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J Oral Implantol. 2014 Dec;40(6):679-89. doi: 10.1563/aaid-joi-D-14-00138.
Advanced platelet-rich fibrin: a new concept for cell-based tissue engineering by means of inflammatory cells.
Ghanaati S1, Booms P, Orlowska A, Kubesch A, Lorenz J, Rutkowski J, Landes C, Sader R, Kirkpatrick C, Choukroun J.
- 11 FORM - Frankfurt Orofacial Regenerative Medicine, Clinic of Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Medical Center of the Goethe University Frankfurt, Frankfurt am Main, Germany.
Abstract
Choukroun's platelet-rich fibrin (PRF) is obtained from blood without adding anticoagulants. In this study, protocols for standard platelet-rich fibrin (S-PRF) (2700 rpm, 12 minutes) and advanced platelet-rich fibrin (A-PRF) (1500 rpm, 14 minutes) were compared to establish by histological cell detection and histomorphometrical measurement of cell distribution the effects of the centrifugal force (speed and time) on the distribution of cells relevant for wound healing and tissue regeneration. Immunohistochemistry for monocytes, T and B -lymphocytes, neutrophilic granulocytes, CD34-positive stem cells, and platelets was performed on clots produced from four different human donors. Platelets were detected throughout the clot in both groups, although in the A-PRF group, more platelets were found in the distal part, away from the buffy coat (BC). T- and B-lymphocytes, stem cells, and monocytes were detected in the surroundings of the BC in both groups. Decreasing the rpm while increasing the centrifugation time in the A-PRF group gave an enhanced presence of neutrophilic granulocytes in the distal part of the clot. In the S-PRF group, neutrophils were found mostly at the red blood cell (RBC)-BC interface. Neutrophilic granulocytes contribute to monocyte differentiation into macrophages. Accordingly, a higher presence of these cells might be able to influence the differentiation of host macrophages and macrophages within the clot after implantation. Thus, A-PRF might influence bone and soft tissue regeneration, especially through the presence of monocytes/macrophages and their growth factors. The relevance and feasibility of this tissue-engineering concept have to be proven through in vivo studies.
KEYWORDS:
PRF; inflammation; macrophages; neutrophils; platelets; tissue engineering
Arch Oral Biol. 2010 Mar;55(3):185-94. doi: 10.1016/j.archoralbio.2010.01.004. Epub 2010 Feb 21.
Choukroun's platelet-rich fibrin (PRF) stimulates in vitro proliferation and differentiation of human oral bone mesenchymal stem cell in a dose-dependent way.
Dohan Ehrenfest DM1, Doglioli P, de Peppo GM, Del Corso M, Charrier JB.
- 1Department of Biomaterials, Institute for Clinical Sciences, The Sahlgrenska Academy at University of Gothenburg, Sweden. LoB5@mac.com
Abstract
BACKGROUND:
Choukroun's platelet-rich fibrin (PRF) is an autologous leukocyte- and platelet-rich fibrin biomaterial. The purpose of this study was to analyse the in vitro effects of PRF on human bone mesenchymal stem cells (BMSC), harvested in the oral cavity after preimplant endosteal stimulation.
MATERIALS AND METHODS:
BMSCs from primary cultures were cultivated with or without a PRF membrane originating from the same donor as for the cells, in proliferation or osteoblastic differentiation conditions. After 7 days, the PRF membranes were removed. A series of cultures were performed using 2 PRF membranes, in order to measure the dose-dependent effect. Cell counts, cytotoxicity tests, alkaline phosphatase (ALP) activity quantification, Von Kossa staining and mineralisation nodules counts were performed at 3, 7, 14, 21 and 28 days. A last independent series was carried on up to 14 days, for a morphological scanning electron microscope (SEM) observation.
RESULTS:
PRF generated a significant stimulation of the BMSC proliferation and differentiation throughout the experimental period. This effect was dose-dependent during the first weeks in normal conditions, and during the whole experimentation in differentiation conditions. The cultures without PRF in differentiation conditions did not rise above the degree of differentiation of the cultures in normal conditions with 1 or 2 PRF up to the 14th and 28th day, respectively. The SEM culture analysis at day 14 allowed to show the mineralisation nodules which were more numerous and more structured in the groups with PRF compared to the control groups.
DISCUSSION AND CONCLUSIONS:
This double contradictory proliferation/differentiation result may be due to the numerous components of PRF, particularly the presence of leukocytes: any culture with PRF is in fact a coculture with leukocytes. It could be the source of differential geographic regulation processes within the culture. The combination of oral BMSC and PRF might offer many potential clinical and biotechnological applications, and deserves new studies.
Copyright 2010 Elsevier Ltd. All rights reserved.
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Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009 Sep;108(3):341-52. doi: 10.1016/j.tripleo.2009.04.020. Epub 2009 Jul 9.
In vitro effects of Choukroun's PRF (platelet-rich fibrin) on human gingival fibroblasts, dermal prekeratinocytes, preadipocytes, and maxillofacial osteoblasts in primary cultures.
Dohan Ehrenfest DM1, Diss A, Odin G, Doglioli P, Hippolyte MP, Charrier JB.
- 1Researcher, Department of Biomaterials, Institute for Clinical Sciences, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden. LoB5@mac.com
Abstract
OBJECTIVES:
The objective of this study was to analyze the effects of Choukroun's PRF (platelet-rich fibrin), a leucocyte and platelet concentrate clinically usable as fibrin membrane or clot, on human primary cultures of gingival fibroblasts, dermal prekeratinocytes, preadipocytes, and maxillofacial osteoblasts.
STUDY DESIGN:
For the proliferation study, these cells were cultivated with or without a PRF membrane originating from the same donor as for the cells. For osteoblasts and fibroblasts, dose-dependent effect was assessed (using 2 membranes). Cell counts and cytotoxicity tests were performed at 3, 7, 14, and 21 days, and even 28 days for osteoblasts. More osteoblast cultures were prepared in differentiation conditions according to 3 modalities (without PRF, with PRF, with PRF the first day and differentiation medium applied only after the first week of culture). Osteoblast differentiation was analyzed using Von Kossa staining and alkaline phosphatase, DNA and total cell proteins dosage.
RESULTS:
PRF induced a significant and continuous stimulation of proliferation in all cell types. It was dose dependent during all the experiment with osteoblasts, but only on day 14 with fibroblasts. Moreover, PRF induced a strong differentiation in the osteoblasts, whatever the culture conditions. The analysis of osteoblast cultures in differentiation conditions with PRF, using light and scanning electron microscopy, revealed a starting mineralization process in the PRF membrane itself after 14 days. Moreover, PRF leucocytes seemed to proliferate and interact with osteoblasts.
CONCLUSIONS:
Cultures with PRF are always cocultures with leucocytes. These "chaperone leucocytes" could be the source of differential geographic regulation within the culture and explain the double contradictory effect proliferation/differentiation observed on osteoblasts.
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Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009 Nov;108(5):707-13. doi: 10.1016/j.tripleo.2009.06.044.
A comparative study of platelet-rich fibrin (PRF) and platelet-rich plasma (PRP) on the effect of proliferation and differentiation of rat osteoblasts in vitro.
He L1, Lin Y, Hu X, Zhang Y, Wu H.
- 1Department of Implantology, School and Hospital of Stomatology, Peking University, Beijing, China.
Abstract
OBJECTIVE:
The purpose of this study was to evaluate the effect of biologic characteristics of platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) on proliferation and differentiation of rat osteoblasts.
STUDY DESIGN:
Blood samples were collected from 14 healthy volunteers (7 male) with a mean age of 23.2 +/- 2.24 years. PRP and PRF were prepared with standard protocols. The exudates of PRP and PRF were collected at the time points of 1, 7, 14, 21, and 28 days. The levels of platelet-derived growth factor AB (PDGF-AB) and transforming growth factor beta1 (TGF-beta1) were quantified in PRP and PRF. Then the exudates of PRP and PRF were used to culture rat calvaria osteoblasts. The biologic characteristics of osteoblasts were analyzed in vitro for 14 days.
RESULTS:
PRP released the highest amounts of TGF-beta1 and PDGF-AB at the first day, followed by significantly decreased release at later time points. PRF released the highest amount of TGF-beta1 at day 14 and the highest amount of PDGF-AB at day 7. Exudates of PRP collected at day 1 and exudates of PRF collected at day 14 expressed maximum alkaline phosphatase (ALP) activity, though no significance was shown. Cells treated with exudates of PRF collected at day 14 reached peak mineralization significantly more than both negative control and positive control groups. PRF is superior to PRP, from the aspects of ｅxpression of ALP and induction of mineralization.
CONCLUSIONS:
PRF released autologous growth factors gradually and expressed stronger and more durable effect on proliferation and differentiation of rat osteoblasts than PRP in vitro.
Comment in
- Selecting a relevant in vitro cell model for testing and comparing the effects of a Choukroun's platelet-rich fibrin (PRF) membrane and a platelet-rich plasma (PRP) gel: tricks and traps. [Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010]
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Int J Periodontics Restorative Dent. 2015 May-Jun;35(3):415-22. doi: 10.11607/prd.1861.
Treatment of Peri-implant Bone Defects with Platelet-Rich Fibrin.
Hamzacebi B, Oduncuoglu B, Alaaddinoglu EE.
Abstract
The objective of this study was to investigate and compare the clinical effectiveness of the application of platelet-rich fibrin (PRF) and conventional flap surgery for the treatment of peri-implant bone loss. Nineteen patients (8 women, 11 men) with peri-implant bone loss were randomly allocated to two groups, with the PRF group comprising patients who received fibrin scaffold and the control group made up of those who received only the access flap. At 3 and 6 months after surgery, respectively, the PRF group demonstrated higher mean probing depth reductions (2.41 ± 1.06 and 2.82 ± 1.03 mm versus 1.65 ± 1.02 and 2.05 ± 0.77 mm) and more gains in clinical attachment level (2.89 ± 1.01 and 3.31 ± 1.08 mm versus 1.43 ± 1.08 and 1.84 ± 0.81 mm) compared with the control group. In addition, the increase in the amount of keratinized mucosa from baseline to 6 months postoperatively was statistically significant for the PRF group (P < .001). Hence, the data from the current study led to the conclusion that PRF application in periimplant bone loss provided better clinical results than conventional flap surgery.
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Srp Arh Celok Lek. 2010 Jan-Feb;138(1-2):11-8.
[The use of platelet-rich fibrin membrane in gingival recession treatment].
[Article in Serbian]
Aleksić Z, Janković S, Dimitrijević B, Divnić-Resnik T, Milinković I, Leković V.
Abstract
INTRODUCTION:
Fibrin, fibronectin, platelet derived growth factor, and transforming growth factors from platelet concetrate are crucial for tissue reparation and regeneration.
OBJECTIVE:
This study was designed to evaluate clinical effectiveness of activated platelet-rich fibrin (PRF) membrane in treatment of gingival recession.
METHODS:
19 gingival recessions Miller class I or II were treated with a coronally advanced flap and the PRF membrane (PRF group). Following the elevation of the flap, bone and root surfaces were covered with the PRF membrane. After suturing, the PRF membrane was covered with a coronally advanced flap. In the same patients, 19 other gingival recessions were treated with CTG in combination with the coronally advanced flap (the CTG group). Clinical recordings were made of vertical recession depth (VRD), probing depth (PD), clinical attachment level (CAL) and keratinized tissue width (KTW) before and 12 months after mucogingival surgical treatment. Clinical evaluation of healing events was estimated with recordings of the healing index (HI). Recordings of HI were performed in the 1st, 2nd and 3rd week post-surgically.
RESULTS:
Mean root coverage was significant in both groups (the PRF group 79.94% and the CTG group 88.56% %; p < 0.01). The difference between the two tested groups was not statistically significant. Results of the keratinized tissue width showed significant increase (p < 0.05) 12 months after the surgery in both, the PRF and CTG groups. Results of KTW showed statistical significance of recorded differences obtained in the two evaluated groups (p < 0.05). There was no statistical significance in reduction of PD and CAL recorded in the PRF and CTG groups. The values of HI recorded in the 1st and 2nd week postoperatively were significantly enhanced in the PRF group (p < 0.05).
CONCLUSION:
Results of this study confirm both procedures as effective with equivalence of clinical results in solving gingival recession problems. The utilization of the PRF resulted in a decreased postoperative discomfort and advanced tissue healing.
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J Conserv Dent. 2013 Jul;16(4):284-93. doi: 10.4103/0972-0707.114344.
Role of Platelet rich fibrin in wound healing: A critical review.
Naik B1, Karunakar P, Jayadev M, Marshal VR.
- 1Department of Conservative Dentistry and Endodontics, Sri Dharmasthala Manjunatheshwara College of Dental Sciences, Dharwad, Karnataka, India.
Abstract
AIM:
The aim is to review and discuss the strategies available for use of platelet rich fibrin as healing aid in dentistry.
BACKGROUND:
Platelet rich fibrin (PRF) is a fibrin matrix in which platelet cytokines, growth factors, and cells are trapped and may be released after a certain time and that can serve as a resorbable membrane. Choukroun and his associates were amongst the pioneers for using PRF protocol in oral and maxillofacial surgery to improve bone healing in implant dentistry. Autologous PRF is considered to be a healing biomaterial, and presently, studies have shown its application in various disciplines of dentistry.
MATERIALS AND METHODS:
By using specific keywords, electronic search of scientific papers was carried out on the entire PubMed database with custom range of 5 years. The electronic search yielded 302 papers; based on inclusion and exclusion criteria which were specifically predetermined, 72 papers were identified as suitable to the inclusion criteria and the remaining 230 papers were excluded. After adding three more selected papers through hand search, full text of all the articles retrieved and review was done. By pooling the extracted data from selected papers, the reviewed data was synthesized.
CONCLUSION:
Recently by showing good promising results with use of the PRF, it has proved to have a good prospect for its use as healing aid in various aspects of the dentistry.
KEYWORDS:
Growth factors; platelet rich fibrin; platelet rich plasma; wound healing
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Int J Med Sci. 2012;9(10):872-80. doi: 10.7150/ijms.5119. Epub 2012 Nov 7.
Platelet Rich Fibrin (P.R.F.) in reconstructive surgery of atrophied maxillary bones: clinical and histological evaluations.
Tatullo M1, Marrelli M, Cassetta M, Pacifici A, Stefanelli LV, Scacco S, Dipalma G, Pacifici L, Inchingolo F.
- 1Dept. of Basic Medical Science, University of Bari, Italy.
Abstract
INTRODUCTION:
Maxillary bone losses often require additional regenerative procedures: as a supplement to the procedures of tissue regeneration, a platelet concentrate called PRF (Platelet Rich Fibrin) was tested for the first time in France by Dr. Choukroun. Aim of the present study is to investigate, clinically and histologically, the potential use of PRF, associated with deproteinized bovine bone (Bio-Oss), as grafting materials in pre-implantology sinus grafting of severe maxillary atrophy, in comparison with a control group, in which only deproteinized bovine bone (Bio-Oss) was used as reconstructive material.
MATERIALS AND METHODS:
60 patients were recruited using the cluster-sampling method; inclusion criteria were maxillary atrophy with residual ridge < 5mm. The major atrophies in selected patients involved sinus-lift, with a second-look reopening for the implant insertion phase. The used grafting materials were: a) Bio-Oss and b) amorphous and membranous PRF together with Bio-Oss. We performed all operations by means of piezosurgery in order to reduce trauma and to optimize the design of the operculum on the cortical bone. The reopening of the surgical area was scheduled at 3 different times.
RESULTS:
72 sinus lifts were performed with subsequent implants insertions.We want to underline how the histological results proved that the samples collected after 106 days (Early protocol) with the adding of PRF were constituted by lamellar bone tissue with an interposed stroma that appeared relaxed and richly vascularized.
CONCLUSIONS:
The use of PRF and piezosurgery reduced the healing time, compared to the 150 days described in literature, favoring optimal bone regeneration. At 106 days, it is already possible to achieve good primary stability of endosseous implants, though lacking of functional loading.
KEYWORDS:
Bone replacement.; Grafting Materials; Platelet Rich Fibrin; Reconstructive Surgery
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Oral Surg Oral Med Oral Pathol Oral Radiol. 2012 May;113(5):583-92. doi: 10.1016/j.tripleo.2011.04.029. Epub 2011 Aug 10.
A comparative study of the effectiveness of sinus bone grafting with recombinant human bone morphogenetic protein 2-coated tricalcium phosphate and platelet-rich fibrin-mixed tricalcium phosphate in rabbits.
Kim BJ1, Kwon TK, Baek HS, Hwang DS, Kim CH, Chung IK, Jeong JS, Shin SH.
- 1Department of Oral and Maxillofacial Surgery, Dong-A University Medical Center, Busan, Korea.
Abstract
OBJECTIVES:
The objective of this histologic study was to evaluate platelet-rich fibrin (PRF)-mixed tricalcium phosphate (TCP) and recombinant human bone morphogenic protein 2 (rhBMP-2)-coated TCP in their potential to enhance bone regeneration in sinus elevation in rabbits as well as in their inflammatory features.
STUDY DESIGN:
Bilateral round-shaped defects (diameter 8.0 mm) were formed in the maxillary anterior sinus walls of 36 New Zealand white rabbits. The defects were grafted with TCP only (control group), with rhBMP-2-coated TCP (experimental group A) and with PRF-mixed TCP (experimental group B). Each group included 12 rabbits. The animals were killed at 3 days, 1 week, 2 weeks, 4 weeks, 6 weeks, and 8 weeks. The specimens underwent decalcification and were stained for histologic analysis.
RESULTS:
There were no significant differences in inflammatory features among the groups at 3 days or the first week after operation. In a histomorphometric analysis, the new bone formation ratio showed significant differentiation between groups A and B. The TCP-only control group showed a relatively lower bone formation ratio rather than the experimental groups. The PRF-mixed TCP group showed a larger bone formation area, compared with both the control group and group A.
CONCLUSIONS:
In the results of the histologic evaluation (hematoxylin-eosin, Masson trichrome stain), the experimental groups A and B showed rapid bone formation, remodeling, and calcification in the second week. Moreover, there was a significant difference between those experimental groups and the control group in the new bone formation area at the fourth, sixth, and eighth weeks. The PRF-mixed TCP showed more rapid bone healing than the rhBMP-2-coated TCP or the TCP-only control.
Copyright © 2012 Elsevier Inc. All rights reserved.
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J Oral Implantol. 2014 Dec;40(6):679-89. doi: 10.1563/aaid-joi-D-14-00138.
Advanced platelet-rich fibrin: a new concept for cell-based tissue engineering by means of inflammatory cells.
Ghanaati S1, Booms P, Orlowska A, Kubesch A, Lorenz J, Rutkowski J, Landes C, Sader R, Kirkpatrick C, Choukroun J.
- 11 FORM - Frankfurt Orofacial Regenerative Medicine, Clinic of Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Medical Center of the Goethe University Frankfurt, Frankfurt am Main, Germany.
Abstract
Choukroun's platelet-rich fibrin (PRF) is obtained from blood without adding anticoagulants. In this study, protocols for standard platelet-rich fibrin (S-PRF) (2700 rpm, 12 minutes) and advanced platelet-rich fibrin (A-PRF) (1500 rpm, 14 minutes) were compared to establish by histological cell detection and histomorphometrical measurement of cell distribution the effects of the centrifugal force (speed and time) on the distribution of cells relevant for wound healing and tissue regeneration. Immunohistochemistry for monocytes, T and B -lymphocytes, neutrophilic granulocytes, CD34-positive stem cells, and platelets was performed on clots produced from four different human donors. Platelets were detected throughout the clot in both groups, although in the A-PRF group, more platelets were found in the distal part, away from the buffy coat (BC). T- and B-lymphocytes, stem cells, and monocytes were detected in the surroundings of the BC in both groups. Decreasing the rpm while increasing the centrifugation time in the A-PRF group gave an enhanced presence of neutrophilic granulocytes in the distal part of the clot. In the S-PRF group, neutrophils were found mostly at the red blood cell (RBC)-BC interface. Neutrophilic granulocytes contribute to monocyte differentiation into macrophages. Accordingly, a higher presence of these cells might be able to influence the differentiation of host macrophages and macrophages within the clot after implantation. Thus, A-PRF might influence bone and soft tissue regeneration, especially through the presence of monocytes/macrophages and their growth factors. The relevance and feasibility of this tissue-engineering concept have to be proven through in vivo studies.
KEYWORDS:
PRF; inflammation; macrophages; neutrophils; platelets; tissue engineering
PMID:
24945603
[PubMed - indexed for MEDLINE]
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J Periodontol. 2010 Apr;81(4):546-55.
Three-dimensional architecture and cell composition of a Choukroun's platelet-rich fibrin clot and membrane.
Dohan Ehrenfest DM1, Del Corso M, Diss A, Mouhyi J, Charrier JB.
- 1Department of Biomaterials, Institute for Clinical Sciences, The Sahlgrenska Academy at University of Gothenburg, Medicinaregatan 8B, 41390 Gothenburg, Sweden. lob5@mac.com
Abstract
BACKGROUND:
Platelet-rich fibrin (PRF; Choukroun's technique) is a second-generation platelet concentrate for surgical use. This easy protocol allows the production of leukocyte and platelet-rich fibrin clots and membranes starting from 10-ml blood samples. The purposes of this study were to determine the cell composition and three-dimensional organization of this autologous biomaterial and to evaluate the influence of different collection tubes (dry glass or glass-coated plastic tubes) and compression procedures (forcible or soft) on the final PRF-membrane architecture.
METHODS:
After centrifugation, blood analyses were performed on the residual waste plasmatic layers after collecting PRF clots. The PRF clots and membranes were processed for examination by light microscopy and scanning electron microscopy.
RESULTS:
Approximately 97% of the platelets and >50% of the leukocytes were concentrated in the PRF clot and showed a specific three-dimensional distribution, depending on the centrifugation forces. Platelets and fibrin formed large clusters of coagulation in the first millimeters of the membrane beyond the red blood cell base. The fibrin network was very mature and dense. Moreover, there was no significant difference in the PRF architecture between groups using the different tested collection tubes and compression techniques, even if these two parameters could have influenced the growth factor content and biologic matrix properties.
CONCLUSIONS:
The PRF protocol concentrated most platelets and leukocytes from a blood harvest into a single autologous fibrin biomaterial. This protocol offers reproducible results as long as the main production principles are respected.
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Int J Periodontics Restorative Dent. 2015 May-Jun;35(3):415-22. doi: 10.11607/prd.1861.
Treatment of Peri-implant Bone Defects with Platelet-Rich Fibrin.
Hamzacebi B, Oduncuoglu B, Alaaddinoglu EE.
Abstract
The objective of this study was to investigate and compare the clinical effectiveness of the application of platelet-rich fibrin (PRF) and conventional flap surgery for the treatment of peri-implant bone loss. Nineteen patients (8 women, 11 men) with peri-implant bone loss were randomly allocated to two groups, with the PRF group comprising patients who received fibrin scaffold and the control group made up of those who received only the access flap. At 3 and 6 months after surgery, respectively, the PRF group demonstrated higher mean probing depth reductions (2.41 ± 1.06 and 2.82 ± 1.03 mm versus 1.65 ± 1.02 and 2.05 ± 0.77 mm) and more gains in clinical attachment level (2.89 ± 1.01 and 3.31 ± 1.08 mm versus 1.43 ± 1.08 and 1.84 ± 0.81 mm) compared with the control group. In addition, the increase in the amount of keratinized mucosa from baseline to 6 months postoperatively was statistically significant for the PRF group (P < .001). Hence, the data from the current study led to the conclusion that PRF application in periimplant bone loss provided better clinical results than conventional flap surgery.
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J Oral Maxillofac Surg. 2015 Mar 26. pii: S0278-2391(15)00333-X. doi: 10.1016/j.joms.2015.03.041. [Epub ahead of print]
Treatment of Oral Mucosal Lesions by Scalpel Excision and Platelet-Rich Fibrin Membrane Grafting: A Review of 26 Sites.
Pathak H1, Mohanty S2, Urs AB3, Dabas J4.
- 1Postgraduate Third-year Student, Department of Oral and Maxillofacial Surgery, Maulana Azad Institute of Dental Sciences, New Delhi, India. Electronic address: drhimanipathak@gmail.com.
- 2Professor and Head, Department of Oral and Maxillofacial Surgery, Maulana Azad Institute of Dental Sciences, New Delhi, India.
- 3Professor and Head, Department of Oral Pathology and Microbiology, Maulana Azad Institute of Dental Sciences, New Delhi, India.
- 4Senior Resident, Department of Oral and Maxillofacial Surgery, Maulana Azad Institute of Dental Sciences, New Delhi, India.
Abstract
PURPOSE:
One of the preferred treatment options for oral mucosal lesions (eg, leukoplakia and lichen planus) is excision, with or without the use of a coverage agent. Platelet-rich fibrin (PRF) membranes are popular fibrin scaffolds with entrapped platelets that release various growth factors and cytokines to support and enhance wound healing. The aim of the present report was to describe the technique, postoperative wound care, and clinical results of PRF membrane grafting after excision of superficial potentially malignant oral lesions.
MATERIALS AND METHODS:
Autologous PRF membrane was fabricated and grafted over 26 wounds created by excision of small, superficial, potentially malignant lesions of oral mucosa (or fiberotomy in cases of oral submucous fibrosis) and assessed clinically at 7, 15, 30, and 60 days.
RESULTS:
Healing was satisfactory in all cases, with minimal and manageable complication at 1 site.
CONCLUSION:
The results of the present study suggest that PRF membrane is a successful coverage agent that aids in the healing of superficial oral mucosal wounds. Additional comparative studies are required to establish its efficacy compared with that of other agents.
Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.
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Implant Dent. 2009 Apr;18(2):102-11. doi: 10.1097/ID.0b013e318198cf00.
The relevance of Choukroun's platelet-rich fibrin and metronidazole during complex maxillary rehabilitations using bone allograft. Part I: a new grafting protocol.
Simonpieri A1, Del Corso M, Sammartino G, Dohan Ehrenfest DM.
- 1Private Practice, Monte Carlo, Monaco.
Abstract
Extensive bone grafting remains a delicate procedure, because of the slow and difficult integration of the grafted material into the physiological architecture. The recent use of platelet concentrates aims to improve this process of integration by accelerating bone and mucosal healing. Choukroun's platelet-rich fibrin (PRF) is a healing biomaterial that concentrates in a single autologous fibrin membrane, most platelets, leukocytes, and cytokines from a 10 mL blood harvest, without artificial biochemical modification (no anticoagulant, no bovine thrombin). Whether used as a membrane or as fragments, PRF allows a significant postoperative protection of the surgical site and seems to accelerate the integration and remodeling of the grafted biomaterial. These properties are particularly helpful for vestibular bone grafting on the alveolar ridges. Moreover, it provides a very high quality of gingival maturation.A small quantity of a 0.5% metronidazole solution (10 mg) can also be used to provide an efficient protection of the bone graft against unavoidable anaerobic bacterial contamination. This article describes a new technique of total maxillary preimplant bone grafting using allograft, Choukroun's PRF membranes and metronidazole. This first part focused on the preimplant reconstructive treatment using allogeneic bone granules. PRF membranes are particularly helpful to protect the surgical site and foster soft tissue healing. This fibrin biomaterial represents a new opportunity to improve both the maturation of bone grafts and the final esthetic result of the peri-implant soft tissue.
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J Periodontol. 2009 Dec;80(12):2056-64. doi: 10.1902/jop.2009.090252.
Sinus floor augmentation with simultaneous implant placement using Choukroun's platelet-rich fibrin as the sole grafting material: a radiologic and histologic study at 6 months.
Mazor Z1, Horowitz RA, Del Corso M, Prasad HS, Rohrer MD, Dohan Ehrenfest DM.
- 1Private Practice, Ra'anana, Israel.
Abstract
BACKGROUND:
Sinus augmentation with simultaneous implant placement without bone graft material is a hotly debated technique. This technique could be improved and secured by the use of an autologous leukocyte- and platelet-rich fibrin (PRF) (Choukroun's technique) concentrate. The objectives of this study were to assess the relevance of PRF clots and membranes as the sole filling material during a lateral sinus lift with immediate implantation using radiologic and histologic analyses in a case series.
METHODS:
Twenty-five sinus elevations with simultaneous implantation were performed on 20 patients with Choukroun's PRF as the sole filling biomaterial. For each patient, a presurgical exam and a 6-month post-surgical radiologic exam were performed with a panoramic x-ray and three-dimensional volumetric computed radiography (VCR) to evaluate the subsinus residual bone height and the final bone gain around the implants. In nine patients, 6 months after the sinus lift, bone biopsies were collected on the buccal wall of the alveolar ridge at the level of the osteotomy window, and evaluated by histomorphometry.
RESULTS:
In this study, 41 implants from three different systems with different screw designs (Biomet 3I Nanotite, MIS Seven, Intra-Lock Ossean) were placed. All implants were inserted in residual bone height between 1.5 and 6 mm (mean +/- SD: 2.9 +/- 0.9 mm). The final bone gain was always very significant (between 7 and 13 mm [mean +/- SD: 10.1 +/- 0.9 mm]). No implant was lost. After radiologic analyses, the position of the final sinus floor was always in the continuation of the end of the implant. All biopsies showed well organized and vital bone.
CONCLUSIONS:
From a radiologic and histologic point of view at 6 months after surgery, the use of PRF as the sole filling material during a simultaneous sinus lift and implantation stabilized a high volume of natural regenerated bone in the subsinus cavity up to the tip of the implants. Choukroun's PRF is a simple and inexpensive biomaterial, and its systematic use during a sinus lift seems a relevant option, particularly for the protection of the Schneiderian membrane.
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Implant Dent. 2009 Jun;18(3):220-9. doi: 10.1097/ID.0b013e31819b5e3f.
The relevance of Choukroun's platelet-rich fibrin and metronidazole during complex maxillary rehabilitations using bone allograft. Part II: implant surgery, prosthodontics, and survival.
Simonpieri A1, Del Corso M, Sammartino G, Dohan Ehrenfest DM.
- 1Department of Periodontology, Turin University, Turin, Italy.
Abstract
Extensive bone grafting remains a delicate procedure, due to the slow and difficult integration of the grafted material into the physiological architecture. The recent use of platelet concentrates aims to improve this process of integration by accelerating bone and mucosal healing. Choukroun's platelet-rich fibrin (PRF) is a healing biomaterial that concentrates in a single autologous fibrin membrane, most platelets, leukocytes, and cytokines from a 10-mL blood harvest, without artificial biochemical modification (no anticoagulant, no bovine thrombin). In this second part, we describe the implant and prosthetic phases of a complex maxillary rehabilitation, after preimplant bone grafting using allograft, Choukroun's PRF membranes, and metronidazole. Twenty patients were treated using this new technique and followed up during 2.1 years (1-5 years). Finally, 184 dental implants were placed, including 54 classical screw implants (3I, Palm Beach Gardens, FL) and 130 implants with microthreaded collar (46 from AstraTech, Mölndal, Sweden; 84 from Intra-Lock, Boca Raton, FL). No implant or graft was lost in this case series, confirming the validity of this reconstructive protocol. However, the number of implants used per maxillary rehabilitation was always higher with simple screw implants than with microthreaded implants, the latter presenting a stronger initial implant stability. Finally, during complex implant rehabilitations, PRF membranes are particularly helpful for periosteum healing and maturation. The thick peri-implant gingiva is related to several healing phases on a PRF membrane layer and could explain the low marginal bone loss observed in this series. Microthreaded collar and platform-switching concept even improved this result. Multiple healing on PRF membranes seems a new opportunity to improve the final esthetic result.
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Implant Dent. 2011 Feb;20(1):2-12. doi: 10.1097/ID.0b013e3181faa8af.
Simultaneous sinus-lift and implantation using microthreaded implants and leukocyte- and platelet-rich fibrin as sole grafting material: a six-year experience.
Simonpieri A1, Choukroun J, Del Corso M, Sammartino G, Dohan Ehrenfest DM.
- 1Department of Odontostomatological and Maxillofacial Sciences, University Federico II of Naples, Italy.
Abstract
PURPOSE:
To assess the relevance of simultaneous sinus-lift and implantation with leukocyte- and platelet-rich fibrin (L-PRF, Choukroun's technique) as sole subsinus filling material.
MATERIALS:
Twenty-three lateral sinus elevations (SA4 sinus) were performed on 20 patients with simultaneous implant placement. Seven patients were treated with 19 Astra implants (AstraTech, Mölndal, Sweden) and 13 patients with 33 Intra-Lock implants (Intra-Lock Ossean, Boca Raton, FL). L-PRF membranes were used to cover the Schneiderian membrane, the implant tips served as "tent pegs" for the L-PRF-patched sinus membranes, and the subsinus cavity was finally filled with L-PRF clots. Clinical and radiographic follow-up was performed just after implant placement, after 6 months, 1 year and each following year.
RESULTS:
Six months after surgery, all implants were clinically stable during abutment tightening. The maximum follow-up was 6 years, and all patients were followed up for a minimum of 2 years. No implant was lost during this 6-year experience, and the vertical bone gain was always substantial, between 8.5 and 12 mm bone gain (10.4 ± 1.2). The final level of the new sinus floor was always in continuation with the implant apical end, and the periimplant crestal bone height was stable.
CONCLUSION:
The use of L-PRF as sole filling material during simultaneous sinus-lift and implantation seems to be a reliable surgical option promoting natural bone regeneration.
PMID:
21278521
[PubMed - indexed for MEDLINE]
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Curr Pharm Biotechnol. 2012 Jun;13(7):1145-52.
Do the fibrin architecture and leukocyte content influence the growth factor release of platelet concentrates? An evidence-based answer comparing a pure platelet-rich plasma (P-PRP) gel and a leukocyte- and platelet-rich fibrin (L-PRF).
Dohan Ehrenfest DM1, Bielecki T, Jimbo R, Barbé G, Del Corso M, Inchingolo F, Sammartino G.
- 1LoB5 unit, Chonnam National University School of Dentistry, 77 Yongbong-Ro, Buk-Gu, Gwangju 500- 757, South Korea.
Abstract
Platelet concentrates for surgical use are tools of regenerative medicine designed for the local release of platelet growth factors into a surgical or wounded site, in order to stimulate tissue healing or regeneration. Leukocyte content and fibrin architecture are 2 key characteristics of all platelet concentrates and allow to classify these technologies in 4 families, but very little is known about the impact of these 2 parameters on the intrinsic biology of these products. In this demonstration, we highlight some outstanding differences in the growth factor and matrix protein release between 2 families of platelet concentrate: Pure Platelet-Rich Plasma (P-PRP, here the Anitua's PRGF - Preparation Rich in Growth Factors - technique) and Leukocyte- and Platelet-Rich Fibrin (L-PRF, here the Choukroun's method). These 2 families are the extreme opposites in terms of fibrin architecture and leukocyte content. The slow release of 3 key growth factors (Transforming Growth Factor β1 (TGFβ1), Platelet-Derived Growth Factor AB (PDGF-AB) and Vascular Endothelial Growth Factor (VEGF)) and matrix proteins (fibronectin, vitronectin and thrombospondin-1) from the L-PRF and P-PRP gel membranes in culture medium is described and discussed. During 7 days, the L-PRF membranes slowly release significantly larger amounts of all these molecules than the P-PRP gel membranes, and the 2 products display different release patterns. In both platelet concentrates, vitronectin is the sole molecule to be released almost completely after only 4 hours, suggesting that this molecule is not trapped in the fibrin matrix and not produced by the leukocytes. Moreover the P-PRP gel membranes completely dissolve in the culture medium after less than 5 days only, while the L-PRF membranes are still intact after 7 days. This simple demonstration shows that the polymerization and final architecture of the fibrin matrix considerably influence the strength and the growth factor trapping/release potential of the membrane. It also suggests that the leukocyte populations have a strong influence on the release of some growth factors, particularly TGFβ1. Finally, the various platelet concentrates present very different biological characteristics, and an accurate definition and characterization of the different families of product is a key issue for a better understanding and comparison of the reported clinical effects of these surgical adjuvants.
PMID:
21740377
[PubMed - indexed for MEDLINE]
Shanghai Kou Qiang Yi Xue. 2015 Feb;24(1):61-4.
[The effect of platelet-rich fibrin on biologic characteristics of osteoblasts].
[Article in Chinese]
Sun XL1, Zhou YM, Zhao JH, Zheng L, Yang TT.
- 1Department of Oral implantation, Jilin University Affiliated Stomatology Hospital. Changchun 130021, Jilin Province, China.E-mail:sxl2673366@126.com.
Abstract
PURPOSE:
To investigate the effect of platelet-rich fibrin on biologic characteristics of osteoblasts.
METHODS:
Osteoblasts were cultured with or without a PRF membrane. The cell proliferation was detected by MTT. The alkaline phosphatase (ALP) stain and the positive ｅxpression of collagen type I, osteoprotegerin and RANKL were measured. The data was statistically analyzed with SPSS17.0 software package.
RESULTS:
PRF promoted cell proliferation and increased ｅxpression of ALP, collagen typeI and OPG significantly, but there was no significant impact on ｅxpression of RANKL.
CONCLUSIONS:
PRF promotes osteoblasts proliferation, differentiation and OPG ｅxpression. PRF is involved in bone remodeling via regulating ｅxpression of OPG and RANKL.
Eur Rev Med Pharmacol Sci. 2015 Mar;19(6):927-30.
Comparison between PRP, PRGF and PRF: lights and shadows in three similar but different protocols.
Giannini S1, Cielo A, Bonanome L, Rastelli C, Derla C, Corpaci F, Falisi G.
- 1Private Practice, Rome, Italy. ricercadentale@libero.it.
Abstract
OBJECTIVE:
The main goal of the modern surgery is to get a low invasiveness and a high rate of clinical healing: in the last years, it has been introduced the concept of a "regenerative surgery", and many techniques has been widely described in the literature. The most used are PRP, PRGF and PRF techniques. Aim of this research is to compare the three protocol of PRP, PRF and PRGF in their essential features, so to suggest to the practitioners the best blood product to use in the regenerative surgery.
DISCUSSION AND CONCLUSIONS:
Among the advantages that shows the PRF, compared to PRP and PRGF, we can cite a greater simplicity of production for the absence of manipulation that leads to a reduced possibility of alteration of the protocol due to an error of the operator. The special texture of the PRF and its biological features shows clearly an interesting surgical versatility and all the characteristics that can support a faster tissues regeneration and high-quality clinical outcomes.
PMID:
25855914
[PubMed - in process]
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J Nat Sci Biol Med. 2015 Jan-Jun;6(1):224-5. doi: 10.4103/0976-9668.149187.
Autologus Platelet Rich Fibrin aided Revascularization of an immature, non-vital permanent tooth with apical periodontitis: A case report.
Jadhav GR1, Shah D1, Raghvendra SS1.
- 1Department of Conservative Dentistry and Endodontics, Sinhgad Dental College and Hospital, Pune, Maharashtra, India.
Abstract
Caries or trauma induced non-vital immature permanent tooth with blunderbuss, thin root which are very common among childrens are corrected using regenerative endodontic (revascularization) procedures. In the presented case, a 16-year-old boy reported with chief complaint of pain in maxillary left central incisor (Tooth #21). Tooth #21 showed grade III mobility, draining labial sinus, and short blunderbuss root with diffuse periapical radiolucency. Patient was explained the treatment plan and written informed consent was taken. Platelet rich fibrin (PRF) was prepared according to standard protocol. Autologous PRF was carried to the apical portion of the root canal after inducing revascularization. Access opening was double sealed with MTA and resin modified glass ionomer cement (RMGI). Baseline, 12 month and 18 month follow-up intraoral radiographs were taken. Clinically case was asymptomatic with complete resolution of intraoral sinus. Periapical healing, apical closure, root lengthening and dentinal wall thickening were uneventful. Thus PRF supplementation hastens the predictability and rate of revascularization in non-vital immature permanent teeth.
KEYWORDS:
Open apex; PRF; revascularization
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Rev Laryngol Otol Rhinol (Bord). 2007;128(4):255-60.
[The relevance of Choukroun's platelet rich fibrin (PRF) during facial aesthetic lipostructure (Coleman's technique): preliminary results].
[Article in French]
- 1AP-HP Hôpital Albert Chenevier-Henri Mondor, Département de Chirurgie Orale, 40 Rue de Mesly, 94000 Créteil, France.
Abstract
OBJECTIVES:
To evaluate the interest of fibrin PRF clots, a concentrate of platelets and immune factors, for the optimization of the adipocyte graft according to the technique of facial lipostructure described by S. Coleman.
MATERIALS AND METHODS:
Between May 2005 and June 2006, 32 patients (7 men and 25 women) benefited from a Coleman lipostructure with the use of PRF. The average age was 59 years (39 to 72 years). Lipostructure was used alone in 22 patients and associated with a face lift and/or a blepharoplasty in 10 patients. Before the adipocyte graft, a mixture of PRF and greasy supernatant (resulting from the purification of the sample of adipocytes) is deposited on the zones to be grafted in the same way as for lipostructure. For 2 patients, the pretreatment of the site to be grafted with PRF was unilateral. Patients were followed-up for one year.
RESULTS:
In this series, all the patients were satisfied with the result with minimal associated resorptions. No massive resorption requiring a resumption of lipostructure was noted. In the 2 patients treated with unilateral use of PRF, one notes a light asymmetry, the hemi-face treated with PRF appearing more stable than the side without PRF. No important residual oedema or echymosis were seen on the 3rd post-operative week.
CONCLUSION:
By offering a matricial support to angiogenesis and by stimulating the proliferation of pre-adipocytes, the PRF could have a beneficial role on the cicatrization and the consolidation of an adipocyte graft. Further studies are necessary to validate the interest of the PRF during aesthetic lipostructures. The potential uses in plastic surgery of such a biomaterial, easy and fast to produce, without any overcost and with no risk, are very numerous and require from now on to be tested and validated methodically.
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J Oral Maxillofac Surg. 2013 Mar;71(3):610-21. doi: 10.1016/j.joms.2012.06.176. Epub 2012 Aug 9.
Use of platelet-rich fibrin and platelet-rich plasma in combination with fat graft: which is more effective during facial lipostructure?
Keyhan SO1, Hemmat S, Badri AA, Abdeshahzadeh A, Khiabani K.
- 1Department of Oral and Maxillofacial Surgery, Joundishapoor University of Medical Science, Ahvaz, Iran. keyhanomid@ymail.com
Abstract
PURPOSE:
Fat grafts have always represented a challenge in inducing the necessary neoangiogenesis, which results in significant resorption. This study was designed to compare the efficiency of first- and second-generation platelet-rich plasmas (PRPs) combined with a fat graft during facial lipostructure surgery.
METHODS AND MATERIALS:
To address the research purpose, the investigators designed and implemented a double-blinded prospective clinical trial. The patients underwent bilateral facial lipostructure, a natural long-lasting method of filling and supporting the face using intricate layers of infiltrated autologous fat. The method involved the use of PRP on 1 side and platelet-rich fibrin (PRF) on the other side. The study population was composed of all patients presenting to the authors' department for the evaluation and management of facial contouring in the cheek and cheekbone areas from June 2008 through December 2010. The primary predictor variable was the type of combination (PRP/fat or PRF/fat). The outcome variables were the amount of resorption, which was estimated by comparing pre- and postsurgical photographic views, pain, edema, and bruising. The statistical evaluation of the findings was performed using SPSS software. Parametric tests (t test and Levene test) were used to compare the treatment efficacy and complications between the groups.
RESULTS:
Twenty-five patients (8 men and 17 women) underwent bilateral facial lipostructure surgery in the cheek and cheekbone areas using PRP and PRF. one year after the operation, a slight esthetic asymmetry was noticeable, with greater average resorption on the PRP/fat side.
CONCLUSIONS:
This first comparative clinical study highlights the value of using concentrated platelets for adipocyte grafts. The results suggest that the combination of fat and PRF is more effective than the combination of fat and PRP in the context of facial lipostructure surgery.
Copyright © 2013 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved
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J Oral Maxillofac Surg. 2013 Mar;71(3):610-21. doi: 10.1016/j.joms.2012.06.176. Epub 2012 Aug 9.
Use of platelet-rich fibrin and platelet-rich plasma in combination with fat graft: which is more effective during facial lipostructure?
Keyhan SO1, Hemmat S, Badri AA, Abdeshahzadeh A, Khiabani K.
- 1Department of Oral and Maxillofacial Surgery, Joundishapoor University of Medical Science, Ahvaz, Iran. keyhanomid@ymail.com
Abstract
PURPOSE:
Fat grafts have always represented a challenge in inducing the necessary neoangiogenesis, which results in significant resorption. This study was designed to compare the efficiency of first- and second-generation platelet-rich plasmas (PRPs) combined with a fat graft during facial lipostructure surgery.
METHODS AND MATERIALS:
To address the research purpose, the investigators designed and implemented a double-blinded prospective clinical trial. The patients underwent bilateral facial lipostructure, a natural long-lasting method of filling and supporting the face using intricate layers of infiltrated autologous fat. The method involved the use of PRP on 1 side and platelet-rich fibrin (PRF) on the other side. The study population was composed of all patients presenting to the authors' department for the evaluation and management of facial contouring in the cheek and cheekbone areas from June 2008 through December 2010. The primary predictor variable was the type of combination (PRP/fat or PRF/fat). The outcome variables were the amount of resorption, which was estimated by comparing pre- and postsurgical photographic views, pain, edema, and bruising. The statistical evaluation of the findings was performed using SPSS software. Parametric tests (t test and Levene test) were used to compare the treatment efficacy and complications between the groups.
RESULTS:
Twenty-five patients (8 men and 17 women) underwent bilateral facial lipostructure surgery in the cheek and cheekbone areas using PRP and PRF. one year after the operation, a slight esthetic asymmetry was noticeable, with greater average resorption on the PRP/fat side.
CONCLUSIONS:
This first comparative clinical study highlights the value of using concentrated platelets for adipocyte grafts. The results suggest that the combination of fat and PRF is more effective than the combination of fat and PRP in the context of facial lipostructure surgery.
Copyright © 2013 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.
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