other substances

that are important in wound healing. Table 1

summarizes these substances and describes

the specific role of each in wound healing.




Bashutski/Wang

BIOLOGIC RATIONALE

PRP contains a plethora of substances

involved in the wound healing process that

have the potential to greatly enhance soft tis-

sue healing. Table 2 summarizes these

mechanisms. In addition, Table 3 and Fig 1

list proposed advantages and disadvantages

for the use of PRP in root-coverage applica-

tions, which are elucidated forthwith.

VASCULARITY

Because PRP contains many growth factors

that stimulate angiogenesis and increase

granulation tissue formation, using PRP in

combination with root-coverage procedures

may be particularly advantageous (see Table

1). Vascular endothelial growth factor and

platelet-derived growth factor are perhaps

the most widely characterized growth factors

Secreted factor Function

Platelet-derived growth factor (PDGF) Accelerates deposition of wound matrix(-AA, -BB, -AB) Promotes chemotaxis of polymorphonuclear leukocytes,

macrophages, fibroblasts, and smooth muscle cellsIncreases fibroblast and endothelial cell differentiationEnhances angiogenesis16,39,72,73

Transforming growth factor (TGF) (-�1, -�2) Accelerates deposition and maturation of collagenPromotes hemotaxis of fibroblastsStimulates collagen and fibronectin productionInhibits collagen degradation16,39,72

Vascular endothelial growth factor (VEGF) Enhances angiogenesis16,39,73

Fibroblast growth factor (FGF) Enhances angiogenesis73

Epithelial cell growth factor (ECGF) Stimulates endothelial chemotaxis and promotes angiogenesis16,39

Platelet-derived angiogenic factor (PDAF) Promotes mitogenesis of endothelial cellsEnhances angiogenesis39

Platelet factor 4 (PF4) Promotes chemotaxis for fibroblasts and monocytesInhibits collagenase39

Platelet-derived endothelial growth factor Stimulates mitogenesis of endothelial cells and keratinocytes39

(PDEGF)Hepatocyte growth factor (HGF) Enhances angiogenesis

Inhibits fibrosis73

Insulin-like growth factor (IGF) Stimulates osteoblast proliferationEnhances matrix synthesis39,72

Fibrin Cell adhesionFibronectin Thrombus formationVitronectin MitogenesisThrombospondin-1 (TSP-1) Hemostasis39,74

Osteocalcin (Oc) Mineralization39

Osteonectin (On)Interleukin-1 (IL-1) Activates growth factor expression in macrophages, fibroblasts,

and keratinocytes24,31

Complement Antimicrobial74

Serotonin Primary hemostasis74

FibrinogenCatecholaminesAdenosine Diphosphate (ADP)Adenosine Triphosphate (ATP)Factor VVon Willebrand factor VIIIThromboxane A2Calcium

Table 1 Growth factors and other components of platelet-rich plasma that contribute to wound healing



Bashutski/Wang

secreted by platelets. Both play key roles in

angiogenesis and fibroblast cell differentia-

tion and are consequently very important in

the wound healing process. Optimizing the

blood supply to the newly covered root sur-

face could theoretically allow for a greater

percentage of root coverage and better soft

tissue graft acceptance rates. Attaining an

adequate blood supply could be particularly

useful in gaining coverage of deep and wide

recession defects or in minimizing sloughing

where a large soft tissue graft is being

placed.15

GRAFT ACCEPTANCE AND WOUND STABILITY

PRP may play a particularly important role in

soft tissue grafting procedures. Compellingly,

the addition of PRP improves graft adhesion

and minimizes micromovement, providing

the most advantageous environment for graft

acceptance.36,37

PRP also increases early wound

strength34,35 through a variety of mecha-

nisms, which would help stabilize the posi-

tion of a coronally advanced flap or ensure


Promote angiogenesis32

Stimulate granulation tissue formation33

Decrease inflammatory phase of wound healing34

Increase collagen content34,32

Increase early glycosaminoglycan (GAG) and fibronectin deposition34

Increase early wound strength34,35

Enhance initial epithelial migration15

Improve hemostasis36,37

Table 2 Mechanisms by which PRP may enhance soft tissue healing

Increased time of procedureIncreased cost for equipmentKnowledge of phlebotomy requiredTechnique sensitive38

A platelet count within a narrow range must be achieved for optimal results39

Lack of long-term data and controlled trials to support efficacy

Table 3 Disadvantages of PRP in root-coverage procedures

Platelet-rich plasma

Increasedvascularity

Increasedwound stability

Increasedesthetics42

Increased regeneration

potiential40,43,45

Decreasedpatient morbidity

•Reduced tissuesloughing26

•Improved healing26,40

•Improved woundclosure15,34,36,41

•Enhanced graftadhesion37

•Reduced micro-movement of graft36

•Increased tissuethickness26

•Reduced scarring22,40,43,44

•Increased healingrate27,40,46,47

•Improved hemostasis36,37

•Minimized immuneresponse26,49

•Decreased infections

Fig 1 Advantages of PRP in root-coverage procedures.

Bashutski.qxd 4/15/08 2:13 PM 76



Bashutski/Wang

soft tissue graft acceptance. This early

wound strength results from the ability of

PRP to decrease the inflammatory phase of

wound healing and to increase collagen con-

tent and early deposition of glycosaminoglycan

and fibronectin.34

ESTHETIC OUTCOMES

Increased graft acceptance rates, a greater

percentage of root coverage, decreased

healing time, and less sloughing of grafts

would all contribute to better esthetics, both

short term and long term. It has been sug-

gested that PRP can also increase tissue

thickness after root coverage,15,38 thereby

improving esthetics and preventing relapse

of the recession since increased flap thick-

ness has been correlated with better out-

comes in root-coverage procedures.50 One

study comparing a coronally advanced flap

to a coronally advanced flap with PRP

showed a trend toward greater tissue thick-

ness in the presence of PRP, although the

study lacked sufficient power to detect a sig-

nificant difference (P = .1).38 To date, the abil-

ity of PRP to enhance tissue thickness in soft

tissue grafting procedures has not been eval-

uated, nor has any mechanism been pro-

posed for the observed increase in tissue

thickness in the above study. This potential

benefit of PRP in root-coverage procedures

requires further investigation, although it

shows promise. The present authors have

experienced and shown38 that PRP can

enhance vascularity (due to release of vascu-

lar endothelial growth factors24) and promote

graft adhesion and wound stability.

Nonetheless, these clinical effects do not

translate in enhancing percentage of root

coverage or in promoting esthetic outcome

when compared to sites treated without PRP.

If vertical incisions are used during root-

coverage procedures, potential scarring of

the mucosa can be an esthetic concern,

especially in patients with a high lip line. PRP

may contribute to improved esthetics by min-

imizing this scar formation.22,42–44 Monteleone

assessed the ability of PRP to accelerate soft

tissue wound healing and epithelialization of

a split-thickness skin graft donor site.44 In this

study, 20 patients with side-by-side split-thick-

ness graft donor sites were treated with either

topical bovine thrombin or PRP in addition

to an occlusive dressing. Wounds were eval-

uated by direct observation, photographic

morphometry, and some histopathology

specimens; patient pain was also evaluated

using a discomfort scale. Accelerated wound

maturity and epithelialization and decreased

scar formation were noted in the PRP group

compared to the control group. Furthermore,

patients in the PRP group reported less pain

and annoyance.

The possible mechanism behind de-

creased scarring may be twofold. First, accel-

erated wound maturation minimizes the

amount of time granulation tissue is present

in the surgical site. Granulation tissue forma-

tion occurs in the proliferative stage of

wound healing and contains collagen that is

less organized and thinner than uninjured tis-

sue.51 It is necessary for wound healing, but

unless the collagen reorganizes, an unsightly

scar will form. Platelet-derived growth factor

and epidermal growth factor, which are both

present in PRP, are the main growth factors

involved in fibroblast migration, proliferation,

and collagen synthesis. Increased concen-

trations of these growth factors are likely the

reason for the accelerated wound healing,

which is suggested to be at least 2 to 3 times

faster than that of normal healing.27 Second,

PRP contains hepatocyte growth factor,

which has powerful antifibrotic effects.

Hepatocyte growth factor has been shown to

reduce scar formation in various animal and

human studies.52–56 Furthermore, 1 study

suggested that hepatocyte growth factor may

even enhance dermal regeneration in addi-

tion to decreasing scar formation.52 PRP con-

tains a higher concentration of all these

growth factors, which would explain the

increased rate of maturation and antifibrotic

effects leading to decreased scar formation.

Although the biologic rationale for decreas-

ing scar formation in root-coverage proce-

dures exists, this has yet to be proven in stud-

ies on gingival tissue.




Bashutski/Wang

PATIENT MORBIDITY

Patient morbidity is also an important issue to

consider with root-coverage procedures.

There are several reports of PRP increasing

healing rates and decreasing postoperative

bleeding and pain.23,27,42,44,46,47,48 Many of the

growth factors present in PRP enhance initial

epithelial migration, creating a more pre-

dictable soft tissue seal than with primary clo-

sure alone.15,36 One author suggests that the

wound-healing process is accelerated with the

use of PRP, minimizing postoperative healing

time for patients and decreasing their morbid-

ity.27 However, studies utilizing PRP for other

applications have revealed that PRP could not

enhance wound healing, bone remodeling, or

sinus augmentation.57,58 Given that PRP has

failed to show promise in other applications,

the initially promising results reported in soft

tissue healing during root-coverage proce-

dures should be interpreted with caution until

more rigorous trials are conducted.

PRP has a pH of 6.5 to 6.7, which is low

compared to the pH of a mature blood clot

(7.0 to 7.2).23 This lowered pH may inhibit

bacterial growth and therefore decrease

infection rates. Furthermore, several growth

factors present in PRP are chemotactic for

neutrophils, which would enhance the

body’s ability to combat a developing infec-

tion. However, Marx reported from his experi-

ence that there was no difference in infection

rates of PRP-treated bone grafts and skin

wounds compared with controls.23 The inci-

dence of infection ranged between 2.0% and

3.5% for both groups.

Since PRP is autologous, there is a rela-

tively low risk of a negative immune reaction

and disease transmission in patients who

receive this product.23,49 The only potential

concern with PRP is the bovine thrombin that

is frequently used to activate it. Several reports

of bleeding coagulopathies exist in the litera-

ture that were attributed to interactions with

bovine and human factor Va, a clotting factor

that binds activated platelets and is critical for

prothrombin activation, after PRP applica-

tion.59–61 However, within the past 10 years, the

amount of bovine factor Va has been signifi-

cantly reduced from 50.0 mg/mL to less than

0.2 mg/mL, thus reducing this complication.61

REGENERATION

In the field of periodontics, tissue regenera-

tion is much preferred over tissue repair.

While PRP has been shown to accelerate the

wound-healing process and hasten repair, lit-

tle is known about its ability to regenerate the

soft tissues of the periodontium, although

some authors suggest that it may have this

potential.27,28 Unfortunately, studies evaluat-

ing the ability of PRP to promote regenera-

tion in bone have shown that PRP actually

has a low regenerative potential.62,63 A signif-

icant amount of data exists for the potential

of growth factors found in PRP to promote

regeneration.40,64–69 However, most of these

studies were performed using the growth

factors in isolation or in pairs, so it remains

unclear what modifying effects these factors

will have on each other.

Some evidence of synergistic effects of

different components of PRP has already

been reported in the literature.70 One recent

study evaluated the effect of PRP itself on

human cell lines.71 In this in vitro study, PRP

caused a marked increase in periodontal lig-

ament cell proliferation, a minor increase in

gingival fibroblast growth, and inhibition of

keratinocyte proliferation. Also, collagen and

alkaline phosphatase activity levels increased

in the presence of PRP, leading the authors

to conclude that PRP may promote regener-

ation by differentially regulating the cell types

of the periodontium. It is also important to

note that platelets may secrete many other

as-yet-unknown growth factors, which have

an unknown effect on the regenerative

potential of cells in the periodontium.

An advantage of using PRP is that numer-

ous growth factors are available in one product.

However, this also creates a disadvantage in

that the concentration of each growth factor

cannot be individually customized. In addi-

tion, the maximum concentration of growth

factors that can be obtained in a PRP prepa-

ration is not necessarily the most optimal

concentration. One recent study found that

fibroblast and osteoblast proliferation was

optimized using a 2.5� concentration of

PRP, but that further increases in concentra-

tion actually reduced this proliferative effect.39

Similar observations were found by Weibrich




Bashutski/Wang

and coworkers, who found that regeneration

of bone around implants placed into rabbit

femurs occurred only within a narrow, inter-

mediate range of PRP concentration.72 Thus,

while further studies are still needed to

assess the ability of PRP to stimulate regen-

eration, it is already acknowledged that the

inherent nature of PRP may present chal-

lenges in this area because of the inability to

achieve optimal levels of each growth factor

with a single PRP concentration.

HUMAN ROOT-COVERAGESTUDIES

Evaluation of PRP and its role in augmenting

root-coverage procedures is limited to 4 pub-

lished reports to date (Table 4). The first case

report using this technique was published in

2001, when Petrungaro used PRP as an

adjunct to traditional treatment of gingival

recession in 3 patients.15 Two patients were

treated using connective tissue grafts, and 1

patient was treated using a barrier mem-

brane. Although complete root coverage was

only obtained in 1 case, the author acknowl-

edged that the gingival recession defects

were difficult to treat and that complete root

coverage was not an intended goal. Based

on the author’s clinical observations, PRP

provided additional benefit to root-coverage

procedures by decreasing pain and bleed-

ing, increasing tissue thickness, enhancing

stabilization of the graft, decreasing infection

and graft sloughing, decreasing healing time,

and promoting revascularization. However, it

is important to note that this publication is a

case report and that the clinical observations

were subjective and nonquantitative. There-

fore, the evidence-based conclusions that

can be obtained from this study are limited

since no quantitative data was presented.

Griffin and Cheung used platelet-concen-

trate gel in a collagen sponge carrier as an

adjunct to a coronally advanced flap in the

treatment of gingival recession in 2 patients.43

Author and year Study design Results Critique

Petrungaro, 200115 3 patients with multiple recession defects: 1/3 complete coverage, faster healing, Case report2 PRP + SCTG less bleeding/pain, increased KG1 PRP + GTR

Griffin and 2 patients PRP + CAF Complete root coverage at 6 m, faster Case reportCheung, 200443 Platelet concentrate gel in sponge carrier healing, decreased inflammation, KG gainCheung and Randomized controlled trial 80% root coverage (60% CRC) in test 2/3 examiners wereGriffin, 200442 Miller Class I or II buccal recession in compared to 95% (65.5% CRC ) in inconsistent in

15 patients control “color match” testSplit-mouth designSCTG or PCG8-m follow-up

Huang et al, 200538 Randomized controlled trial 81.0% root coverage in CAF + PRP Only Miller Class 123 Miller Class I buccal recession defects group (63.6% CRC) compared to recessions usedCAF + PRP or CAF alone 83.5% (58.3% CRC) in the control Insufficient power to24-w follow-up Trend toward lower WHI and GI scores detect a difference

in PRP group

(PRP) Platelet-rich plasma; (SCTG) subepithelial connective tissue graft; (GTR) guided tissue regeneration; (KG) keratinized gingiva; (CAF) coronallyadvanced flap; (PCG) platelet-concentrate grafts; (CRC) complete root coverage; (WHI) Wound Healing Index; (GI) Gingival Index.

Table 4 Publications evaluating the effects of PRP in root-coverage procedures




Bashutski/Wang

The authors reported “strikingly mature” soft

tissue healing at 1 week, and decreased

inflammation, excellent tissue contour and

color, and complete root coverage at 6

months. In 1 patient, there was a 1.5-mm

gain in keratinized tissue. A lack of scar for-

mation was reported, despite vertical releas-

ing incisions in both cases. Again, the major

drawback to this publication is that it is a

case report where many of the observations

were not quantified.

A randomized controlled trial compared

the use of platelet-concentrate grafts (PCGs)

with subepithelial connective tissue grafts

(SCTGs) in Miller Class I or II buccal reces-

sion defects in 15 patients.42 At 8 months,

80% root coverage (60% complete root

coverage) was achieved in the PCG group

compared to 95% (65.5% complete root cov-

erage) in the SCTG group, although this dif-

ference was not statistically significant.

Notably, the control group outperformed the

PCG group by 15%. In contrast, the PCG

group resulted in significantly shallower

probing depths (1.05 mm versus 1.79 mm).

Postsurgical discomfort levels were evaluat-

ed using a visual analog scale from 0 (no

pain) to 10 (most pain). The group treated

using PCGs had significantly less pain at 3

weeks, with a pain rating of 0.15 ± 0.34 com-

pared to 0.59 ± 0.78 in the SCTG group,

although it is questionable whether this dif-

ference is clinically significant. Finally, the

PCG group exhibited significant improve-

ments in soft tissue contour and texture com-

pared to controls. These findings were based

on the observations of 3 blinded examiners

who reviewed slides of the cases and scored

them twice using a subjective esthetic rating

of 1 (most favorable esthetics) to 4 (least

favorable esthetics).

Another study evaluated the effect of PRP

on the coronally advanced flap procedure.38

In this randomized controlled trial, 23

patients with Miller Class I buccal recession

defects were treated with either PRP plus

coronally advanced flap or coronally

advanced flap alone and followed for 24

weeks postsurgery. Mean root coverage was

81.0% (63.6% complete root coverage) in the

coronally advanced flap plus PRP group

compared to 83.5% (58.3% complete root

coverage) in the control group, which was not

significantly different. PRP-treated recession

defects resulted in lower Gingival Index73

scores, although this was not statistically sig-

nificant. A Wound Healing Index38 was devel-

oped for this study, which scored the tissue

healing on a scale from 1 (uneventful healing)

to 3 (poor wound healing). At 2 weeks, the

PRP group had lower Wound Healing Index

scores than did controls, although this also

was not statistically significant and this effect

was no longer seen at 1 month. However, the

authors suggested that this lack of signifi-

cance may be due to small sample sizes and

the fact that only Miller Class I recession

defects were studied and these respond well

to most root-coverage techniques.

CONCLUSION

Using PRP as an adjunct to root-coverage pro-

cedures is a relatively new phenomenon,

although PRP has been used to promote

wound healing and hemostasis in medical

and dental applications for many years.

Specifically, PRP has been used most com-

monly in sinus augmentation procedures,74

esthetic plastic surgery,75 and spinal surgery.76

Preliminary reports suggest that the potential

benefits of PRP in root-coverage procedures

may be improved esthetics, decreased patient

morbidity, and accelerated wound healing.

Further investigation of this technique is war-

ranted with larger sample sizes, more chal-

lenging defects, and histologic data to better

determine the value of PRP as an adjunct to

traditional root-coverage procedures. At this

point, sufficient long-term evidence and rigor-

ous clinical studies to support the use of PRP

for this purpose are lacking. Although PRP

may show promise in this area, there is insuffi-

cient evidence to support its use at this time.

ACKNOWLEDGMENT

This work was partially supported by the University of

Michigan Periodontal Graduate Student Research Fund.




Bashutski/Wang

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