PRF 1) Introduction To PRF

PRF
1) Introduction to PRF:
The first act of healing associates many actors, first of all platelets, leukocytes,
fibrin matrix and many growth factors. All these actors work in synergy during the
coagulation process, and many products logically tried to mimic these natural
mechanisms in order to improve healing on a surgical site. This trend started many
years ago with fibrin glues in 1970s and evolved recently with platelet concentrates
technologies. Both have same concept of technology.
Fibrin glues technology based on polymerization of fibrinogen into fibrin.
The concept of platelet concentrations is to use a centrifugation procedure (often in
2 steps) in order to concentrate and collect most platelets from a blood harvest
(taken with anticoagulant), and to inject them into a wounded site in order to
improve healing. The activation of the product (with thrombin for example)
induces the platelet growth factors release and the polymerization of fibrinogen
(released by platelets or free in the plasma) into fibrin, leading to a platelet gel.
Platelets play a crucial role not only in hemostasis, but also in the wound healing
process, as they are reservoirs of growth factors and cytokines, which in turn are
key promoters for bone and soft tissues regeneration. After platelets are activated,
they become trapped within a fibrin matrix and release growth factors. Together
the fibrin can form a scaffold and the growth factors can stimulate tissue healing
and regeneration repair responses.
2) Types of platelet concentrate in dentistry:

These variations include differences in centrifugation speeds and times, differences
in adding chemicals, and differences in the selection of supernatants and
precipitates. These variations can cause differences in fibrin network structures and
in platelets, leucocyte and growth factors content.
 PRP, In the PRP method, an initial centrifugation to separate red blood cells
(RBC) is followed by a second centrifugation to concentrate platelets, the
first one with anticoagulant and second one with no anticoagulant. The first
one on 240-300 g centrifugation force for 5-8 mins according to the device,
the second one on 700-1000 g for 17 mins. One of the reported drawbacks
of PRP is that it contains anticoagulants, an event that interferes with the
natural healing process despite containing a number of growth factors
implicated in tissue repair and the other one is multiple steps protocol so
consume time and costy.
 In 1999, Anitua described a manual version of the original PRP technology,
using a one-step centrifugation process and several pipetting steps. The final
product was called PRGF (Plasma or Preparation Rich in Growth Factors),
and contained no leukocyte and lower platelet and growth factor
concentrations than other products. The blood is centrifuged (580g) in 9 ml
tubes with anticoagulant during 8 minutes allowing the separation of red and
white blood cells from the platelet-rich plasma. The two fractions of PRGF
are separated from the rest of the blood components by means of the plasma
transfer device (PTD). It could be activated with calcium chloride in order to
produce a PRGF gel.
The difference between PRGF and PRP is that PRGF is optimized to deliver a
more sustained release of growth factors. PRGF can create a three-dimensional
fibrin scaffold which can be injected into a tissue defect, to maintain the
regenerative space and can be used as a scaffold for cells to accomplish tissue
regeneration.
 Choukroun et al. described in 2001 the Platelet-Rich Fibrin (PRF) technique,
it was considered as a second-generation platelet concentrate technology.
Blood is collected without anticoagulant and centrifuged immediately for 10
mins at 400gm and 2700 rpm, leading to the natural formation of a strong
PRF clot in the middle of the tube. The platelet activation and the fibrin
polymerization are not the final step of the process, they are the process.
 L-PRF, Recently, a considerable evidence on the role of white cells as
monocytes on the bone regeneration and the vessels growth emerged
through numerous publications. The monocytes play an essential role on
bone growth, vascularization and production of vascular endothelial growth
factor (VEGF). The monocytes have BMP receptors and recently it was
demonstrated that Monocytes produce BMP-2. We started to try to include
the monocytes within the PRF. The first clinical and scientific outcomes are
very exciting: more and earlier vascularization, faster soft tissue growth,
release of BMPs and more cytokines than classical PRF. blood sample is
taken in 9ml tubes without anticoagulant and immediately centrifuged at
2700 rpm during 12 minutes at 400 g. L-PRF is the source of a strong and
slow release of growth factors during more than 7 days in vitro, through the
release of the platelet growth factors trapped within the fibrin gel or through
the production of new molecules by the leukocytes of the clot. In vitro, the
L-PRF membranes have strong effects on the stimulation of the proliferation
of most cell types (fibroblasts, keratinocytes, pre-adipocytes, osteoblasts,
bone mesenchymal stem cells) and on the differentiation of the bone cells.
Also released the highest total amount of growth factors when compared to
either PRF or PRP. the tensile strength, stiffness, and toughness of early L-
PRF membranes were higher than the PRGF and PRF
 i-PRF, The same PRF concept as no anticoagulant neither an additive gives
us at the end of the spin a PRF liquid and injectable. It coagulates
immediately after the injection. 10 ml of blood is collected and centrifugatd
at 700 rpm for 3 mins.
3) Growth factors:
Platelets contain the alpha granules which when activated release the following
biological growth factors: platelet-derived growth factor (PDGF), transforming
growth factor-beta (TGF-b), vascular endothelial growth factor (VEGF), insulin-
like growth factor I, epidermal growth factor (EGF) and epithelial cell growth
factor.
4) When I can’t do PRF?
Absolute Contraindications:
• Platelet dysfunction syndrome
• Critical thrombocytopenia
• Hemodynamic instability
• Septicemia
• Local infection at the site of the procedure
• Patient unwilling to accept risks
• HGB < 10 g/dl
• Platelet count < 105/ul
• Cancer- especially hematopoetic or of bone
5) Clinical applications of platelet concentrates in dentistry:

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PRF

2) Types of platelet concentrate in dentistry:

4) When I can’t do PRF?

5) Clinical applications of platelet concentrates in dentistry:

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