Clinical Uses of Platelet-Rich Fibrin in Oral and Maxillofacial Surgery

PRF and PRP in Dentistry: An Umbrella Review

Introduction: Platelet-rich fibrin (PRF) and platelet-rich plasma (PRP) utilize autologous blood and share the objective of leveraging blood-derived growth factors to enhance the body's natural healing process. A large extensive use has been made in various branches of dentistry. Methods: A total of 4175 records were identified from the electronic search, specifically 291 from BioMed Central, 3406 from MEDLINE/PubMed, 304 from the Cochrane library databases, and 174 from the PROSPERO register. This review was performed in relation to the PRISMA flow chart and was annotated in the PROSPERO register. Results: In total, 3416 title abstracts were screened, and a total of 40 systematic reviews were finally included in the present umbrella review. Conclusions: Research supports the use of PRF and PRP in different fields of dentistry. This is a huge potential for the patient but also for the doctor as these products are from the patient and have zero cost. However, further studies are needed, especially RCTs, to have clearer evidence on the role of PRF and PRP.

Platelet-Rich Fibrin Mediates Beneficial Effects on Adipose-Derived Stem Cells via Increased Levels of Key Cytokines

Recent studies showcased the regenerative potential of Platelet-Rich Fibrin (PRF) combined with Adipose-Derived Stem Cells (ASC). PRF enhances cellular proliferation through sustained growth factor secretion which are continuously released to surrounding cells. However, its regulatory mechanisms remain unclear. ASC were isolated from liposuction and abdominoplasty samples of healthy donors, characterised via flow-cytometry and cultured for 7 days. Four cell culture conditions were tested: (1) 10% PRF extract (PRFe), (2) 10% Platelet-Low Plasma (PLP), (3) 10% Foetal Bovine Serum (FBS) and (4) basal medium as control. Cell viability and proliferation were assessed using AlamarBlue and PicoGreen assays, as well as live-dead staining. Enzyme-Linked Immunosorbent Assays quantified growth factor concentrations, while multiplex qPCR and immunocytochemical staining analysed gene and protein expression on days 1 and 7. PRFe-supplemented cultures showed the highest viability and proliferation, significantly surpassing other groups at day 7 (p < 0.05). Supernatant analysis revealed significantly elevated TGF-β1 and PDGF-AA/BB levels in PRFe cultures at day 7 (p of at least < 0.05). Multiplex qPCR indicated increased expression of proliferation and pluripotency markers (NANOG, JUN, SOX2, RPS6KA4; p < 0.05) and fibrillar collagen (COL1A; p < 0.05) in the PRFe group. These findings demonstrate that PRFe significantly enhances ASC proliferation and regenerative potential. Elevated levels of TGF-1, PDGF-AA/BB and to a lesser extend VEGF in PRFe cultures suggest that its benefits in regenerative medicine may be linked to these cytokines' upregulation. These results underscore PRFe's potential as a key supplement for optimising ASC-based therapies in tissue regeneration.

Innovative Method for Preparing Platelet-Rich Fibrin Sheets: Applications in Middle Ear Surgery

Platelet rich fibrin (PRF) is known for regenerative properties and therapeutic potential in various medical and surgical conditions. In Otorhinolaryngology, PRF has been documented for use in repair of traumatic perforations. It has shown to accelerate healing, reduce inflammation, and improve tissue regeneration. PRF, with its higher concentration of growth factors, offers prolonged benefits in tissue repair and regeneration. This study introduces a novel technique for preparing PRF sheets and investigates their potential to enhance outcomes in endoscopic middle ear surgery, with a particular focus on healing and graft integration. We describe in detail a novel technique for preparing PRF sheets and propose their application in middle ear surgery. Clinical observations focused on epithelialization, graft integration, and the overall healing process of the mastoid cavities following surgery. The use of PRF sheets resulted in healthy epithelization and successful graft intake. Additionally, early epithelization of mastoid cavities was observed, demonstrating the therapeutic efficacy of PRF sheets in promoting tissue regeneration. The application of PRF sheets during middle ear surgery shows promising results, offering a novel approach for enhancing healing and improving clinical outcomes in endoscopic procedures. Further studies are needed to confirm these findings and optimize the technique. Level of Evidence: Level 4.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-025-05421-8.

Bioactivity of dressings based on platelet-rich plasma and Platelet-rich fibrin for tissue regeneration in animal model

BACKGROUND

Skin wounds are common injuries that affect quality of life and incur high costs. A considerable portion of healthcare resources in Western countries is allocated to wound treatment, mainly using mechanical, biological, or artificial dressings. Biological and artificial dressings, such as hydrogels, are preferred for their biocompatibility. Platelet concentrates, such as platelet-rich plasma (PRP) and platelet-rich fibrin (PRF), stand out for accelerating tissue repair and minimizing risks of allergies and rejection. This study developed PRF and PRP-based dressings to treat skin wounds in an animal model, evaluating their functionality and efficiency in accelerating the tissue repair process.

AIM

To develop wound dressings based on platelet concentrates and evaluating their efficiency in treating skin wounds in Wistar rats.

METHODS

Wistar rats, both male and female, were subjected to the creation of a skin wound, distributed into groups (n = 64/group), and treated with Carbopol (negative control); PRP + Carbopol; PRF + Carbopol; or PRF + CaCl2 + Carbopol, on days zero (D0), D3, D7, D14, and D21. PRP and PRF were obtained only from male rats. On D3, D7, D14, and D21, the wounds were analyzed for area, contraction rate, and histopathology of the tissue repair process.

RESULTS

The PRF-based dressing was more effective in accelerating wound closure early in the tissue repair process (up to D7), while PRF + CaCl2 seemed to delay the process, as wound closure was not complete by D21. Regarding macroscopic parameters, animals treated with PRF + CaCl2 showed significantly more crusting (necrosis) early in the repair process (D3). In terms of histopathological parameters, the PRF group exhibited significant collagenization at the later stages of the repair process (D14 and D21). By D21, fibroblast proliferation and inflammatory infiltration were higher in the PRP group. Animals treated with PRF + CaCl2 experienced a more pronounced inflammatory response up to D7, which diminished from D14 onwards.

CONCLUSION

The PRF-based dressing was effective in accelerating the closure of cutaneous wounds in Wistar rats early in the process and in aiding tissue repair at the later stages.

Effect of platelet-rich plasma and platelet-rich fibrin on healing of burn wound with dual-species biofilm

This study evaluated the impact of platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) on burn wound with dual-species biofilm. Pseudomonas aeruginosa (P. aeruginosa) and Staphylococcus aureus (S. aureus) were applied to infect the burn wound in rats to establish a dual-species biofilm model. After infection, the wound was treated with ionized silver (AG), PRF, and PRP. Silver scanning electron microscopy (SEM) was used to assess adhesion after infection. PRF and PRP reduced wound size from day 8 after burn injuries, while AG significantly promoted burn wound healing at day 12. New collagen was formed in the shortest time in PRF and PRP groups compared to AG and control groups. PRF and PRP greatly lowered the bacterial numbers in wounds with S. aureus and P. aeruginosa biofilm, whereas AG showed weak bacteriostatic effects. AG, PRF, and PRP treatments significantly reduced inflammatory mediators and induced VEGFA. However, AG treatment increased TNF-α. PRF and PRP accelerate wound healing in the presence of dual-species biofilm infection and show strong antibacterial activity against S. aureus and P. aeruginosa, indicating that PRF and PRP could be potential therapies for burn wounds with dual-species biofilm infection.

The efficacy of platelet-derived extracellular vesicles in the treatment of diabetic wounds: a systematic review and meta-analysis of animal studies

Platelet-derived extracellular vesicles (PEVs) are rich in growth factors and have significant potential for facilitating tissue repair and regeneration. Therefore, we conducted this meta-analysis to assess the efficacy of PEVs in treating diabetic wounds. To assess the efficacy and safety of PEVs in treating diabetic wounds, we conducted a systematic review of several databases and performed a meta-analysis using a random effects model. Nine studies (n = 128 animals) meeting the inclusion criteria for this review were identified. The pooled analysis revealed that compared to the control group, wounds treated with PEVs had a higher healing rate (SMD = 4.43, 95% CI = 2.85-6.01, P < 0.00001). In subgroup analysis, PEVs combined with hydrogel showed better efficacy than PEVs alone (SMD = 7.96, 95% CI = 5.05-10.87, P < 0.00001). Additionally, the PEVs treatment group outperformed the control group in other outcomes, such as vessel density and number, re-epithelialization rate, and collagen deposition. PEVs have the potential to promote angiogenesis at diabetic wound sites and alleviate inflammatory responses, ultimately aiding in wound healing, especially when combined with hydrogels or other medications.

In vitro comparison of the effects of titanium-prepared platelet-rich fibrin and leukocyte platelet-rich fibrin on osteoblast behavior and their gen expression

OBJECTIVE

To compare the effects of titanium-prepared platelet-rich fibrin (T-PRF) and leukocyte platelet-rich fibrin (L-PRF) on osteoblasts.

METHODS

Venous blood samples were collected from ten volunteer patients to obtain T-PRF and L-PRF. The T-PRF group was labelled as Group T, the L-PRF group as Group L, and the control group, which includes only osteoblasts, was Group K. PRF samples were added to cultured osteoblast cells and cell proliferation was assessed using an MTT (3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyl tetrazolium bromide) assay. The effect of different groups on osteoblast proliferation was observed for 72 h and the results were analysed statistically. Additionally, real-time polymerase chain reaction (RT-PCR) was conducted to evaluate gene expression levels of COL1A1, ALP, OCN, and RUNX2 within 48 h.

RESULTS

We found that the MTT results at 24 h were significantly lower than those at 48 and 72 h (p = 0.036 and p < 0.001, respectively). L-PRF levels showed an increase from 24 to 48 h followed by a decrease from 48 to 72 h. T-PRF levels were seen to increase at both the 24-48 h and 48-72-hour intervals. The changes in the COLA1, OCN, ALP, and RUNX2 genes at 24 h and 48 h did not significantly differ among the groups (p > 0.05).

CONCLUSIONS

In this study, we investigated the effects of T-PRF and L-PRF on osteoblast proliferation over a 72-hour period. Both groups improved osteoblast proliferation, however T-PRF group showed a consistent increase in osteoblast proliferation up to 72 h, in contrast to the L-PRF group. No differences in gene expression were found. However, osteoblastic marker genes can be significantly expressed over longer time periods. Therefore, long-term studies are needed.

Assessing the effectiveness of advanced platelet rich fibrin in treating gingival recession: a systematic review and meta-analysis

OBJECTIVES

The literature lacks comprehensive evidence on the efficacy of advanced platelet rich fibrin(A-PRF) in treating gingival recession. Therefore, this systematic review and meta-analysis aimed to evaluate the effectiveness of A-PRF in the treatment of gingival recession.

MATERIALS AND METHODS

We adhered to the guidelines of PRISMA in searching the following databases: PubMed/MEDLINE, Embase, Cochrane Library, Web of Science, and Scopus to include all the eligible studies according to the prespecified inclusion and exclusion criteria. We conducted our search up to February 28, 2024. We conducted a meta-analysis of the primary and secondary clinical outcomes to measure the changes from baseline to 6 months after surgery.

RESULTS

Our review included 10 randomized clinical trials in which 146 participants with 457 recession defects were included. We found that combination of A-PRF with various surgical techniques, such as coronally advanced flap (CAF) connective tissue graft (CTG), VISTA, tunneling, and pinhole surgical technique, demonstrated promising outcomes but varied by comparison group. We observed that CTG with CAF showed a higher reduction in recession depth in comparison to A-PRF with CAF. This review indicated no statistical or clinical differences in recession width, width of keratinized gingiva, probing depth, and clinical attachment level between the study and control groups.

CONCLUSIONS

Due to the less invasive nature of A-PRF, it provides a better clinical option to improve the outcomes of treating gingival recession. However, more well-designed RCTs with standardized approaches are needed to confirm these results.

Impact of Infrabony Defects Treatment on Periodontal Markers and Glycated Hemoglobin Using Platelet-Rich Fibrin, Guided Tissue Regeneration, and Access-Flap Surgery

Background and Objectives: This study evaluated the outcomes of single open-flap debridement, open-flap debridement (OFD) plus resorbable membrane placement, and OFD with resorbable membrane placement plus platelet-rich fibrin (PRF) in terms of periodontal clinical parameters and glycated hemoglobin (HbA1c) levels in 24 adult patients with stage 3 grade C periodontitis and type II diabetes mellitus. Materials and Methods: The primary outcome measure for this study was the clinical attachment level (CAL); secondary outcomes included additional periodontal parameters, such as the plaque index (PI), bleeding on probing (BOP), probing depth (PD), as well as glycated hemoglobin (HbA1c) levels to evaluate the systemic impact of the treatments on glycemic control. The parameters were assessed before and at three and six months post-surgery. In Group A, the flap was sutured closed; in Group B, an absorbable collagen membrane was placed over the defect; and in Group C, PRF was utilized in the defect, with two additional PRF membranes used to cover the defect. The wound healing index (WHI) was recorded at 7 and 14 days after the surgery. Results: The initial findings indicated no significant differences in the periodontal parameters among the three groups. However, improvements in the PD and CAL were most notable in Group C, followed by Group B, with Group A showing the slightest improvement. At six months, there was a highly significant difference in the CAL (p < 0.001). Group C (4.92 ± 0.35) and Group B (4.99 ± 0.31) demonstrated the most significant improvements in the CAL compared to Group A (5.89 ± 0.57). At seven days post-surgery, Group C demonstrated significant healing, with 85% of the sites showing complete healing. By the 14-day mark, all sites in Group C indicated complete healing. Although the HbA1c values did not exhibit statistically significant differences among the groups at baseline, at the 6-month evaluation, all groups showed significantly lower values than baseline. However, the comparison between groups revealed significantly improved values for Group C. Conclusions: The study's results suggest that PRF is an exceptional material for infrabony defects treatment and notably improves HbA1c levels.

Facial nerve regeneration via body-brain crosstalk: The role of stem cells and biomaterials

The human body is a complex, integral whole, and disruptions in one organ can lead to dysfunctions in other parts of the organ network. The facial nerve, as the seventh cranial nerve, arises from the brainstem, controls facial expression muscles and plays a crucial role in brain-body communication. This vulnerable nerve can be damaged by trauma, inflammation, tumors, and congenital diseases, often impairing facial expression. Stem cells have gained significant attention for repairing peripheral nerve injuries due to their multidirectional differentiation potential. Additionally, various biomaterials have been used in tissue engineering for regeneration and repair. However, the therapeutic potential of stem cells and biomaterials in treating facial nerve injuries requires further exploration. In this review, we summarize the roles of stem cells and biomaterials in the regeneration and repair of damaged facial nerves, providing a theoretical basis for the recovery and reconstruction of body-brain crosstalk between the brain and facial expression muscles.

The efficacy of Platelet and Leukocyte Rich Fibrin (L-PRF) in the healing process and bone repair in oral and maxillofacial surgeries: a systematic review

INTRODUCTION

The search to optimize the healing and bone repair processes in oral and maxillofacial surgeries reflects the constant evolution in clinical practice, driven by the demand for increasingly satisfactory results and the need to minimize postoperative complications.

OBJECTIVE

To evaluate the efficacy of Platelet and Leukocyte Rich Fibrin (L-PRF) in the healing and bone repair process in oral and maxillofacial surgeries.

MATERIALS AND METHODS

The systematic review protocol for this study included the definition of the research question, the domain of the study, the databases searched, the search strategy, the inclusion and exclusion criteria, the types of studies to be included, the measures of effect, the methods for screening, data extraction and analysis, and the approach to data synthesis. Systematic literature searches were carried out on Cochrane databases, Web of Science, PubMed, ScienceDirect, Embase and Google Scholar.

RESULTS

The strategic search in the databases identified 1,159 studies. After removing the duplicates with the Rayyan© software, 946 articles remained. Of these, 30 met the inclusion criteria. After careful evaluation based on the inclusion and exclusion criteria, 8 studies were considered highly relevant and included in the systematic review.

CONCLUSION

Platelet and Leukocyte Rich Fibrin (L-PRF) has a positive effect on the healing process and bone repair in oral and maxillofacial surgeries.

The impact of submucosal PRP injection on wound healing after endoscopic sinus surgery: a randomized clinical trial

PURPOSE

Chronic rhinosinusitis (CRS) is a prevalent chronic disease observed on a global scale. The utilization of endoscopic sinus surgery (ESS) has gained significant recognition as an effective intervention for individuals with CRS and nasal polyps who have not responded to conventional treatments. The need (or not) for revision surgery frequently relies on the promotion of optimal wound healing. The impact of platelet-rich plasma (PRP) on tissue healing has been extensively examined in various surgical fields.

METHODS

The present prospective study involved 30 patients suffering with nasal polyposis who underwent endoscopic sinus surgery. 15 patients were assigned to the PRP group, and 15 patients to the control group. The clinical follow-up of the patients took place at specific intervals, at weeks 1, 2, 3, 4, 8, and 12 after the surgical procedure. The evaluator identified the existence of adhesions, crusting, bleeding, granulation and infection using a visual analogue scale score. The patients also completed the SNOT 22 questionnaire prior to surgery and at each postoperative visit.

RESULTS

The present study observed a lower incidence of adhesion, infection, hemorrhage and granulation in the PRP group. Furthermore, a statistically significant difference was detected between the groups.

CONCLUSION

Based on the findings of the present investigation, it seems that platelet-rich plasma (PRP) is beneficial on wound healing during the early stages following the surgical procedure. The technique is characterized by its limited invasiveness, which contributes to its low risk profile and the achievement of clinically good outcomes.

The Role of Leukocyte-Platelet-Rich Fibrin in Promoting Wound Healing in Diabetic Foot Ulcers

To explore the effect of leukocyte-platelet-rich fibrin (L-PRF) on promoting wound healing in diabetic foot ulcers. A total of 42 patients with diabetic foot ulcers at our hospital from January 2017 to July 2020 were retrospectively analyzed. A control group and a PRF group were established. The two groups of patients underwent debridement. In the platelet-rich fibrin (PRF) group, autologous L-PRF was used to cover ulcer wounds. One time each week, Vaseline gauze was used to cover the ulcer wounds. In contrast, the control group was treated with the external application of mupirocin ointment and recombinant human epidermal growth factor gel (yeast). Two times each week, the sterile Vaseline gauze was covered with a bandage. Both groups were treated for 5 weeks. The wound recovery of the two groups was observed. During the early stage of treatment (first and second weeks) for diabetic foot ulcers, the wound healing rate was significantly better with L-PRF treatment than traditional treatment. For later-stage treatment (third to fifth weeks), the overall cure rate was higher with L-PRF than the traditional treatment method. L-PRF can effectively promote wound healing in diabetic foot ulcers.

Impact of aminopenicillin administration routes on antimicrobial effects of platelet-rich fibrin: An in-vitro investigation

INTRODUCTION

The aim of the study was to investigate the impact of different aminopenicillin administration routes on the antimicrobial effects of platelet-rich fibrin (PRF).

METHODS

We enrolled patients undergoing treatment with amoxicillin/clavulanic acid (AMC) orally or ampicillin/sulbactam (SAM) intravenously. AMC was applied in a single oral dose (875/125 mg), or in a double oral dose (1750/250 mg), and SAM in a dose of 2000/1000 mg. Blood was obtained one hour after the intake of AMC or 15 min after the infusion of SAM ended. Antimicrobial effects were investigated in agar diffusion tests with fresh PRF, PRF stored for 24, and PRF stored for 48 h. Agar diffusion tests were performed with Escherichia coli, Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae, and Porphyromonas gingivalis. Inhibition zones (IZs) around a 6 mm PRF disc were measured after 24 h.

RESULTS

IZs for fresh PRF and the single oral dose of AMC were 0.0, 4.7, 15.2, 2.3, and 0.9 mm (E. coli, S. aureus, S. pneumoniae, H. influenzae, and P. gingivalis, respectively). For the double oral dose, these values were 0.0, 11.4, 20.0, 8.1, and 7.4 mm. IZs for SAM were 11.9, 18.2, 24.7, 20.3, and 22.1 mm. Differences between parenteral and oral application as well as between different oral doses were significant (p<0.0001, one-way ANOVA).

DISCUSSION

The results of our study demonstrate that oral administration is a suitable route to load PRF with these drugs. This could expand the scope of PRF application to prevent infections at the surgical site, especially in an outpatient setting in which drugs are normally applied orally.

Leukocytes within Autologous Blood Concentrates Have No Impact on the Growth and Proliferation of Human Primary Osteoblasts: An In Vitro Study

Platelet-rich fibrin (PRF) is a widely used autologous blood concentrate in regenerative medicine. This study aimed to characterize the cellular composition and distribution of different PRF matrices generated by high (710 g) and low (44 g) relative centrifugal forces (RCFs) and to analyze their bioactivity on human primary osteoblasts (pOBs). PRF was separated into upper layer (UL) and buffy coat (BC) fractions, and their cellular contents were assessed using histological and immunohistochemical staining. The release of platelet-derived growth factor (PDGF) and transforming growth factor (TGF-β) was quantified using an ELISA. Indirect PRF treatment on pOBs was performed to evaluate cell viability and morphology. A histological analysis revealed higher quantities of leukocytes and platelets in the low-RCF PRF. TGF-β release was significantly higher in the low-RCF PRF compared to the high-RCF PRF. All PRF fractions promoted pOB proliferation regardless of the centrifugation protocol used. The low-RCF PRF showed higher TGF-β levels than the high-RCF PRF. These findings contribute to understanding the cellular mechanisms of PRF and provide insights into optimizing PRF protocols for bone regeneration, advancing regenerative medicine, and improving patient outcomes.

L-PRF Secretome from Both Smokers/Nonsmokers Stimulates Angiogenesis and Osteoblast Differentiation In Vitro

Leukocyte and Platelet-Rich Fibrin (L-PRF) is part of the second generation of platelet-concentrates. L-PRF derived from nonsmokers has been used in surgical procedures, with its beneficial effects in wound healing being proven to stimulate biological activities such as cell proliferation, angiogenesis, and differentiation. Cigarette smoking exerts detrimental effects on tissue healing and is associated with post-surgical complications; however, evidence about the biological effects of L-PRF derived from smokers is limited. This study evaluated the impact of L-PRF secretome (LPRFS) derived from smokers and nonsmokers on angiogenesis and osteoblast differentiation. LPRFS was obtained by submerging L-PRF membranes derived from smokers or nonsmokers in culture media and was used to treat endothelial cells (HUVEC) or SaOs-2 cells. Angiogenesis was evaluated by tubule formation assay, while osteoblast differentiation was observed by alkaline phosphatase and osterix protein levels, as well as in vitro mineralization. LPRFS treatments increased angiogenesis, alkaline phosphatase, and osterix levels. Treatment with 50% of LPRFS derived from smokers and nonsmokers in the presence of osteogenic factors stimulates in vitro mineralization significantly. Nevertheless, differences between LPRFS derived from smokers and nonsmokers were not found. Both LPRFS stimulated angiogenesis and osteoblast differentiation in vitro; however, clinical studies are required to determine the beneficial effect of LPRFS in smokers.

Ultrasonographic analysis of palatal donor site healing accelerated with platelet-rich fibrin following subepithelial connective tissue harvesting

OBJECTIVE

Platelet-rich fibrin (PRF) contains a variety of growth factors and bioactive molecules that play crucial roles in wound healing and angiogenesis. We aimed to evaluate the effects of PRF on tissue thickness and vascularization of the palatal donor site by ultrasound (USG) following subepithelial connective tissue harvesting.

METHODOLOGY

A subepithelial connective tissue graft was harvested from the palatal region with a single incision for root coverage in 20 systemically healthy patients. In the test group (n = 10), the PRF membrane was placed at the donor site, whereas no material was applied in the control group (n=10). Palatal tissue thickness (PTT) and pulsatility index (PI) were evaluated by USG at baseline and on the 3rd, 7th, 14th, 30th, and 90th days after surgery. The early healing index (EHI) was used to evaluate donor site healing for 30 days.

RESULTS

PTT was significantly higher in the PRF group on the 3rd and 14th days after surgery when compared to the controls. In the PRF-treated group, PI levels were significantly higher than in the controls, especially on the 14th day. PTT increased significantly 90 days after surgery compared to the test group baseline, but controls showed a significant decrease. The PRF group showed statistically significant improvements in EHI scores compared to controls on days 3, 7, and 14. This study found a negative correlation between PI values and EHI scores on postoperative days three and seven in the test group.

CONCLUSION

USG is a non-invasive, objective method to radiographically evaluate the regenerative effects of PRF on palatal wound healing after soft tissue harvesting. To overcome graft inadequacy in reharvesting procedures, PRF application may enhance clinical success and reduce possible complications by increasing tissue thickness and revascularization in the donor area.

Use of platelet- and leukocyte-rich fibrin (L-PRF) as a healing agent in the postoperative period of third molar removal surgeries: a systematic review

OBJECTIVE

The aim of this study was to analyze the effectiveness of L-PRF as a healing agent in the postoperative period of third molar extraction surgeries, as well as to investigate secondary effects, such as the reduction of pain, edema and other discomforts after the surgical intervention.

MATERIALS AND METHODS

The methodology adopted consisted of carrying out a systematic review of the literature, following the model outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The inclusion criteria were previously established according to a systematic review protocol approved by the Prospective Register of Systematic Reviews (PROSPERO) under number CRD42023484679. In order to carry out a comprehensive search, a search in five databases was carried out, PubMed, Web of Science, Scopus, Cochrane Library and Embase.

RESULTS

The search resulted in the selection of randomized controlled trials that conformed to the established criteria. Two authors independently screened the records and extracted the data. The assessment of bias was conducted according to the guidelines recommended by the Cochrane Collaboration, using version 2 of the Cochrane tool for assessing the risk of bias in randomized trials (RoB 2).

CONCLUSION

This study demonstrated that L-PRF stands out by providing direct benefits to healing, vascularization and tissue regeneration.

CLINICAL RELEVANCE

L-PRF plays an important role in reducing postoperative pain, edema, the incidence of alveolar osteitis and infections after third molar removal surgery, compared to patients who did not undergo the use of L-PRF.

The Use of Platelet-Rich Fibrin in Sinus Floor Augmentation Surgery: a Systematic Review

Objectives

This systematic review aims to critically assess the impact of platelet-rich fibrin on maxillary sinus floor augmentation and outline the specific aspects of new bone formation, bone height, implant stability quotient, and Schneiderian membrane thickness.

Material and Methods

A systematic review and meta-analysis were conducted, analysing studies from MEDLINE (PubMed), the Cochrane Library, and ScienceDirect databases, published from January 29, 2018 until January 29, 2024 that compared maxillary sinus floor augmentation (MSFA) using bone graft material with and without platelet-rich fibrin (PRF). This review focused on patients 18 years and older who undergone MSFA before the dental implant placement. It systematically examined five studies, encompassing randomized controlled trials, and reported on 112 MSFA procedures conducted in 84 patients.

Results

The meta-analysis reveals a marginal significance in new bone formation with PRF, suggesting a trend towards beneficial outcomes that were not statistically significant. No significant impact on bone height was observed. However, a notable improvement in implant stability quotient (ISQ) was recorded, indicating enhanced implant stability with PRF. The Schneiderian membrane thickness did not show significant changes post-treatment with PRF.

Conclusions

While platelet-rich fibrin shows promise in enhancing implant stability, its effects on new bone formation and Schneiderian membrane thickness are inconclusive, highlighting the need for further research. Platelet-rich fibrin did not significantly affect bone height. The findings support platelet-rich fibrin's potential as a beneficial adjunct in maxillary sinus floor augmentation, particularly for implant stability.

The Effect of Platelet-Rich Fibrin and Platelet-Rich Plasma in Secondary Alveolar Bone Grafting in Cleft Lip and Palate Patients: A Systematic Review

(1) Background: Cleft lip, alveolus, and palate are the most common congenital abnormalities in the world, occurring in one in seven hundred live births. Secondary alveolar bone grafting (SABG) is usually performed when the permanent canine root shows one-half to two-thirds of root development. To improve the surgical outcome, supplemental grafting materials such as platelet-rich fibrin (PRF) and platelet-rich plasma (PRP) have been used as an adjunct. This review is designed to assess the efficacy of PRF and PRP in improving the outcome of SABG. (2) Methods: A comprehensive literature search was performed until 13 October 2022 on MEDLINE, EMBASE, The Cochrane Library, and Pubmed. The full text of potentially relevant studies was reviewed, and only randomised clinical trials (RCTs) were included based on the inclusion criteria. (3) Results: A total of 656 studies were screened, of which four were included for final review. All of the four included studies that evaluated the quantitative or qualitative surgical outcome in varied ways. (4) Conclusions: Results of this review suggest that both PRF or PRP and control group (without the use of PRF/PRP) achieved similar successful outcomes in bone height, bone density, and bone volume in both qualitative and quantitative assessment.

Platelet-rich fibrin in dentistry

OBJECTIVES

To review the progress of Platelet Rich Fibrin (PRF) as a biomaterial in dentistry and to highlight its promising application as a safe and biocompatible autologous platelet concentrate. Publications were searched in GeenMedical, X-mol, GoogleScholar, and PubMed from October 2024 with no language restrictions. The literature was searched for relevant databases and journals on the use of PRFs in dentistry up to October 2024, and the inclusion criteria included randomized controlled trials, clinical trials, case series, and systematic reviews.

CONCLUSION

PRF is a second-generation platelet concentrate that is sourced from oneself, has fewer adverse effects, and is simple and safe to prepare. These materials include growth factors and fibrin scaffolds, which are extensively utilized in regenerative medicine. By outlining PRF, we found that good results can be achieved when PRF is used to treat these conditions.

CLINICAL SIGNIFICANCE

The application of PRF in dentistry is widespread, particularly in periodontal soft and hard tissue regeneration, oral lichen planus, and pulpal regeneration. This article reviews the background, classification, and preparation methods of PRFs, along with their dental applications. We anticipate further research on various PRF derivatives in the future, which will significantly improve the utilization of PRF in oral applications and offer fresh insights for diagnosing and treating oral diseases.

Leukocyte- and Platelet-Rich Fibrin (L-PRF) Obtained from Smokers and Nonsmokers Shows a Similar Uniaxial Tensile Response In Vitro

We evaluated and compared the biomechanical properties of Leukocyte-and Platelet Rich Fibrin L-PRF clots and membranes derived from smoker and nonsmoker donors. Twenty venous-blood donors (aged 18 to 50 years) were included after signing informed consent forms. L-PRF clots were analyzed and then compressed to obtain L-PRF membranes. L-PRF clot and membrane samples were tested in quasi-static uniaxial tension and the stress-stretch response was registered and characterized. Furthermore, scanning electron microscope representative images were taken to see the fibrin structure from both groups. The analysis of stress-stretch curves allowed us to evaluate the statistical significance in differences between smoker and nonsmoker groups. L-PRF membranes showed a stiffer response and higher tensile strength when compared to L-PRF clots. However, no statistically significant differences were found between samples from smokers and nonsmokers. With the limitations of our in vitro study, we can suggest that the tensile properties of L-PRF clots and membranes from the blood of smokers and nonsmokers are similar. More studies are necessary to fully characterize the effect of smoking on the biomechanical behavior of this platelet concentrate, to further encourage its use as an alternative to promote wound healing in smokers.

The Potential Therapeutic Effects of Platelet-Derived Biomaterials on Osteoporosis: A Comprehensive Review of Current Evidence

Osteoporosis is a chronic multifactorial condition that affects the skeletal system, leading to the deterioration of bone microstructure and an increased risk of bone fracture. Platelet-derived biomaterials (PDBs), so-called platelet concentrates, such as platelet-rich plasma (PRP) and platelet-rich fibrin (PRF), have shown potential for improving bone healing by addressing microstructural impairment. While the administration of platelet concentrates has yielded positive results in bone regeneration, the optimal method for its administration in the clinical setting is still debatable. This comprehensive review aims to explore the systemic and local use of PRP/PRF for treating various bone defects and acute fractures in patients with osteoporosis. Furthermore, combining PRP/PRF with stem cells or osteoinductive and osteoconductive biomaterials has shown promise in restoring bone microstructural properties, treating bony defects, and improving implant osseointegration in osteoporotic animal models. Here, reviewing the results of in vitro and in vivo studies, this comprehensive evaluation provides a detailed mechanism for how platelet concentrates may support the healing process of osteoporotic bone fractures.

The role and mechanism of platelet-rich fibrin in alveolar bone regeneration

Platelet-rich fibrin (PRF), as an autologous blood preparation, has been receiving increasing attention in recent years and has been successfully applied in various clinical treatments for alveolar bone regeneration in the oral field. This review focuses on analyzing and summarizing the role and mechanism of PRF in alveolar bone regeneration. We first provide a brief introduction to PRF, then summarize the mechanisms by which PRF promotes alveolar bone regeneration from three aspects: osteogenesis mechanism, bone induction mechanism, and bone conduction mechanism, involving multiple signaling pathways such as Smad, ERK1/2, PI3K/Akt, and Wnt/β-catenin. We also explore the various roles of PRF as a scaffold, filler, and in combination with bone graft materials, detailing how PRF promotes alveolar bone regeneration and provides a wealth of experimental evidence. Finally, we summarize the current applications of PRF in various oral fields. The role of PRF in alveolar bone regeneration is becoming increasingly important, and its role and mechanism are receiving more and more research and understanding. This article will provide a reference of significant value for research in related fields. The exploration of the role and mechanism of PRF in alveolar bone regeneration may lead to the discovery of new therapeutic targets and the development of more effective and efficient treatment strategies.

Investigation of three common centrifugation protocols for platelet-rich fibrin (PRF) as a bio-carrier for ampicillin/sulbactam: a prospective trial

OBJECTIVES

Different platelet-rich fibrin (PRF) protocols exist and are known to differ in resulting mechanical and bioactive properties. Centrifugation parameters may also influence drug release, in particular antibiotics, when using PRF as a bio-carrier. We thus evaluated three common protocols regarding effects on the bio-carrier properties.

MATERIALS AND METHODS

In a prospective trial comprising 33 patients, we compared different protocols for PRF as a bio-carrier for ampicillin/sulbactam (SAM). Blood samples were taken shortly after a single dose of ampicillin/sulbactam (2 g/1 g) was administered to patients intravenously. PRF was obtained by centrifugation and three protocols were used: protocol A (1300 rpm, 8 min, RCF-max = 208 g), B (2300 rpm, 12 min, RCF-max = 652 g), and C (1500 rpm, 14 min, RCF-max = 276 g). The antibacterial activity of PRF was investigated against five oral species in vitro, based on agar diffusion methodology.

RESULTS

The study demonstrates that a single dose of SAM is sufficient to reach high concentrations in PRF in all protocols (150 µg/ml), which is comparable to the plasma SAM concentration. Antibacterial activity was inferred from the diameter of inhibition zones seen in agar diffusion tests using PRF discs. Protocol B resulted in the largest inhibition zones. One-way ANOVA revealed statistically improved results for protocol B for some bacteria.

CONCLUSIONS

The study provides valuable data on PRF antibiotic enrichment, notably SAM. A single dose of SAM is sufficient to reach clinically relevant concentrations in PRF.

CLINICAL RELEVANCE

These findings potentially extend the application of PRF, for example in patients with osteonecrosis of the jaw or in oral surgery (e.g., stick bone).

Platelet mitochondria, a potent immune mediator in neurological diseases

Dysfunction of the immune response is regarded as a prominent feature of neurological diseases, including neurodegenerative diseases, malignant tumors, acute neurotraumatic insult, and cerebral ischemic/hemorrhagic diseases. Platelets play a fundamental role in normal hemostasis and thrombosis. Beyond those normal functions, platelets are hyperactivated and contribute crucially to inflammation and immune responses in the central nervous system (CNS). Mitochondria are pivotal organelles in platelets and are responsible for generating most of the ATP that is used for platelet activation and aggregation (clumping). Notably, platelet mitochondria show marked morphological and functional alterations under heightened inflammatory/oxidative stimulation. Mitochondrial dysfunction not only leads to platelet damage and apoptosis but also further aggravates immune responses. Improving mitochondrial function is hopefully an effective strategy for treating neurological diseases. In this review, the authors discuss the immunomodulatory roles of platelet-derived mitochondria (PLT-mitos) in neurological diseases and summarize the neuroprotective effects of platelet mitochondria transplantation.

Current Progress of Platelet-Rich Derivatives in Cartilage and Joint Repairs

In recent years, several types of platelet concentrates have been investigated and applied in many fields, particularly in the musculoskeletal system. Platelet-rich fibrin (PRF) is an autologous biomaterial, a second-generation platelet concentrate containing platelets and growth factors in the form of fibrin membranes prepared from the blood of patients without additives. During tissue regeneration, platelet concentrates contain a higher percentage of leukocytes and a flexible fibrin net as a scaffold to improve cell migration in angiogenic, osteogenic, and antibacterial capacities during tissue regeneration. PRF enables the release of molecules over a longer period, which promotes tissue healing and regeneration. The potential of PRF to simulate the physiology and immunology of wound healing is also due to the high concentrations of released growth factors and anti-inflammatory cytokines that stimulate vessel formation, cell proliferation, and differentiation. These products have been used safely in clinical applications because of their autologous origin and minimally invasive nature. We focused on a narrative review of PRF therapy and its effects on musculoskeletal, oral, and maxillofacial surgeries and dermatology. We explored the components leading to the biological activity and the published preclinical and clinical research that supports its application in musculoskeletal therapy. The research generally supports the use of PRF as an adjuvant for various chronic muscle, cartilage, and tendon injuries. Further clinical trials are needed to prove the benefits of utilizing the potential of PRF.

Comparative Investigation of Anti-Inflammatory Effect of Platelet-Rich Fibrin after Mandibular Wisdom Tooth Surgery: A Randomized Controlled Study

This study evaluated the anti-inflammatory effect of platelet-rich fibrin (PRF) applied to the extraction socket after impacted mandibular third molar surgery with subjective and objective parameters. Forty-eight patients with impacted wisdom teeth in bilateral and similar positions were included in the study. The control group was formed with the standard surgery and the PRF group was formed with local PRF application in addition to standard procedure (n = 96). The anti-inflammatory activity of PRF on postoperative 2nd and 7th days was evaluated subjectively by clinical parameters and objectively by biochemical parameters. Postoperative 2nd- and 7th-day follow-up data of pain, edema, and trismus in the PRF group were found to be statistically significantly lower. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were found to be statistically significantly lower in the PRF group than the control in the postoperative 2nd-day follow-up period (p < 0.001). There was no statistically significant difference in interleukin 6 (IL-6) and tumor necrosis factor-alpha (TNF-α) parameters when the PRF group and the control group were compared in both follow-up periods (p > 0.05). The study has demonstrated the effectiveness of locally applied PRF after ITM surgery via clinical parameters and objective data. The quantitative analysis of CRP and ERS can be an effective parameter in determining the amount of inflammation after ITM surgery.

The Effect of Advanced Platelet-Rich Fibrin in Tissue Regeneration in Reconstructive and Graft Surgery: Systematic Review

This systematic review answered the guiding question using the PICO system: "What are the effects of advanced platelet-rich fibrin (A-PRF) on alveolar ridge preservation and tissue gain in reconstructive and jaw graft surgery?" Searches were performed in the PubMed|MEDLINE, Scopus, Embase, Web of Science, Cochrane Library, and LILACS|bvs databases. In total, 573 articles were found in the initial search, and 564 were evaluated after the removal of duplicates, of which 5 randomized controlled trials met the eligibility criteria and were included 2 studies investigated the effect of A-PRF on the preservation of the bone ridge, 1 study evaluated the tissue repair after tooth extraction with A-PRF, 1 evaluated the peri-implant gap filling with A-PRF-xenograft mixture, and other the A-PRF on the treatment of alveolar osteitis. Advanced-PRF preparation protocol varied between the included studies from 8 to 13 minutes of centrifugation, at 1300 RPM (200 g ). The use of A-PRF provided greater dimensions of height and more favorable maintenance of the ridge profile, probing depth, and gingival margin level after extraction. Advanced-PRF also increased bone density, vital bone, epithelial healing, and control of postoperative pain and swelling after tooth extraction and in the treatment of alveolar osteitis.

Comparative Study of Frequency of Alveolar Osteitis, with and without using Platelet-Rich Fibrin in Mandibular Third Molar Surgery

INTRODUCTION

Alveolar ostitis (AO) is the dissolution of blood clot due to enhanced local fibrinolysis and is caused by trauma to the jaw (direct) or because of bacterial involvement (indirect), which result in the activation of plasminogen pathway. Platelet-rich fibrin (PRF) is a platelet concentrate that comprises numerous autologous growth factors, and immune cells hence has the potential to expedite the healing process. The objective of the study was to determine the efficacy of PRF in the surgically extracted third molar in the context of its potential progress to AO.

MATERIALS AND METHODS

A total of 180 patients of 18-65 years with unilateral painful mandibular third molars due to caries, failed endodontics treatment, and pericoronitis were included in the study. Exclusion criteria were patients who were medically compromised, smokers, alcoholic, poor oral hygiene, third molar having associated periapical pathology, and receiving antibiotic regime in the last 2 weeks. Before starting surgical procedure, patients were randomly divided into two groups using lottery method. Group I received PRF in the extraction socket, while in Group II, the extraction site was left for normal healing as practiced in a standard procedure. Pain was assessed in terms of pain score, and it was recorded on a 10 mm visual analog scale on the first and third postoperative days.

RESULTS

Mean age of the patients was 41.35 ± 9.87 years. The mean age in Group I was 42.84 ± 10.52 years, and in Group II, it was 40.54 ± 9.52 years. Out of 180 patients, 90 (50.0%) were male and 90 (50.0%) were female, with a male-to-female ratio of 1 : 1. Frequency of AO following mandibular third molar surgery in Group I receiving PRF was 2.22% and in non-PRF group 12.22% (p-value = 0.010).

CONCLUSION

The incidence of AO following mandibular third molar surgery was lower when PRF was used.

Can Our Blood Help Ensure Antimicrobial and Anti-Inflammatory Properties in Oral and Maxillofacial Surgery?

In recent decades, the potential of PRF has been extensively studied. The number of studies about PRF has increased three times since the year 2012, but the full spectrum of its fundamental properties, such as antimicrobial and anti-inflammatory activity, is not clearly described. In oral and maxillofacial surgery, PRF is described in alveolar ridge preservation, orthognathic surgery, cleft lip and palate surgery, maxillary sinus augmentation, and dental implant placement as demonstrating favorable results and its clinical advantages. The structural complexity, inhomogeneous nature, and clotting ability of PRF make its antimicrobial effect evaluation complicated. Nevertheless, most of the used antimicrobial testing methods are based on antibacterial agent diffusion ability in culture media. Because the oral and maxillofacial region is the most frequent area of PRF application, its antimicrobial activity evaluation also prevails in the oral microbiome. PRF's biological potential is highly dependent on the specific preparation protocol and methodology used; it should be carefully prepared and kept under proper conditions to keep cellular content alive. PRF's influence on living cells demonstrates a stimulating effect on bone regeneration, and an angiogenetic effect, and it provides anti-inflammatory activity. According to analyzed studies, PRF demonstrated success in oral and maxillofacial surgery in various methods of application. Antibacterial and anti-inflammatory properties were proven by antibacterial activity against different bacterial species, sustained growth factor, sustained release, and cell activity on the material application. Accurately and correctly prepared PRF can ensure antibacterial and anti-inflammatory properties, and it can be a beneficial clinical tool in oral and maxillofacial surgery.

Evaluation of advanced platelet-rich fibrin (PRF) as a bio-carrier for ampicillin/sulbactam

OBJECTIVES

Mechanisms of wound healing are often impaired in patients with osteonecrosis of the jaw (ONJ). According to the guidelines for the treatment of this disease, early surgical intervention is indicated. However, surgery often faces complications such as wound healing disorders. The application of platelet-rich fibrin (PRF) after necrosectomy between bone and mucosa may constitute a promising approach to improve surgical results. An aspect that was not investigated until now is that PRF acts as a "bio-carrier" for antibiotics previously applied intravenously.

MATERIALS AND METHODS

We investigated the antimicrobial properties of PRF in 24 patients presenting ONJ undergoing systemic antibiosis with ampicillin/sulbactam. We measured the concentration of ampicillin/sulbactam in plasma and PRF and performed agar diffusion tests. Ampicillin/sulbactam was applied intravenously to the patient 10 minutes for blood sampling for PRF. No further incorporation of patients' blood or PRF product with antibiotic drugs was obtained. Four healthy patients served as controls.

RESULTS

Our results revealed that PRF is highly enriched with ampicillin/sulbactam that is released to the environment. The antibiotic concentration in PRF was comparable to the plasma concentration of ampicillin/sulbactam. The inhibition zone (IZ) of PRF was comparable to the standard ampicillin/sulbactam discs used in sensitivity testing.

CONCLUSIONS

The results of our study demonstrated that PRF is a reliable bio-carrier for systemic applied antibiotics and exhibits a large antimicrobial effect.

CLINICAL RELEVANCE

We describe a clinically useful feature of PRF as a bio-carrier for antibiotics. Especially when applied to poorly perfused tissues and bone such as in ONJ, the local release of antibiotics can reduce wound healing disorders like infections.

The application of leukocyte- and platelet-rich fibrin (L-PRF) in maxillary sinus augmentation

BACKGROUND

Since the introduction of sinus augmentation in the 1970s the procedure has been performed with or without biomaterials. Autologous blood products (ABPs) for use in sinus augmentation was first introduced in the 2000s, to aid potentially in bone and soft tissue healing.

METHODS

Three different applications of leukocyte- and platelet-rich fibrin (L-PRF) in maxillary sinus augmentation are presented in this case series. In case 1, L-PRF is used in bilateral sinus augmentation to support placement of implants to support a maxillary hybrid denture. Case 2 highlights the use of L-PRF in a complication associate with Schneiderian membrane elevation. Case 3 provides histology taken at the time of implant placement 6 months following L-PRF/xenograft sinus augmentation.

RESULTS

All cases resulted in the successful placement of dental implants. In case 2, an osseodensification procedure was performed with freeze-dried bone allograft, which provided an approximate 4 mm of additional vertical height for implant placement. Histology from case 3 at 6 months post sinus augmentation demonstrated the presence of new vital bone in contact with the xenograft.

CONCLUSION

To date, there is only a limited amount of evidence reporting on platelet-rich fibrin (PRF) or L-PRF use in maxillary sinus augmentation. Bone gain from either product has ranged from 3.2 to 11.8 mm, with the percentage of newly formed bone reported in case series as 33% ± 5%. Despite the lack of strong evidence, L-PRF appears to have beneficial effects on bone regeneration when used in sinus augmentation.

Can L-PRF be helpful for delayed deep wound healing after a tracheotomy or lymph node dissection in a pN0 status?: A case report

INTRODUCTION AND IMPORTANCE

Leukocyte platelet-rich fibrin (L-PRF) is used for its ability to deliver high concentrations of autologous growth factors to host tissues, to promote tissue repair.

CASE PRESENTATION

This report describes the case of a 48-year-old woman with tongue cancer treated surgically (pT3pN0), who experienced a delay of five weeks in the process of deep wound healing after a tracheotomy and cervical lymph node dissection that was treated with L-PRF. The patient had no risk factors for delayed wound healing, except for active preoperative smoking. Several attempts were made to stimulate bleeding and edge-to-edge closure, without conclusive results. However, five days after L-PRF placement, the subcutaneous tissues were adhering to the deep planes in both wounds. Fifteen days after L-PRF treatment, a complete wound healing was observed which allowed initiation of postoperative radiotherapy.

CLINICAL DISCUSSION

This case report questions the potential of L-PRF for patients with a pN0 status, not only in superficial wounds, but also in deep wound healing. However, the use of L-PRF for patients with a pN1 status is not recommended, given the possible presence of tumour cells in the tissues, and the activation of these tumour cells by the growth factors present in L-PRF.

CONCLUSION

This report supports the idea that L-PRF can contribute to deep soft tissue healing for patients with a pN0 status due to its positive clinical healing effects.

Human umbilical cord platelet-rich plasma to treat endometrial pathologies: methodology, composition and pre-clinical models

STUDY QUESTION

Can human umbilical cord platelet-rich plasma (hUC-PRP) efficiently treat endometrial damage and restore fertility in a preclinical murine model?

SUMMARY ANSWER

Local application of hUC-PRP promotes tissue regeneration and fertility restoration in a murine model of Asherman syndrome and endometrial atrophy (AS/EA).

WHAT IS KNOWN ALREADY

AS/EA are well-described endometrial pathologies that cause infertility; however, there are currently no gold-standard treatments available. Recent reports have described the successful use of human platelet-rich plasma in reproductive medicine, and its regenerative potential is further enhanced using hUC-PRP, due to the ample growth factors and reduced pro-inflammatory cytokines in the latter.

STUDY DESIGN SIZE DURATION

hUC-PRP (n = 3) was processed, characterized and delivered locally to endometrial damage in a murine model (n = 50). The hUC-PRP was either used alone or loaded into a decellularized porcine endometrium-derived extracellular matrix (EndoECM) hydrogel; endometrial regeneration, fertility outcomes and immunocompatibility were evaluated 2 weeks following treatment administration.

PARTICIPANTS/MATERIALS SETTING METHODS

Umbilical cord blood was obtained from women in childbirth. Endometrial damage (mimicking AS/EA) was induced using ethanol in 8-week-old C57BL/6 mice, and treated with the most concentrated hUC-PRP sample 4 days later. Characterization of hUC-PRP and immunotolerance was carried out with multiplex technology, while uterine samples were analyzed by immunohistochemistry and quantitative PCR. The number of embryos and their morphology was determined visually.

MAIN RESULTS AND THE ROLE OF CHANCE

Platelet density was enhanced 3-fold in hUC-PRP compared to that in hUC blood (P < 0.05). hUC-PRP was enriched with growth factors related to tissue regeneration (i.e. hepatocyte growth factor, platelet-derived growth factor-BB and epidermal growth factor), which were released constantly (in vitro) when hUC-PRP was loaded into EndoECM. Both treatments (hUC-PRP alone and hUC-PRP with EndoECM) were immunotolerated and caused significantly regeneration of the damaged endometrium, evidenced by increased endometrial area, neoangiogenesis, cell proliferation and gland density and lower collagen deposition with respect to non-treated uterine horns (P < 0.05). Additionally, we detected augmented gene expression of Akt1, VEGF and Ang, which are involved in regenerative and proliferation pathways. Finally, hUC-PRP treatment restored pregnancy rates in the mouse model.

LARGE SCALE DATA

N/A.

LIMITATIONS REASONS FOR CAUTION

This proof-of-concept pilot study was based on a murine model of endometrial damage and the use of EndoECM requires further validation prior to clinical implementation for women affected by AS/EA.

WIDER IMPLICATIONS OF THE FINDINGS

The local administration of hUC-PRP has high impact and is immunotolerated in a murine model of AS/EA, as has been reported in other tissues, making it a promising candidate for heterologous treatment of these endometrial pathologies.

STUDY FUNDING/COMPETING INTERESTS

This study was supported by the Ministerio de Ciencia, Innovación y Universidades; Conselleria de Innovación, Universidades, Ciencia y Sociedad Digital, Generalitat Valenciana; and Instituto de Salud Carlos III. The authors do not have any conflicts of interest to declare.

Platelet-derived growth factors from a single donor by apheresis and one freeze-thaw cycle for treating medication-related osteonecrosis of the jaw

Aim: To assess whether the use of allogeneic platelet-derived growth factors could serve as a feasible, effective and safe biological therapy for the treatment of medication-related osteonecrosis of the jaw (MRONJ). Materials & methods: Patients with multiple myeloma and MRONJ were included and treated with allogeneic platelet-rich plasma, continued for between 6 and 18 weeks (mean: 9). Results: We observed a treatment success rate of 87.5% (p < 0.05). Assessing the association between healing and treatment duration, we observed a statistically significant relationship (χ² = 8.00; p = 0.018; Cramer's V = 1), confirming that healing was very closely related to the duration of the treatment. Conclusion: Allogeneic platelet-rich plasma could be a recommended treatment for MRONJ. Future research with a large sample to validate our findings is required.

Gradual Drug Release Membranes and Films Used for the Treatment of Periodontal Disease

Periodontitis is an inflammatory disease that, if not treated, can cause a lot of harm to the oral cavity, to the patients' quality of life, and to the entire community. There is no predictable standardized treatment for periodontitis, but there have been many attempts, using antibiotics, tissue regeneration techniques, dental scaling, or root planning. Due to the limits of the above-mentioned treatment, the future seems to be local drug delivery systems, which could gradually release antibiotics and tissue regeneration inducers at the same time. Local gradual release of antibiotics proved to be more efficient than systemic administration. In this review, we have made a literature search to identify the articles related to this topic and to find out which carriers have been tested for drug release as an adjuvant in the treatment of periodontitis. Considering the inclusion and exclusion criteria, 12 articles were chosen to be part of this review. The selected articles indicated that the drug-releasing carriers in periodontitis treatment were membranes and films fabricated from different types of materials and through various methods. Some of the drugs released by the films and membranes in the selected articles include doxycycline, tetracycline, metronidazole, levofloxacin, and minocycline, all used with good outcome regarding their bactericide effect; BMP-2, Zinc-hydroxyapatite nanoparticles with regenerative effect. The conclusion derived from the selected studies was that gradual drug release in the periodontal pockets is a promising strategy as an adjuvant for the treatment of periodontal disease.

Initial Healing Effects of Platelet-Rich Plasma (PRP) Gel and Platelet-Rich Fibrin (PRF) in the Deep Corneal Wound in Rabbits

Platelet concentrates (PCs), including platelet-rich plasma (PRP) gel and platelet-rich fibrin (PRF), are autologous blood-derived biomaterials containing numerous growth factors. This study aimed to evaluate the initial healing effects of PRP gel and PRF on deep corneal wounds. Thirty-three eyes from New Zealand white rabbits were divided into four groups: group 1, lamellar keratectomy (LK); group 2, LK + commercial porcine small intestinal submucosal membrane (SIS); group 3, LK + SIS + PRP gel; and group 4, LK + SIS + PRF. Postoperative clinical and histological findings were observed for eight weeks. Group 1 showed no neovascularization during the observation period, and incompletely recovered with a thin cornea. Group 2 showed active healing through neovascularization, and a thick cornea was regenerated through the sufficient generation of myofibroblasts. Although group 3 showed a healing effect similar to that of group 2, angiogenesis and subsequent vessel regression were promoted, and corneal opacity improved more rapidly. In group 4, angiogenesis was promoted during initial healing; however, the incidence of complications, such as inflammation, was high, and myofibroblasts were hardly generated in the corneal stroma, which adversely affected remodeling. In conclusion, while PRP gel is a safe surgical material for promoting remodeling through vascular healing and myofibroblast production in deep corneal wounds, the use of PRF is not recommended.

Injectable Platelet-Rich Fibrin as a Drug Carrier Increases the Antibacterial Susceptibility of Antibiotic—Clindamycin Phosphate

The aim of this study was to investigate the change in clindamycin phosphate antibacterial properties against Gram-positive bacteria using the platelet-rich fibrin as a carrier matrix, and evaluate the changes in the antibiotic within the matrix. The antibacterial properties of CLP and its combination with PRF were tested in a microdilution test against reference cultures and clinical isolates of Staphylococcus aureus (S. aureus) or Staphylococcus epidermidis (S. epidermidis). Fourier-transform infrared spectroscopy (FTIR) and scanning electron microscope (SEM) analysis was done to evaluate the changes in the PRF_CLP matrix. Release kinetics of CLP was defined with ultra-performance liquid chromatography (UPLC). According to FTIR data, the use of PRF as a carrier for CLP ensured the structural changes in the CLP toward a more active form of clindamycin. A significant decrease in minimal bactericidal concentration values (from 1000 µg/mL to 62 µg/mL) against reference cultures and clinical isolates of S. aureus and S. epidermidis was observed for the CLP and PRF samples if compared to pure CLP solution. In vitro cell viability tests showed that PRF and PRF with CLP have higher cell viability than 70% after 24 h and 48 h time points. This article indicates that CLP in combination with PRF showed higher antibacterial activity against S. aureus and S. epidermidis compared to pure CLP solution. This modified PRF could be used as a novel method to increase drug delivery and efficacy, and to reduce the risk of postoperative infection.

Silk Fibroin as Adjuvant in the Fabrication of Mechanically Stable Fibrin Biocomposites

Fibrin is a very attractive material for the development of tissue-engineered scaffolds due to its exceptional bioactivity, versatility in the fabrication, affinity to cell mediators; and the possibility to isolate it from blood plasma, making it autologous. However, fibrin application is greatly limited due to its low mechanical properties, fast degradation, and strong contraction in the presence of cells. In this study, we present a new strategy to overcome these drawbacks by combining it with another natural polymer: silk fibroin. Specifically, we fabricated biocomposites of fibrin (5 mg/mL) and silk fibroin (0.1, 0.5 and 1% w/w) by using a dual injection system, followed by ethanol annealing. The shear elastic modulus increased from 23 ± 5 Pa from fibrin alone, to 67 ± 22 Pa for fibrin/silk fibroin 0.1%, 241 ± 67 Pa for fibrin/silk fibroin 0.5% and 456 ± 32 Pa for fibrin/silk fibroin 1%. After culturing for 27 days with strong contractile cells (primary human arterial smooth muscle cells), fibrin/silk fibroin 0.5% and fibrin/silk fibroin 1% featured minimal cell-mediated contraction (ca. 15 and 5% respectively) in contrast with the large surface loss of the pure fibrin scaffolds (ca. 95%). Additionally, the composites enabled the formation of a proper endothelial cell layer after culturing with human primary endothelial cells under standard culture conditions. Overall, the fibrin/silk fibroin composites, manufactured within this study by a simple and scalable biofabrication approach, offer a promising avenue to boost the applicability of fibrin in tissue engineering.

Alopecia Areata Treated with Advanced Platelet-rich Fibrin Using Micronization

Platelet-rich plasma (PRP) has been shown to release a multitude of growth factors, but its preparation requires the use of anticoagulants. In contrast, advanced platelet-rich fibrin (aPRF) is produced by centrifuging whole blood and allowing it to clot. The clot contains the platelets, growth factors, and neutrophils, and it is composed of a fibrin matrix that continuously releases more growth factors over a longer time period. Advanced PRF is commonly used in dental and bone grafting procedures, but it is rarely used for cosmetic injectables because its high density makes it difficult to inject through smaller gauge needles. A technique is described whereby aPRF is reduced to an injectable form with micronization and used to treat alopecia areata (AA) in a 28-year-old patient who developed it after symptomatic COVID-19 infection a month before presentation. The patient was vaccinated in between infection, and symptoms were limited to headache and sore throat. He had complete resolution of his AA at 6-month follow-up with only two treatments as opposed to monthly intralesional steroids. We report our results using aPRF for AA with promising results as a possible future treatment for patients with this autoimmune disease.

Evaluation of mechanical properties of platelet-rich fibrin membrane for implant surgery: An analysis in vitro

The aim of this study was to evaluate and compare the mechanical resistance of platelet-rich fibrin (PRF) membrane when submitted to resistance traction on longitudinal axis. Blood collection of a healthy individual was collected with an amount of 300 mL and divided into 30 tubes containing 10 mL each one. The samples were divided into three groups, according to the g-force protocols: (1) F200 g: (2) F400 g; (3) F800 g. Membranes of each g-force group were divided into subgroups, according to waiting time after centrifugation: (T0) immediate use and (T30) use after 30 min. Considering these intervals of time, the concentrate was removed from tubes and inserted in a PRF metallic box to confection of the membrane. The PRF membranes were submitted to mechanical tension on a universal testing machine and obtained to a resistance force of each membrane. The centrifugation time showed no statistically significant difference for membrane resistance for any force applied (P > 0.05; Student's t-test). For T0 group results demonstrated no influence for membrane resistance (P = 0.357; Student's t-test), therefore T30 showed statistically significant difference (P = 0.040; Student's t-test) for membrane resistance for centrifugation forces applied, with highest value when applied greatest force. The findings suggest that the waiting time for centrifugation could be determined according to demand of application, and for immediate use of the membrane, the centrifugation did not influence the resistance, on the other hand, after 30 min, the application of higher force resulted in a membrane with considerable resistance.

Applications of the regenerative capacity of platelets in modern medicine

Platelets produce platelet growth factors such as PDGF, IGF-1, EGF-, HGF, TGFβ, bFGF, and VEGF, which are crucial in regulating all stages of the wound healing process. The source of these substances is platelet-rich plasma (PRP). Over the past five decades, the interest and use of the regenerative properties of platelets have increased significantly in many different fields of medicine around the world. PRP and PRF plate preparations are used in: 1. Dentistry (they reduce bleeding, facilitate and accelerate soft tissue healing and bone regeneration - FGF 2, IGF-1, IGF-2, TGF-β1, and PDGF); 2. Sports medicine - IGF-1, IGF-2, TGF-β, VEGF, PDGF and bFGF, EGF); 3. dermatology and cosmetology (treatment of alopecia, hair reconstruction - FGF-7, HGF, acne scars, skin rejuvenation and regeneration, treatment of chronic and poorly healing wounds, burns, and acquired vitiligo); 4. Gynecology and reproductive medicine (treatment of infertility, erectile dysfunction - PDGF-β, TGF-β, IGF-1, in sexual dysfunction - PDGF, in vaginal atrophy); 5 Ophthalmology (in the healing of corneal epithelial wounds, in the treatment of dormant corneal ulcers, dry eye syndrome and the reconstruction of the corneal surface; 6. Neurology (regeneration of neurons, pain alleviation, and clinical symptoms - TGF-β 1, IGF-1, PDGF, VEGF) and FGF). Platelet-rich plasma therapy is a very interesting alternative and complement to traditional methods of treatment. However, the potential for using platelets is still not fully understood. The composition of platelet-rich plasma depends on many factors that may affect its use's efficacy and clinical benefits. Further research is necessary to standardize PRP delivery's preparation procedures and methods for a specific disease entity or clinical case.

Plasma Rich in Growth Factors in the Treatment of Endodontic Periapical Lesions in Adult Patients: A Narrative Review

Platelet concentrates have been widely used in regenerative medicine, including endodontics. The aim of this manuscript was to assess critically the efficacy of PRF in the treatment of endodontic periapical lesions in adult patients on the basis of the literature. The PICO approach was used to properly develop literature search strategies. The PubMed database was analyzed with the keywords: "((PRP) OR (PRF) OR (PRGF) OR (CGF)) AND (endodontic) AND ((treatment) OR (therapy))". After screening of 155 results, 14 articles were included in this review. Different types of platelet concentrates are able to stimulate the processes of proliferation and differentiation of mesenchymal stem cells. Platelet rich fibrin (PRF) releases growth factors for at least 7 days at the application site. Growth factors and released cytokines stimulate the activity of osteoblasts. Moreover, the release of growth factors accelerates tissue regeneration by increasing the migration of fibroblasts. It was not possible to assess the efficacy of PRF supplementation in the treatment of endodontic periapical lesions in permanent, mature teeth with closed apexes, due to the lack of well-designed scientific research. Further studies are needed to analyze the effect of PRF on the healing processes in the periapical region.

Application of platelet-rich fibrin on mandibular third molar extraction: systematic review and Meta-analysis

OBJECTIVES

This study aims to analyze the effectiveness of platelet-rich fibrin (PRF) in mandibular third molar extraction and provide suggestions for alleviating postoperative complications.

METHODS

Pubmed, EMBASE, Web of Science, and SinoMed were searched electronically on February 2020. Randomized controlled trials focusing on PRF usage in mandibular third molar extraction were included. Reviewers assessed the risk of bias in the included literature and extracted data independently using the criteria recommended by the Cochrane Collaboration. Meta-analysis was performed using RevMan 5.3 and STATA 13.0.

RESULTS

Twenty-one studies were included, comprising 991 patients who had mandibular third molar extraction. The topical application of PRF effectively reduced pain after extraction [MD=-12.06, 95%CI (-21.42, -2.71), P=0.01], attenuated post-extraction swelling [MD=-1.42, 95%CI (-2.41, -0.44), P=0.005], and promoted soft tissue hea-ling [MD=0.66, 95%CI (0.34, 0.99), P<0.000 1]. PRF significantly reduced trismus and alveolar osteitis (P<0.05). However, data could not prove whether PRF has any significant positive effect on bone healing compared with the control group (P>0.05).

CONCLUSIONS

Limited clinical evidence indicates that applying PRF after mandibular third molar extraction could reduce pain, swelling, trismus and the occurrence of dry socket and promote soft tissue healing. However, the effect of PRF on bone healing requires further large-scale randomized controlled trials and unified measurement criteria.

Clinical outcomes of operative arthroscopy and temporomandibular medical infiltration with platelet-rich fibrin in upper and lower articular space

This study aims to describe the short-term therapeutic results of patients treated with operative arthroscopy and medical infiltration with platelet-rich fibrin in upper and lower articular space. The study design is descriptive observational with retrospective case series of patients with Wilkes II and III. These patients were managed with operative arthroscopy viscosupplementation with platelet-rich fibrin (PRF) and were followed up for up to 8 months to evaluate their response to treatment. 17 patients were included in the study. In the pre-surgical assessment (T1) mean VAS was 7.1 and MID was 22.2 mm. Eight months later (T4) a relevant improvement in both mentioned variables MID 38.2 ± 4.1 and VAS 1.1 ± 0.2 was observed. Regarding the reduction of pain, a significant improvement in symptoms were found, this being 84.6% ± 3.5% and in mandibular mobility satisfactory results were also obtained, improving in 41.7% ± 20.9%. Within the limitations of the study temporomandibular joint arthroscopy and medical infiltration platelet-rich fibrin viscosupplementation is a procedure of limited invasiveness that shows promising results.

Application of Platelet-Rich Fibrin Derivatives for Mandibular Third Molar Extraction Related Post-Operative Sequelae: A Systematic Review and Network Meta-Analysis

PURPOSE

Leukocyte- and platelet-rich fibrin (L-PRF) and advanced-platelet-rich fibrin (A-PRF) that are derivatives of PRF (platelet-rich fibrin) accelerate wound healing and reduce postoperative sequelae after tooth extraction. This network meta-analysis aimed to investigate the effectiveness of L-PRF and A-PRF in mandibular third molar extraction and provide suggestions for alleviating postoperative symptoms and signs.

METHODS

A comprehensive search of the literature was conducted in PubMed, Embase, Web of Science, and SinoMed databases up to Oct 9, 2020. Three types of randomized controlled trials were included to investigate the effects of PRF derivatives after extracting mandibular third molars: A-PRF and L-PRF groups; A-PRF and control groups; L-PRF and control groups. Their relative effectiveness and ranking were assessed using network meta-analysis and the surface under the cumulative ranking curve (SUCRA) with STATA 16.0 and Revman 5.3, respectively.

RESULTS

Ten randomized controlled trials were included, with 307 mandibular third molar extraction patients involved. The results showed that A-PRF had the best effect among the 3 groups in improving postoperative pain on the third (SUCRA = 98.2%) and seventh (SUCRA = 88.4%) days; L-PRF promoted soft tissue healing (MD = -0.90, 95% CI [-1.40, -0.40], P = .0004) on the seventh day compared with the control. However, other comparisons showed no significant differences (P > .05).

CONCLUSION

The limited results confirmed that PRF derivatives only reduced some postoperative symptoms and did not prevent them all. Application of A-PRF after third molar extraction reduced postoperative pain, and L-PRF improved the degree of soft tissue healing.

Periodontally accelerated osteogenic orthodontics with platelet-rich fibrin in an adult patient with periodontal disease: A case report and review of literature

BACKGROUND

In the clinical scenario, adult patients with periodontal diseases and dental malformation, characterized by dental crowding in lower anterior teeth with the thin biotype, often require orthodontic treatment. This case report aimed to evaluate the clinical and radiographic outcomes of periodontally accelerated osteogenic orthodontics (PAOO) combined with autologous platelet-rich fibrin (PRF) in an adult patient with class I malocclusion along with dental crowding, a thin periodontal biotype, and buccal plate deficiency.

CASE SUMMARY

A 32-year-old female complaining of dental crowding and gingival bleeding was referred to the orthodontic clinic. The patient underwent periodontal risk assessment prior to orthodontic treatment. She was diagnosed with a high risk of gingival recession due to dental crowding, root prominence, loss of buccal plates, and a thin gingival tissue biotype. The treatment regimen included PAOO combined with autologous PRF for alveolar augmentation and interproximal enamel reduction for moderate dental crowding. Clinically, PAOO-assisted orthodontic tooth movement in this case showed enhanced periodontium remodeling. Radiographic outcomes also showed statistically significant improvements (P < 0.01) in the mandibular buccal alveolar bone.

CONCLUSION

This case report suggests the combination of autologous PRF with PAOO to enhance bone augmentation and long-term tissue support in adult orthodontic patients with periodontal disease.