Fig.1- The PRF obtaining technology involves blood drawl and a centrifuge

 

A-PRF si I-PRF membranes: the most biologic choice in dental surgery

 

In the last 3 years dental surgery started using even more biological augmentation procedures. When and why do we need these augmentations? In many cases where the alveolar bone is diminished, either due to time, or the untreated periodontal lesions or endodontic lesions (cysts , granulomas), or advanced ridge resorption (where teeth were taken out and the bone has suffered a severe retraction, in both height and thickness.

In all of these cases a simple dental implant cannot solve the situation of the bone deficit. In order to ensure the implant a very good stability we need a serious bone support. This requires supplementary procedures, like bone augmentation and membrane application. Bone augmentation can either be of human nature, animal nature  or non-animal.

As we already know, the lowest of all risks when inserting a foreign material into the human body is of human origin, either own or foreign (other human). The risk of rejection in these cases is 0. For bone reconstruction we, the dental surgeons, can sample bone from the chin, maxillary prominence or the iliac ridge. The membranes used to cover the augmented bone are also of different natures: epithelial, collagenic of animal origin, dehydrated and sterilized. Clinical studies have shown that patient sampled membranes were used in dental surgery with great results. So how do we do this and why are these membranes so good?

Platelet concentrate fibrin is an evolution of the fibrin glue widely used in the oral surgery. The principle of this new technology is based on concentrating platelets and growth factors in a plasma solution, and activating them in a fibrin gel in order to improve the healing of surgical wounds. This platelet suspension, defined as platelet-rich plasma (PRP), as the platelet concentrate used in transfusional medicine, is the precursor of another autologous derived, the platelet-rich fibrin (PRF), a solid fibrin-based biomaterial. There are many different techniques to get the platelets concentrations, but its applications have caused some confusion, as each different method led to different products with different biological potentials and applications.

A recent classification of the different platelet concentrates divided them into four different categories depending on the leukocytes and fibrin content: pure platelet-rich plasma (P-PRP), such as cell separator PRP, Vivostat PRF or Anitua's PRGF; leucocyte- and platelet-rich plasma (L-PRP), such as Curasan, Regen, Plateltex, SmartPReP, PCCS, Magellan or GPS PRP; pure plaletet-rich fibrin (P-PRF), such as Fibrinet and leucocyte- and platelet-rich fibrin (L-PRF), such as Choukroun's PRF. This classification allows us to analyze the successes and failures that have occurred so far in oral surgery, and direct research towards further applications of these technologies^.

The different applications of the PRF were tested in various fields of surgery and particularly in periodontics, oral and maxillofacial surgery, ear-nose-throat plastic surgery.

In fact, these preparations are not limited to the concentration of growth factors, but associate many factors of healing such as leukocytes, fibrin matrix, circulating progenitor cells and are as complex as blood itself.

If platelets concentrates have been used to improve healing of surgical wounds (such as fibrin glue enriched with growth factors), further developments of these preparations include applications in regenerative medicine and tissue engineering. Obviously the future of these products is related with the scientific consistency of their applications. The aim of this review was to discuss PRF in oral and maxillofacial surgery.

The regenerative medicine techniques are applied in dentistry to restore the bone loss: the PRF was tested for the first time in France by Dr. Choukroun^. In Choukroun's PRF protocol, blood is collected without any anticoagulant and immediately centrifuged .A natural coagulation process then occurs and allows for the easy collection of a L-PRF clot, without the need for any biochemical modification of the blood, that is, no anticoagulants, thrombin or calcium chloride are required . This open-access technique is the most simple and also the least expensive protocol developed so far. However, some confusion is likely because different suppliers use similar nomenclature for their distinct products (such as Vivostat PRF and Fibrinet Platelet-Rich Fibrin Matrix).

In dentistry we usually use the PRF variants. These would be A-PRF and I-PRF.

 

Fig,2- blood draw is done in the dental office by the clinic’s personnel

 

A-PRF is an platelet enriched plasma product. Its intense healing action is due to the growth factors it contains. These growth factors are slowly released and their healing action in the first 3 days after a dental surgery process is immense. Either we use it in a sinus elevation technique, an implant insertion, apical resection or periodontal aesthetic surgery, this product helps by circulation stimulation, diminishing dental trauma effects, and after surgery pain. These membranes can be applied on to the bone granules or in-between them. The greatest advantage would be their origin: the patient’s, without adding any other products (calcium chloride , trombin).  

Fig.3- you can see the entire kit for correct PRF prelevation

Blood is drawn from the patient, a viol is filled and introduced in to the centrifuge. After several minutes, using no anticoagulant, the plasma separates from the other cells. The dentist has to take out only the plasma part, by simply cutting it with scissors. This plasma in then put into a metal case, horizontally. A cap is placed onto it, flattening it and dehydrating it partially. After a couple of minutes the desired membrane can be used, after cutting it depending on the surgical area needed.

 

Fig. 4, 5 si 6 – the concentrate is separated and put on a horizontal metal case

 

Fig.7 – several membranes correctly obtained

 

The other PRF membrane is called I-PRF and is a liquid growth factor concentrate. It is usually injected in or under soft tissues, or together with bone augmentation products in periodontology and implantology. This product is even richer in platelets and white cells. Together with the augmentation materials it strongly reduces the inflammation process and ensures the desired result. Together with the A-PRF product, they lower the post surgical pain and edema. They are used together is sinus lifting techniques, dental and implant bone augmentation and esthetic procedures.

The blood draw is done in the dental office by the dental personnel, before the dental surgery. Special one use only products are used for every patient. The blood is then put in the centrifuge and the program is started. In the meanwhile the surgeon can start his procedure. Another doctor usually handles the centrifuge and takes out the viols. Than the concentrate is separated by cutting and then put on the metal horizontal sterile case. In the end of the intervention the surgeon cuts the membranes as desired. If he chooses to also use the I-PRF product, a new centrifuge program will be used with a newly drawn blood. The program for I-PRF is shorter. 

Fig.8 – I-PRF is a liquid serum applied by injection

 

There is no need for morning blood draw and eating restriction. The patient needs to be rested , calm and medicated (is he has any usual medication).

This entire procedure is not painful, but similar to any usual blood draw. The special kit and the centrifuge is needed and also a steady calm hand. All doctors and nurses are trained for this procedure.

 

At ABC Eurodent we have ensured to have all of these above mentioned so you can benefit from this anytime, without having to go to another clinic, hospital or institution.