Platelet concentrates have been used in the medical and dental fields for over 20 years for their favorable wound healing capabilities. In the 1990s, the initial biomaterial was PRP (platelet-rich plasma), but PRP needed anticoagulant medications to prolong its working time. Within the past five years, PRF (platelet-rich fibrin, which contains approximately 10 times the platelet concentration that is found in the body) has come to be known as the “golden child,” not only due to better growth factor (GF) concentrates and extension of its properties from 2–4 weeks (PRP) to 4–6 months (PRF), but it is a much more natural delivery method, and no anticoagulants are needed. Today, these platelet concentrates are used worldwide in regenerative medicine because of their anti-inflammatory and antimicrobial properties as well as their incredible wound-healing capabilities. Platelet concentrates create the opportunity to deliver many GFs simultaneously and together with platelets, leukocytes (white blood cells) serve in the natural wound-healing process.
PRF is considered a second-generation platelet concentrate with a longer growth factor release profile. It forms a 3D scaffolding or matrix that, in addition to its high concentration of beneficial leukocytes, plays a key role in tissue healing and tissue formation. The takeaway here is that even though PRP, which stays active for 2–4 weeks, has been used in almost every aspect of medicine for over 20 years and is recommended for the fast release of GFs, PRF is better suited for long-term delivery and has a greater wound-healing potential over a longer period, since it can be extended to 4–6 months. Additionally, PRF can stimulate osteogenesis (new bone formation) and angiogenesis (new blood vessel formation). In PRF, the fibrin matrix is better organized and is therefore able to more efficiently direct stem cell migration toward the healing site.
PRF in Dentistry
In dentistry, PRF has numerous implications—from preserving bone in extraction sites, repairing periodontal (gum) defects, gingival recessions, implant placements, bone regeneration, sinus grafts, healing soft tissues by joining them when even sutures won’t work, and even facial esthetics. New studies have shown that PRF significantly lowers the rate of dry sockets and post-operatory pain following third molar (wisdom teeth) extractions, and there are even new studies in regenerative dentistry mainly because of PRF’s unique biocompatible properties and regenerative abilities.
This is why we highly recommend PRF in just about every extraction performed. Not only is it the most natural way to help in healing, but also in preserving the jaw bones with its prolonged delivery time of GFs to the extraction site. Multiple studies have been published on the use of PRF vs. regular bone grafts (cadaver, bovine, etc.); no significant differences were found between the two groups except that PRF alone is all natural; there is no need for cadaver or bovine/porcine bone material. In some cases, we will add a tricalcium phosphate in order to make a “thicker” matrix (also known as “sticky bone”); this also allows for better maintenance of the site if the patient will have an implant placed immediately or in the near future.
The Future of PRF
The new frontier in Regenerative Dentistry includes regenerating pulpal (nerve) cells, TMD (temporomandibular disorders), and even ONJ (osteonecrosis of the jaws). Although there are no systemic reviews on the use of PRF in these cases, there are many case reports and studies showing promising outcomes.
At Pure Dental Naples, we have had success avoiding root canals in certain teeth. While we obviously cannot bring back to life a tooth (nerve) that is dead, there is a sensitive protocol that needs to be followed, and the outcomes have been excellent. When teeth have very large or deep cavities, the use of ozone O2/O3, bioactive materials, and PRF is showing promising results. Additionally, many patients will be happy to find that PRF can be used in facial esthetics: skin regeneration (micro-needling), skin re-volumizing, and reshaping fillers (also known as BioPRF). Although in the early stages, using PRF vs. the traditional fillers (Juvederm, Restylane, Voluma) provides a more natural approach to the traditional chemical materials currently being used. Some clinicians are effectively using PRF for certain hair loss treatments as well.
It is exciting to see that PRF is also being used in diabetic ulcer treatments with excellent results. Because of its ability to revascularize tissues and its incorporation of defense fighting immune cells, PRF has proven to be a relatively low cost, easily procurable regenerative strategy. There are numerous studies being conducted presently on PRF and its regenerative and anti-microbial properties, and I believe PRF will be the new “go-to” in regeneration and healing protocols. All these features support the conclusion that PRF is the superior option to better enhance the healing of soft and hard tissues. I sometimes joke: “PRP is old school…we use PRF in our office!”
Dr. Josephine Perez, DMD, has been practicing dentistry for 29 years. She is a graduate of Tufts University School of Dentistry in Boston and interned at New Orleans Coast Guard/Navy Base. Her holistic approach to dentistry encompasses each person’s unique and entire (or whole—holistic) state of physical and emotional well-being. The ability to maintain health through preventive measures and treatments of oral disease is her priority. Dr. Perez focuses on the underlying condition, rather than only treating the symptoms. She tests for biocompatibility to find pathways to reduce inflammation and apply biocompatible and biomimetic materials, supplements, essential oils to restore and strengthen the oral cavity and ultimately, the whole body. After decades of restoring and transforming smiles, Dr. Perez has integrated total wellness into her oral health enhancement practice—a revolutionary style of dentistry.
Visit Pure Dental in Naples at 4444 Tamiami Trail N, Ste. 6–7, call 239.692.9623 or go to: www.puredentalnaples.com.