ABSTRACT
Platelet-rich fibrin (PRF) is a biocompatible fibrin matrix that acts as a resorbable membrane, collecting platelet cytokines, growth factors, and cells and releasing them. It is easily extracted from blood. Many dentists use PRF, a concentrated growth factor solution, to treat various lesions and regenerate tooth and oral tissues. This research examines the pros, cons, and suggestions of using PRF in dentistry.
KEYWORDS: Dentistry, PRF, PRP
INTRODUCTION
Dr. Joseph Choukroun and colleagues introduced platelet-rich fibrin (PRF) in 2001. It’s a second-generation platelet concentrate made from the patient’s blood without anticoagulants or biochemical alterations. PRF produces hard and soft tissues, increasing healing alone or with a bone substitute.[1]
In the 1970s, a platelet concentrate known as PRP, which was of the first generation, was very common. The method of preparation was challenging, and the bovine thrombin used could spread illness to other patients. Because of the difficulties presented by these factors, researchers developed Choukroun’s PRF, a more recent platelet concentrate.[2] This article will elaborate various applications of PRF in dentistry, as well as its benefits, limitations, and recommendations.
PRF preparation
PRF preparation is simple and uses the same equipment as PRP. Each of the two 6-ml sterile vacutainer tubes receives about 5 ml of whole blood without anticoagulant. After that, the vacutainer tubes spin at 3,000 rpm for 10 min in a centrifuge. Centrifuged test tube contents form three layers. Acellular platelet-deficient plasma is on top of the test tube, followed by a PRF clot and red blood cells. The central layer of the PRF clot is removed from the red blood cells (RBC) layer underlying it with sterile tweezers and scissors, placed on a sterile plate, and refrigerated. Hypothesis: Multiple development components conserve the PRF-RBC confluence [Tables 1 and 2].[3]
Table 1.
| Growth factors | Function |
|---|---|
| PDGFs | Cell migration, proliferation, and collagen formation; all these play specific roles in the remodeling of the extracellular matrix to close the wound |
| TGF-β1 | Extracellular matrix production, immunological regulation, and tissue repair |
| VEGF | Promote angiogenesis and also contributes to tissue remodeling |
| EGF | Endothelial and mesenchymal cell growth and proliferation, which results in epithelization |
| IGFs | It has a cell-protective character and takes part in the growth and differentiation of different types of cells |
PDGFs=Platelet-derived growth factors; TGF-β1=transforming growth factor β1; VEGF=vascular endothelial growth factor; EGF=endothelial growth factor; IGFs=insulin-like growth factors
Table 2.
| Advantages | Disadvantages |
|---|---|
| Simple process | Autologous blood limits volume |
| Needs only autologous blood | Puncture for blood collection may cause treatment rejection |
| Minimal blood manipulation | The PRF protocol’s performance depends on blood collection timing and centrifuge transfer |
| Faster healing | Very difficult to store PRF after preparation |
| Cost-effective | Manipulation of PRF requires clinical experience |
| It can be utilized with or without bone transplants |
The present utilization of PRF in the field of dentistry encompasses the following applications
PRF in oral surgical procedures
According to the findings of some studies, PRF can be utilized to fill empty extraction sites. When PRF is used as a filler material in extraction sockets, it will function as a stable blood clot to encourage neovascularization and hasten the process of tissue regeneration. Diabetics and others whose immune systems are not functioning properly may benefit from using this to speed up their recovery from injuries. Patients who are taking anticoagulant medication may benefit from using PRF as an adjuvant because it encourages the formation of blood clots (through thrombospondin) and the closure of wounds.[3]
PRF in regenerative endodontics
Revascularization successfully prevented root canal blood clots. Platelet concentrations become autologous scaffolds for revascularization. PRF scaffolds and growth factors can revascularize young permanent teeth with necrotic pulps and support tissue development. Growth factors release as the fibrin matrix resorbs, ensuring healing. Shivashankar et al. found that PRF thickened dentinal walls, extended roots, regressed the peri-apical lesion, and closed the apex on a tooth with pulpal necrosis.[4,5]
PRF in periodontics
In periodontal therapy, the goal is to regenerate damaged tissues in order to improve the health, function, and look of the peri-odontium. PRF is utilized in the field of periodontics for the treatment of gingival recession, osseous defects, peri-apical lesions, and periodontal bone rejuvenation. PRF membrane can be used to treat gingival recession by creating a coronally advanced flap and functioning as a subepithelial connective tissue transplant.
PRF may also restore peri-implant bone deficiencies. Peri-implantitis-induced bone loss can be filled with PRF and bone transplants. In cases with inadequate bone around the implant, the implant can be placed straight into the socket after tooth extraction. PRF improves osseointegration and peri-implant bone healing.[6]
PRF in pediatric dentistry
PRF’s tissue-stimulating and -healing characteristics may make it popular in pediatric dentistry. Due to its wound healing, tissue regeneration, and osteogenic properties, PRF may be useful for direct pulp capping and pulpotomy.[7]
Tissue engineering PRF
In recent years, the application of PRF in tissue engineering has been the focus of a significant amount of research. In a study, Gassling and colleagues successfully constructed in-vitro bone tissue using human periosteal cells. Nevertheless, further research is needed to identify the clinical applications of PRF membranes; therefore, the study was not conclusive.[8]
Other applications of PRF
As a result of the high incidence of alopecia in guys, medication is typically the first line of treatment for the condition. PRP has been put to use in the field of medical science to stimulate new hair growth and hair follicle regeneration, with encouraging results. On the other hand, PRF has been shown to have higher regeneration properties. Injectable (i-PRF), which is a liquid form of PRF, is the most current advancement that has been made in the field of scalp injections. This is because it is the most practical way to administer PRF. The i-PRF formulation includes progenitor cells that can regenerate damaged tissue. The use of PRF, also known as i-PRF, has shown promising results in the treatment of alopecia types VI and VII, two difficult disorders that make it extremely difficult to locate treatments that are helpful.[9]
CONCLUSION
PRF can be used in a variety of medical and dental procedures, amongst other fields, including dentistry and medicine. Its application has repeatedly resulted in extremely impressive accomplishments in a short period of time. In addition, a wealth of research, conducted both now and in the past, has unequivocally demonstrated that it is safe to use PRF in craniofacial applications. PRF has been the subject of a number of research projects that have investigated its potential usefulness as a therapeutic on its own or in combination with other biomaterials. These investigations yield positive, secure results without dispute. Long-term studies are needed to assess this biomaterial’s efficacy and optimize its use in traditional clinical dentistry.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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