Oral surgeons use fibrin rich in white blood cells and platelets (L-PRF) in clinical surgery, including transplantation, soft tissue transplantation, Bone grafting and most implant implantation. He said L-PRF is "like a magical drug". One week after the surgery, the surgical site using L-PRF appears to have healed for three to four weeks, which is very common, "Hughes said. It greatly accelerates the therapeutic cascade reaction.''
Platelet rich fibrin (PRF) and its predecessor platelet rich plasma (PRP) are classified as autologous blood concentrates, which are blood products made from patients' own blood. Clinicians extract blood samples from patients and use a centrifuge to concentrate them, separating different blood components into separate concentration layers that can be used by clinical doctors. Although there are several variants of this technology today that prioritize different blood components, the overall concept of dentistry is the same - they use the patient's own blood to promote healing after oral surgery.
Hughes said that rapid healing is just one of the benefits. When specifically discussing L-PRF, he pointed out a series of benefits for patients and dentists: it reduces intraoperative bleeding and reduces inflammation. It enhances the primary closure of the surgical flap for re approach. L-PRF is rich in white blood cells, thus reducing the risk of postoperative infection. Because it is made from the patient's own blood, it eliminates the risk of allergies or immune rejection. Finally, Hughes said that it is also easy to make.
''In my 30 years of clinical practice, there are no other drugs, devices, or technologies that can accomplish all of these things like L-PRF, "Hughes said. Autologous blood concentrates can assist patients during and after oral surgery, but ordinary dentists often face challenges when adding PRP/PRF to their practice. The specific challenges of increasing the use of autologous blood concentrates include managing the growing equipment market, understanding different changes and how to use them, and explaining their use in dental applications.
PRP and PRF: Important Differences that General Dentists Should Understand
PRP and PRF are not the same product, although practitioners and researchers alternate the use of these two terms for the next generation of biomaterials for bone and periodontal regeneration "and" Platelet rich fibrin in regenerative dentistry: biological background and clinical indications ". Miron said that PRP was first used in oral surgery in 1997. It refers to a platelet rich concentrate mixed with Anticoagulant. PRF was launched as the second generation platelet concentrate in 2001, without Anticoagulant.
''Compared to PRP, data from many medical fields clearly demonstrate better results for PRF, as coagulation is an important event in the wound healing process, "Miron said. He said that the advantage of using PRP and PRF is that they can promote tissue regeneration at a relatively low cost. "However, the argument that PRP" always "uses Anticoagulant has caused controversy among Arun K. Garg, DMD, the co-discoverer of PRP.
"In the early days of using PRP, we sometimes omit Anticoagulant as soon as we need to use this material," Garg said. "For longer operation time, we added a Anticoagulant to preserve platelet-derived growth factor until we are ready to use this material, and then we will induce coagulation when using it." Hughes specifically uses PRF in his practice, adding that part of the reason for the need to improve PRP is because the original PRP equipment is expensive, and the technology is more complex and time-consuming - PRP requires two rotations in a centrifuge with the addition of thrombin, while PRF only needs to be rotated once without the need to be added. ''PRP was initially most commonly used in large oral or plastic surgery cases in hospitals, "Hughes said. PRP has been shown to be impractical for use in typical dental clinics.
From theory to practice: Blood concentrates, PRF, and PRP in clinical dental environments are collected and produced in a similar manner. They explain that blood is taken from patients and placed in a small bottle. Then rotate the vial in a centrifuge at a predetermined speed and duration to separate PRF from the blood during this process. The PRF obtained is a yellow gel like membrane, which is usually compressed into a flatter membrane. "These membranes can then be adapted to Bone grafting materials, combined with Bone grafting materials, or positioned around or on the top of dental implants to provide a biofilm that promotes bone maturation and improves patient health. Keratized gingival tissue," Kussek said. PRF can also be used as the only transplant material for periodontal surgery. In addition, this material is very helpful for repairing perforations during sinus enlargement, preventing infections, and improving clinical outcomes.''
''The typical use of PRP includes combining it with PRF and bone particles to form a 'sticky' bone that is easy to adapt and operate in the oral cavity during the transplantation process, "Kusek continued. PRP materials can also be injected into the transplant area to increase stability and inject into surrounding tissues to improve healing.'' "In practice, they are used for Bone grafting by mixing PRP with Bone grafting materials and placing them, then placing PRF membrane on the top, and then placing polytetrafluoroethylene membrane on it," Rogge said. I am still using PRF as a clot after tooth extraction - including wisdom teeth - to help reduce dry socket and promote healing. To be honest, I have not had dry socket since implementing PRF. Eliminating dry socket is not the only benefit Rogge sees.
''Not only did I see faster healing and increased bone growth, but I also noticed a decrease in postoperative pain reported when using PRP and PRF.'' ''If PRP/PRF is not used, will the patient recover? "Watts said. But if you can make it easier and faster for them to achieve the final result, with fewer complications, why don't you?''
The cost of adding PRP/PRF varies in general dental practice, largely due to the flourishing development of autologous blood concentrates. These products have spawned a multi billion dollar industry, with different manufacturers creating subtle (sometimes proprietary) variants of centrifuges and small bottles. ''Centrifuges with different speed settings have been introduced in the market, and changes in centrifugation can affect the vitality and effectiveness of cells in them, "Werts said. Is it clinically meaningful? I'm not sure how someone will measure this.'' In addition to centrifuge investment and phlebotomy training, Werts said that other costs involved in using PRP/PRF in practice, such as vacuum sealed collection tubes, Winged infusion set and suction tubes, are "minimal".
''The use of absorbable membranes in transplant surgery may cost $50 to $100 each, "Werts said. In contrast, using the patient's own PRF as the external cost of the membrane plus your time can be charged. Autologous blood products have an insurance code, but the insurance coverage rarely pays for this fee. I often charge for surgery and then give it as a gift to the patient.''
Paulisick, Zechman, and Kusek estimate that the initial cost of adding centrifuges and PRF membrane compressors in their practice ranges from $2000 to $4000, with the only additional cost being a disposable blood collection kit, typically costing less than $10 per box. Due to industry competition and the large number of centrifuges available in the market, dentists should be able to find equipment at various price points. Research has shown that as long as the protocol is consistent, there may not be significant differences in the quality of PRF produced using different centrifuges.
''Our research team recently published a systematic review in which we found that PRF significantly improved clinical outcomes in periodontal and soft tissue repair, "Miron said. Nevertheless, we have concluded that there is still a lack of good research to convincingly demonstrate the role of PRF in inducing bone formation (bone induction). Therefore, clinical doctors should be informed that PRF has stronger soft tissue regeneration ability than hard tissue.''
Most scientific research seems to support Miron's claim. There is evidence to suggest that PRP/PRF does contribute to the healing process, even when the improvement level is not statistically significant. Although there is a lot of Anecdotal evidence, researchers believe that more conclusive evidence is needed. Since PRF was first used in oral surgery in 2001, there have been several changes - L-PRF, A-PRF (advanced platelet rich fibrin), and i-PRF (injectable platelet rich fibrin) fibrin). As Werts said, it is "enough to make you dizzy and strive to learn and remember them.''
''Essentially, all of this can be traced back to the original concept of PRP/PRF, "he said. Yes, the advantages of each of these new 'improvements' can be scientifically proven, but in clinical practice, their effects are all the same - they all significantly promote healing.'' Hughes agreed and pointed out that L-PRF, A-PRF, and i-PRF are all "small" variants of PRF. These varieties do not require special equipment, but rather require adjustments to the centrifugal scheme (time and rotational force). ''To create different types of PRFs, it is necessary to change the rotation time or revolutions per minute (RPM) of the blood during the centrifugation process, "Hughes explained.
The first variant of PRF is L-PRF, followed by A-PRF. The third variety, i-PRF, is a liquid, injectable form of PRF that provides an alternative to PRP. ''It is important to understand that PRF usually takes the form of clumps, "Hughes said. ''If you need to inject PRF, you only need to change the centrifugation time and RPM to make it into liquid form - this is i-PRF.'' If there is no Anticoagulant, i-PRF will not remain liquid for a long time. Hughes said that if it is not injected quickly, it will become a sticky colloidal gel, but the product is also very useful. "It is an excellent adjunct to granular or massive Bone grafting, which helps stabilize and fix the graft," he said. ''I have seen that using it in this capacity has achieved very good results.''
If varieties, abbreviations, and naming conventions confuse industry professionals, how should ordinary dentists explain the concept of autologous blood concentrate to patients?
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Post time: Jul-24-2023