The 3 R’s for Platelet-Rich Fibrin: A “Super” Tri-Dimensional Biomaterial for Contemporary Naturally-Guided Oro-Maxillo-Facial Soft and Hard Tissue Repair, Reconstruction and Regeneration

Abstract

Platelet-Rich fibrin (PRF) is a three-dimensional (3-D) autogenous biomaterial obtained via simple and rapid centrifugation from the patient’s whole blood samples, without including anti-coagulants, bovine thrombin, additives, or any gelifying agents. At the moment, it is safe to say that in oral and maxillofacial surgery, PRFs (particularly, the pure platelet-rich fibrin or P-PRF and leukocyte and platelet-rich fibrin or L-PRF sub-families) are receiving the most attention, essentially because of their simplicity, cost-effectiveness, and user-friendliness/malleability; they are a fairly new “revolutionary” step in second-generation therapies based on platelet concentration, indeed. Yet, the clinical effectiveness of such surgical adjuvants or regenerative platelet concentrate-based preparations continues to be highly debatable, primarily as a result of preparation protocol variability, limited evidence-based clinical literature, and/or poor understanding of bio-components and clinico-mechanical properties. To provide a practical update on the application of PRFs during oral surgery procedures, this critical review focuses on evidence obtained from human randomized and controlled clinical trials only. The aim is to serve the reader with current information on the clinical potential, limitations, challenges, and prospects of PRFs. Accordingly, reports often associate autologous PRFs with early bone formation and maturation; accelerated soft-tissue healing; and reduced post-surgical edema, pain, and discomfort. An advanced and original tool in regenerative dentistry, PRFs present a strong alternative and presumably cost-effective biomaterial for oro-maxillo-facial tissue (soft and hard) repair and regeneration. Yet, preparation protocols continue to be a source of confusion, thereby requiring revision and standardization. Moreover, to increase the validity, comprehension, and therapeutic potential of the reported findings or observations, a decent analysis of the mechanico-rheological properties, bio-components, and their bioactive function is eagerly needed and awaited; afterwards, the field can progress toward a brand-new era of “super” oro-dental biomaterials and bioscaffolds for use in oral and maxillofacial tissue repair and regeneration, and beyond.

Platelet-Rich Fibrin – new course in regenerative medicine and dentistry

“…20 W stomatologii, PRF to zaawansowane i oryginalne narzędzie, które stanowi silny alternatywny i opłacalny biomateriał do naprawy i regeneracji tkanek ustno-szczękowo-twarzowych (miękkich i twardych). 20 Od wprowadzenia w 2001 roku, 11 różne badania in vitro wykazały, że PRF wywiera pozytywny wpływ na fibroblasty dziąseł, osteoblasty jamy ustnej i fibroblasty więzadła przyzębia, co czyni go dobrym środkiem wspomagającym leczenie chorób periodontologicznych. 21 Interesujące wyniki uzyskano w testach migracyjnych fibroblastów in vitro.…”

“…W kontekście inwazyjnych procedur chirurgicznych, takich jak ekstrakcje trzeciego trzonowca, resekcja torbieli lub wyłuszczenie dużych zmian okołowierzchołkowych PRF zmniejsza zapotrzebowanie na leki i przyspiesza rekonwalescencję, a także chroni przed zakażeniami pozabiegowymi. 20 Autologiczne czynniki wzrostu uwalniane podczas degranulacji płytek krwi, stanowią biologiczny lek. 29 Jak wykazano, PRF stymuluje tworzenie nowych naczyń krwionośnych zarówno in vitro, jak i in vivo.…”

“…8 Skuteczność kliniczna PRF jest wysoce dyskusyjna ze względy na ograniczoną literaturę kliniczną opartą na dowodach oraz słabe zrozumienie właściwości mechanicznych i klinicznych biokomponentów PRF. 20 Mimo wielu wątpliwych wyników badań klinicznych, fibryna bogatopłytkowa ma coraz szersze grono zwolenników. Jej zastosowanie ciągle jest rozszerzane.…”

Platelet-Rich Fibrin: A Versatile Purpose for Alveolar Ridge Preservation

“…Since the first use of platelet-rich fibrin (PRF) in France reported in 2001 by Choukron, the reports in the last 18 years in the clinical use of PRF have increased [5]. PRF is a functional autologous fibrin matrix obtained by immediate centrifugation of the blood immediately collected from patient without the use of additives by the own dentist in-office [6,7]. Although the technique of preparation, standing time, transfer process, temperature of centrifuge and vibration are factors for the mixed results reported in the literature, PRF represents a promising alternative in the regeneration of soft and hard tissues, whether associated with biomaterials or alone [2,7,8].…”

“…Significant pocket depth reduction, clinical attachment level gain and bone fill (mean value of 1.7 ± 0.7 mm) was achieved when comparing PRF to open flap debridement in intra-bony defects and furcation defects [13]. Simplicity, cost-effectiveness, and user-friendliness/malleability are attractive factors to the multivariate use of PRF [7]. However, more randomized clinical trials protocol standardization are required to obtain reproducible results [12,13].…”