Joseph Choukroun

• MD
• Goethe University Frankfurt

Objectives Platelet‐rich fibrin (PRF) has had a marked impact on regenerative medicine due to its widespread ability to promote angiogenesis to defective tissues. Particularly in the dental field, evidence from randomized clinical trials has further shown that PRF facilitates greater soft‐tissue regeneration when compared with hard tissues. Clinic...

Based on the evidence of a significant communication and connection pathway between the bone and immune systems, a new science has emerged: osteoimmunology. Indeed, the immune system has a considerable impact on bone health and diseases, as well as on bone formation during grafts and its stability over time. Chronic inflammation induces the excessi...

Background The present study evaluated the cellular tissue reaction of two equine-derived collagen hemostatic sponges (E-CHS), which differed in thickness after pressing, over 30 days in vivo. The inflammatory response during physiological wound healing in sham-operated animals was used as control group. Material and methods First, the E-CHS was p...

This chapter highlights the relationship between biologic conditions, oxidative stress and long‐term stability in bone management. Cholesterol and vitamin D have a major influence on bone and tissue metabolism. Anxiety is a major oxidative stress factor. The easiest way to decrease this stress and its effects on surgical outcomes is to perform pre...

Platelet-rich fibrin (PRF) is a blood concentrate derived from venous blood that is processed without anticoagulants by a one-step centrifugation process. This three-dimensional scaffold contains inflammatory cells and plasma proteins entrapped in a fibrin matrix. Liquid-PRF was developed based on the previously described low-speed centrifuge conce...

Osseointegration of dental implants requires sufficient intrabony blood supply. In extremely resorbed areas, however, the main source of blood is the periosteal arteries. Basal implant placement in severely atrophic jaws is thus especially challenging because of the poor quality as well as the reduced volume of the future recipient bone site. This...

Different tissue engineering techniques are used to support rapid vascularisation. A novel technique is the use of platelet-rich fibrin (PRF), an autologous source of growth factors. This study was the first to investigate the influence of PRF matrices, isolated following different centrifugation protocols, on human dermal vascular endothelial cell...

Platelet concentrates have had a long history of use in various fields of dentistry and medicine as an autogenous source of growth factors derived from human peripheral blood. While platelet-rich plasma (PRP) was proposed as a first-generation platelet concentrate over three decades ago, over the past 10 years, platelet-rich fibrin (PRF) has seen a...

Impact statement: This study evaluated for the first time the composition and bioactivity of platelet-rich fibrin (PRF) produced from small animal blood by reducing the initial blood volume needed for the preparation of PRF from 10 to 3 mL. The results showed that different preparation protocols of PRF produced using 3 mL of animal blood exhibit t...

Objective: To evaluate the clinical benefits of liquid platelet-rich fibrin (PRF) in patients with temporomandibular joint (TMJ) pain and dysfunction. Methods: Forty-eight TMJs in 37 patients with painful internal derangement (ID) (Wilkes’ I–V) were included. Patients were injected with 1.5–2cc of PRF within the superior joint space at 2-week inter...

Platelet-rich fibrin is a blood concentrate system used for soft tissue and bone tissue regeneration. In the last decade, platelet rich fibrin (PRF) has been widely used in different indication fields, particularly in oral and maxillofacial surgery. This review is aimed to investigate the level of scientific evidence of published articles related t...

The native structure of the PRF matrices differed according to centrifugation protocol. High PRF was denser than medium PRF. High PRF prevented cellular penetration over 10 days and showed a significantly less number of vessels in the matrix compared to medium PRF. By contrast, medium PRF demonstrated a significantly higher number of vimentin-posit...

Original Article

Platelet-rich fibrin (PRF) is generated from the patients’ own venous blood by a single centrifugation step without the additional use of anticoagulants. Based on the previously described LSCC (low-speed centrifugation concept), our group showed that modification of the centrifugation setting, that is, reducing the relative centrifugal force (RCF)...

PurposeThe aim of this study was to analyze systematically the influence of the relative centrifugation force (RCF) on leukocytes, platelets and growth factor release within fluid platelet-rich fibrin matrices (PRF). Materials and methodsSystematically using peripheral blood from six healthy volunteers, the RCF was reduced four times for each of th...

Immediate implant placement often presents challenges in terms of predictably obtaining soft-tissue coverage over the implant site. While delayed implant placement offers the ability for soft tissues to grow and invade the extraction socket making their attachment around implants more predictable, immediate implant placement poses a significant ris...

Leukocyte and platelet‑rich fibrin (PRF), a second‑generation platelet concentrate has been the focus of intensive research endeavors over the last 2 decades. Over the years, numerous reports have however failed to accurately report g‑force values which have caused considerable confusion in the field. These values have since been re‑transcribed inc...

The aim of the present study was to evaluate the effect of injectable platelet-rich fibrin (i-PRF) on cultivated chondrocytes and osteochondral regeneration in critical-sized osteo-chondral defect of the rabbit's knee in comparison to autologous platelet-rich plasma (PRP). Chondrocytes were first investigated for their ability to proliferate and di...

Objectives: Platelet rich plasma (PRP) has been utilized in regenerative dentistry as a supra-physiological concentrate of autologous growth factors capable of stimulating tissue regeneration. Despite this, concerns have been expressed regarding the use of anti-coagulants, agents known to inhibit wound healing. In this study, a liquid formulation...

Platelet rich fibrin (PRF) is a blood concentrate system obtained by centrifugation of peripheral blood. First PRF matrices exhibited solid fibrin scaffold, more recently liquid PRF-based matrix was developed by reducing the relative centrifugation force and time. The aim of this study was to systematically evaluate the influence of RCF (relative c...

Almost two decades have passed since platelet rich fibrin (PRF) was first introduced. Initially, the primary objective was to develop a therapy where platelet concentrates could be introduced into wounds by effectively utilizing the body's natural healing capacity. This was achieved by collecting growth factors derived from blood in a natural way....

It becomes very interesting to point out how rapidly platelet rich fibrin (PRF) has exponentially developed over the past half-decade. Despite its first publication in 2001, many clinicians (even those working within universities) had not yet discovered PRF until the years 2012-2014. It therefore took many clinicians by surprise that this relativel...

Platelet rich fibrin (PRF) has extensively been utilized in dental medicine but many practitioners may be surprised to learn that it has far more often been applied in general medicine for a variety of indications highlighted in this chapter. While PRF was first utilized for the treatment of hard-to-heal leg ulcers, it remains interesting to point...

One constantly evolving field demanding much research has been dedicated to the use of platelet rich fibrin (PRF) in regenerative dentistry. Over the past half-decade, the number of publications listed on Medline has exponentially increased and this trend is only expected to continue. In the early stages of its use, attempts were made to determine...

This chapter describes the development of platelet rich fibrin (PRF) as a fully autologous blood concentrate system. The low-speed centrifugation concept (LSCC) indicates that reducing the relevant centrifugation force (RCF) advances PRF matrices with an enhanced number of inflammatory cells and platelets. This effect was shown in Advanced PRF (A-P...

Objectives: Research across many fields of medicine now points towards the clinical advantages of combining regenerative procedures with platelet-rich fibrin (PRF). This systematic review aimed to gather the extensive number of articles published to date on PRF in the dental field to better understand the clinical procedures where PRF may be utili...

The multidisciplinary field of tissue engineering has tackled a wide variety of medical challenges over the years with the aim to predictably repair, regenerate or restore damaged and diseased tissues [1–4]. Defects frequently encountered are commonly produced by a variety of underlying conditions caused by congenital abnormalities, injury, disease...

In the context of prevascularization strategies for tissue engineering purposes, co-culture systems consisting of outgrowth endothelial cells (OECs) and primary osteoblasts (pOBs) have been established as a promising in vitro tool to study regeneration mechanisms and to identify factors that might positively influence repair processes like wound he...

Platelet-rich plasma (PRP) has been utilized for many years as a regenerative agent capable of inducing vascularization of various tissues using blood-derived growth factors. Despite this, drawbacks mostly related to the additional use of anti-coagulants found in PRP have been shown to inhibit the wound healing process. For these reasons, a novel p...

Various strategies have been employed to speed tissue regeneration using bioactive molecules. Interestingly, platelet concentrates derived from a patient’s own blood have been utilized as a regenerative strategy in recent years. In the present study, a novel liquid platelet formulation prepared without the use of anti-coagulants (injectable-platele...

The social impact and the patients’ quality of life, in regard with their oral health status, show important alterations during the immediately post-surgery period, after alveoloplastic extractions. Alveoloplastic extraction is a usual surgical dental-alveolar procedure. Depending on the number of extracted teeth, their location, duration of proced...

The growing multidisciplinary field of tissue engineering aims to predictably regenerate, enhance or replace damaged or missing tissues for a variety of conditions caused by trauma, disease and old age. One area of research that has gained tremendous awareness in recent years is that of platelet rich fibrin (PRF) which has been utilized across a wi...

Background: Over the past decade, the use of leukocyte platelet rich fibrin (L-PRF) has gained tremendous momentum in regenerative dentistry as a low-cost fibrin matrix utilized for tissue regeneration. In this study, we characterized how centrifugation speed (G-force) along with centrifugation time influence growth factor release from fibrin clot...

Bone substitute materials of different origin and chemical compositions are frequently used in augmentation procedures to enlarge the local bone amount. However, relatively few data exist on the long-term tissue reactions. The presented case reports for the first time histological and histomorphometrical analyses of a nanocrystaline Hydroxyapatite...

The present study aimed to analyze the effects of the addition of blood to the phycogenic bone substitute Algipore® on the severity of the in vivo tissue reaction. Initially, Fourier transform infrared spectroscopy (FTIR) of the bone substitute was conducted to analyze its chemical composition. The subcutaneous implantation model in Balb/c mice was...

Abstract In this study, the tissue reactions to two new porcine dermis-derived collagen membranes of different thickness were analyzed. The thicker material (Mucoderm®) contained sporadically pre-existing vessel skeletons and fatty islands. The thinner membrane (Collprotect®) had a bilayered structure (porous and occlusive side) without any pre-exi...

Purpose: The host tissue reaction to the xenogeneic bone substitute Bio-Oss™ (Geistlich Biomaterials, Wolhousen, Switzerland) was investigated focusing on the participating inflammatory cells and implantation bed vascularization. Materials and Methods: Bio-Oss™ was implanted subcutaneously into CD1 mice for up to 60 days and analyzed by means of s...

Abstract The present preclinical and clinical study assessed the inflammatory response to a high temperature-treated xenogeneic material (Bego-Oss®) and the effects of this material on the occurrence of multinucleated giant cells, implantation bed vascularization and regenerative potential.After evaluation of the material characteristics via scanni...

Abstract Choukroun´s PRF (platelet- rich fibrin) is obtained from blood without adding anticoagulants. In this study, protocols for standard platelet-rich fibrin (S-PRF) (rpm 2700, 12 minutes), and A (advanced)-PRF (rpm 1500, 14 minutes) were compared to establish by histological cell detection and histomorphometrical measurement of cell distributi...

Abstract Following a failure of a bone graft or an implant placement, the hypothesis of a biological abnormality is rarely evocated. Systematic search of dyslipidemia or Vitamin D deficiency before major surgery or after a failure in oral surgery may prevent or could explain the failure. Excess LDL cholesterol is responsible for a slower metabolism...

Abstract The present study reports the 3- year clinical and radiological follow up investigation of dental implants placed three and six month after sinus augmentation in 14 patients. Augmentation was performed with a synthetic bone substitute material, composed from nanocristaline Hydroxyapatite.Aim of the study was to determine the influence of t...

Objectives: To evaluate the interest of growth factors adjonction during lipostructure. Materials and methods: Between May 2005 and June 2012, 232 patients benefited from this modern approach of lipostructure with concentrate of platelets. The technique evolves on the simplification way. Results: All the patients were satisfied with the result...

Over the last decade success rate of dental implant therapy is in constant rise. Cases that were once considered difficult can now be managed much more easily, with significantly better results. Reasons can be found in mayor technological advancements in dental implant macro and micro design, evolution of diagnostic procedures and techniques but al...

The use of platelet concentrates for topical use is of particular interest for the promotion of skin wound healing. Fibrin-based surgical adjuvants are indeed widely used in plastic surgery since many years in order to improve scar healing and wound closure. However, the addition of platelets and their associated growth factors opened a new range o...

To assess the relevance of simultaneous sinus-lift and implantation with leukocyte- and platelet-rich fibrin (L-PRF, Choukroun's technique) as sole subsinus filling material. Twenty-three lateral sinus elevations (SA4 sinus) were performed on 20 patients with simultaneous implant placement. Seven patients were treated with 19 Astra implants (AstraT...

Analysis of tomodensitometric controls following sinus grafts clearly demonstrates a quite systematic lack of homogeneity. Sinus contamination by anaerobic bacteria seems almost unavoidable during bone graft surgery, and this problem may jeopardize the healing process. The aim of this study was to characterize in a systematic way the nonhomogeneiti...

The primary function of a dental implant is to act as an abutment for a prosthetic device, similar to a natural tooth root and crown. Any success criteria, therefore, must include first and foremost support of a functional prosthesis. In addition, although clinical criteria for prosthetic success are beyond the scope of this article, patient satisf...

To analyze the effects of PRF (a platelet and immune autologous concentrate) on in vitro proliferation of human keratinocytes and preadipocytes, and to determine if these results may offer an opening on new clinical investigations, particularly in the improvement of tympanoplasties and facial lipostructures (Coleman's technique). Human tympanic ker...

Platelet-rich fibrin (PRF) belongs to a new generation of platelet concentrates geared to simplified preparation without biochemical blood handling. In this initial article, we describe the conceptual and technical evolution from fibrin glues to platelet concentrates. This retrospective analysis is necessary for the understanding of fibrin technolo...

Platelet-rich fibrin (PRF) belongs to a new generation of platelet concentrates, with simplified processing and without biochemical blood handling. In this second article, we investigate the platelet-associated features of this biomaterial. During PRF processing by centrifugation, platelets are activated and their massive degranulation implies a ve...

Platelet-rich fibrin (PRF) belongs to a new generation of platelet concentrates, with simplified processing and without biochemical blood handling. In this third article, we investigate the immune features of this biomaterial. During PRF processing, leucocytes could also secrete cytokines in reaction to the hemostatic and inflammatory phenomena art...

Platelet-rich fibrin (PRF) belongs to a new generation of platelet concentrates, with simplified processing and without biochemical blood handling. In this fourth article, investigation is made into the previously evaluated biology of PRF with the first established clinical results, to determine the potential fields of application for this biomater...

Platelet-rich fibrin (PRF) belongs to a new generation of platelet concentrates, with simplified processing and without biochemical blood handling. The use of platelet gel to improve bone regeneration is a recent technique in implantology. However, the biologic properties and real effects of such products remain controversial. In this article, we t...

Research for protocols supporting haemostasis and cicatrisation is a recurrent problem in all types of surgery. Platelet concentrates, as cytokines-enriched biological adhesives constitute some novel research fields. The first generation of these surgical additives, generally named cPRP (concentrated platelet-rich plasma), come from the autologous...

Many years of research were necessary to accept the concept of immediate post-extraction implant placement. This approach combines post-extraction cicatrization with the osteointegration phase of the implants and presents a lot of physiological and psychological advantages. The limits of immediate post-extraction implantation can be pushed back tod...

The use of platelet gel as surgical additive is still recent and suffers from the lack of serious investigations as for their biological properties. It highlights the need for rationalized, reproducible and reliable protocols of analysis of the results obtained by addition of these preparations. Because of the total absence of work on the PRF (Plat...

The analysis of scan controls after sinus lifts reveals a lacunar and inhomogeneous aspect, which is considered as “normal”. However, the oral cavity contains a very significant anaerobic flora: our assumption is thus that the contamination of the sinus by the anaerobic germs is unavoidable during the bone graft surgery and that this phenomenon har...

Introduction. – Le PRF (Platelet Rich Fibrin) appartient à une nouvelle génération de concentrés plaquettaires recherchant des modes de production simplifiés et sans manipulation biochimique du sang (héparine, EDTA, thrombine bovine, chlorure de calcium...).But. – Dans ce premier article, nous nous sommes intéressés à la molécule clé de tout concen...

The PRF (Platelet Rich Fibrin) belongs to a new generation of platelet concentrates, with simplified modes of production and without biochemical handling of blood (heparin, EDTA, bovine thrombin, Calcium chloride…). In this fourth article, we sought to correlate the previously evaluated biology of the PRF with first established clinical results, in...