ENHANCING BONE HEALING WITH AUTOGENOUS PRP AND HYALURONIC ACID: AN EXPERIMENTAL STUDY
Keywords:
Autogenous PRP, Hyaluronic Acid, Bone Healing, Oral Surgery, Osteogenesis
Abstract
Objective: The aims of this study was to unveil the accelerated bone healing potential of PRP and HA, either separately or in a mixture. By evaluating their impact on tissue response, inflammation, granulation tissue formation, and osteoid presence.
Background. This experimental study explores the dynamic interplay of Platelet-rich plasma (PRP) and Hyaluronic acid (HA) in this context. PRP, rich in growth factors, has emerged as a potential substitute for traditional bone grafts, while HA plays a crucial role in tissue morphogenesis and bone regeneration. This research investigates their combined effects and individual contributions to bone healing acceleration.
Methods: Twenty-five adult male rabbits were introduced in the study and divided the subjects into five groups (each group 5 rabbits). Surgical procedures were performed, followed by postoperative assessments at intervals (days 3, 7, 14, 21, and 28). Bone healing progression was evaluated using a histopathological and computed tomography CT scans.
Results: PRP alone demonstrated significant a cumulative effect over time, enhancing bone density. Similarly, HA exhibited noteworthy improvements at later stages. However, their combination showed significant differences compared to the control group, highlighting a potential synergistic effect on bone healing at days 14, 21, and 28.
Conclusion: The combination between PRP and HA holds promise for bone healing enhancement, potentially reshaping clinical approaches
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References
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Chen, C. H., Li, D. L., Chuang, A. D. C., Dash, B. S., & Chen, J. P. (2021). Tension stimulation of tenocytes in aligned hyaluronic acid/platelet-rich plasma-polycaprolactone core-sheath nanofiber membrane scaffold for tendon tissue engineering. International journal of molecular sciences, 22(20), 11215.
Council for International Organizations of Medical Sciences. (1985). International guiding principles for biomedical research involving animals. Altern Lab Anim., 12, ii.
Dhillon, M. S., Patel, S., & John, R. (2017). PRP in OA knee - update, current confusions and future options. SICOT-J, 3, 27. https://doi.org/10.1051/sicotj/2017004
Dimitriou, R., Jones, E., McGonagle, D., & Giannoudis, P. V. (2011). Bone regeneration: current concepts and future directions. BMC medicine, 9, 66. https://doi.org/10.1186/1741-7015-9-66
Elgendy EA, Shoukheba, MYM (2013). Histological and Histomorphometric Study of the Effect of Strontium Ranelate on the Healing of One-Wall Intrabony Periodontal Defects in Dogs. J Cytol Histol; 3(6): 1-6
Everts, P., Onishi, K., Jayaram, P., Lana, J. F., & Mautner, K. (2020). Platelet-Rich Plasma: New Performance Understandings and Therapeutic Considerations in 2020. International journal of molecular sciences, 21(20), 7794. https://doi.org/10.3390/ijms21207794
Fathi, W. K. (2012). The effect of hyaluronic acid and platelet-rich plasma on soft tissue wound healing: an experimental study on rabbits. Al-Rafidain Dental Journal, 12(1), 115-125.
Ghatak, S., Maytin, E. V., Mack, J. A., Hascall, V. C., Atanelishvili, I., Moreno Rodriguez, R., Markwald, R. R., & Misra, S. (2015). Roles of Proteoglycans and Glycosaminoglycans in Wound Healing and Fibrosis. International journal of cell biology, 2015, 834893. https://doi.org/10.1155/2015/834893
Gilat, R., Haunschild, E. D., Knapik, D. M., Evuarherhe, A., Jr, Parvaresh, K. C., & Cole, B. J. (2021). Hyaluronic acid and platelet-rich plasma for the management of knee osteoarthritis. International orthopaedics, 45(2), 345–354. https://doi.org/10.1007/s00264-020-04801-9
Gupta, R. C., Lall, R., Srivastava, A., & Sinha, A. (2019). Hyaluronic Acid: Molecular Mechanisms and Therapeutic Trajectory. Frontiers in veterinary science, 6, 192. https://doi.org/10.3389/fvets.2019.00192
Holmes MW, Bayliss MT, Muir H. Hyaluronic acid in human articular cartilage. Age-related changes in content and size. Biochem J. 1988 Mar 1;250(2):435-41. doi: 10.1042/bj2500435. PMID: 3355532; PMCID: PMC1148875.
Kim SY, Kim SG, Lim SC, Bae CS (2004). Effects on bone formation in ovariectomized rats after implantation of tooth ash and plaster of Paris mixture. J Oral Maxillofac Surg; 62: 852–5
Knox, R. L., Hunt, A. R., Collins, J. C., DeSmet, M., & Barnes, S. (2006). Platelet-rich plasma combined with skin substitute for chronic wound healing: a case report. The journal of extra-corporeal technology, 38(3), 260–264.
Litwiniuk, M., Krejner, A., Speyrer, M. S., Gauto, A. R., & Grzela, T. (2016). Hyaluronic acid in inflammation and tissue regeneration. Wounds, 28(3), 78-88.
Maeda, ST, Bramane CM, Taga R, Garcia RB, de Moraes IG, Bernadineli N (2007). Evaluation of surgical cavities filled with three types of calcium sulfate. J Appl Oral Sci; 15(5): 416-419.
Marques, L. F., Stessuk, T., Camargo, I. C. C., Sabeh Junior, N., Santos, L. D., & Ribeiro-Paes, J. T. (2015). Platelet-rich plasma (PRP): methodological aspects and clinical applications. Platelets, 26(2),
Maruyama, M., Rhee, C., Utsunomiya, T., Zhang, N., Ueno, M., Yao, Z., & Goodman, S. B. (2020). Modulation of the Inflammatory Response and Bone Healing. Frontiers in endocrinology, 11, 386. https://doi.org/10.3389/fendo.2020.00386
Marx R. E. (2001). Platelet-rich plasma (PRP): what is PRP and what is not PRP?. Implant dentistry, 10(4), 225–228. https://doi.org/10.1097/00008505-200110000-00002
Moshiri, A., & Oryan, A. (2013). Role of platelet rich plasma in soft and hard connective tissue healing: an evidence based review from basic to clinical application. Hard Tissue, 2(1), 6.
Nikolidakis D., Jansen J.A.. The biology of platelet-rich plasma and its application in oral surgery: literature review. Tissue Eng. Part B Rev. 2008;14:249–258
Park, H., Jin, Y., Shin, J., Yang, K., Lee, C., Yang, H., … & Cho, S. (2016). Catechol-functionalized Hyaluronic Acid Hydrogels Enhance Angiogenesis and Osteogenesis Of Human Adipose-derived Stem Cells In Critical Tissue Defects. Biomacromolecules, 6(17), 1939-1948. https://doi.org/10.1021/acs.biomac.5b01670
Pazzini JM, Nardi ABD, Huppes RR, Gering AP, Ferreira MG, Silveira CP & Santos R (2016). Method to obtain platelet-rich plasma from rabbits (Oryctolagus cuniculus). Pesquisa Veterinária Brasileira 36, 39-44
Plachokova, A., Dolder, J., Stoelinga, P., Jansen, J. (2006). The Bone Regenerative Effect Of Platelet-rich Plasma In Combination With An Osteoconductive Material In Rat Cranial Defects. Clin Oral Implants Res, 3(17), 305-311. https://doi.org/10.1111/j.1600-0501.2005.01208.x
Sanchez A.R., Sheridan P.J., Kupp L.I.. Is platelet-rich plasma the perfect enhancement factor? A current review. Int. J. Oral Maxillofac. Implants. 2003;18:93–103
Schlundt, C., Schell, H., Goodman, S., Vunjak-Novakovic, G., Duda, G., Schmidt-Bleek, K. (2015). Immune Modulation As a Therapeutic Strategy In Bone Regeneration. J EXP ORTOP, 1(2). https://doi.org/10.1186/s40634-014-0017-6
Singh, R., Rohilla, R., Gawande, J., & Kumar Sehgal, P. (2017). To evaluate the role of platelet-rich plasma in healing of acute diaphyseal fractures of the femur. Chinese journal of traumatology = Zhonghua chuang shang za zhi, 20(1), 39–44. https://doi.org/10.1016/j.cjtee.2016.03.007
Van Lieshout, E., & Den Hartog, D. (2021). Effect of platelet-rich plasma on fracture healing. Injury, 52 Suppl 2, S58–S66. https://doi.org/10.1016/j.injury.2020.12.005
Verma, R., Negi, G., Kandwal, A., Chandra, H., Gaur, D. S., & Harsh, M. (2019). Effect of autologous PRP on wound healing in dental regenerative surgeries and its correlation with PDGF levels. Asian journal of transfusion science, 13(1), 47–53. https://doi.org/10.4103/ajts.AJTS_25_17
Yang LC, Hu SW, Yan M, Yang JJ, Tsou SH, Lin YY. Antimicrobial activity of platelet-rich plasma and other plasma preparations against periodontal pathogens. J Periodontol 2015;86:310–318.
Yu, W., Xu, P., Huang, G., & Liu, L. (2018). Clinical therapy of hyaluronic acid combined with platelet rich plasma for the treatment of knee osteoarthritis. Experimental and therapeutic medicine, 16(3), 2119-2125.
Zhai, P., Peng, X., Li, B., Liu, Y., Sun, H., & Li, X. (2020). The application of hyaluronic acid in bone regeneration. International journal of biological macromolecules, 151, 1224–1239. https://doi.org/10.1016/j.ijbiomac.2019.10.169
Zhai, P., Peng, X., Li, B., Liu, Y., Sun, H., & Li, X. (2020). The application of hyaluronic acid in bone regeneration. International journal of biological macromolecules, 151, 1224–1239. https://doi.org/10.1016/j.ijbiomac.2019.10.169
Zhang, X. L., Wang, Y. M., Chu, K., Wang, Z. H., Liu, Y. H., Jiang, L. H., ... & Yin, G. (2018). The application of PRP combined with TCP in repairing avascular necrosis of the femoral head after femoral neck fracture in rabbit. Eur Rev Vet Med Pharm Sci, 22, 903-90
Anitua, E., Sánchez, M., & Orive, G. (2011). The importance of understanding what is platelet-rich growth factor (PRGF) and what is not. Journal of shoulder and elbow surgery, 20(1), e23–e24. https://doi.org/10.1016/j.jse.2010.07.005
Aslan M, Simsek G & Dayi E (2006). The effect of hyaluronic acid-supplemented bone graft in bone healing: experimental study in rabbits. Journal of biomaterials applications. 20(3), 209–220. https://doi.org/10.1177/0885328206051047
Casale, M., Moffa, A., Vella, P., Sabatino, L., Capuano, F., Salvinelli, B., Lopez, M. A., Carinci, F., & Salvinelli, F. (2016). Hyaluronic acid: Perspectives in dentistry. A systematic review. International journal of immunopathology and pharmacology, 29(4), 572–582. https://doi.org/10.1177/0394632016652906
Chen, C. H., Li, D. L., Chuang, A. D. C., Dash, B. S., & Chen, J. P. (2021). Tension stimulation of tenocytes in aligned hyaluronic acid/platelet-rich plasma-polycaprolactone core-sheath nanofiber membrane scaffold for tendon tissue engineering. International journal of molecular sciences, 22(20), 11215.
Council for International Organizations of Medical Sciences. (1985). International guiding principles for biomedical research involving animals. Altern Lab Anim., 12, ii.
Dhillon, M. S., Patel, S., & John, R. (2017). PRP in OA knee - update, current confusions and future options. SICOT-J, 3, 27. https://doi.org/10.1051/sicotj/2017004
Dimitriou, R., Jones, E., McGonagle, D., & Giannoudis, P. V. (2011). Bone regeneration: current concepts and future directions. BMC medicine, 9, 66. https://doi.org/10.1186/1741-7015-9-66
Elgendy EA, Shoukheba, MYM (2013). Histological and Histomorphometric Study of the Effect of Strontium Ranelate on the Healing of One-Wall Intrabony Periodontal Defects in Dogs. J Cytol Histol; 3(6): 1-6
Everts, P., Onishi, K., Jayaram, P., Lana, J. F., & Mautner, K. (2020). Platelet-Rich Plasma: New Performance Understandings and Therapeutic Considerations in 2020. International journal of molecular sciences, 21(20), 7794. https://doi.org/10.3390/ijms21207794
Fathi, W. K. (2012). The effect of hyaluronic acid and platelet-rich plasma on soft tissue wound healing: an experimental study on rabbits. Al-Rafidain Dental Journal, 12(1), 115-125.
Ghatak, S., Maytin, E. V., Mack, J. A., Hascall, V. C., Atanelishvili, I., Moreno Rodriguez, R., Markwald, R. R., & Misra, S. (2015). Roles of Proteoglycans and Glycosaminoglycans in Wound Healing and Fibrosis. International journal of cell biology, 2015, 834893. https://doi.org/10.1155/2015/834893
Gilat, R., Haunschild, E. D., Knapik, D. M., Evuarherhe, A., Jr, Parvaresh, K. C., & Cole, B. J. (2021). Hyaluronic acid and platelet-rich plasma for the management of knee osteoarthritis. International orthopaedics, 45(2), 345–354. https://doi.org/10.1007/s00264-020-04801-9
Gupta, R. C., Lall, R., Srivastava, A., & Sinha, A. (2019). Hyaluronic Acid: Molecular Mechanisms and Therapeutic Trajectory. Frontiers in veterinary science, 6, 192. https://doi.org/10.3389/fvets.2019.00192
Holmes MW, Bayliss MT, Muir H. Hyaluronic acid in human articular cartilage. Age-related changes in content and size. Biochem J. 1988 Mar 1;250(2):435-41. doi: 10.1042/bj2500435. PMID: 3355532; PMCID: PMC1148875.
Kim SY, Kim SG, Lim SC, Bae CS (2004). Effects on bone formation in ovariectomized rats after implantation of tooth ash and plaster of Paris mixture. J Oral Maxillofac Surg; 62: 852–5
Knox, R. L., Hunt, A. R., Collins, J. C., DeSmet, M., & Barnes, S. (2006). Platelet-rich plasma combined with skin substitute for chronic wound healing: a case report. The journal of extra-corporeal technology, 38(3), 260–264.
Litwiniuk, M., Krejner, A., Speyrer, M. S., Gauto, A. R., & Grzela, T. (2016). Hyaluronic acid in inflammation and tissue regeneration. Wounds, 28(3), 78-88.
Maeda, ST, Bramane CM, Taga R, Garcia RB, de Moraes IG, Bernadineli N (2007). Evaluation of surgical cavities filled with three types of calcium sulfate. J Appl Oral Sci; 15(5): 416-419.
Marques, L. F., Stessuk, T., Camargo, I. C. C., Sabeh Junior, N., Santos, L. D., & Ribeiro-Paes, J. T. (2015). Platelet-rich plasma (PRP): methodological aspects and clinical applications. Platelets, 26(2),
Maruyama, M., Rhee, C., Utsunomiya, T., Zhang, N., Ueno, M., Yao, Z., & Goodman, S. B. (2020). Modulation of the Inflammatory Response and Bone Healing. Frontiers in endocrinology, 11, 386. https://doi.org/10.3389/fendo.2020.00386
Marx R. E. (2001). Platelet-rich plasma (PRP): what is PRP and what is not PRP?. Implant dentistry, 10(4), 225–228. https://doi.org/10.1097/00008505-200110000-00002
Moshiri, A., & Oryan, A. (2013). Role of platelet rich plasma in soft and hard connective tissue healing: an evidence based review from basic to clinical application. Hard Tissue, 2(1), 6.
Nikolidakis D., Jansen J.A.. The biology of platelet-rich plasma and its application in oral surgery: literature review. Tissue Eng. Part B Rev. 2008;14:249–258
Park, H., Jin, Y., Shin, J., Yang, K., Lee, C., Yang, H., … & Cho, S. (2016). Catechol-functionalized Hyaluronic Acid Hydrogels Enhance Angiogenesis and Osteogenesis Of Human Adipose-derived Stem Cells In Critical Tissue Defects. Biomacromolecules, 6(17), 1939-1948. https://doi.org/10.1021/acs.biomac.5b01670
Pazzini JM, Nardi ABD, Huppes RR, Gering AP, Ferreira MG, Silveira CP & Santos R (2016). Method to obtain platelet-rich plasma from rabbits (Oryctolagus cuniculus). Pesquisa Veterinária Brasileira 36, 39-44
Plachokova, A., Dolder, J., Stoelinga, P., Jansen, J. (2006). The Bone Regenerative Effect Of Platelet-rich Plasma In Combination With An Osteoconductive Material In Rat Cranial Defects. Clin Oral Implants Res, 3(17), 305-311. https://doi.org/10.1111/j.1600-0501.2005.01208.x
Sanchez A.R., Sheridan P.J., Kupp L.I.. Is platelet-rich plasma the perfect enhancement factor? A current review. Int. J. Oral Maxillofac. Implants. 2003;18:93–103
Schlundt, C., Schell, H., Goodman, S., Vunjak-Novakovic, G., Duda, G., Schmidt-Bleek, K. (2015). Immune Modulation As a Therapeutic Strategy In Bone Regeneration. J EXP ORTOP, 1(2). https://doi.org/10.1186/s40634-014-0017-6
Singh, R., Rohilla, R., Gawande, J., & Kumar Sehgal, P. (2017). To evaluate the role of platelet-rich plasma in healing of acute diaphyseal fractures of the femur. Chinese journal of traumatology = Zhonghua chuang shang za zhi, 20(1), 39–44. https://doi.org/10.1016/j.cjtee.2016.03.007
Van Lieshout, E., & Den Hartog, D. (2021). Effect of platelet-rich plasma on fracture healing. Injury, 52 Suppl 2, S58–S66. https://doi.org/10.1016/j.injury.2020.12.005
Verma, R., Negi, G., Kandwal, A., Chandra, H., Gaur, D. S., & Harsh, M. (2019). Effect of autologous PRP on wound healing in dental regenerative surgeries and its correlation with PDGF levels. Asian journal of transfusion science, 13(1), 47–53. https://doi.org/10.4103/ajts.AJTS_25_17
Yang LC, Hu SW, Yan M, Yang JJ, Tsou SH, Lin YY. Antimicrobial activity of platelet-rich plasma and other plasma preparations against periodontal pathogens. J Periodontol 2015;86:310–318.
Yu, W., Xu, P., Huang, G., & Liu, L. (2018). Clinical therapy of hyaluronic acid combined with platelet rich plasma for the treatment of knee osteoarthritis. Experimental and therapeutic medicine, 16(3), 2119-2125.
Zhai, P., Peng, X., Li, B., Liu, Y., Sun, H., & Li, X. (2020). The application of hyaluronic acid in bone regeneration. International journal of biological macromolecules, 151, 1224–1239. https://doi.org/10.1016/j.ijbiomac.2019.10.169
Zhai, P., Peng, X., Li, B., Liu, Y., Sun, H., & Li, X. (2020). The application of hyaluronic acid in bone regeneration. International journal of biological macromolecules, 151, 1224–1239. https://doi.org/10.1016/j.ijbiomac.2019.10.169
Zhang, X. L., Wang, Y. M., Chu, K., Wang, Z. H., Liu, Y. H., Jiang, L. H., ... & Yin, G. (2018). The application of PRP combined with TCP in repairing avascular necrosis of the femoral head after femoral neck fracture in rabbit. Eur Rev Vet Med Pharm Sci, 22, 903-90
Published
2023-10-09
How to Cite
MAHMOOD, F. H., & KASKOS, H. H. (2023). ENHANCING BONE HEALING WITH AUTOGENOUS PRP AND HYALURONIC ACID: AN EXPERIMENTAL STUDY. Journal of Duhok University, 26(2), 266-276. https://doi.org/10.26682/sjuod.2023.26.2.23
Section
Pure and Engineering Sciences
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