Platelet-rich fibrin (PRF) or leukocyte- and platelet-rich fibrin (L-PRF) is a second-generation
PRP where
autologous
Autotransplantation is the transplantation of organs, tissues, or even particular proteins from one part of the body to another in the same person ('' auto-'' meaning "self" in Greek).
The autologous tissue (also called autogenous, autogene ...
platelet
Platelets, also called thrombocytes (from Greek θρόμβος, "clot" and κύτος, "cell"), are a component of blood whose function (along with the coagulation factors) is to react to bleeding from blood vessel injury by clumping, thereby ini ...
s and leukocytes are present in a complex fibrin matrix
to accelerate the healing of soft and hard tissue
and is used as a tissue-engineering scaffold for endodontics.
To obtain PRF, required quantity of blood is drawn quickly into test tubes without an anticoagulant and centrifuged immediately. Blood can be centrifuged using a tabletop centrifuge from 3-8 minutes for 1300 revolutions per minute. The resultant product consists of the following three layers; topmost layer consisting of platelet poor plasma, PRF clot in the middle, and red blood cells (RBC) at the bottom. PRF is available as a fibrin clot. PRF clot can be removed from the test tube using a sterile tweezer-like instrument. After lifting, the RBC layer attached to the PRF clot can be carefully removed using a sterilized scissor.
Platelet activation in response to tissue damage occurs during the process of making PRF release several biologically active proteins including; platelet alpha granules, platelet‑derived growth factor (PGDF), transforming growth factors‑β (TGF‑β), vascular endothelial growth factor (VEGF), and epidermal growth factor. Actually, the platelets and leukocyte cytokines play important parts in role of this biomaterial, but the fibrin matrix supporting them is the most helpful in constituting the determining elements responsible for real therapeutic potential of PRF. Cytokines are immediately used and destroyed in a healing wound. The harmony between cytokines and their supporting fibrin matrix has much more importance than any other platelet derivatives.
Dentistry
Ridge preservation
Ridge preservation (Colloquially
Socket preservation
Socket preservation or alveolar ridge preservation is a procedure to reduce Dental alveolus, bone loss after tooth extraction. After tooth extraction, the jaw bone has a natural tendency to become bone remodeling, narrow, and lose its original sha ...
), a procedure to reduce bone loss after
tooth extraction
A dental extraction (also referred to as tooth extraction, exodontia, exodontics, or informally, tooth pulling) is the removal of teeth from the dental alveolus (socket) in the alveolar bone. Extractions are performed for a wide variety of reason ...
to preserve the
dental alveolus
Dental alveoli (singular ''alveolus'') are sockets in the jaws in which the roots of teeth are held in the alveolar process with the periodontal ligament. The lay term for dental alveoli is tooth sockets. A joint that connects the roots of the t ...
(containing the tooth socket) in the
alveolar bone
The alveolar process () or alveolar bone is the thickened ridge of bone that contains the tooth sockets on the jaw bones (in humans, the maxilla and the mandible). The structures are covered by gums as part of the oral cavity.
The synonymous ter ...
. A platelet-rich fibrin (PRF) membrane containing bone growth enhancing elements can be stitched over the wound or a graft material or scaffold is placed in the socket of an extracted tooth at the time of extraction. The socket is then directly closed with stitches or covered with a non-resorbable or resorbable membrane and
sutured.
Sinus lift
A platelet-rich fibrin can be used if a
sinus lift
Maxillary sinus floor augmentation (also termed sinus lift, sinus graft, sinus augmentation or sinus procedure) is a surgical procedure which aims to increase the amount of bone in the posterior maxilla (upper jaw bone), in the area of the prem ...
is required for a
dental implant
A dental implant (also known as an endosseous implant or fixture) is a prosthesis that interfaces with the bone of the jaw or skull to support a dental prosthesis such as a crown, bridge, denture, or facial prosthesis or to act as an orthodonti ...
.
Periodontal regeneration
Reproduction or reconstitution of a lost or injured part to restore the architecture and function of the periodontium becomes the integral part of comprehensive periodontal therapy. Conventional
open flap debridement falls short of regenerating tissues destroyed by the disease.
Platelet derived growth factor
Platelet-derived growth factor (PDGF) is one among numerous growth factors that regulate cell growth and division. In particular, PDGF plays a significant role in blood vessel formation, the growth of blood vessels from already-existing bloo ...
along with bone morphogenetic proteins are among the most researched growth factors in periodontal regeneration. Platelet rich fibrin showed significant improvement in clinical periodontal parameter as well as in radiograph when compared with open flap debridement alone in a
meta analysis
A meta-analysis is a statistical analysis that combines the results of multiple scientific studies. Meta-analyses can be performed when there are multiple scientific studies addressing the same question, with each individual study reporting me ...
. Several bone graft materials have been used in the treatment of infrabony defects.
Demineralized freeze dried bone allograft (DFDBA) has been histologically proven to be the material of choice for regeneration. Platelet-rich fibrin has shown significant results comparable to DFDBA for periodontal regeneration. One of the most common aesthetic problem encountered in the field of periodontology is gingival recession, which is, perceived by the patients as increase in length of teeth. Though connective tissue graft is a gold standard procedure, PRF can be used as an alternative procedure by keeping patient's comfort in mind.
Guided bone and tissue regeneration
PRF is used in
guided bone and tissue regeneration.
Regenerative endodontics
PRF enhances
alveolar bone augmentation and necrotic
dental pulp
The pulp is the connective tissue, nerves, blood vessels, and odontoblasts that comprise the innermost layer of a tooth. The pulp's activity and signalling processes regulate its behaviour.
Anatomy
The pulp is the neurovascular bundle centr ...
and open
tooth apex can be revitalized in
regenerative endodontics
Regenerative endodontic procedures is defined as biologically based procedures designed to replace damaged structures such as dentin, root structures, and cells of the pulp-dentin complex. This new treatment modality aims to promote normal function ...
with platelet-rich fibrin.
See also
*
Dressing (medical)
A dressing is a sterile pad or compress applied to a wound to promote healing and protect the wound from further harm. A dressing is designed to be in direct contact with the wound, as distinguished from a bandage, which is most often used to hold ...
*
Platelet alpha-granule
Alpha granules, (α-granules) also known as platelet alpha-granules are a cellular component of platelets. Platelets contain different types of granules that perform different functions, and include alpha granules, dense granules, and lysosomes. ...
References
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Blood products
Dentistry
Transfusion medicine