CONSENT FOR PLATELET RICH PLASMA GEL (PRP)
Cosmetic Dentist of Katy
PRP is a product derived from your own blood. A small amount of your blood (usually 30 to 60cc) is drawn into a donor bag or syringe. This is a relatively small amount of blood. When you donate blood, you give 500cc to the blood bank. It is separated into its components; red blood cells (RBC’s), platelet rich plasma and plasma using a centrifuge. The platelet rich plasma is then separated. If required and deemed necessary by physician, the PRP is then activated with small amount of thrombin and calcium that releases growth factors from the platelets that amplifies the healing process.
PRP has been shown to contain at least five growth factors. The most important activities of these factors are to increase the healing cell population at the surgical site, stimulate blood vessel growth and promote hemostasis into the surgical site, increase the rate of wound healing and bone repair. The concentration of platelets in the PRP is responsible for the release of these growth factors resulting in a significant enhancement of wound healing and bone repair. Finally, it has been shown that PRP facilitate osseointegration of the implant to the surrounding bone in implant therapy.
Since PRP is from your own body, there is no risk of disease transmission or blood incompatibility. However, there are some possible risks associated with the use of PRP that you should know:
1. PRP is activated with bovine (cow) thrombin. A very small percentage of people may develop an antibody to bovine thrombin that can degrade their own thrombin. This could cause excessive bleeding.
It is often necessary to use a second IV to obtain the PRP. This will be a larger bore IV and may cause some bruising and minor local discomfort.
2. Although all care is taken to obtain PRP in a sterile manner. There is at least a theoretical risk of contamination of the PRP that could cause an infection when placed back in a wound site.
3. Although all care is taken to obtain the blood draw. There are some risks that might be associated with this procedure. Some might include bruising, bleeding, thrombosis and in extreme and rare cases some nerve impairment.
ALTERNATIVES TO TREATMENT
If this procedure is not done, then the planned surgery may be possible without the addition of PRP. However, there may be added risks of infection, post-operative bleeding at the operative site, delayed healing and some increased loss of a bone graft mass and density if a bone graft its planned. In the aesthetic area such as the anterior maxilla or mandible, we cannot afford to having multiple surgery without the increased risk of gum recession to other teeth, scar tissue formation, and also increasing the treatment time prior to the final restoration. Having these complications will risk and highly compromise the esthetic result. Needless to say, I prefer to have only one surgery and be successful at the first try.
It has been explained to me that during the course of the procedure unforeseen conditions may be revealed which will necessitate extension of the original procedure or different procedure(s) from those set forth above. I authorize my doctor to perform such procedures as necessary and desirable in the exercise of professional judgment. I also understand that even though PRP can greatly enhance the prognosis of an aesthetic result, no guarantees of either a cosmetic or functional nature have been made to me regarding the outcome of my surgery and also no guarantees as to the increased benefits of the use of PRP have been made in regarding to the use of PRP due to the simple fact that everyone heals differently and there is no predictor of how our body will heal with certain procedure. Moreover, our healing potential is always changing due to age, environment, stress level, and systemic factor (health condition).
I, ______________________ (patient), certified that I have read or had read to me the contents of this form and do realize the risks and limitations involved and do consent to the Platelet Rich Plasma Gel (PRP) procedure. I also consent to the taking of photographs and x-ray before, during, and after treatment, and to the use of same by the doctor in scientific papers or demonstrations.
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Patient Signature Date