Extended platelet-rich fibrin

Effect of Autologous Concentrated Growth Factor in Regenerative Dentistry: A Systematic Review and Meta-Analysis

INTRODUCTION

Concentrated growth factor (CGF), a novel autologous platelet concentrate, has gained substantial interest for its potential role in managing oral diseases. The objective of this study is to evaluate the effectiveness of CGF in regenerative dentistry.

METHODS

A systematic search was performed across MEDLINE, OVID, Scopus, Cochrane Library, Google Scholar, Web of Science, and Elsevier for publications between July 1, 2013, and July 1, 2023. Only randomized clinical trials were included. The quality of the methodology was assessed using the Cochrane Risk of Bias Tool. Data were analyzed using RevMan 5.4 software.

RESULTS

In 3 trials treating periodontal intrabony defects, CGF combined with bone grafts showed significant superiority over bone grafts alone (P < .00001), with a mean reduction of 1.41 mm in intrabony defect depth and a mean gain of 0.55 mm in clinical attachment level (P = 0.002). For gingival recession in 5 trials, CGF combined with coronally advanced flap (CAF) was more effective than CAF alone, resulting in a mean increase in keratinized tissue width of 0.41 mm and a mean increase in gingival thickness of 0.26 mm (P < 0.00001). However, CGF combined with CAF was less effective than connective tissue graft (CTG) combined with CAF, showing a mean difference in root coverage of -15.09% and a mean difference in gingival thickness of -0.50 mm (P < 0.0001). In alveolar ridge preservation, sinus elevation, guided bone regeneration, dental implant procedures, and postextraction healing, CGF gave better values in clinical practice.

CONCLUSIONS

CGF enhances regenerative surgery outcomes for periodontal intrabony defects. Combined with CAF, CGF improves therapeutic efficacy for gingival recession, although less so than CTG with CAF. CGF shows promise in various regenerative dentistry areas. However, the absence of meta-analysis and low-quality assessments in many studies necessitates further high-quality research.Knowledge Transfer Statement:The use of concentrated growth factors (CGFs) in regenerative dentistry, within the limitation of low-quality studies, shows promising benefits in treating periodontitis infrabony defects, gingival recession, guided bone regeneration, dental implant alveolar ridge preservation, sinus elevation, and third molar extraction. Future research should focus on high-quality studies and explore combining CGF with grafting materials to enhance therapeutic outcomes in oral surgery.

Biomaterials for Guided Tissue Regeneration and Guided Bone Regeneration: A Review

This review aims to provide an overview of the types of membranes, bone substitutes, and mucosal substitutes used for GTR and GBR and briefly explores recent innovations for tissue regeneration and their future perspectives. Since this is a narrative review, no systematic search, meta-analysis, or statistical analysis was conducted. Using biomaterials for GTR and GBR provides a reduction in postoperative morbidity, as it contributes to less invasive clinical procedures, serving as an alternative to autogenous grafts. Moreover, randomized clinical trials (RCTs) and systematic reviews are essential for the evaluation of new biomaterials. These studies provide more robust evidence and help guide clinical practice in the selection of safer and more effective biomaterials, allowing for the personalization of treatment protocols for each patient.

Platelet-rich plasma (PRP) versus injectable platelet-rich fibrin (i-PRF): A systematic review across all fields of medicine

This systematic review aimed to evaluate all available evidence across all fields of medicine regarding the comparative effectiveness of platelet-rich plasma (PRP) versus injectable platelet-rich fibrin (i-PRF). A comprehensive search was conducted in PubMed, Scopus, and Web of Science up to September 30, 2024. Following a thorough screening process, studies were divided into in vitro, in vivo, and clinical studies based on their tissue/clinical indications. The initial search generated 2192 articles, of which 23 met the inclusion criteria. The findings demonstrated that i-PRF yielded higher platelet concentrations and offered a more sustained, long-term release of growth factors over time when compared to PRP. Overall, it was determined from in vitro studies that i-PRF significantly improved the activity of many cell types, including for skin, cartilage, periodontal, bone, soft tissue around dental implants, and pulp cells. In vivo outcomes also generally indicated that i-PRF outperformed PRP in cartilage and testicular regeneration. However, in orthodontic tooth movement, PRP was found to lead to superior short-term effects, while i-PRF showed more beneficial long-term effects. Clinical studies also found superior outcomes of i-PRF in skin regeneration, cartilage, and pulp regeneration. Outcomes regarding orthodontic tooth movement utilizing i-PRF or PRP remain controversial. In 72% of studies, i-PRF was found to lead to better outcomes across the various fields of medicine when compared to PRP, whereas 24% found no differences between the groups. Reasons and inconsistencies across the studies may be attributed to protocol differences and tissue types. Overall, additional clinical studies are needed with well-designed research and centrifugation protocols to better understand the regenerative potential of platelet concentrates in medicine. i-PRF offers a more sustained and prolonged release of growth factors and was favored in the majority of studies over PRP and should, therefore, be favored for the majority of medical and dental applications.

Nonsurgical Facial Esthetic Procedures

Nonsurgical facial esthetic procedures have revolutionized cosmetic enhancement, offering minimally invasive options for facial rejuvenation. This comprehensive overview covers a wide range of techniques, including wrinkle relaxation with botulinum toxin, skin volumization using dermal fillers and biostimulators, hair restoration, and various skin tightening and texture improvement methods. The article details the mechanisms, applications, and potential risks of each procedure, highlighting recent advancements and trends in the field. It classifies these treatments into clinically-oriented categories based on patients' desired changes.

Autolougous platelet concentrates in esthetic medicine

This narrative review summarizes current knowledge on the use of autologous platelet concentrates (APCs) in esthetic medicine, with the goal of providing clinicians with reliable information for clinical practice. APCs contain platelets that release various growth factors with potential applications in facial and dermatologic treatments. This review examines several facial esthetic applications of APCs, including acne scarring, skin rejuvenation, melasma, vitiligo, stretchmarks, peri-orbital rejuvenation, peri-oral rejuvenation, hair regeneration and the volumizing effects of APC gels. A systematic review of literature databases (PubMed/MEDLINE) was conducted up to October 2023 to identify randomized controlled trials (RCTs) in the English language on APCs for facial rejuvenation and dermatology. A total of 96 articles were selected including those on platelet rich plasma (PRP), plasma-rich in growth factors (PRGF), and platelet-rich fibrin (PRF). Clinical recommendations gained from the reviews are provided. In summary, the use of APCs in facial esthetics is a promising yet relatively recent treatment approach. Overall, the majority of studies have focused on the use of PRP with positive outcomes. Only few studies have compared PRP versus PRF with all demonstrating superior outcomes using PRF. The existing studies have limitations including small sample sizes and lack of standardized assessment criteria. Future research should utilize well-designed RCTs, incorporating appropriate controls, such as split-face comparisons, and standardized protocols for APC usage, including optimal number of sessions, interval between sessions, and objective improvement scores. Nevertheless, the most recent formulations of platelet concentrates offer clinicians an ability to improve various clinical parameters and esthetic concerns.

Essential principles for blood centrifugation

Currently, autologous platelet concentrates (APCs) are frequently used for soft- and hard-tissue regeneration, not only within the oral cavity, but also extra-orally including chronic wounds, burns, joints, dermatological conditions, among others. The benefits of APCs are largely influenced by the treatment strategy but also their preparation. This paper therefore discusses in detail: the physical properties of blood cells, the basic principles of blood centrifugation, the impact of the centrifugation protocol (rotations/revolutions per minute, g-force, variation between centrifuges), the importance of timing during the preparation of APCs, the impact of the inner surface of the blood tubes, the use/nonuse of anticoagulants within APC tubes, the impact of the patient's hematocrit, age, and gender, as well as the important requirements for an optimal centrifugation protocol. All these variables indeed have a significant impact on the clinical outcome of APCs.

Extended Platelet-Rich Fibrin as a Membrane for Lateral Window Sinus Lifts: A Case Series

INTRODUCTION

Platelet-rich fibrin (PRF) is being increasingly utilized in surgical procedures due to various improvements in clinical outcomes. More recently, a heating process to denature albumin in the platelet poor plasma (PPP) layer has been shown to extend the resorption time of PRF from a typical 2-week period to 4-6 months. Because of its > 4 month resorption properties, extended PRF (e-PRF) membranes have been used in dentistry as an alternative to collagen membranes in alveolar ridge preservations, ridge augmentations, soft tissue grafting, and as a barrier membrane in lateral sinus grafting procedures.

MATERIALS AND METHODS

A total of 22 patients from 3 different clinical facilities participated in this multicenter case series study. All clinicians completed a standard lateral window sinus technique with sticky bone utilizing allograft, xenograft, or autologous dentin with an e-PRF membrane utilized for sole coverage of the lateral window. The survival rate at second stage implant surgery (~6 months) and radiographic analysis determined on consecutive radiographs: (1) the mean residual bone height (RBH) under the maxillary sinus at implant placement and (2) the change in endosinus bone level, were calculated to assess the endosinus bone changes at 6 months.

RESULTS

Between June 2022 and December 2023, 22 patients were included in this study. Patients included 12 women and 10 men with a mean age of 58.8 years, ranging from 32 to 78 years. In 22 lateral window sinuses completed, a total of 31 implants were placed. All patients healed uneventfully without any post-operative complications. Post-op CBCTs were taken at 6 months to demonstrate successful sinus floor augmentation and to calculate endosinus gain. No soft tissue invagination was encountered in any of the study participants nor displacement of the graft material into the buccal mucosa. In one case highlighted in this study, the e-PRF membrane was utilized to repair a sinus perforation. The average 6-month post-operative sinus height was 12.3 mm with a mean change in endosinus bone gain of 8.0 mm.

CONCLUSION

Utilizing extended-PRF membranes in place of collagen membranes for coverage of the lateral window during sinus floor elevation was shown to be a successful treatment modality in this case series. These findings provide new opportunities utilizing denatured albumin membranes in implant dentistry and paves the way for additional applications. The material is 100% autologous, low cost. This is the first case series study highlighting its novel use for coverage of the lateral window during sinus grafting. Larger longitudinal studies are now needed with comparison to standard resorbable membranes as well as long-term follow-up of implants placed into sites grafted with e-PRF membranes.

Platelet-rich fibrin application after mandibular third molar extraction: an umbrella review

OBJECTIVES

The aim of this study was evaluate the effect of Platelet-Rich Fibrin (PRF) in patients after mandibular third molar extraction through an analysis of the most current literature on systematic reviews and meta-analyses.

DATA, SOURCES AND STUDY SELECTION

By using computer-assisted search technology, we comprehensively searched several reliable databases, such as China National Knowledge Infrastructure (CNKI), WanFang Data, the Chinese biomedical literature database, PubMed, Web of Science, EMBase, and the Cochrane Library, and performed a systematic retrospective meta-analysis on all of the collected studies on the therapeutic effects of PRF on patients after mandibular third molar extraction. A total of nine meta-analyses were performed in this study, and all nine studies were rated as high quality on the basis of the AMSTAR 2 criteria. Seven outcome indicators were extracted from the nine meta-analyses.

CONCLUSION

According to the included studies, which all demonstrated high scientific quality, PRF application after mandibular third molar extraction significantly reduces postoperative pain and inflammation, accelerates soft tissue healing, and effectively lowers the incidence of complications such as dry socket and alveolar osteitis. However, PRF did not significantly affect trismus or bone density. The conclusion has reliable support and clinical significance.

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.

In vitro ultrastructure and biodegradation of activated plasma albumin gel derived from human samples: A prospective observational study

BACKGROUND

In soft tissue regeneration, the clinical efficacy of fibrin membranes has been a pressing concern. The key to this efficacy lies in the stability of membrane and its controlled absorption. Human serum albumin, with its influence on the formation and stability of fibrin networks, could hold the key to developing a more stable alternative. This study investigates the ultrastructure and biodegradability of plasma albumin-activated gel, a potential game-changer in the field.

METHODS

Blood samples were collected from the participants and centrifuged to obtain the concentrated growth factor. The poor platelet plasma syringe was placed inside the activated plasma albumin gel device. The ultrastructure of the membrane was examined using a scanning electron microscope (SEM). The weight difference was measured over 21 days to investigate the biodegradability of the samples.

RESULTS

Twenty-two samples were prepared from six individuals (three males and three females). Based on SEM images, activated albumin gel after 21 days in Hank's solution exhibited a significant decrease in density and evident signs of surface degradation. The weight was significantly reduced after 21 days (p < 0.05).

CONCLUSION

In the present study, the investigation of the ultrastructure and biodegradability of activated albumin gel showed that, based on the observed weight difference, the amount of biodegradation is high, and it may be necessary to use a thicker membrane compared to the conventional thickness of the connective tissue graft.

KEY POINTS

Enhanced stability and biocompatibility: The study highlights plasma albumin-activated gel's potential as a soft tissue scaffold, demonstrating significant biodegradation and structural changes that support cell infiltration and nutrient exchange, essential for tissue regeneration. Controlled degradation profile: Plasma albumin gel offers a prolonged biodegradation period compared to conventional fibrin membranes, making it suitable for applications requiring stable, long-lasting scaffolds in soft tissue regeneration. Future clinical applications: Findings suggest that thicker plasma albumin membranes may be needed for optimal effectiveness, paving the way for further exploration in clinical trials and animal models to validate this approach in soft tissue grafting.

PLAIN LANGUAGE SUMMARY

This study investigates plasma albumin-activated gel as a promising material for supporting soft tissue repair, particularly in periodontal regeneration. Traditional materials, such as fibrin membranes, are often used to aid healing, but their rapid breakdown can limit effectiveness in the body. Plasma albumin, a protein naturally found in human blood, might offer a more stable alternative by forming a longer-lasting structure. In this study, researchers processed blood samples from participants to create the gel, examining its structure under a powerful microscope and tracking changes in weight over 21 days to assess its breakdown. Results showed that the gel gradually became less dense and more porous, allowing for cell movement and nutrient flow-both critical for tissue repair. Additionally, a significant reduction in weight indicated a controlled breakdown over time. These findings suggest that plasma albumin-activated gel may serve as a more durable scaffold for soft tissue regeneration, potentially improving healing outcomes in periodontal applications where a stable, longer-lasting material is needed.

ALB-PRF facilitates chondrogenesis by promoting chondrocytes migration, proliferation and differentiation

Cartilage injury is common in orthopedics and cartilage tissue engineering provides a therapeutic direction for cartilage regeneration. Albumin (ALB)-platelet-rich fibrin (PRF) is speculated to be an ideal natural scaffold material for cartilage tissue engineering theoretically as a product derived from human venous blood. Through in vitro and in vivo experiments, it was demonstrated that ALB-PRF displayed porous structure and slowly released growth factors (TGF-β1, PDGF-AA, PDGF-AB, PDGF-BB, EGF, IGF-1 and VEGF), ALB-PRF conditioned media promoted proliferation, migration, adhesion, phenotype maintenance and extracellular matrix secretion of rabbit chondrocytes. Moreover, ALB-PRF facilitated chondrogenesis in vivo, the regenerative cartilage formed by ALB-PRF/chondrocytes was histologically similar to that of natural knee joint cartilage, the regenerative cartilage expressed cartilage differentiation marker (SOX9, ACAN and COL II), and proliferation marker PCNA and secreted abundant glycosaminoglycans (GAGs) in extracellular matrix. In conclusion, ALB-PRF promoted the migration, proliferation and phenotype maintenance of chondrocytes in vitro. Its loose, porous structure and rich growth factors contained enhanced cell adhesion and growing into the materials. ALB-PRF facilitated chondrogenesis of chondrocytes in vivo.

Leukocyte-and Platelet-Rich Fibrin for enhanced tissue repair: an in vitro study characterizing cellular composition, growth factor kinetics and transcriptomic insights

BACKGROUND

Leukocyte- and platelet-rich fibrin (L-PRF) is an autologous platelet concentrate, prepared by centrifugation of blood and consisting of a dense fibrin network with incorporated leukocytes and platelets. This study aims to perform an in-depth analysis of the cells, growth factors, and transcriptome of L-PRF.

METHODS AND RESULTS

Fresh, 1 week and 2 weeks cultured human L-PRF membranes and liquid L-PRF glue were characterized on cellular and transcriptional level using flow cytometry (n = 4), single-cell RNA sequencing (n = 5) and RT-qPCR. Growth factor kinetics were investigated using ELISA (EGF, VEGF, PDGF-AB, TGF-β1, bFGF). L-PRF contained a large number of viable cells (fresh 97.14 ± 1.09%, 1 week cultured 93.57 ± 1.68%), mainly granulocytes in fresh samples (53.9 ± 19.86%) and T cells in cultured samples (84.7 ± 6.1%), confirmed with scRNA-seq. Monocytes differentiate to macrophages during 1 week incubation. Specifically arterial L-PRF membranes were found to release significant amounts of VEGF, EGF, PDGF-AB and TGF-β1.

CONCLUSION

We characterized L-PRF using in vitro experiments, to obtain an insight in the composition of the material including a possible mechanistic role for tissue healing. This was the first study characterizing L-PRF at a combined cellular, proteomic, and transcriptional level.

Treatment of a fractured humerus and partially torn supraspinatus tendon in a professional boxer with liquid platelet-rich fibrin and heat-coagulated albumin gel: a case report

INTRODUCTION

Fractures with delayed healing can be a serious complication, especially for athletes depending on quick return to sports. To our knowledge, no cases of increased healing of delayed union fractures with autologous biomedical interventions have been reported.

CASE PRESENTATION

A 33-year-old Swedish professional boxer with a fractured humerus with a delayed union and a partially torn supraspinatus tendon was treated with injections of liquid platelet-rich fibrin and heat-coagulated albumin gel. He recovered almost completely from both injuries in only 1 month and could return to professional boxing in 3 months.

CONCLUSION

This case raises the hypothesis that liquid platelet-rich fibrin and heat-coagulated albumin gel may be an effective, minimally invasive intervention in fractures with a delayed union. Further research is required to test this theory.

Delayed centrifugation weakens the in vitro biological properties of platelet-rich fibrin membranes

OBJECTIVE

To investigate how delayed blood centrifugation affects the composition of the resultant platelet rich fibrin membrane (PRF, a concentrated growth factor preparation) and its biological effects towards gingival fibroblasts.

MATERIALS AND METHODS

Blood samples were collected from 18 healthy individuals and centrifuged immediately (T-0), or after a 1-6-minute delay (T-1-6, respectively), to generate PRF. Each PRF membrane was weighed. T-0 and T-6 membranes were incubated for 48 h in cell culture medium at 37 °C to create PRF "releasates" (soluble factors released from the PRF). Human gingival fibroblasts were incubated for 48 h with or without the releasates, followed by RNA isolation and real-time polymerase chain reaction to measure expression of select genes associated with granulation tissue formation, angiogenesis and wound contraction. Additional T-0 and T-6 membranes were used for visualization of leucocyte nuclei and platelets by immunostaining.

RESULTS

Immediate centrifugation (T-0) resulted in the largest membranes, T-6 membranes being on average 29% smaller. Leucocytes and platelets were significantly more abundant in T-0 than in T-6 samples. Majority of the fibroblast genes studied were consistently either upregulated or downregulated by the T-0 PRF releasates. However, centrifugation after a 6-minute delay significantly weakened the fibroblast responses.

CONCLUSIONS

Delayed centrifugation resulted in smaller PRF membranes with fewer leucocytes and platelets and also significantly reduced on the expression of a set of healing-related gingival fibroblast genes.

CLINICAL RELEVANCE

The higher expression of wound healing-related genes in gingival fibroblasts by the immediately-centrifuged PRF membranes may increase their biological properties in clinical use.

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.