PRF in dental implantology can help achieving accelerated wound healing and tissue regeneration, increased stimulation of osteogenesis and new blood vessel formation.
Platelet-rich fibrin (PRF) is a patient blood-derived living biomaterial with applications in a wide range of fields, including implant dentistry, periodontics, oral surgery.
The 3D architecture of the fibrin matrix provides the PRF membrane with great density, elasticity, flexibility and strength that are excellently suited for handling, manipulation and suturing.
Clinical application of membrane
PRF membranes in dental implantology are easy to drape over a surgical or augmented site. The elastic consistency also allows the clinician to punch a hole in the membrane to drape over a healing abutment before suturing the flap (Ghetiu, et al., 2015). Mixing autogenous bone or bone substitutes (allografts) with i-PRF (PRF liquid) for use in GBR procedures transforms particulate bone into an easy to handle gel consistency.
A PRF membrane is a blood clot prepared in an optimized form that is rich in cells and growth factors, and acts as a natural bioactive barrier, allowing interaction with the tissues below and above it. This interaction with tissues facilitates natural tissue regeneration (NTR) and healing. PRF will undergo quicker remodeling (biodegradation) in situ than a resorbable collagen membrane, but will also promote a strong induction on the periosteum/gingival tissue due to the slow release of growth factors and other matrix proteins (Krasny, et al., 2011; Kim, et al., 2013).
Competitive interposition barrier
GTR membranes are cell-proof barriers against soft tissue invagination, whereas PRF membranes allow cells to migrate through it, thus allowing new blood vessel formation that will facilitate regenerative and healing interactions between the tissues below and above the PRF membrane. The PRF membrane in dental implantology is a highly stimulating matrix, attracting cell migration and differentiation preferentially, and also reinforcing the natural periosteal barrier.
The hard and soft tissues migrate and interact within the PRF matrix. The PRF matrix becomes the interface between the tissues and therefore avoids the migration of the soft tissues deeper within grafted defect or augmented site. This biological characteristic is referred to as a competitive barrier (Krasny, et al., 2011). However, it is important to recognize that using PRF as a competitive barrier does not have the graft stability or space maintenance characteristics of a normal collagen membrane, and therefore cannot be recommended for use as such.
Protective barrier and healing booster
PRF membranes in dental implantology are frequently used for the protection of the grafted area and as a healing booster for the soft tissues above the grafted defects or augmented sites (Inchingolo, et al., 2010). The purpose of the PRF membrane is not only to protect the blood clot and/or the graft material, like in the GTR concept, but also to promote the induction of a strong and thick periosteum and gingiva. This boosted periosteum functions as a true barrier between the soft tissue and bone compartments, and constitutes probably the best protection and regenerative barrier for the intrabony defects (Inchingolo, et al., 2010)
The benefits of PRF in dental implantology are faster wound and bone healing, antibacterial and antihemorrhagic effects, low risks with its use, and the availability of easy and low-cost preparation methods which should encourage more clinicians to adopt this technology in their practices for the benefit of their patients.
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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 2
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. 101:299-303.
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):e56-e60