Third-Generation Platelet Concentrates in Periodontal Regeneration: Gaining Ground in the Field of Regeneration

Abstract

Platelets are important for hemostasis and the healing of wounds. In clinical settings, healing cytokines including insulin-like growth factors (IGF), platelet-derived growth factors (PDGF), and transforming growth factors (TGF) are commonly implemented. The regenerative approach in dentistry frequently employs platelet concentrates (PCs) that are "autologous in origin" and have a high concentration of platelets, growth factors, and leukocytes. First-generation PCs is made of platelet-rich plasma (PRP), while secondgeneration PC is made of platelet-rich fibrin (PRF). Both have limitations, so modification protocols and development in PRP and PRF derivatives are required for advancement mechanisms, strength, biodegradability, retention ability in the field of regenerative dentistry, and so on. As third-generation PC, newer genera kinds of PRF, such as advanced-PRF (A-PRF), advanced-PRF+ (A-PRF+), injectable-PRF (i-PRF), and titanium-PRF (T-PRF), were introduced. A-PRF matrices in their solid form were introduced using the low-speed centrifugation concept (LSCC). The applied relative centrifugal force (RCF) for A-PRF is reduced to 208 g as a result of this improved preparation process. A-PRF features a greater number of neutrophil granules in the distal region, especially at the red blood cells-buffer coat (RBC-BC) interface, and the A-PRF clot has a more porosity-like structure with a bigger interfibrous space than PRF. Since the PRF is in a gel form and is difficult to inject, i-PRF was formulated to address this problem. Compared to the other two protocols, the i-PRF protocol requires far less time, and this is the advantage of this PC. This is because i-PRF just needs the blood components to be separated, which happens within the first two to four minutes. Compared to normal L-PRF, T-PRF creates fibrin that is thicker and more densely woven. Titanium has a higher hemocompatibility than glass, which could lead to greater polymerized fibrin formation. In periodontal regenerative operations, oral surgery, and implant dentistry, PRF and its newer advanced modifications have demonstrated promising results and desirable results in both soft and hard tissue regenerative techniques.

Evolution and Clinical Advances of Platelet-Rich Fibrin in Musculoskeletal Regeneration

“…With H and E staining, T-PRF exhibits a highly and densely organized meshwork of fibrin with continuous integrity [56]. In immunofluorescent staining, T-PRF appears more mature and denser than L-PRF.…”

“…In immunofluorescent staining, T-PRF appears more mature and denser than L-PRF. In SEM analysis, the T-PRF clot appears as a well-organized fen-like matrix containing slender fibrin fibrils along with plugged-in platelets [56]. Though it possesses better hemocompatibility, T-PRF clot displays more polymerized fibrin meshwork [54,57].…”

From Basic Science to Clinical Practice: A Review of Current Periodontal/Mucogingival Regenerative Biomaterials

“…[59,108] It affects the osteoblastic behavior and enhances periodontal regeneration in the treatment of gingival recessions, intra-bony defects, and furcation defects. [58,71,108] A-PRF requires centrifugation of venous blood in a glass tube at 1500 rpm for 14 min and has a more porous-like structure with bigger interfibrous space than PRF. [108] Additionally, A-PRF increases the expression of VEGF, which is advantageous for the angiogenesis of the gingiva.…”

“…[71,108] Moreover, T-PRF releases a higher concentration of VEGF, PDGF-BB, TGF-𝛽 and IGF-1. [108] Clinically, CGF is mainly used for hard tissue regeneration. [59] Clinical trials indicate its superior efficacy to surgical procedures alone for alveolar ridge preservation and intra-bony defects.…”

A Combination of Platelet-Rich Fibrin and Collagen Membranes for Sinus Membrane Repair: A Case Report (Repair of Sinus Membrane Perforation)

“…For this purpose, two vials of the patient’s venous blood sample were first taken for preparing platelet-rich fibrin (PRF). The blood was placed in a 10 mL glass test tube, without anticoagulant, and then immediately centrifuged at a speed of 2700 rpm for 12 min [ 31 ]. To seal the lacerated Schneiderian membrane, a resorbable collagen material (i.e., CollaTape, ACE surgical supply, Brockton, MA, USA) was first applied, followed by the PRF membrane.…”