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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.

Using PRF: physical application

PRF (A-PRF or L-PRF) can either be used as a clot, membrane, injectable liquid (i-PRF), plug, or the membrane can be cut up in fragments. PRF can either be applied in stand-alone, additive, or in combination therapies.

Clinical application of PRF

Stand-alone therapies

Typical stand-alone therapies include using the fibrin plug or membrane as a filler material in extraction sockets to prevent complications and to enhance socket healing (Choukroun, et al., 2006).

PRF membrane used as a filler material in a socket

PRF can also be used as a protective barrier membrane to seal off and promote healing of oroantral communications following extractions; to close a palatal connective tissue harvesting site; or as sole grafting material in sinus floor elevations; or as a vestibuloplasty wound bandage.

PRF membrane used as a protective and regenerative barrier for intrabony defect

Additive therapies

PRF (membrane or liquid) can be added or mixed to bone substitutes such as xenograft or biphasic calcium phosphate (BCP) to enhance the formation of new bone (Toeroek and Dohan 2013).

PRF membrane cut to use as used fragments (left) and PRF membrane cut in fragments to mix with bone particulate (right)

Combination therapies

The PRF membrane is often used in combination with other biomaterials in bone augmentation and grafting sites as a graft material or barrier membrane (Hamzacebi, et al., 2015).

The purpose of PRF is to activate and facilitate the healing and regenerative capacity of the host tissue, by providing a strong fibrin scaffold, major growth factors, and allowing space for tissue regeneration.

Using PRF as a protective barrier on bone graft sites helps avoid perforations of the weakened gingival tissues and prevent associated contamination of the bone graft below.

PRF membrane placed above a GBR membrane as interposition barrier to promote soft tissue healing

Handling PRF: clinical application

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.

PRF membranes are easy to drape over a surgical or augmented site. The elastic consistency of the PRF membrane 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.

Punching a hole in a PRF membrane. Draping a punched membrane over a healing abutment

A PRF membrane also could be used for the following purposes:

Bioactive barrier

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 (Inchingolo, et al., 2010). 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 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 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)

PRF membrane used as a protective and regenerative barrier for intrabony defect

Conclusion

The therapeutic use of PRF for accelerating tissue healing and regeneration has increasingly grabbed the attention of clinicians worldwide because this biomaterial is of natural origin (autologous/derived from the patients’ own blood); PRF technology is readily available; is easy to prepare; can be produced immediately at chairside; is easy to use; and widely applicable in dentistry, while being financially realistic for the patient and the clinician, and with virtually no risk of a rejection reaction (foreign body response).

The use of PRF enables local delivery of a fibrin matrix, cells, growth factors, and proteins that provide unique biological properties and cues for promoting new blood vessel formation, and accelerating wound healing and tissue regeneration, while at the same time reducing adverse events. Consequently, the benefits of PRF in wound and bone healing, its antibacterial and antihemorrhagic effects, the low risks with its use, and the availability of easy and low-cost preparation methods should encourage more clinicians to adopt this technology in their practices for the benefit of their patients

References:

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

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