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Use of PRF membranes in dental surgery

Dental Iceberg

A PRF membrane is a blood clot prepared from patient’s blood in a clinically usable form that is rich in cells and growth factors and acts as a natural bioactive barrier, allowing interaction with the tissues below and above it. This interaction with tissues facilitates natural tissue regeneration and healing.

The use of PRF membranes in dental surgery helps achieving accelerated wound healing and tissue regeneration, increased stimulation of osteogenesis and new blood vessel formation.

The 3D architecture of the fibrin matrix provides the PRF membrane with great density, elasticity, flexibility and strength that are excellently suited for handling, manipulation and suturing.

PRF in bone regeneration is being used to improve the osseointegration of dental implants easily and cost effectively.  PRF also has excellent biological properties – they are rich in platelets, growth factors, and cytokines – which opens many new clinical avenues. PRF membranes remain solid and intact and continuously release large quantities of growth factors for between 10 and 14 days.

PRF membrane dental course
PRF membranes

Clinical application of PRF membrane in dental surgery

PRF membranes in dental implantology are easy to drape over a surgical or augmented site. The elastic consistency also allows the clinician to punch a hole in the membrane to drape over a healing abutment before suturing the flap. Mixing autogenous bone or bone substitutes (allografts) with i-PRF (PRF liquid) for use in GBR procedures transforms particulate bone into an easy to handle gel consistency.

Bioactive barrier

The PRF membrane is rich in cells and growth factors, and acts as a natural bioactive barrier, allowing interaction with the tissues below and above it. This interaction with tissues facilitates natural tissue regeneration and healing. PRF will undergo quicker remodeling (biodegradation) in situ than a resorbable collagen membrane, but will also promote a strong induction on the periosteum/gingival tissue due to the slow release of growth factors and other matrix proteins (Krasny, et al., 2011; Kim, et al.)

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.

Competitive interposition barrier

GTR membranes are cell-proof barriers against soft tissue invagination, whereas PRF membranes allow cells to migrate through it, thus allowing new blood vessel formation that will facilitate regenerative and healing interactions between the tissues below and above the PRF membrane. The PRF membrane in dental surgery is a highly stimulating matrix, attracting cell migration and differentiation preferentially, and also reinforcing the natural periosteal barrier.

The hard and soft tissues migrate and interact within the PRF matrix thus PRF will improve the osseointegration. The PRF matrix becomes the interface between the tissues and therefore avoids the migration of the soft tissues deeper within grafted defect or augmented site. This biological characteristic is referred to as a competitive barrier (Krasny, et al., 2011). However, it is important to recognise that using PRF as a competitive barrier does not have the graft stability or space maintenance characteristics of a normal collagen membrane, and therefore cannot be recommended for use as such.

PRF membranes dentistry
Dr. Choukroun teaching how to prepare and use PRF membranes

Protective barrier and healing booster

PRF membranes in dental implantology are frequently used for the protection of the grafted area and as a healing booster for the soft tissues above the grafted defects or augmented sites (Inchingolo, et al., 2010). The purpose of the PRF membrane is not only to protect the blood clot and/or the graft material, like in the GTR concept, but also to promote the induction of a strong and thick periosteum and gingiva. This boosted periosteum functions as a true barrier between the soft tissue and bone compartments, and constitutes probably the best protection and regenerative barrier for the intrabony defects (Inchingolo, et al., 2010)

Research has shown that PRF is great to improve osseointegration. The benefits of PRF in dental implantology are faster wound and bone healing, antibacterial and antihemorrhagic effects, low risks with its use, and the availability of easy and low-cost preparation methods encourages more clinicians to adopt this technology in their practices for the benefit of their patients.

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References:

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 2

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. 101:299-303.

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):e56-e60

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