Platelet rich fibrin: a new paradigm in periodontal regeneration
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ORIGINAL PAPER
Platelet rich fibrin: a new paradigm in periodontal regeneration R. Vinaya Kumar • N. Shubhashini
Received: 14 October 2011 / Accepted: 3 November 2012 Ó Springer Science+Business Media Dordrecht 2012
Abstract Among the great challenges facing clinical research is the development of bioactive surgical additives regulating inflammation and increasing healing. Although the use of fibrin adhesives and platelet-rich plasma (PRP) is well documented, they have their own limitations. Hence, reconstructive dental surgeons are looking for an ‘‘edge’’ that jump starts the healing process to maximize predictability as well as the volume of regenerated bone. Overcoming the restrictions related to the reimplantation of bloodderived products, a new family of platelet concentrate, which is neither a fibrin glue nor a classical platelet concentrate, was developed in France. This second generation platelet concentrate called platelet-rich fibrin (PRF), has been widely used to accelerate soft and hard tissue healing. Its advantages over the better known PRP include ease of preparation/application, minimal expense, and lack of biochemical modification (no bovine thrombin or anticoagulant is required). This article serves as an introduction to the PRF
R. Vinaya Kumar (&) Department of Periodontics, Rajarajeswari Dental College and Hospital, Mysore Road, Ramohalli Cross, Bangalore 560060, India e-mail: [email protected] N. Shubhashini Department of Conservative Dentistry and Endodontics, Rajarajeswari Dental College and Hospital, Mysore Road, Ramohalli Cross, Bangalore 560060, India
‘‘concept’’ and its potential clinical applications with emphasis on periodontal regeneration. Keywords Platelet-rich fibrin Cytokines Fibrin fibrillae Root coverage Regeneration Healing Abbreviations ALP Alkaline phosphatase CCE Crestal core elevation CD Cluster of Differentiation cPRP Concentrated platelet-rich plasma CR3 Complement Receptor 3 FDBA Freeze-dried bone allograft FDPs Fibrinogen degradation products GBR Guided bone regeneration IGF Insulin-like growth factor IL Interleukin IL-1Ra Interleukin-1 receptor antagonist L-PRF Leucocyte- and platelet-rich fibrin MCAF Modified coronally advanced flap OFD Open flap debridement OMSFE Osteotome-mediated sinus floor elevation OPG Osteoprotegrin PDGF Platelet-derived growth factor p-ERK Phosphorylated extracellular signalregulated protein kinase PPP Platelet-poor plasma PRF Platelet-rich fibrin PRFe PRF extract PRFM Platelet-rich fibrin matrix
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Cell Tissue Bank
PRP RBCs TGF TNF VEGF WBCs
Platelet-rich plasma Red blood cells Transforming growth factor Tumor necrosis factor Vascular endothelial growth factor White blood cells
Introduction Among the great challenges facing clinical research is the development of bioactive surgical additives regulating inflammation and increasing healing. In fact, after every intervention, surgeons face complex tissue remodeling phenomena and the consequences on healing and tissue survival (Dohan et al. 2006a). Hence, reconstructive
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