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The purpose of PRF treatment in implant dentistry

PRF in implant dentistry can help achieving accelerated wound healing and tissue regeneration, increased stimulation of osteogenesis and new blood vessel formation.

Platelet Rich Fibrin has emerged in recent years as a highly promising technique with many applications in dental surgery. The second generation of platelet concentrates – PRF – was subsequently introduced by Joseph Choukroun and his co-workers in 2001. Platelet Rich Fibrin is one of the most powerful and 100% autologous tissue healing booster to be utilised in dental surgery.

The biological properties clearly show an interesting surgical versatility and all the characteristics that can support faster tissue regeneration and high-quality clinical outcomes. It can stimulate osteogenesis as well as angiogenesis and it provides a scaffold that allows cellular migration.

These are certainly the fundamental aspects for bone regeneration.

Where and how can I use it?

A general rule of guidance is to use it in surgical situations where protection and stimulation of healing and regeneration is critical and where the prognosis for tissue repair is poor or potentially compromised.

PRF in implant dentistry is indicated in numerous clinical applications, such as socket augmentation, jump gap filling during immediate extraction and implant placement, and stimulation of bone and soft tissue healing during bone augmentations or during sinus elevation.

PRF in implant dentistry

Increasing implant stability and osseo-integration

PRF application into the osteotomy site increases implant stability during the early healing period, as evidenced by higher ISQ values. Simple application of this material also provides faster osseointegration. Furthermore, when L-PRF is used during one-stage implant placement, the amount of initial bone remodelling (first three months after implant placement) can be reduced significantly. (Öncu and Alaaddinoõglu. 2015).

Ridge preservation

The application of the membrane in an extraction socket significantly reduces the horizontal/vertical ridge resorption, even at sites with bone dehiscence. The observed reduction in bone resorption is comparable to the current best performingclinical procedures (using a bone substitute in combination with connective-tissue graft or membrane).

As a filling material in extraction sockets, it will act as a stable blood clot for neovascularization and accelerated tissue regeneration. Ass a filling material after third-molar extraction has a beneficial effect on both post-operative pain and soft-tissue healing. It enables fast neoangiogenesis and promotes bone regeneration by releasing  growth factors and a good cloth stability.

Alveolar ridge preservation (socket augmentation) for early or late implant placement

The use of membranes to fill the socket after tooth extraction has shown to improve alveolar bone healing and preservation of the alveolar crest width. Plugs or membranes can also be used to fill extraction sockets, even when associated with compromised extraction sockets, severe cystic destructions, or after cyst enucleations to allow early bone and gingival regeneration required for implant placement. (Choukroun, et al., 2006; Magremanne, et al., 2009)

Alternatively, it can also be mixed with a bone substitute to fill the socket and used as a protective cover over the grafted socket. This is particularly important when gingival wound closure is impossible or difficult with the sutures (Del Corso, et al., 2012).

The purpose of the membrane is not only to stimulate gingival healing, but also to protect the bone graft from the oral environment and to maintain it within the extraction socket, like a biological barrier.

 

Sinus floor elevation – using PRF as sole or combination graft biomaterial

The material can either be cut to fragments and mixed with different bone substitutes or can be used as a sole filling material during sinus floor elevation. It can be applied either via a lateral window technique or through a trans-alveolar approach. Several studies have confirmed a natural bone regeneration around the implants (± 10mm vertical bone gain with the window technique, ±4mm for trans- alveolar approach).

Various case studies have demonstrated that the membranes can be used successfully as a protective barrier to cover the sinus membrane during grafting procedures (Diss, et al., 2008; Toffler, et al., 2010; Kanayama, et al., 2014). 

Combined with a bone allograft or other bone substitutes it accelerates graft maturation and decreases the healing period before implant placement. The latter finding has also been confirmed by other clinical trials and case studies (Choukroun, et al., 2006; Tatullo, et al., 2012; Zhang, et al., 2012; Bökbas, et al., 2013).

Guided bone regeneration

As a membrane for guided bone regeneration, the dense matrix architecture covers, protects and stabilizes bone graft material.

PRF liquid (i-PRF) can be injected above, or (A-PRF or L-PRF) membrane placed above the GBR or GTR membrane to act as an interposition barrier to protect and stimulate the bone compartment, and as a healing membrane in order to improve the soft tissue healing and remodeling, and thus avoid soft tissue dehiscence (Peck, et al., 2011; Inchingolo, et al., 2010).

 

Its use in Oral Surgery

In the field of oral surgery the material reduces postoperative complications following third molar extractions.

Post-extraction socket augmentation and healing

The healing and remodeling of an extraction socket is highly dependent on the initial stabilization of the blood clot and the quick gingival wound closure. This can be achieved by placing fibrin plug in the socket (with or without a bone substitute) and closing with a fibrin membrane. Its use as a post extraction sockets filling biomaterial is recommended as a useful procedure in order to reduce the early adverse effects of the inflammation, such as postoperative pain and to promote the soft tissue healing and bone regeneration process.

Reduce post-extraction complications in medically compromised cases

The membrane can be used to minimize post-extraction complications such as osteitis, dry or infected sockets resulting from delayed or potentially compromised healing or bleeding situations in systemic conditions such as such as with diabetics, patients receiving oral bisphosphonate medication presenting a risk of osteonecrosis of the jaws, or patients receiving anticoagulants.

Find out more about the PRF course by clicking on the link below:

PRF 2 day

References:

Ana B. Castro,Nastaran Meschi,Andy Temmerman,Nelson Pinto,Paul Lambrechts,Wim Teughels,Marc Quirynen: Regenerative potential of leucocyteand plateletrich fibrin. Part B: sinus floor elevation, alveolar ridge preservation and implant therapy. A systematic review

Ana B. Castro,Nastaran Meschi,Andy Temmerman,Nelson Pinto,Paul Lambrechts,Wim Teughels,Marc Quirynen: Regenerative potential of leucocyte- and platelet-rich fibrin. Part A: intra-bony defects, furcation defects and periodontal plastic surgery. A systematic review and meta-analysis

Drs. Johan Hartshorne and Howard Gluckman: A comprehensive clinical review of platelet-rich fibrin (PRF) and its role in promoting tissue healing and regeneration: part 3

Michael Pikos, Richard J Miron: PRF as a Barrier Membrane in Guided Bone Regeneration

Choukroun J, Diss A, Simonpieri A, et al. Platelet-rich fibrin (PRF): a second-generation platelet concentrate. Part IV clinical effects on tissue healing. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;101(3):299-303.

Choukroun J, Diss A, Simonpieri A, et al. Platelet-rich fibrin (PRF): a second-generation platelet concentrate. Part V: histologic evaluations of PRF effects on bone allograft maturation in sinus lift. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;101:299-303

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