Platelet Rich Fibrin; Does it Have a Future in Implant Dentistry?

With the rapid advancement in dental materials science and technology, the focus of research has now towards developing

With the rapid advancement in dental materials science and technology, the focus of research has now towards developing natural materials and treatment models which are much more effective and safer than the currently available dental therapeutic materials.

One aspect of this research is to utilize growth factors, which can accelerate healing by promoting the development and maturation of new hard and soft tissue cells and tissues. One such therapeutic model is the platelet-rich fibrin (PRF) for use in oral and maxillofacial surgery for improving the healing process in oral tissues, a fact which has been proven with several research studies.

Now, as implantologists, naturally we would think what this PRF technology can offer us? This article is dedicated to exploring whether PRF will be a suitable biomaterial for enhancing the success and minimizing complications associated with implant dentistry. However, before we focus ourselves towards implantology, let us first discuss some more about PRF.

What is Platelet Rich Fibrin?

Platelet Rich Fibrin is a natural biomaterial containing fibrin, which does not contain any modifiers, additives or anticoagulants. One of the unique features of the PRF is that it allows the production of autologous fibrin-based membranes which contain a rich supply of the platelets and white blood cells. PRF works by locally releasing growth factors around the surgical site for up to 14 days, thereby promoting the healing process.

How is Platelet Rich Fibrin Works?

Platelet-rich fibrin (PRF) is a concentrated collection of immune cells and platelets which form on a single membrane. Basically, it contains all the constituents of blood which play a vital role during the healing of a surgical site. In addition, PRF also provides a rich source for the white blood cells, thereby enhancing local immunity.

  • Fibrin – fibrin serves as a bridge, which allows multiple cellular interactions to take place. It also serves as a matrix, where all the constituent cells of the PRF organize themselves and carry out their respective functions. These include platelets, cytokines, growth factors, and immune cells.
  • Platelets – since the PRF is rich in platelets, the addition of PRF at an implant placement site will naturally enhance the number of blood cells which get attached to them. Generally, the more platelets there are at a surgical or wound site, the higher is the quality of the clot formed in the region. We are also familiar with the fact a good quality clot will in-turn get converted into bone tissue. Hence, there is a direct relationship between PRF, clot development and formation of bone at the implant site.
  • White Blood Cells – another constituent of the PRF is the immune cells. If you use PRF during any pre-prosthetic or implant insertion procedure, these immune cells will actually minimize the chances of an inflammatory response in the region which can negatively affect the healing process.
  • Stem Cells – the stem cells released from the PRF promote the formation and accelerated the maturation of the osteoblast cells[1]. As a result, they can help in the early stabilization of dental implants by promoting bone formation.

So, we can safely say that the PRF is a double-edged sword for the implant dentists.

What are the Applications of PRF in Implant Dentistry?

As implantologists, the first question that might have come to your mind would be “so, how is PRF beneficial for my implant patients”. Well, actually there are plenty of areas in which the PRF technology can prove to be useful in implant dentistry. Major applications among them include

  • Bone Grafting – in cases where bone grafting is essential for implant placement, the use of PRF technology will not only accelerate the healing process but will also ensure that good quality bone forms in the region.
  • Sinus Lift – when replacing the maxillary molar teeth with implants, one of the most common problems faced by the implantologists is the risk of perforating or damaging the maxillary sinus during implant insertion. PRF, in conjunction with a sinus lift bone graft procedure can be useful for improving the prognosis of such a clinical situation.
  • Wound Healing – PRF may also be useful in accelerating healing where surgical procedures had to be performed prior to implant insertion.

In addition to these uses, PRF biomaterial may also find application in immediate implant loading by promoting primary stability as well as osseointegration. This is a big thing as dentists nowadays seem to prefer immediate implant loading over the conventional method. So, the opportunities virtually endless, when it comes to implant dentistry.

The production of PRF does not demand any special protocol. The autologous blood source is simply centrifuged and therefore, it does not require the addition of any coagulants of chemical modifiers[2]. This makes their fabrication process relatively simpler and easier.

PRP Versus PRF. Which one to Choose?

Now, here you might think “so, what’s the difference between PRP and platelet-rich fibrin (PRF)? Which one is better for dental use?” Well. Current evidence establishes that PRP tends to offer several advantages over conventional PRF technology. Some of them include:

  • No need for additives
  • Cost-effective procedure
  • Improved healing due to the slow polymerization process of PRF
  • Better cell migration and proliferation
  • The immune system is improved
  • Hemostasis is achieved

Despite the advantages, there are some problems associated with PRF as well. Firstly, the quantity of the PRF is quite low. This is because the blood is obtained from the autologous source. Secondly, very quick handling of the blood is needed, as PRF does not contain any coagulants. Therefore, it must be placed at the surgical site within minutes of extraction, before the clotting starts.

From the above discussion, we can see that PRF has application in virtually all areas of dentistry, especially implantology. This biomaterial can prove to be a superior alternative to PRF in minimizing the complications, which are associated with dental implants. Therefore, we recommend that dentists should utilize this technology for improving the success of their dental implant cases.

[1] Platelet-rich fibrin increases cell attachment, proliferation and collagen-related protein expression of human osteoblasts.

[2] Platelet-rich fibrin (PRF): a second-generation platelet concentrate. Part IV: clinical effects on tissue healing