ArticlePDF Available

Abstract and Figures

Platelet rich fibrin (PRF) is an autogenous biomaterial consisting of growth factors and cytokines entrapped in a fibrin matrix. It combines the fibrant sealant properties along with growth factors thereby providing an ideal environment for wound healing and regeneration of tissues. In recent times it has been used various disciplines in dentistry in a wide range of treatment modalities.
Content may be subject to copyright.
51
National Journal of Medical and Dental Research, April – June 2014: Volume-2, Issue-3, Page 51-58
Platelet Rich Fibrin and its Applications in Dentistry- A
Review Article
Megha AgrawalA, Vineet AgrawalB
A Private Dental Practioner, Vadodara, Gujrat, India
B Senior Lecturer, Department of Conservative Dentistry and Endodontics,
Manubhai Patel Dental College, Vadodara, Gujrat, India
Abstract:
Platelet rich brin (PRF) is an autogenous biomaterial consisng of growth factors
and cytokines entrapped in a brin matrix. It combines the brant sealant properes
along with growth factors thereby providing an ideal environment for wound healing
and regeneraon of ssues. In recent mes it has been used various disciplines in
denstry in a wide range of treatment modalies.
Key Words: Platelet rich brin (PRF), Wound healing, Denstry, Maxillofacial surgery
Natl J Med Dent Res 2014; 2(3) : 51-58
Manuscript Reference
Number: Njmdr_231_14
Date of submission: 28 April 2014
Date of Editorial approval: 03 May 2014
Date of Peer review approval: 16 May 2014
Date of Publication: 30 June 2014
Conict of Interest: Nil; Source of support: Nil
Name and addresses of corresponding author:
Dr Megha Agrawal
Nisha Dental Clinic, 68, Gayatri Chambers
B/H Railway Station, Alka Puri Road
Vadodara, Gujarat – 390007
India
Phone – 07567146877
Email: drmeghaa4u@gmail.com
Review Article
Introduction:
In the last few decades a variety of
biomaterials have been introduced in
dentistry that can ll in osseous defects and
accelerate wound healing. Materials like
hydroxyapatite, freeze dried bone graft,
tricalcium phosphate, bioactive glass etc.
have been widely used and tested for their
contribution in healing and regeneration of
soft and hard tissues. It was rst described
by Dr. Joseph Choukroun in France to
promote wound healing in implants.
Currently, the studies have been focussed
on the use of an autogenous material
called Platelet Rich Fibrin that provides
an osteoconductive scaffold along with
growth factors to stimulate patient’s own
cells towards a regenerative response [1].
Platelet rich brin (PRF) is a brin matrix
in which platelet cytokines, growth factors
and cells are trapped and may be released
after a certain time and that can serve as a
resorbable membrane [2]. It can be obtained
from blood with the help of a simple
process. PRF is basically a concentrate of
growth factors that promote wound healing
and regeneration which is used in various
disciplines of dentistry to repair various
lesions and regenerate dental and oral
tissues.
Healing of any wound is initiated by clot
formation and inammation, followed by
a proliferative stage which comprises of
epithelialization, angiogenesis, granulation
tissue formation and collagen deposition
and nally collagen maturation and
contraction. Growth factors are mitogenic
(proliferative), chemotactic (stimulate
directed migration of cells) and angiogenic
(stimulate new blood vessel formation).
Therefore, they appear to be critical to the
wound-healing process [1].
52
National Journal of Medical and Dental Research, April – June 2014: Volume-2, Issue-3, Page 51-58
The use of blood derived products to heal wounds started
back in 1970 with the use of brin glues or brin sealants
which were formed by polymerizing brinogen with
thrombin and calcium. It was originally prepared using
donor plasma; however, because of the low concentration
of brinogen inplasma, the stability and quality of brin
glue was low [3, 4].
Regenerative potential of platelets was introduced in 1974
when Ross et al. identied platelet derived growth factor
as a serum growth factor for broblasts, smooth muscle
cells and glial cells (Kohler and Lipton 1974; Ross et al.
1974; Westermark and Wasteson 1976). Now it has been
well documented that platelets provide a rich pool of varied
growth factors such as PDGF-AB (platelet derived growth
factor A B), TGF-Beta1 (transforming growth factor beta-
1), VEGF (vascular endothelial growth factors) broblast
growth factor, insulin like growth factor, epidermal growth
factor, connective tissue growth factor etc.
In transfusion medicine, platelet concentrates were
originally used for the treatment and prevention of
haemorrhage due to severe thrombopenia which is often
caused by medullar aplasia, acute leukemia or signicant
blood loss during long lasting surgery.[3] Platelet
concentrates have also been used in plastic surgery, nerve
injuries, tendinitis, osteoarthritis etc.
In recent times, a variety of platelet concentrates has
been developed and has shown promising results. Platelet
concentrates have been developed with an idea to combine
the brin sealant properties with the growth factors in
platelets thereby providing an ideal base for wound healing
and regeneration of tissues [5]. Platelet rich plasma (PRP),
the rst generation platelet concentrates showed positive
results, however, the complexity of PRP preparation
protocol and the risk of cross-infectiondue to the use of
bovine thrombin led to development a newer generation of
completely autologous platelet concentrates- platelet rich
brin also called as Choukroun’s platelet rich brin named
after its inventor.
PRF was developed in France by Joseph Choukroun et al.
in 2001. They used PRF to improve bone healing in cases
of implants. It is a brin matrix in which platelet cytokines,
growth factors and cells are trapped and may be released
after a certain time and that can serve as a resorbable
membrane. Growth factors are released after activation
from the platelets trapped within brin matrix, and have
been shown to stimulate the mitogenic response in the
periosteum for bone repair during normal wound healing
[2].
A variety of materials are available for bone regeneration,
which are highly osteoconductive or osteoinductive like,
freeze dried bone graft, bioactive glass, emdogain, PTR
polymer, MTA, tricalcium phosphate, and octacalcium
phosphate. PRF is an autogenous osteoinductive material
that enhances osteogenesis in the extraction tooth socket
in comparison to the physiological healing process. It
is an optimized blood clot. It also provides a signicant
postoperative protection of the surgical site and seems to
accelerate the integration and remodeling of the grafted
biomaterial [6].
Preparation of PRF:
The classical technique for PRF preparation was invented
by Dr. Joseph Choukroun in 2000. It is the current PRF
technique authorized by the French Health Ministry in
which PRF is prepared without using an anticoagulant
during blood harvesting or bovine thrombin during gelling
[7].
For preparation of PRF, blood sample is collected from the
patient without anticoagulant using a buttery needle and
10 ml blood collection tubes. After collection of blood, it
is immediately centrifuged on a table-top centrifuge at a
rate of 3000 rpm for 10 minutes. After centrifugation, 3
layers are obtained in the test tube (Figure 1). The topmost
layer consisting of acellular PPP (platelet poor plasma),
PRF clot in the middle and RBCs at the bottom of the test
tube. The middle layer of PRF clot is then removed with
sterile tweezers and separated from the underlying RBC
layer using scissors and then transferred on a sterile dish
and stored in a refrigerator. It is supposed that the junction
of PRF to the RBC layer is rich in growth factors and
therefore this region is preserved [8].
Figure 1 – Layers of PRF
53
National Journal of Medical and Dental Research, April – June 2014: Volume-2, Issue-3, Page 51-58
PRF results from a natural and progressive polymerization
which occurs during centrifugation [9]. Because of the
absence of an anticoagulant, blood begins to coagulate
as soon as it comes in contact with the glass surface.
Therefore, for successful preparation of PRF, speedy blood
collection and immediate centrifugation, before the clotting
cascade is initiated, and is absolutely essential [10]. The
slow handling of blood to centrifugation process will result
in diffuse polymerization of brin leading to the formation
of a small blood clot with irregular consistency [2].
Also, PRF membrane can be obtained by squeezing out
the liquids present in the brin clot. Liquid removal from
the PRF fraction can be done through mechanical pressure
between gauze layers resulting in a fairly solid, gel-like
material that can be used in various clinical applications
as a lling material or as a suturing membrane [11]. PRF
membrane can also be prepared by compressing PRF clot
in special tools like “PRF Box” resulting in standardized
membranes of constant thickness and size along with
PRF exudate. PRF exudate contains good amount of
growth factors (TGF-b1, PDGF-AB, VEGF etc.), matrix
glycoproteins (bronectin, vitronectin etc.) and proteins
specialized in increasing cell attachment to biomaterials
and titanium and therefore can be used for biomaterial
impregnation, rinsing surgical sites, hydration of graft
materials and for storage of autologous grafts[2,12].
Advantages of PRF over PRP:
1. Simple and cost effective method of preparation of
PRF
2. Eliminates the use of bovine thrombin and thereby
reduces the chances of crossinfection.It has been
discovered that the use of bovine thrombin may be
associated with the development of antibodies to the
factors V, XI and thrombin, resulting in the risk of life-
threatening coagulopathies [2].
3. Slow natural polymerization of PRF on contact with
glass particles of the test tube results in physiologic
thrombin concentration, while in PRP, there is sudden
brin polymerization depending on the amount of
surgical additives (thrombin and calcium chloride) [5].
4. Fine and exible 3-D structure of PRF more
favourable to cytokine enmeshment and cellular
migration.3-D network-connected tri-molecular or
equilateral junctions in PRF allows the establishment
of a ne and exible brin network able to support
cytokines enmeshment and cellular migration while
3-D organization of PRP consists of a brin network-
condensed tetra molecular or bilateral junctions
constituted with strong thrombin concentrations which
allows the thickening of brin polymers leading
to a rigid network, not very favourable to cytokine
enmeshment and cellular migration [5].
5. PRF has supportive effect on immune system [13]
6. PRF helps in hemostasis [13]
7. A in-vitro study showed that PRF is superior to PRP,
considering the expression of alkaline phosphatase
and induction of mineralization, caused markedly by
release of TGF-β1and PDGF-AB [14]
Role of PRF in Wound Healing:
Wound healing consists of three phases:
Role of PRF in wound healing:
Prolonged release of growth factors
at the wound site
Proliferation of fibroblasts and
osteoblasts
Promotes angiogenesis
Induces collagen synthesis
Guides in wound coverage
Mechanical adhesion by fibrin
Trapping of circulating stem cells
Regulation of immunity
1. Inammatory phase (1-4 days) (substrate-preparation
phase)
2. The proliferation phase (2-22 days) (collagen-building
phase)
fEpithelialation
fAngiogenesis
fGranulation tissue formation
fCollagen deposition
3. Maturation (remodeling phase) (6-12 months)
fCollagen maturation and contraction
PRF consists of a brin matrix polymerized in a tetra
molecular structure with the incorporation of platelets,
54
National Journal of Medical and Dental Research, April – June 2014: Volume-2, Issue-3, Page 51-58
leukocyte and cytokines, and the presence of circulating
stem cells [9]. PRF stimulates osteoblasts, gingival
broblasts, and periodontal ligament cells proliferation
as a mitogen. Its molecular structure with low thrombin
concentration is an optimal matrix for migration of
endothelial cells and broblasts [15] It permits a rapid
angiogenesis and an easier remodelling of brin.The
Leukocytes and key immune cytokines like IL 1β, IL 6,
IL 4 and TNF α trapped in PRF give it the anti-infectious
effect and lets PRF act as an immune regulation mode [8].
It features all the necessary parameters permitting optimal
healing.
PRF matrix can release various growth factors and
cytokines locally at the wound site for a prolonged period
of time which play important role in various stages of
wound healing promoting periapical tissue generation.
Growth factors are released from the alpha-granules in the
platelets when they are activated, secreted, or aggregated
by collagen or epinephrine [15]. TGF-beta and PDGF
are the typical two growth factors which promote healing
of soft tissue and bone through stimulation of collagen
production to improve wound strength and initiation of
callus formation [16].
Platelet-derived growth factor (PDGF) is a potent activator
for cells of mesenchymal origin. It is among the rst cells
to reach at the wound site. Strayhorn et al suggested that
PDGF might act mostly on osteoblastic cell proliferation,
exerting most of its effects during the early phases of wound
healing [1]. It also stimulates chemotaxis, proliferation,
and new gene expression in monocytes-macrophages and
broblasts in vitro, cell types considered essential for tissue
repair.
Vascular endotheilial growth factor (VEGF) is a major
angiogenic growth factor. It acts on endothelial cells,
being produced by numerous cell types, including vascular
smooth muscle cells (VSMC), broblasts etc. initiating
blood vessel formation.
Transforming growth factor Beta-1 (TGF beta-1), an
inammatory regulator, is the most powerful brosis agent
amongst all cytokines and can induce a massive synthesis of
collagen and bronectin either by broblasts or osteoblasts
[2].
The physiologic brin matrix of PRF, obtained as the result
of slow polymerization, has the ability to hold various
growth factors and cytokines and release them at the wound
site for a prolonged time period. Moreover, the brin matrix
itself shows mechanical adhesive properties and biologic
functions like brin glues: it maintains the ap in a high
and stable position, enhances neoangiogenesis, reduces
necrosis and shrinkage of the ap, and guarantees maximal
root coverage. It plays an important role in angiogenesis
and wound coverage [17].
Angiogenesis requires an extracellular matrix to allow
migration, proliferation and phenotype differentiation of
endothelial cells. The angiogenesis property of the brin
matrix is explained by the 3-dimensional structure of the
brin gel and the simultaneous action of the cytokines
trapped in brin meshes [18]. Furthermore, main
angiogenesis soluble factors such broblast growth factor-
basic (FGFb), vascular endothelial growth factor (VEGF),
angiopectin and platelet derived growth factor (PDGF) are
included in brin gel which can bind to brin with high
afnity.
Fibrin matrix guides the wound coverage affecting
the metabolism of broblasts and epithelial cells. The
epithelial cells around the wound margins lose their basal
and apical polarity and produce basal andlateral extensions
towards the wound site. These cells then migrate onto the
transitory matrix made by brinogen, bronectin, tenascin
and vitronectin [18]. Fibrin, bronectin, PDGF and TGF-B
are essential to modulate integrin expression, broblast
proliferation and their migration inside the wound. After
migration and degradation of brin, broblasts start the
collagen synthesis.
PRF also aids in trapping circulating stem cells brought
to the wound site due to initial neovascularization during
hemostasis and healing [18]. Set in the brin matrix, these
cells converge on a secretory phenotype, allowing the
vascular and tissue restoration. This aspect of PRF serving
as a net to the stem cells can be benecial in cases of wide
defects.
Current Applications of PRF In Dentistry:
In recent times a lot of research has been done on PRF and
numerous cases have been reported regarding the use of
PRF clot and PRF membranes. Majority of the research
has been concentrated on the use of PRF in oral surgery
for bone augmentation, sinus lifts, avulsion sockets etc
and in periodontics to correct intra-bony defects, gingival
55
National Journal of Medical and Dental Research, April – June 2014: Volume-2, Issue-3, Page 51-58
recession, guided bone regeneration, periapical lesions
etc. It has also been used for regeneration in open apex,
regenerative pulpotomies, periapical surgeries etc.
In Oral and Maxillofacial Surgery:
Studies show that PRF can be used as lling material in
extraction sockets. As a lling material in extraction sockets,
PRF will act as a stable blood clot for neovascularization
and accelerated tissue regeneration. This can be used to
improve wound healing in immunocompromised and
diabetic patients. Also, as PRF stimulates coagulation (with
thrombospondin) and wound closure, it can be used as an
adjuvant in patients on anticoagulant therapy [12]
PRF has been extensively used in sinus lift procedures.
Some studies show the use of PRF as the sole lling
material during sinus lift and implantation. Some studies
show the use of PRF in combination with other bone graft
materials in various direct and indirect sinus lift techniques
like bone-added sinus oor elevation, osteotome-mediated
sinus oor elevation, minimally invasive antral membrane
ballon elevation etc [2]. Some studies also show the use
of PRF in combination with beta Tricalcium phosphate
(beta TCP) without bone graft in sinus lift procedures and
chronic periodontal lesions.
The lling of avulsion sockets with PRF leads to
very favourable results when bony walls are intact. A
combination of PRF with bone substitutes and other
adjuncts may be necessary in residual defects where one
or several walls are missing or damaged in order to provide
an adequate reconstruction of bone volume. PRF increases
the cohesion between the graft materials as brin act as
physiological glue between the wound tissues [12]. Natural
blood coagulation leads to formation of a brin matrix that
biologically links wounded tissue together along with cell
proliferation, cell migration, neomatrix apposition and
remodelling. Therefore, the combination of PRF with other
graft materials should improve the integration of graft
material, since PRF is an optimized blood clot.
In cases of wide sockets and lesions where primary closure
is difcult, PRF membrane can be used as a covering and
protective membrane that promotes re-epithelialization of
the site and accelerates the merging of the wound margins.
The elasticity and strength of PRF brin membrane
makes it easy to suture. As a membrane for guided bone
regeneration (GBR), the PRF dense matrix architecture
covers, protects and stabilizes bone graft material and
operative site in general.
In Periodontics:
In periodontics, PRF has been used to treat gingival
recession, intra-bony defects and periapical lesions. Some
case reports show the use of a combination of PRF gel,
hydroxyapatite graft and guided tissue regeneration (GTR)
membrane to treat IBD [10]. Some studies show the use of
PRF gel and PRF membrane in combination with a bone
graft for treating a tooth with a combined periodontic-
endodontic lesion [19]. Some studies show use of two layers
of PRF membrane with to cover the defect. The membranes
are very thin and inhomogeneous and leucocytes and
platelet aggregates are believed to be concentrated in end
of the membrane. Therefore, two layers of membrane in
opposite sense can be used to prevent the resorption of
the thin membrane and to allow the entire surgical area to
be exposed to same components (leucocytes and platelet
aggregates) [19]. Platelet rich brin as a potential novel
root coverage approach has been reported by Anil kumar et
al. for covering localised gingival recession in mandibular
anterior teeth using combined laterally positioned ap
technique and PRF membrane.
PRF can promote the healing of osseous defects by the
following mechanisms. According to Chang et al. PRF
promotes the expression of phosphorylated extracellular
signal-regulated protein kinase (p-ERK) and stimulates
the production of osteoprotegerin (OPG) which in turn
causes proliferation of osteoblasts [7, 13]. Another
study by Huang et al. reported that PRF stimulates the
osteogenic differentiation of the human dental pulp cells
by up regulating osteoprotegerin and alkaline phosphatise
expression. PRF also releases growth factors such as
platelet-derived growth factor and transforming growth
factor which promote periodontal lregeneration [7].
In Endodontics:
Studies have shown that PRF can be used as a scaffolding
material in an infected necrotic immature tooth for pulpal
regeneration and tooth revitalization [20]. Also, some case
reports show that the combination of PRF membrane as a
matrix and MTA in apexication procedures prove to be an
effective alternative for creating articial root-end barriers
and to induce faster periapical healing in cases with
large periapical lesions. Use of a membrane can prevent
56
National Journal of Medical and Dental Research, April – June 2014: Volume-2, Issue-3, Page 51-58
the extrusion of material [6]. Use of PRF in regenerative
pulpotomy procedures have also been documented where
coronal pulp is removed and the pulp wound is covered by
PRF followed by sealing it with MTA and GIC [6]. PRF
has also been used to ll in the bony defects after periapical
surgeries like root end resection etc.
PRF might serve as a potentially ideal scaffold in
revascularization of immature permanent teeth with
necrotic pulps as it is rich in growth factors, enhances
cellular proliferation and differentiation, and acts as a
matrix for tissue ingrowth. The potential theory behind the
success of the use of PRF for regeneration of open apex
could be attributed to a study conducted by Huang et al,
who concluded that the PRF causes proliferation of human
Dental Pulp Cells and increases the protein expression of
these Dental Pulp Cells differentiate into odontoblasts like
cells. OPG and ALP expression are generally regarded as
markers of odontoblastic differentiation [20].
In Tissue Engineering:
The use of PRF as a tissue engineering scaffold was
investigated by many researchers for the past few years. In
a study by Gassling et al. reported that PRF appears to be
superior to collagen as a scaffold for human periosteal cell
proliferation and PRF membranes can be used for in vitro
cultivation of periosteal cells for bone tissue engineering.
Thus PRF is a potential tool in tissue engineering but clinical
aspects of PRF in this eld requires further investigation.
Conclusion:
The use of PRF as an adjunct in wound healing and
periodontal regeneration has shown promising results. It
has been successfully used for correction of osseous defects
in periodontics, oral and maxillofacial surgery and implant
dentistry. In addition to these, PRF has shown good results
in regeneration of pulp-dentin complex for endodontic
procedures. However, most studies with PRF have shown
short term results only. More controlled clinical trials with
long term results are needed to acquire deeper knowledge
about the efcacy and credibility of this biomaterial on a
long term basis and to optimize its use in daily procedures.
In addition to clinical trials, histopathological studies are
also required to learn about the nature of the newly formed
tissue in the defect and to understand the biology, efcacy
and its mode of action of PRF more effectively.
APPLICATIONS OF PRF
ORAL AND MAXILLOFACIAL SURGERY
Filling material in avulsion
sockets, bony defects etc.
Bone augmentation in sinus
lifts for posterior maxilla
augmentation for implants,
bony defects etc.
Ridge preservation
Guided bone regenetration,
PERIODONTICS
For treatment of
intrabony defects
For treatment of
gingival recession
Guided tissue
regeneration
Periapical lesions
TISSUE ENGINEERING
For in vitro
cultivation of
human periosteal
cellsfor bone
tissue engineering
57
National Journal of Medical and Dental Research, April – June 2014: Volume-2, Issue-3, Page 51-58
References:
1. Kanakamedala A, Ari G, Sudhakar U,
RajaramVijayalakshmi, Ramakrishnan T, Emmad P.
Treatment of a furcation defect with a combination
of platelet-rich brin (PRF) and bone graft – a case
report. ENDO (LondEngl) 2009; 3(2):127–135
2. Gupta V, Bains VK, Singh GP, Mathur A, Bains R.
Regenerative Potential of Platelet Rich Fibrin In
Dentistry: Literature Review. Asian J Oral Health
Allied Sci 2011; 1(1):22-28
3. David M, Dohan E, Rasmusson L, Albrektsson T.
Classication of platelet concentrates: from pure
platelet rich plasma(P-PRP) to leucocyte and platelet
rich brin(L-PRF). Trends Biotechnol2008; 27(3):
158-167
4. Man D, Plosker H, Winland-Brown JE. The Use of
Autologous Platelet-Rich Plasma (Platelet Gel) and
Autologous Platelet-Poor Plasma (Fibrin Glue) in
Cosmetic Surgery. PlastReconstrSurg 2001; 107(1):
229-237
5. Prakash S, Thakur A. Platelet concentrates:present,
past and future. J Maxillofac Oral Surg 2011; 10(1):
45–49.
6. I.B. Geeta, Galagali G, Kulkarni S, Suran P, Noushin
F. A Natuaral Meliorate: Revolutionary Tissue
Engineering in Endodontics. J ClinDiagn Res. 2013;
7(11):2644-2646
7. Chandran P, Sivadas A. Platelet-rich brin: Its role
in periodontal regeneration.. King Saud University
Journal of Dental Sciences 2013. Article in Press.
8. Malathi K, Muthukumaraswamy A, Beri S. Periodontal
regeneration of an intrabony osseous defect with
combination of platelet rich brin and bovine derived
demineralized bone matrix: A case report. IOSR-JDMS
2013; 4(2):20-26
9. Singh S, Singh A, Singh S, Singh R. Application of
PRF in surgical management of periapical lesions. Natl
J MaxillofacSurg 2013; 4(1):94-99
10. Ari G, Kumar A, Ramakrishnan T. Treatment of an
intrabony defect combined with an endodontic lesion:
a case report . ENDO (LondEngl) 2010; 4(3):215–222
11. Qi Li, Shuang Pan, Smit J. Dangaria, et al. “Platelet-
Rich Fibrin Promotes Periodontal Regeneration and
Enhances Alveolar Bone Augmentation,” BioMed
Research International, vol. 2013, Article ID 638043,
13 pages, 2013. doi:10.1155/2013/638043
12. Corso MD, Tofer M, David M, Ehrenfest D. Use of
autologous leukocyte and platelet rich brin (L-PRF)
membrane in post avulsion sites: an overview of
Choukroun’s PRF. The journal of implant and advanced
clinical dentistry 2010; 1(9):27-35.
13. Naik B, Karunakar P, Jayadev M, Marshal VR. Role of
Platelet rich  brin in wound healing: A critical review.
J Conserv Dent 2013;16(4):284-93.
14. Bajaj P, Rao NS, Agarwal E, Pradeep AR. Treatment of
intrabony defect with platelet rich brin: a case report.
AOSR 2011;1(2):90-94.
15. Rudagi KB, Rudagi BM. One-step apexication in
immature tooth using grey mineral trioxide aggregate
as an apical barrier and autologus platelet rich brin
membrane as an internal matrix. J Conserv Dent 2012;
15(2):196-99.
16. K. B. Jayalakshmi, ShipraAgarwal, M. P. Singh, B.
T. Vishwanath, Akash Krishna, and RohitAgrawal,
“Platelet-Rich Fibrin with β-Tricalcium Phosphate—A
Noval Approach for Bone Augmentation in Chronic
Periapical Lesion: A Case Report,” Case Reports in
Dentistry, vol. 2012, Article ID 902858, 6 pages, 2012.
doi:10.1155/2012/902858
17. Baiju RM, Ahuja R, Ambili G, Janam P. Case Report
- Autologous platelet-rich brin: a boon to periodontal
regeneration- report of two different clinical
applications. Health Sciences 2013;2(3):1-13.
18. Choukroun J., Antione B., Alain S., Marie-G, Christian
S., Steve D., Anthony J. J., Jaafar M., David D. PRF: A
second generation platelet concentrate. Oral Surg Oral
Med Oral Pathol Oral RadiolEndod 2006; 101:E56-60
58
National Journal of Medical and Dental Research, April – June 2014: Volume-2, Issue-3, Page 51-58
19. Shivashankar VY, Johns DA, Vidyanath S, Sam G.
Combination of platelet rich  brin, hydroxyapatite
and PRF membrane in the management of large
inammatory periapical lesion. J Conserv Dent
2013;16(3):261-64
20. Shivashankar VY, Johns DA, Vidyanath S, Kumar
MR. Platelet Rich Fibrin in the revitalization of tooth
with necrotic pulp and open apex. J Conserv Dent
2012;15:395-398
... 7 Open flap debridement only eliminates the etiologic factors but could not restore the structure of periodontal tissues which are damaged and lost due to bacterial infections, 6,8 so research on a variety of growth factors and host modulation drugs has started to be conducted in OFD treatment to enhance tissue regeneration and periodontal treatment success. 5,9 Previous research by Suwondo et al (2018) showed that Advanced-Platelet Rich Fibrin (A-PRF) was able to regenerate the periodontal tissues better than the conventional Platelet Rich Fibrin (PRF) based on parameters of probing depth (PD) and relative attachment loss. However, there was no difference in the increase in alveolar bone height because PRF only had an effect on the first initial stage, i.e., osteogenesis phase by optimizing osteoblast diffierentiation. ...
... The homogeneous rosuvastatin gel was then transferred into a 2 ml syringe applicator. 9 The preparation of A-PRF started by taking blood intravenously from the median cubital vein using a 10 ml syringe then the blood was placed into a glass tube and centrifuged at a speed of 1,500 rpm for 14 minutes. The centrifugation promoted the formation of three layers, namely cellular plasma in the upper layer, A-PRF in the middle layer, and red blood cells in the bottom layer. ...
Article
Full-text available
Open flap debridement (OFD) is an invasive therapy for chronic periodontitis with pocket 5 mm or more. However, it is difficult to achieve regeneration and new attachment with this therapy. Periodontitis starts to add growth factors and local drugs delivery as host modulation therapy. Advanced-PRF (A-PRF) contains more growth factor than PRF which plays a role in promoting fibroblast proliferation, reepithelization, extracellular matrix production, and endothelial cell migration. 1.2% rosuvastatin gel (RSV) is a local delivery drug with a pleiotropic effect that can modify host response to promoting BMSCs, BMP-2, OPG, ALP, RANKL, and osteoblasts. This study aimed to examine the effect of the application of A-PRF+RSV in OFD therapy of which the parameters were probing depth (PD), relative attachment loss (RAL), and alveolar bone height. The study samples consisted of 24 periodontal pockets which were divided into 2 groups of 12 pockets each, namely A-PRF+RSV for group 1 and PRF+RSV for group 2. Clinical evaluations were carried out on baseline, day-30, and day-90 for PD and RAL, and on baseline and day -90 for alveolar bone height. Data of PD and RAL reduction were analyzed with non-parametric test Mann-Withney, while data of reduction of alveolar bone height were analyzed with parametric Independent-T test. Group 1 obtained a statistically more significant result in reducing PD, RAL, and alveolar bone height compared to group 2 (p<0.05) To conclude, the application of A-PRF and 1.2% rosuvastatin gel in OFD procedure promotes a higher PD and RAL reduction and alveolar bone height increase than the application of PRF coupled with 1.2% rosuvastatin gel.
... The regenerative potential of platelets was introduced in 1970' s, when it is found that the platelet concentrates contains different growth factors that helps in increasing the production of collagen along with the growth of the blood vessels. [1][2][3][4] The major drawback in other bioactive materials used in the process of tissue engineering is that, most of them are avascular in nature therefore they are not able to provide blood supply to the hard or soft tissue for the process of regeneration. Due to the release of various growth factors, platelet rich fibrin is found to be the key component in the early phase of regeneration. ...
Article
Full-text available
Platelet rich fibrin contains various growth factors with in it and it is composed of fibrin matrix. Platelet rich fibrin is a concentrate of platelets of the second generation. Platelet rich fibrin helps in reducing the process of inflammation and enhance the healing process. An ideal environment is provided by platelet rich fibrin for the process of wound healing as well as regeneration of the tissue, as they combine the properties of fibrant sealant along with the properties of the growth factors in it. Platelet rich plasma has some advantages as it is derived more easily and with economical method of preparation along with it, it also eliminates the requirement of any exogenous compound for e.g. bovine thrombin or calcium chloride during the process of fabrication.
... Another convenient and economical approach to procure growth factors at the surgical site is the use of autologous plateletrich fibrin (A-PRF). Autologous platelet-rich fibrin is basically a concentrate of growth factors that promote wound healing and regeneration [32]. Choukran demonstrated that A-PRF has higher amounts of platelets and growth factors and more mechanical properties compared to PRF due to lower speed of centrifugation [33]. ...
Article
Introduction: Dental implants have become the treatment of option for replacing missing teeth. But dental implant placement needs adequate available bone for primary stability to attain successful osseointegration. In patients with inadequate bone volume, various bone augmentation procedures are available for facilitating implant placement. The mandibular ramus acts as an admirable source of autogenous bone for alveolar ridge augmentation procedures. Case Report: In the present case report a female patient with Siebert class III defect with respective to 46 was managed by implant placement along with autogenous bone grafting keeping in mind about the crown root ratio which could be a post-complication in anticipation. Conclusion: Thus, this article describes a case report of reconstruction of extensive vertical bone defect, using intraoral ramus block bone graft and autogenous A-PRF for implant site augmentation presented admirable results.
... One of the most recently used local agents to accelerate the rate of orthodontic tooth movement is platelet-rich plasma (PRP) [1]. The healing wound process initiates through formation of clot, followed by proliferative stage which comprises of new epithelial formation, blood vessel formation, granulation tissue formation, deposition of collagen and finally maturation and contraction of collagen [2]. This process involves aggregation and adherence of platelets which favours the formation of thrombin and fibrin. ...
Article
Acceleration of tooth movement is always a concern of both orthodontist and patient. Demand for shorter treatment time with none to minimal side effects is a main request of orthodontic treatment. The submucosal injection of PRP is a clinically feasible and effective technique to accelerate orthodontic tooth movement and at the same time, preserve the alveolar bone on the pressure side of orthodontic tooth movement, and the optimal dose of PRP for the best clinical performance is 11.0–12.5 folds.
... The end product comprises the following layers: top-most layer of an acellular plasma, PRF clot in the middle and a red corpuscle base settled at the bottom. [39,40] Compressing the PRF between two sterile gauzes or in a specific PRF tool to obtain the clot into a membrane. [39] When the blood comes in contact with silica surface, it activates the process of clot polymerisation, thus reducing the risk of cytotoxicity. ...
... Cieslik-Bielecka et al and Bielecki et al [9] proposed that PRP was an inactive substance, while PRG (Platelet Rich Gel) was more active, consisting of a fibrin matrix which is rich in leukocytes, platelets and relative active molecule. Also, the concept of CGF was introduced by Sacco [10]. ...
Article
Full-text available
Platelets are small cells that circulate in blood playing an important role in managing hemostasis and vascular integrity. They are also known to release several growth factors which stimulate tissue regeneration. The ability of platelet concentrates (PC) to achieve the goals of tissue regeneration has been explored in sports medicine, orthopedics and maxillofacial surgeries. The use of PC in the treatment of periodontal or bone defects is a much more natural approach compared to other modalities such as guided tissue and bone regeneration. Currently platelet concentrates are utilized in various regenerative and rehabilitative surgeries such as perio-plastic surgeries, ridge preservation and implant surgeries. Platelet concentrates have the ability to harness body’s own growth factors and utilize it for regeneration. It is a trialed and proven fact that they can dramatically increase the treatment results in a beneficial manner.
... PRF is basically a concentrate of growth factors that promote wound healing and regeneration which is used in various disciplines of dentistry to repair various lesions and regenerate dental and oral tissues. 3 Thus Present review of literature aims to provide details of PRF preparation and its application in dentistry. ...
... Wound healing is initiated by clot formation, followed by proliferative stage which comprises of epithelialization, angiogenesis, granulation tissue formation, collagen deposition and finally collagen maturation and contraction. [1] This involves adherence and aggregation of platelets favoring formation of thrombin and fibrin. Platelets contain biologically active proteins, binding of these proteins within a developing fibrin mesh or to the extracellular matrix can create chemotactic gradients favoring recruitment of stem cells, stimulating cell migration, differentiation, and promoting repair. ...
Article
Full-text available
This article provides review on Injectable Platelet-Rich Fibrin (Albumin Gel and Liquid Platelet-Rich Fibrin). The current findings suggest that AlbPRF has regeneration characteristics that are caused by the slow and steady release of growth factors contained in liquid PRF via albumin gel breakdown. Future research is needed to thoroughly define the degrading features of Alb-PRF in vivo and to investigate potential therapeutic uses in other domains of medicine. Platelet concentrates are easy to apply in clinical practice and offer potential benefits including rapid wound healing and bone regeneration, and can therefore be considered to be new therapeutic adjuvants. In dental implant surgery they are used in bone reconstruction prior or concomitant to implant procedures, and also for dental extraction socket preservation.
Article
Full-text available
Background: Platelet Rich Fibrin (PRF) is a growth factor concentration functioning as an initiator of wound healing and bone regeneration, and it is mainly reported in dentistry rehabilitation and rejuvenation. Objective: summarize and analyze the evidence based on the effect of PRF on the bone osteogenesis Methods: A comprehensive search was conducted on the bibliographic databases or Medical Subject Headings in the PubMed. The search was conducted among articles that were published between 2010 and 2021. Required article information was extracted from each article by abstract and full paper availability that focuses on the Platelet-Rich Fibrin (PRF) And Osteogenesis. We recruited studies with the design was employed clinical trials with in vitro and in vivo approaches. The only study that provided osteogenesis outcome proceeded to the quantitative analysis. Results: Regarding literature search and screening processes, it yielded 24 studies for qualitative assessment and eleven studies for quantitative analysis. Most of the studies performed a combination of PRF with other materials such as Mg ring, BMSCs, Gold nanoparticles, and PDLSCs. It showed that PRF combined with other materials enhanced the osteogenic ability. The assessment of PRF only showed the various result in multiple outcome markers. For the ALP, the mean difference is 1.40 [1.14-1.67] p-value 0.001. It indicates there is a significant effect of PRF application with the increase of ALP. For the RUNX2, there is a significant effect of PRF application with the increase of RUNX2 1.10 [0.93, 1.26]. For OCN, the mean difference of PRF in OCN is 0.77 [0.43, 1.12] p=0.001. It showed a significant effect of PRF application with the increase of OCN. There is also a significant effect of PRF application for TRAP with the declining number of TRAP is -1.59 [-2.96, -0.22] p=0.001. Conclusion: PRF combined with other materials showed more promising results rather than PRF only. Moreover, in the assessment of PRF only, it was found that PRF has a significant effect in accelerating bone osteogenesis. Keywords: PRF, Platelet-Rich Fibrin, Osteogenesis
Article
Full-text available
about PRF (platelet rich Fibrin) an autologous platelet concentrate used to periodontal regenerative surgery. The article covers its various applications
Article
Full-text available
Platelet rich fibrin (PRF) is a fibrin matrix in which platelet cytokines, growth factors and cells are trapped and may be released after a certain time and that can serve as a resorbable membrane. Choukroun and his associates were amongst the pioneers for using PRF protocol in oral and maxillofacial surgery to improve bone healing in implant dentistry. Autologous PRF is considered to be a healing biomaterial, and presently, studies have shown its application in various disciplines of dentistry.
Article
Full-text available
Platelet-Rich Fibrin (PRF) was first described by Choukroun et al., (2001). It has been referred to as a second-generation platelet concentrate, which has been shown to have several advantages over traditionally prepared platelet-rich plasma. PRF has a physiologic architecture that is very favourable to the healing process, obtained due to the slow polymerization process. The development of platelet concentrate as bioactive surgical additives that are applied locally to promote wound healing stems from the use of fibrin adhesive. Developments in the field of tissue engineering have made the generation of artificial substitutes in several areas of medicine. Various clinical applications in endodontics include Periapical surgeries, Revascularisationprocedures, Regenerative pulpotomy, Perforation repair. This article aims to discuss the various applications of PRF in the field of Endodontics with few case reports.
Article
Full-text available
Platelets can play a crucial role in periodontal regeneration as they are reservoirs of growth factors and cytokines which are the key factors for regeneration of the bone and maturation of the soft tissue. Platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) are autologous platelet concentrates prepared from patient’s own blood. Recent researches are being focused on the development of therapeutic alternatives which are easy to prepare, non-toxic or biocompatible to living tissues and economically cheap that might result in the local release of growth factors accelerating hard and soft tissue healing. PRF is a natural fibrin-based biomaterial prepared from an anticoagulant-free blood harvest without any artificial biochemical modification that allows obtaining fibrin membranes enriched with platelets and growth factors. Evidence from the literature suggests the potential role of PRF in periodontal regeneration and tissue engineering. The slow polymerization during centrifugation and fibrin-based structure makes PRF a better healing biomaterial than PRP and other fibrin adhesives. The main aim of this review article is to briefly describe the novel platelet concentrate PRF and its potential role in periodontal regeneration.
Article
Full-text available
Periapical inflammatory lesion is the local response of bone around the apex of tooth that develops after the necrosis of the pulp tissue or extensive periodontal disease. The final outcome of the nature of wound healing after endodontic surgery can be repair or regeneration depending on the nature of the wound; the availability of progenitor cells; signaling molecules; and micro-environmental cues such as adhesion molecules, extracellular matrix, and associated non-collagenous protein molecules. The purpose of this case report is to add knowledge to the existing literature about the combined use of graft material [platelet rich fibrin (PRF) and hydroxyapatite (HA)] and barrier membrane in the treatment of large periapical lesion. A periapical endodontic surgery was performed on a 45 year old male patient with a swelling in the upper front teeth region and a large bony defect radiologically. The surgical defect was filled with a combination of PRF and HA bone graft crystals. The defect was covered by PRF membrane and sutured. Clinical examination revealed uneventful wound healing. Radiologically the HA crystals have been completely replaced by new bone at the end of 2 years. On the basis of the results obtained in our case report, we hypothesize that the use of PRF in conjunction with HA crystals might have accelerated the resorption of the graft crystals and would have induced the rapid rate of bone formation.
Article
Full-text available
In the present study we have determined the suitability of platelet-rich fibrin (PRF) as a complex scaffold for periodontal tissue regeneration. Replacing PRF with its major component fibrin increased mineralization in alveolar bone progenitors when compared to periodontal progenitors, suggesting that fibrin played a substantial role in PRF-induced osteogenic lineage differentiation. Moreover, there was a 3.6-fold increase in the early osteoblast transcription factor RUNX2 and a 3.1-fold reduction of the mineralization inhibitor MGP as a result of PRF application in alveolar bone progenitors, a trend not observed in periodontal progenitors. Subcutaneous implantation studies revealed that PRF readily integrated with surrounding tissues and was partially replaced with collagen fibers 2 weeks after implantation. Finally, clinical pilot studies in human patients documented an approximately 5 mm elevation of alveolar bone height in tandem with oral mucosal wound healing. Together, these studies suggest that PRF enhances osteogenic lineage differentiation of alveolar bone progenitors more than of periodontal progenitors by augmenting osteoblast differentiation, RUNX2 expression, and mineralized nodule formation via its principal component fibrin. They also document that PRF functions as a complex regenerative scaffold promoting both tissue-specific alveolar bone augmentation and surrounding periodontal soft tissue regeneration via progenitor-specific mechanisms.
Article
Full-text available
Introduction. This paper describes a case of bone augmentation with combination of Platelet-Rich Fibrin (PRF) and β-TCP for treatment of chronic periapical cyst. The case was followed for 12 months. Methods. Patient presented with chronic periapical lesion in maxillary anterior teeth with history of trauma 8 years back. Radiographically, a periapical cyst was seen in relation to maxillary left central and lateral incisors. Conventional endodontic treatment was started. Since it was not successful, apical surgery was performed. Bone augmentation was done using PRF in combination with β-TCP bone graft to achieve faster healing of the periapical region. Regular followups at 3, 6, 9, and 12 months were done. Results. Healing was uneventful. Follow-up examinations revealed progressive, significant, and predictable clinical and radiographic bone regeneration/healing without any clinical symptoms. Conclusions. Combined use of PRF and β-TCP for bone augmentation in treatment of periapical defects is a potential treatment alternative for faster healing than using these biomaterials alone.
Article
The aim is to review and discuss the strategies available for use of platelet rich fibrin as healing aid in dentistry. Platelet rich fibrin (PRF) is a fibrin matrix in which platelet cytokines, growth factors, and cells are trapped and may be released after a certain time and that can serve as a resorbable membrane. Choukroun and his associates were amongst the pioneers for using PRF protocol in oral and maxillofacial surgery to improve bone healing in implant dentistry. Autologous PRF is considered to be a healing biomaterial, and presently, studies have shown its application in various disciplines of dentistry. By using specific keywords, electronic search of scientific papers was carried out on the entire PubMed database with custom range of 5 years. The electronic search yielded 302 papers; based on inclusion and exclusion criteria which were specifically predetermined, 72 papers were identified as suitable to the inclusion criteria and the remaining 230 papers were excluded. After adding three more selected papers through hand search, full text of all the articles retrieved and review was done. By pooling the extracted data from selected papers, the reviewed data was synthesized. Recently by showing good promising results with use of the PRF, it has proved to have a good prospect for its use as healing aid in various aspects of the dentistry.