Platelet-rich fibrin (PRF) or leukocyte- and platelet-rich fibrin (L-PRF) is a derivative of PRP where

autologous Autotransplantation is the transplantation of organs, tissues, or even particular proteins from one part of the body to another in the same person ('' auto-'' meaning "self" in Greek). The autologous tissue (also called autogenous, autogenei ...

platelet Platelets or thrombocytes () are a part of blood whose function (along with the coagulation#Coagulation factors, coagulation factors) is to react to bleeding from blood vessel injury by clumping to form a thrombus, blood clot. Platelets have no ...

s and leukocytes are present in a complex fibrin matrix to accelerate the healing of soft and hard tissue and is used as a tissue-engineering scaffold in oral and maxillofacial surgeries. PRF falls under FDA Product Code KST, labeling it as a blood draw/Hematology product classifying it as 510(k) exempt. To obtain PRF, the required quantity of blood is drawn into test tubes without an anticoagulant and centrifuged immediately. Blood can be centrifuged using a tabletop centrifuge from 3-8 minutes for 1300 revolutions per minute. The resultant product consists of the following three layers: the topmost layer consisting of platelet poor plasma, the PRF clot in the middle, and the red blood cells (RBC) at the bottom. The PRF clot can be removed from the test tube using a pickup instrument (such as Gerald tissue forceps). The RBC layer attached to the PRF clot can be carefully removed using scissors or a blunt instrument. Platelet activation in response to tissue damage occurs during the process of making PRF release several biologically active proteins including; platelet alpha granules, platelet‑derived growth factor (PDGF), transforming growth factors‑β (TGF‑β), vascular endothelial growth factor (VEGF), and epidermal growth factor. Actually, the platelets and leukocyte cytokines play important parts in role of this biomaterial, but the fibrin matrix supporting them is the most helpful in constituting the determining elements responsible for real therapeutic potential of PRF. Cytokines are immediately used and destroyed in a healing wound. The harmony between cytokines and their supporting fibrin matrix has much more importance than any other platelet derivatives.

Dentistry

Ridge preservation

Ridge preservation (Colloquially

Socket preservation Socket preservation or alveolar ridge preservation is a procedure to reduce bone loss after tooth extraction. After tooth extraction, the jaw bone has a natural tendency to become narrow, and lose its original shape because the bone quickly re ...

), a procedure to reduce bone loss after

tooth extraction A dental extraction (also referred to as tooth extraction, exodontia, exodontics, or informally, tooth pulling) is the removal of teeth from the dental alveolus (socket) in the alveolar bone. Extractions are performed for a wide variety of reas ...

to preserve the

dental alveolus Dental alveoli (singular ''alveolus'') are sockets in the jaws in which the roots of teeth are held in the alveolar process with the periodontal ligament. The lay term for dental alveoli is tooth sockets. A joint that connects the roots of the t ...

(containing the tooth socket) in the

alveolar bone The alveolar process () is the portion of bone containing the tooth sockets on the jaw bones (in humans, the maxilla and the mandible). The alveolar process is covered by gums within the mouth, terminating roughly along the line of the mandibu ...

. A platelet-rich fibrin (PRF) membrane containing bone growth enhancing elements can be stitched over the wound or a graft material or scaffold is placed in the socket of an extracted tooth at the time of extraction. The socket is then directly closed with stitches or covered with a non-resorbable or resorbable membrane and sutured.

Sinus lift

A platelet-rich fibrin can be used if a

sinus lift Maxillary sinus floor augmentation (also known as a sinus lift, sinus graft, sinus augmentation, or sinus procedure) is a Surgery, surgical procedure to increase the amount of bone in the upper back part of the jaw (Commonly used terms of relat ...

is required for a

dental implant A dental implant (also known as an endosseous implant or fixture) is a prosthesis that interfaces with the bone of the jaw or skull to support a dental prosthesis such as a crown (dentistry), crown, bridge (dentistry), bridge, dentures, denture ...

Periodontal regeneration

Reproduction or reconstitution of a lost or injured part to restore the architecture and function of the periodontium becomes the integral part of comprehensive periodontal therapy. Conventional open flap debridement falls short of regenerating tissues destroyed by the disease.

Platelet derived growth factor Platelet-derived growth factor (PDGF) is one among numerous growth factors that regulate cell growth and division. In particular, PDGF plays a significant role in blood vessel formation, the growth of blood vessels from already-existing blood ...

along with bone morphogenetic proteins are among the most researched growth factors in periodontal regeneration. Platelet rich fibrin showed significant improvement in clinical periodontal parameter as well as in radiograph when compared with open flap debridement alone in a

meta analysis Meta-analysis is a method of synthesis of quantitative data from multiple independent studies addressing a common research question. An important part of this method involves computing a combined effect size across all of the studies. As such, th ...

. Several bone graft materials have been used in the treatment of infrabony defects. Demineralized freeze dried bone allograft (DFDBA) has been histologically proven to be the material of choice for regeneration. Platelet-rich fibrin has shown significant results comparable to DFDBA for periodontal regeneration. One of the most common aesthetic problem encountered in the field of periodontology is gingival recession, which is perceived by the patients as increase in length of teeth. Though connective tissue graft is a gold standard procedure, PRF can be used as an alternative procedure by keeping patient's comfort in mind.

Guided bone and tissue regeneration

PRF is used in guided bone and tissue regeneration.

Regenerative endodontics

PRF enhances alveolar bone augmentation and necrotic

dental pulp The pulp is the connective tissue, nerves, blood vessels, and odontoblasts that comprise the innermost layer of a tooth. The pulp's activity and signalling processes regulate its behaviour. Anatomy The pulp is the neurovascular bundle cen ...

and open tooth apex can be revitalized in

regenerative endodontics Regenerative endodontic procedures is defined as biologically based procedures designed to replace damaged structures such as dentin, root structures, and cells of the pulp-dentin complex. This new treatment modality aims to promote normal function ...

with platelet-rich fibrin.

References

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