PRF AND A-PRF IN DENTISTRY

PRP (Platelet Rich Plasma) – is a plasma enriched with platelets, derived as a result of thrombopheresis of the blood collected from the patient. After adding thrombin and calcium ions, we get a platelet rich preparation with consistency similar to the one of a gel, which includes a variety of growth factors affecting the bone regeneration process.

PRF (Platelet Rich Fibrin) and A-PRF (Advanced Platelet Rich Fibrin) – is a fibrin enriched in platelets which is very effective in stimulating bone growth thanks to a slow release of cell growth factors, thus producing the best results when it comes to healing.

What can you learn from this article?

  • What the difference between PRP and PRF is, and what PRF and A-PRF are.
  • Why these elements are used in dentistry – recommendations.
  • What the healing and regeneration mechanism with the use of PRF and A-PRF consists in.

The development of contemporary dentistry consists in more than just new materials used in cosmetic dentistry as it also includes prosthodontics, orthodontics or conservative dentistry. Moreover, it covers materials and modern methods of complex regenerative treatment of soft tissue and osseous tissue in the oral cavity.

When planning parodontosis treatment and prosthetic or implant procedures, insufficient bone or gum volume usually proves to be an obstacle almost impossible to overcome. This substantial deficit of hard and soft tissue is often a result of bones damaged by periodontal inflammatory processes, periodontal diseases or tissue damaged during extraction (tooth removal). However, there is a way to reduce the risk of losing tissue due to the above reasons. Tissue stimulation protocol, which consists in using the patient’s own blood, is a simple, safe and very natural method of shaping the healing process. Platelet rich fibrin is put in the place of the deficit. It has a high content of the patient’s proteins from the venous blood which stimulate the process of osteocyte multiplication (cells forming bones).

The method of obtaining PRP and PRF is relatively new – it was created in 1990s and referred to the white blood cells’ potential of stimulating progenitor bone cells. Since that time, PRP has been employed in a variety of medical branches where there are bone regeneration processes.

What is PRF?
Platelet rich fibrin (PRF) is an autogenous matrix obtained from the patient’s platelet concentration. After a simple collection procedure and spinning the patient’s blood in a centrifuge in the clinic, we get a fibrin membrane which stimulates healing and growth of bones and soft tissue. It is rich in leukocytes and the vascular endothelial growth factor (VEGF).

PRF also initiates permanent release of the platelet derived growth factor (PDGF), a protein which plays a vital role in the angiogenesis process; beta–transforming growth factor (TGF), a protein which stimulates tissue growth; thrombospondin 1, an adjacent glycoprotein which participates in interactions between cells and in the angiogenesis process. The presence of these proteins significantly accelerates healing, especially in the critical phase during the first daysafter surgery.

The main advantage of this autogenous biomaterial is the slow release of growth factors from PRF which lasts more than 7 days. It may be done only from the RF membrane, but not from PRP or PRGF. The liquid drained from membranes is accumulated. It contains high numbers of proteins specialized in increasing the cell attachment to biomaterial and titanium.

In the clinical view, membranes have extraordinary properties. They are springy, resilient and flexible which makes it easy to manipulate them easily, cut and sew. PRF is exceptionally stable at a room temperature, which makes it possible to extend the working time. Membranes are very easy to create (a special PRF Box) and are very similar to natural post-procedure fibrin networks. The biological and biomimetic quality of that membrane supports effective migration and cell proliferation and also eliminates the need to use biomechanical additions or anticoagulants.

It is very easy to create membranes in a clinic. To sum up, it requires that the precise spinning protocol of a given level of the patient’s blood be strictly followed, and that membranes be drained and cut to the specified and fixed thickness.

What is the difference between PRP and PRF?
In comparison to the PRP technique (plasma enriched with platelets determining immediate release of growth factors which limits healing and regeneration effects) employed in dentistry and orthopedics, now the best results in regeneration techniques are achieved with the use of the method for obtaining PRF (Platelet Rich Fibrin) which causes a slow, over 7-day long, release of cell growth factors, thus providing the best results with respect to vascularisation, healing and regeneration therapy. In the case of surgical, periodontological or implantological treatment, the modern A-PRF technique is used. Thanks to appropriate techniques of collection and spinning of the patient’s blood, and proper execution, A-PRF is a source of collagen, elasticin, platelet growth factors (determining the process of multiplication and creation of blood vessels, as well as stimulating and differentiating other cells, e.g. endothelium, fibroblasts, bone cells) and also includes leukocytes releasing further growth factors, working with platelet factors. An increased effect of A-PRF stimulation is also related to trapping the whole volume of monocytes and ensuring their faster transformation into macrophages, thus increasing the effect of bone stimulation.

Why is this method used in dentistry?
A-PRF factor in the shape of membranes, corks or powdered structure is used to accelerate wound healing and regeneration (growth and diversification) of tissue structures in areas of the oral cavity that are difficult to handle due to the patient’s anatomy. Moreover, it is used in combined techniques (with bones, MSC) to intensify ossification (bone formation) and tissue regeneration (e.g. gingiva or damaged mucous membrane in the oral cavity).

Other recommendations in the area of dentistry:

  • Sinus lift (a procedure of maxillary sinus floor augmentation employed in implantological treatment);
  • Soft tissue transplants;
  • Periodontal defects (parodontosis treatment);
  • Post-extraction alveolar ridges (bone regeneration for future implants and prosthetic reconstruction);
  • Enhancing wound healing (wound closure).

Causes of tissue healing and regeneration following the use of PRF and A-PRF
All clinical recommendations for PRF stress accelerated tissue healing. It is caused by:

  • Effective creation of new vessels;
  • Accelerated wound closure;
  • Fast scar tissue remodeling.

Tissue growth stimulation, thanks to protein growth factors, significantly accelerates healing of the tissue immediately after surgical procedures. Slow release of growth factors from PRF takes place for longer than 8 days after depositing A-PRF in the post surgery location. This valuable autogenous material is obtained from the patient’s venous blood which is spun in particular parameters and then drawn and shaped as a membrane or corks in the form of the alveolar ridge. A-PRF may be used in the course of surgical and implantological treatment, particularly in clinical procedures requiring augmentation procedures where there is tissue deficiency.