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DOI: 10.7759/cureus.69498
Effects of Platelet-Rich Plasma Injections on
Periodontal Health During Accelerated
Orthodontic Tooth Movement
May Akel , Basima Yosef , Fadi Khalil 
1. Department of Orthodontics, Faculty of Dentistry, Tishreen University, Latakia, SYR 2. Department of
Histopathology, Faculty of Dentistry, Tishreen University, Latakia, SYR
Corresponding author: May Akel, drmayakel@gmail.com
Abstract
Background: The interplay between orthodontics and periodontics is crucial for successful orthodontic
treatment. Accelerating orthodontic tooth movement (OTM) can enhance treatment efficiency, but it is
important to assess the impact of such methods on periodontal health. Platelet-rich plasma (PRP) has
emerged as a promising adjunct in accelerating OTM, but its effects on periodontal health require further
investigation.
Objective: This study aimed to evaluate the impact of PRP injections on periodontal health during
accelerated OTM by comparing clinical and biochemical parameters between a PRP-enhanced orthodontic
treatment group and a conventional orthodontic treatment group.
Methods: In this randomized controlled trial, 40 participants with anterior teeth crowding were divided into
two groups: the PRP group (n = 20), which received standard orthodontic treatment with PRP injections, and
the control group (n = 20), which received standard orthodontic treatment alone. Periodontal parameters,
including periodontal probing depth (PPD), clinical attachment level (CAL), bleeding on probing (BOP), and
gingival recession (GR), were recorded at baseline, four, eight, and 12 weeks. Salivary aspartate
aminotransferase (AST) levels were measured at baseline, one hour, 24 hours, seven days, and 14 days post
treatment.
Results: No statistically significant differences were found between the PRP and control groups regarding
periodontal parameters (PPD, CAL, BOP, and GR) and AST enzyme levels throughout the study period. Both
groups exhibited slight increases in PPD, CAL, GR, and BOP over time, consistent with typical orthodontic
effects. AST levels showed fluctuations but no significant differences between the groups.
Conclusion: PRP injections did not demonstrate significant advantages over conventional orthodontic
treatment in terms of periodontal health or AST enzyme levels. This suggests that PRP is a safe and non-
inferior method for accelerating OTM without adversely affecting periodontal tissues. Further research with
larger sample sizes and longer follow-ups is recommended to validate these findings and explore the long-
term effects of PRP.
Categories: Dentistry
Keywords: platelet-rich plasma (prp), aspartate aminotransferase (ast), accelerated orthodontics, tooth movement,
acceleration
Introduction
The interrelationship between periodontics and orthodontics has been extensively studied over the years.
Orthodontic treatment can enhance oral hygiene by correcting dental irregularities and reducing or
eliminating occlusal trauma. However, the placement of orthodontic appliances often leads to changes in
oral hygiene habits and affects periodontal health [1]. Orthodontic forces trigger an acute inflammatory
response, which reduces blood flow within the periodontal ligament and results in the release of
inflammatory mediators. These mediators activate osteoclasts and osteoblasts: osteoclasts are responsible
for bone resorption, while osteoblasts facilitate new bone formation. The activity of these cells can be
monitored through biological indicators present in gingival crevicular fluid [2].
In modern orthodontics, there is a notable shift toward accelerating orthodontic tooth movement (OTM) to
shorten treatment duration and mitigate the adverse effects associated with prolonged therapy [3]. Various
methods for accelerated OTM have been proposed, including both surgical and non-surgical techniques.
Surgical approaches include periodontally assisted accelerated orthodontics [4], corticotomy [5], piezocision,
dentoalveolar distraction, corticision, and discision [6]. Non-surgical methods encompass micro-
osteoperforations, micropulse, cyclic forces, resonance vibration, pulsed magnetic field forces, low-intensity
laser therapy (LILT) [7], low-level light therapy (LLLT), low-level pulsed ultrasound, gene therapy, and the
1 2 1
 Open Access Original Article
How to cite this article
Akel M, Yosef B, Khalil F (September 16, 2024) Effects of Platelet-Rich Plasma Injections on Periodontal Health During Accelerated Orthodontic
Tooth Movement. Cureus 16(9): e69498. DOI 10.7759/cureus.69498
https://www.cureus.com/users/862468-may-akel
https://www.cureus.com/users/762521-basima-yosef
https://www.cureus.com/users/762517-fadi-khalil
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systemic and local administration of chemical agents [8]. Among the most promising local agents for
accelerating OTM is platelet-rich plasma (PRP) [9]. PRP is an autologous plasma preparation enriched with a
higher concentration of platelets compared to whole blood. Recent studies have highlighted the positive
effects of PRP on accelerating OTM, with local injections around treated teeth resulting in faster tooth
movement in animal models [10,11]
Numerous studies have examined the impact of orthodontic treatment on periodontal health. Fixed
orthodontic appliances are often associated with gingival inflammation, primarily due to difficulties in
maintaining oral hygiene and increased bacterial plaque accumulation [12-14]. Although some studies
report a higher incidence of periodontal attachment loss in patients undergoing fixed orthodontic treatment
compared to controls [15,16], most longitudinal studies indicate that gingival changes induced by
orthodontic appliances are transient and do not cause permanent damage to periodontal structure [12-14].
Aspartate aminotransferase (AST) is a biological marker of tooth movement, released into the gingival
crevicular fluid (GCF). AST, an enzyme predominantly found in the liver and heart, is typically located in the
cytoplasm and is released during cellular apoptosis. Trauma to periodontal tissue stimulates AST release
into the GCF. AST activity has been used as an indicator for bone remodeling and periodontal disease
progression [17,18]. Previous research has shown increased AST activity in the GCF of patients with
periodontal disease and elevated AST levels in saliva [19]. Several orthodontic studies have also confirmed
increased AST activity in the GCF due to orthodontic forces [20,21].
The aim of this study is to evaluate the impact of utilizing PRP injections for accelerating OTM on
periodontal health using clinical and immunological parameters.
Materials And Methods
Study design and sample size calculation
This randomized controlled clinical trial was conducted at the Department of Orthodontics, Faculty of
Dentistry, University of Tishreen, from January 2022 to August 2023, following the Consolidated Standards
of Reporting Trials (CONSORT) reporting guidelines. Ethical approval was obtained from the Scientific
Research Council of Tishreen University (approval number: 2608), and informed consent was secured from
all participants. This study was registered at the International Standard Randomised Controlled Trial
Number registry under the number ISRCTN18306557.
The sample size was calculated using G*Power software (version 3.1.9.7; Heinrich Heine University
Düsseldorf, Düsseldorf, Germany). Based on an effect size of 1.118, indicating a clinically significant 10%
expected difference in tooth movement between groups, and the highest reported standarddeviation of 0.54
[10], a sample size of 28 patients (14 per group) was determined to achieve a type I error rate of 5% and a
power of 80%. To account for a potential 20% dropout rate, 40 patients were recruited (20 per group).
Inclusion and exclusion criteria
Eligible participants were individuals aged 16 to 25 years with anterior teeth crowding ranging from 3 to 6
mm, maintaining excellent oral hygiene evident by low plaque index and periodontal health, and without
prior orthodontic treatment history. Exclusion criteria included systemic medical conditions, dental
anomalies in tooth size or shape, and current use of anti-inflammatory medications.
Patients’ recruitment, randomization, allocation, and blinding
Out of 57 assessed patients, 40 met the inclusion criteria and were randomized into two equal groups. The
first group received orthodontic therapy with PRP injections, while the second group received standard
orthodontic treatment without supplementary interventions. Randomization was achieved using sealed
envelopes containing the allocation sequence, ensuring that treatment assignments remained concealed
from both researchers and participants until the designated phase of the study. The randomization sequence
was generated by an independent academic specialist. Due to the nature of the interventions, blinding was
not feasible for practitioners or patients; therefore, blinding was limited to outcome assessors only.
Study methods
Comprehensive pre-treatment records were collected, and orthodontic treatment began with the application
of 0.022-inch brackets using the McLaughlin, Bennett, and Trevisi (MBT) technique (IOS, Boston, USA).
Treatment continued until a 0.017 x 0.025-inch stainless steel archwire was in place.
In the PRP group, PRP was prepared using the double-spin method as described by Marx and Garg and
Rashid et al. [10]. Buccal infiltration anesthesia was administered with 2% lidocaine hydrochloride
containing 1:80,000 epinephrine (Kwang Myung Pharm, Seoul, Korea). A 0.5 ml aliquot of PRP was injected
at four sites near the mesial and distal root surfaces of the lateral incisor on the buccal side (Figures 1, 2). The
PRP was introduced submucosally, similar to the technique used for local anesthesia. Each patient received a
 
2024 Akel et al. Cureus 16(9): e69498. DOI 10.7759/cureus.69498 2 of 9
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total of 2 ml of PRP, with 0.5 ml injected through the attached gingiva. PRP injections were administered at
zero, seven, and 14 days.
FIGURE 1: Platelet-rich plasma (PRP) preparation using the double-spin
method.
(A) Blood centrifuged after the first spin. (B) PRP formed after the second spin. (C) PRP ready to be used.
 
2024 Akel et al. Cureus 16(9): e69498. DOI 10.7759/cureus.69498 3 of 9
https://assets.cureus.com/uploads/figure/file/1183373/lightbox_3efae830621911ef8a55ad4e0336b97a-Untitled-1.png
FIGURE 2: Injection of platelet-rich plasma on the buccal side.
The control group received only the standard orthodontic treatment described earlier, without additional
interventions. This group served as a baseline to compare the effectiveness of PRP in accelerating OTM.
Saliva samples were collected from all participants at baseline (before treatment), one hour after the start of
treatment, one week after, and two weeks after treatment. Samples were stored at -80°C until analysis.
Salivary AST activity was measured using a spectrophotometer. Reagent 1 included 1000 µL of Tris buffer
(pH 7.65, 80 mmol/L), L-aspartate (240 mmol/L), malate dehydrogenase (MDH) (≥600 U/L), and lactate
dehydrogenase (LDH) (≥900 U/L), incubated at 37°C for one minute. Reagent 2, containing 2-oxoglutarate
and nicotinamide adenine dinucleotide (NAD) + hydrogen (NADH), was also incubated at 37°C for one
minute. A 100 µL sample was then added for activity measurement. Periodontal health parameters, including
periodontal probing depth (PPD), clinical attachment level (CAL), bleeding on probing (BOP), and gingival
recession (GR), were recorded at baseline, four weeks, eight weeks, and 12 weeks.
Statistical analysis
Continuous measurements were reported as means and standard deviations and compared using two-
sample t-tests and one-way ANOVA. Categorical variables were presented as percentages and compared
using chi-square tests. Data normality was assessed with the Shapiro-Wilk test. A significance level of P 0.05). Baseline values are summarized in Table 2.
Variables
Mean (SD)
P-value
Control group (n = 20) PRP group (n = 20)
PPD (mm) 2.53 (0.95) 2.87 (1.03) 0.291
CAL (mm) 2.79 (0.36) 3.07 (0.60) 0.317
BOP (%) 46.9 (0.46) 49.3 (0.44) 0.437
GR (mm) 0.66 (0.23) 0.87 (0.31) 0.051
AST (IU/L) 38.87 (25.20) 22.91 (21.78) 0.060
TABLE 2: Periodontal parameters and level of AST enzyme at baseline.
AST: aspartate aminotransferase; BOP: bleeding on probing; CAL: clinical attachment level; GR: gingival recession; PPD: periodontal probing depth; PRP:
platelet-rich plasma; SD: standard deviation.
Changes in periodontal parameter measurements and AST enzyme
levels
Both groups exhibited slight increases in PPD, CAL, and GR, and higher BOP percentages at four, eight, and
12 weeks compared to baseline. However, there were no statistically significant changes within or between
the groups over time (P > 0.05). Detailed measurements of periodontal parameters during follow-up are
presented in Table 3.
 
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Variables
After 4 weeks After 8 weeks After 12 weeks
P-value
Control PRP Control PRP Control PRP
PPD (mm) 2.61 (0.98) 2.91 (0.98) 2.72 (0.91) 2.96 (0.93) 2.86 (0.87) 3.07 (0.90) 0.936
CAL (mm) 2.83 (0.67) 3.11 (0.83) 2.91 (0.62) 3.19 (0.76) 3.03 (0.58) 3.24 (0.72) 0.322
BOP (%) 49.7 (0.51) 51.1 (0.56) 51.9 (0.48) 52.6 (0.52) 53.1 (0.42) 53.9 (0.47) 0.536GR (mm) 0.83 (0.31) 0.92 (0.39) 0.94 (0.27) 1.03 (0.32) 1.07 (0.24) 1.13 (0.28) 0.200
Variables
After 4 weeks After 8 weeks After 12 weeks
P-value
Control PRP Control PRP Control PRP
PPD (mm) 2.61 (0.98) 2.91 (0.98) 2.72 (0.91) 2.96 (0.93) 2.86 (0.87) 3.07 (0.90) 0.936
CAL (mm) 2.83 (0.67) 3.11 (0.83) 2.91 (0.62) 3.19 (0.76) 3.03 (0.58) 3.24 (0.72) 0.322
BOP (%) 49.7 (0.51) 51.1 (0.56) 51.9 (0.48) 52.6 (0.52) 53.1 (0.42) 53.9 (0.47) 0.536
GR (mm) 0.83 (0.31) 0.92 (0.39) 0.94 (0.27) 1.03 (0.32) 1.07 (0.24) 1.13 (0.28) 0.200
TABLE 3: Mean (standard deviation) of periodontal parameters at different follow-up periods.
BOP: bleeding on probing; CAL: clinical attachment level; GR: gingival recession; PPD: periodontal probing depth; PRP: platelet-rich plasma.
AST enzyme levels in the control group increased after one hour, peaked at seven days, and then decreased
by 14 days, with no statistically significant differences observed between the time points (P > 0.05). In the
PRP group, AST levels initially increased after one hour, decreased at 24 hours, increased again at seven
days, and decreased by 14 days, with the highest level recorded after one hour. One-way ANOVA indicated
no significant differences between the groups or across time points (P > 0.05). Changes in AST enzyme levels
during follow-up are summarized in Table 4.
Follow-up period
Mean (SD)
P-value
Control PRP
After an hour 40.22 (38.07) 36.60 (40.81) 0.280
After 24 hours 47.00 (30.91) 27.47 (20.76) 0.119
After 7 days 56.77 (38.67) 36.14 (30.38) 0.161
After 14 days 31.00 (25.43) 29.95 (32.75) 0.161
TABLE 4: Mean values of AST enzyme level at different follow-up periods.
AST: aspartate aminotransferase; PRP: platelet-rich plasma; SD: standard deviation.
Discussion
Orthodontics stands out among dental specialties for its unique use of the inflammatory response to address
both functional and aesthetic concerns. Recently, there has been a growing interest in methods to accelerate
OTM. This interest is largely driven by patients’ desire for shorter treatment durations with orthodontic
appliances [22]. Accelerated tooth movement techniques aim to reduce the overall time required for
treatment, thereby enhancing patient satisfaction and compliance. These methods include both surgical and
non-surgical approaches, each designed to expedite the remodeling of bone and the movement of teeth,
ultimately achieving the desired dental alignment more efficiently [6].
Accelerated OTM has garnered significant attention due to its potential to reduce treatment duration, which
is particularly advantageous for adult patients who experience slower tissue metabolism and are at higher
risk for complications such as gingival inflammation and root resorption during prolonged treatment periods
[23]. Various methods, including surgical techniques like corticotomy and piezocision, have been shown to
 
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effectively enhance OTM by activating local acceleratory phenomena, although these methods can be
invasive [24]. However, the relationship between OTM and periodontal health remains complex.
Orthodontic forces can induce inflammatory responses in the periodontium, which are necessary for tooth
movement but may compromise oral hygiene and lead to increased bacterial formation, potentially
exacerbating periodontal issues [25]. Therefore, while accelerated OTM can shorten treatment time and
improve patient outcomes, careful management of periodontal health is essential to mitigate risks
associated with orthodontic appliances [26].
The aim of this study was to evaluate the effects of PRP injections, a method of accelerating OTM, on the
health of periodontal tissues. This method is less invasive and offers a gentler approach to accelerating
tooth movement compared to surgical methods. Our results showed no statistically significant differences
between the control group (conventional orthodontic treatment) and the PRP group in terms of PPD, CAL,
BOP, and GR throughout the follow-up period. Both groups exhibited a slight increase in PPD, CAL, GR, and
the percentage of BOP after four, eight, and 12 weeks compared to baseline. This is a normal outcome, as
orthodontic treatment naturally induces gingivitis due to alterations in oral hygiene habits and periodontal
health associated with the placement of orthodontic appliances.
On the other hand, AST enzyme levels increased after one hour, 24 hours, and seven days in the control
group, with the highest value observed after seven days. However, 14 days later, the AST level decreased in
the control group, with no statistically significant differences between the studied periods. Furthermore,
there were no statistically significant differences between the two groups. This signifies the inflammatory
process that normally occurs during orthodontic treatment. Our results indicate that there was no difference
in AST enzyme levels between the two groups, asserting the safety of the PRP injection technique for
accelerating OTM on periodontal tissues.
Our findings align with previous research that reported a significant increase in AST levels in GCF at both
compression and tension sites on days seven and 14. This increase is likely due to controlled trauma, which
induces cell death as a result of mechanical forces applied to the periodontal ligament (PDL) and alveolar
bone [20]. Additionally, our study is comparable to another investigation that evaluated AST levels in GCF
during canine distalization, where a similar increase was observed at the compression site [27]. The rise in
AST levels indicates the application of orthodontic force on teeth and is directly associated with the
compression site during OTM.
This study has a few limitations that should be considered. Firstly, the sample size was relatively small,
which may affect the generalizability of the results. Additionally, the follow-up period was relatively short,
so the long-term effects of PRP injections on periodontal health were not assessed. The study also focused
on specific clinical parameters, and other potential indicators of periodontal health were not evaluated.
Moreover, due to the nature of the interventions, it was not possible to blind patients, which may have
introduced some bias. Future research with larger sample sizes, longer follow-up periods, and a broader
range of clinical parameters would be beneficial to further validate and expand upon these findings.
Conclusions
This study aimed to evaluate the effects of PRP injections on the health of periodontal tissues during
accelerated OTM. Our findings indicate that there were no statistically significant differences between the
control group (conventional orthodontic treatment) and the PRP group in terms of periodontal health
parameters. Additionally, the AST enzyme levels did not show statistically significant differences between
the two groups. Indicating that the PRP injection technique for accelerating OTM is safe for periodontal
tissues.
Overall, our study supports the use of PRP injections as a less invasive and effective method for accelerating
OTM without compromising periodontal health. Further research with larger sample sizes and longer
follow-up periods is recommended to validate these findings and explore the long-term effects of PRP on
periodontal tissues.
Additional Information
Author Contributions
All authors have reviewed the final version to be published and agreed to be accountable for all aspects of the
work.
Concept and design: May Akel, Basima Yosef, Fadi Khalil
Acquisition, analysis, or interpretation of data: May Akel, Basima Yosef, Fadi Khalil
Drafting of the manuscript: May Akel, Basima Yosef, Fadi Khalil
Critical review of the manuscript for important intellectual content: May Akel, Basima Yosef, Fadi
 
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Khalil
Supervision: Basima Yosef, Fadi Khalil
Disclosures
Human subjects: Consent was obtained or waived by all participants in this study. Ethics Committee of
Tishreen University issued approval 2608. The Ethics Committee has thoroughly reviewed the study protocol
and confirms that it meets the ethical standards required for conducting research involving human
participants. The committee has also ensured that appropriate measures are in place to safeguard the rights
and well-being of the study participants. Animal subjects: All authors have confirmed that this study did
not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform
disclosure form, all authors declare the following: Payment/services info: All authors have declared that no
financial support was received from any organization for the submitted work. Financial relationships: All
authors have declared that they have no financial relationships at present or within the previous three years
with any organizations that might have an interest in the submitted work. Other relationships: All authors
have declared that there are no other relationships or activities that could appear to have influenced the
submitted work.
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https://openurl.ebsco.com/EPDB%3Agcd%3A2%3A10455570/detailv2?sid=ebsco%3Aplink%3Ascholar&id=ebsco%3Agcd%3A91525866&crl=c
	Effects of Platelet-Rich Plasma Injections on Periodontal Health During Accelerated Orthodontic Tooth Movement
	Abstract
	Introduction
	Materials And Methods
	Study design and sample size calculation
	Inclusion and exclusion criteria
	Patients’ recruitment, randomization, allocation, and blinding
	Study methods
	FIGURE 1: Platelet-rich plasma (PRP) preparation using the double-spin method.
	FIGURE 2: Injection of platelet-rich plasma on the buccal side.
	Statistical analysis
	Results
	Demographic data
	TABLE 1: Demographic characteristics of the included participants in each group.
	Periodontal parameters and level of AST enzyme at baseline
	TABLE 2: Periodontal parameters and level of AST enzyme at baseline.
	Changes in periodontal parameter measurements and AST enzyme levels
	TABLE 3: Mean (standard deviation) of periodontal parameters at different follow-up periods.
	TABLE 4: Mean values of AST enzyme level at different follow-up periods.
	Discussion
	Conclusions
	Additional Information
	Author Contributions
	Disclosures
	References