Understanding Platelet-Rich Fibrin. Richard J. Miron

ms

      Private Practice Limited to Oral Surgery Buffalo Grove, Illinois

      Yoshinori Shirakata, dds, phd

      Associate Professor, Department of Periodontology

      Kagoshima University Graduate School of Medical and Dental Sciences

      Kagoshima, Japan

      Miguel Stanley, dds

      Private Practice

      Lisbon, Portugal

      Robert Talac, md, phd

      Director, Renaxis Spine and Orthopedic Clinic

      Houston, Texas

      Mustafa Tunali, dds, phd

      Professor, Department of Periodontology

      Haydarpasa Training Hospital

      Gulhane Military Medical Academy

      Istanbul, Turkey

      Delia Tuttle, dds, ms

      Private Practice

      Lake Elsinore, California

      Hom-Lay Wang, dds, msd, phd

      Professor and Director of Graduate Periodontics

      Department of Periodontics and Oral Medicine

      University of Michigan School of Dentistry

      Ann Arbor, Michigan

      Hudi Xu, dds, phd

      Research Associate, Department of Dental Implantology

      School of Stomatology

      Wuhan University

      Wuhan, China

      Yufeng Zhang, md, dds, phd

      Professor, Department of Dental Implantology

      School of Stomatology

      Wuhan University

      Wuhan, China

Abbreviations

      The abbreviations listed here are used throughout the book and are NOT always spelled out in the chapters for ease of reading.

ALP	alkaline phosphatase
AM	amniotic membrane
A-PRF	advanced PRF
BoP	bleeding on probing
BMP	bone morphogenetic protein
CAF	coronally advanced flap
CAL	clinical attachment level
CBC	complete blood count
CEJ	cementoenamel junction
C-PRF	concentrated-PRF
CTG	connective tissue graft
DBBM	deproteinized bovine bone mineral
DFDBA	demineralized freeze-dried bone allograft
ECM	extracellular matrix
EDTA	ethylenediaminetetraacetic acid
EGF	epidermal growth factor
EMD	enamel matrix derivative
e-PRF	extended-PRF
ePTFE	expanded polytetrafluoroethylene
FDA	US Food and Drug Administration
FDBA	freeze-dried bone allograft
GBR	guided bone regeneration
GF	growth factor
H&E	hematoxylin-eosin stain
hPDLC	human periodontal ligament cell
H-PRF	PRF obtained through horizontal centrifugation
IGF	insulinlike growth factor
IL	interleukin
i-PRF	injectable-PRF
ISQ	implant stability quotient
KTW	keratinized tissue width
L-PRF	leukocyte PRF
LPS	lipopolysaccharide
LSCC	low-speed centrifugation concept
mRNA	messenger RNA
MRONJ	medication-related osteonecrosis of the jaw
MSC	mesenchymal stem cell
OFD	open flap debridement
ONJ	osteonecrosis of the jaw
PD	probing depth
PDGF	platelet-derived growth factor
PPE	personal protective equipment
PPP	platelet-poor plasma
PRF	platelet-rich fibrin
PRGF	plasma rich in growth factors
PRP	platelet-rich plasma
PTFE	polytetrafluoroethylene
RBC	red blood cell
RBH	residual bone height
RCF	relative centrifugal force
RCT	randomized controlled trial
rpm	revolutions per minute
RT-PCR	real-time polymerase chain reaction
SD	standard deviation
SE	standard error
SEM	scanning electron microscopy
TGF-β	transforming growth factor β
TMJ	temporomandibular joint
TNF-α	tumor necrosis factor α
T-PRF	titanium-prepared PRF
VEGF	vascular endothelial growth factor
WBC	white blood cell

1

       Evolution of Platelet Concentrates

      Contributors

      Richard J. Miron

      Chapter Highlights

       Evolution of PRF and the reasons for its discovery

       Discussion of PRP vs PRGF vs PRF vs L-PRF, A-PRF, etc

       Biologic background of key steps involved during wound healing

      

       Video 1-1

      Platelet concentrates were derived more than 20 years ago following the discovery that platelets themselves act as key regulators during the wound healing process. Initial attempts were first made to concentrate these cells using anticoagulants and a centrifugation device; the resulting biomaterial was called platelet-rich plasma (PRP). Shortly thereafter, protocols were developed with the aim of avoiding the use of anticoagulants altogether, because clotting is a pivotal step during the wound healing cascade; the resulting biomaterial was called platelet-rich fibrin (PRF). Today, platelet concentrates have become incredibly relevant worldwide, with their use spanning across nearly every field of regenerative medicine. Furthermore, one of the main growth factors (GFs) found in platelets—platelet-derived growth factor (PDGF)—has been commercialized as a ready-made laboratory recombinant protein under the trade name GEM 21S (Lynch Biologics). Thus, as medicine has continued to evolve and progress, an obvious and clear trend favoring GF use has been established. Furthermore, by modifying centrifugation devices and spin protocols of PRP/PRF, a greater ability to concentrate not only platelets but also leukocytes became possible, further favoring tissue regeneration. This chapter takes a deep look at the years of research leading to the significant advancement that has been made in this field. The evolution from PRP to PRF, including pioneering concepts such as the low-speed centrifugation concept and horizontal centrifugation, are discussed in terms of their ability to favor higher cell content, GF concentration, and ultimately better wound healing.

Platelet concentrates have been utilized in medicine for over two decades because of their ability to rapidly secrete autologous GFs and ultimately speed wound healing. They have gained tremendous momentum as a regenerative agent derived from autologous sources capable of stimulating tissue regeneration in a number of medical fields.^1,2 Many years ago, it was proposed that by concentrating platelets using a centrifugation device, GFs derived from blood could be collected from a platelet-rich plasma layer and later utilized