PRF in dental implantology – how to utilise it
PRF in dental implantology helps achieving accelerated healing and regeneration of bone and soft tissue and new blood vessel formation which are the fundamentals of successful dental implant treatment. It provides a scaffold and a natural bioactive barrier, allowing cellular migration and interaction with the tissues below and above it. This interaction between tissues facilitates natural healing.
PRF is an autologous fibrin-based living biomaterial rich in platelets, growth factors, stem cells and white blood cells and derived from patient’s blood. PRF makes dental surgery much easier and promotes high quality clinical outcome.
Where and how can I use PRF?
Use in surgical situations where protection, stimulation of healing and regeneration is critical and where the prognosis for tissue repair is poor or potentially compromised.
- Increasing implant stability and osseo-integration
- Ridge preservation, extraction sockets
- Socket augmentation for early or late implant placement
- Sinus floor elevation
- Guided bone regeneration
Uses of PRF in dental implantology
Increasing implant stability and osseo-integration
PRF application into the osteotomy site increases implant stability during the early healing period, as evidenced by higher ISQ values. Simple application of PRF also provides faster osseointegration. Furthermore, when L-PRF is used during one-stage implant placement, the amount of initial bone remodelling (first three months after implant placement) can be reduced significantly. (Öncu and Alaaddinoõglu. 2015).
Ridge preservation, extraction socket
The application of the membrane in an extraction socket significantly reduces the horizontal/vertical ridge resorption, even at sites with bone dehiscence. The observed reduction in bone resorption is comparable to the current “best performing” clinical procedures (using a bone substitute in combination with connective-tissue graft or membrane).
As a filling material in extraction sockets, PRF will act as a stable blood clot for neovascularization and accelerated tissue regeneration. As a filling material after third-molar extraction has a beneficial effect on both post-operative pain and soft-tissue healing. PRF enables fast neoangiogenesis and promotes bone regeneration by releasing growth factors and a good cloth stability.
PRF course with the inventor Dr. Joseph Choukroun
25-26th March, 2022 London
- Dr. Choukroun’s upcoming Platelet Rich Fibrin -PRF- course is an enlightenment on the biological and mechanical conditions for long term stability and success of bony and soft tissue management.
- Learn about PRF use in dental implantology, oral surgery, bone graft. Prepare PRF products on the hands-on session, practice phlebotomy and start utilising PRF from the next day in your dental practice.
Alveolar ridge preservation (socket augmentation) for early or late implant placement
The use of PRF membranes to fill the socket after tooth extraction has shown to improve alveolar bone healing and preservation of the alveolar crest width. Plugs or membranes can also be used to fill extraction sockets, even when associated with compromised extraction sockets, severe cystic destructions, or after cyst enucleations to allow early bone and gingival regeneration required for implant placement. (Choukroun, et al., 2006; Magremanne, et al., 2009)
Alternatively, it can also be mixed with a bone substitute to fill the socket and used as a protective cover over the grafted socket. This is particularly important when gingival wound closure is impossible or difficult with the sutures (Del Corso, et al., 2012).
The purpose of the membrane is not only to stimulate gingival healing, but also to protect the bone graft from the oral environment and to maintain it within the extraction socket, like a biological barrier.
Sinus floor elevation – using PRF as sole or combination graft biomaterial
PRF can either be cut to fragments and mixed with different bone substitutes or can be used as a sole filling material during sinus floor elevation. It can be applied either via a lateral window technique or through a trans-alveolar approach. Several studies have confirmed a natural bone regeneration around the implants (± 10mm vertical bone gain with the window technique, ±4mm for trans- alveolar approach).
Various case studies have demonstrated that the membranes can be used successfully as a protective barrier to cover the sinus membrane during grafting procedures (Diss, et al., 2008; Toffler, et al., 2010; Kanayama, et al., 2014).
Combined with a bone allograft or other bone substitutes it accelerates graft maturation and decreases the healing period before implant placement. The latter finding has also been confirmed by other clinical trials and case studies (Choukroun, et al., 2006; Tatullo, et al., 2012; Zhang, et al., 2012; Bölükbas, et al., 2013).
Guided bone regeneration
As a membrane for guided bone regeneration, the dense matrix architecture covers, protects and stabilizes bone graft material.
PRF liquid (i-PRF) can be injected above, or (A-PRF or L-PRF) membrane placed above the GBR or GTR membrane to act as an interposition barrier to protect and stimulate the bone compartment, and as a healing membrane in order to improve the soft tissue healing and remodeling, and thus avoid soft tissue dehiscence (Peck, et al., 2011; Inchingolo, et al., 2010).
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Ana B. Castro,Nastaran Meschi,Andy Temmerman,Nelson Pinto,Paul Lambrechts,Wim Teughels,Marc Quirynen: Regenerative potential of leucocyte‐and platelet‐rich fibrin. Part B: sinus floor elevation, alveolar ridge preservation and implant therapy. A systematic review
Ana B. Castro,Nastaran Meschi,Andy Temmerman,Nelson Pinto,Paul Lambrechts,Wim Teughels,Marc Quirynen: Regenerative potential of leucocyte- and platelet-rich fibrin. Part A: intra-bony defects, furcation defects and periodontal plastic surgery. A systematic review and meta-analysis
Drs. Johan Hartshorne and Howard Gluckman: A comprehensive clinical review of platelet-rich fibrin (PRF) and its role in promoting tissue healing and regeneration: part 3
Michael Pikos, Richard J Miron: PRF as a Barrier Membrane in Guided Bone Regeneration
Choukroun J, Diss A, Simonpieri A, et al. Platelet-rich fibrin (PRF): a second-generation platelet concentrate. Part IV clinical effects on tissue healing. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;101(3):299-303.
Choukroun J, Diss A, Simonpieri A, et al. Platelet-rich fibrin (PRF): a second-generation platelet concentrate. Part V: histologic evaluations of PRF effects on bone allograft maturation in sinus lift. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;101:299-303