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      Role of Platelet rich fibrin in wound healing: A critical review

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          Abstract

          Aim:

          The aim is to review and discuss the strategies available for use of platelet rich fibrin as healing aid in dentistry.

          Background:

          Platelet rich fibrin (PRF) is a fibrin matrix in which platelet cytokines, growth factors, and cells are trapped and may be released after a certain time and that can serve as a resorbable membrane. Choukroun and his associates were amongst the pioneers for using PRF protocol in oral and maxillofacial surgery to improve bone healing in implant dentistry. Autologous PRF is considered to be a healing biomaterial, and presently, studies have shown its application in various disciplines of dentistry.

          Materials and Methods:

          By using specific keywords, electronic search of scientific papers was carried out on the entire PubMed database with custom range of 5 years. The electronic search yielded 302 papers; based on inclusion and exclusion criteria which were specifically predetermined, 72 papers were identified as suitable to the inclusion criteria and the remaining 230 papers were excluded. After adding three more selected papers through hand search, full text of all the articles retrieved and review was done. By pooling the extracted data from selected papers, the reviewed data was synthesized.

          Conclusion:

          Recently by showing good promising results with use of the PRF, it has proved to have a good prospect for its use as healing aid in various aspects of the dentistry.

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          Most cited references88

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          Platelet-rich plasma: Growth factor enhancement for bone grafts.

          R Marx, E R Carlson, R M Eichstaedt … (1998)
          Platelet-rich plasma is an autologous source of platelet-derived growth factor and transforming growth factor beta that is obtained by sequestering and concentrating platelets by gradient density centrifugation. This technique produced a concentration of human platelets of 338% and identified platelet-derived growth factor and transforming growth factor beta within them. Monoclonal antibody assessment of cancellous cellular marrow grafts demonstrated cells that were capable of responding to the growth factors by bearing cell membrane receptors. The additional amounts of these growth factors obtained by adding platelet-rich plasma to grafts evidenced a radiographic maturation rate 1.62 to 2.16 times that of grafts without platelet-rich plasma. As assessed by histomorphometry, there was also a greater bone density in grafts in which platelet-rich plasma was added (74.0% +/- 11%) than in grafts in which platelet-rich plasma was not added (55.1% +/- 8%; p = 0.005).
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            Platelet-rich fibrin (PRF): a second-generation platelet concentrate. Part V: histologic evaluations of PRF effects on bone allograft maturation in sinus lift.

            Joseph Choukroun, Antoine Diss, Alain Simonpieri … (2006)
            Platelet-rich fibrin (PRF) belongs to a new generation of platelet concentrates, with simplified processing and without biochemical blood handling. The use of platelet gel to improve bone regeneration is a recent technique in implantology. However, the biologic properties and real effects of such products remain controversial. In this article, we therefore attempt to evaluate the potential of PRF in combination with freeze-dried bone allograft (FDBA) (Phoenix; TBF, France) to enhance bone regeneration in sinus floor elevation. Nine sinus floor augmentations were performed. In 6 sites, PRF was added to FDBA particles (test group), and in 3 sites FDBA without PRF was used (control group). Four months later for the test group and 8 months later for the control group, bone specimens were harvested from the augmented region during the implant insertion procedure. These specimens were treated for histologic analysis. Histologic evaluations reveal the presence of residual bone surrounded by newly formed bone and connective tissue. After 4 months of healing time, histologic maturation of the test group appears to be identical to that of the control group after a period of 8 months. Moreover, the quantities of newly formed bone were equivalent between the 2 protocols. Sinus floor augmentation with FDBA and PRF leads to a reduction of healing time prior to implant placement. From a histologic point of view, this healing time could be reduced to 4 months, but large-scale studies are still necessary to validate these first results.
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              A comparative study of platelet-rich fibrin (PRF) and platelet-rich plasma (PRP) on the effect of proliferation and differentiation of rat osteoblasts in vitro.

              Ling He, Ye Lin, Xiulian Hu … (2009)
              The purpose of this study was to evaluate the effect of biologic characteristics of platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) on proliferation and differentiation of rat osteoblasts. Blood samples were collected from 14 healthy volunteers (7 male) with a mean age of 23.2 +/- 2.24 years. PRP and PRF were prepared with standard protocols. The exudates of PRP and PRF were collected at the time points of 1, 7, 14, 21, and 28 days. The levels of platelet-derived growth factor AB (PDGF-AB) and transforming growth factor beta1 (TGF-beta1) were quantified in PRP and PRF. Then the exudates of PRP and PRF were used to culture rat calvaria osteoblasts. The biologic characteristics of osteoblasts were analyzed in vitro for 14 days. PRP released the highest amounts of TGF-beta1 and PDGF-AB at the first day, followed by significantly decreased release at later time points. PRF released the highest amount of TGF-beta1 at day 14 and the highest amount of PDGF-AB at day 7. Exudates of PRP collected at day 1 and exudates of PRF collected at day 14 expressed maximum alkaline phosphatase (ALP) activity, though no significance was shown. Cells treated with exudates of PRF collected at day 14 reached peak mineralization significantly more than both negative control and positive control groups. PRF is superior to PRP, from the aspects of expression of ALP and induction of mineralization. PRF released autologous growth factors gradually and expressed stronger and more durable effect on proliferation and differentiation of rat osteoblasts than PRP in vitro.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Conserv Dent
                Journal ID (iso-abbrev): J Conserv Dent
                Journal ID (publisher-id): JCD
                Title: Journal of Conservative Dentistry : JCD
                Publisher: Medknow Publications & Media Pvt Ltd (India )
                ISSN (Print): 0972-0707
                ISSN (Electronic): 0974-5203
                Publication date (Print): Jul-Aug 2013
                Volume: 16
                Issue: 4
                Pages: 284-293
                Affiliations
                [1]Department of Conservative Dentistry and Endodontics, Sri Dharmasthala Manjunatheshwara College of Dental Sciences, Dharwad, Karnataka, India
                [1 ]Department of Conservative Dentistry and Endodontics, Panineeya Dental College, Hyderabad, Andhra Pradesh, India
                [2 ]Department of Oral Medicine and Radiology, Panineeya Dental College, Hyderabad, Andhra Pradesh, India
                Author notes
                Address for correspondence: Dr. M Jayadev, Department of Conservative Dentistry and Endodontics, Panineeya Dental College, Road No 5, Kamala Nagar, Dilsukhnagar, Hyderabad - 500 060, Andhra Pradesh, India. E-mail: jayadev311@ 123456gmail.com
                Article
                Publisher ID: JCD-16-284
                DOI: 10.4103/0972-0707.114344
                PMC ID: 3740636
                PubMed ID: 23956527
                SO-VID: f87c124e-a352-40b6-a051-c04988198665
                Copyright © Copyright: © Journal of Conservative Dentistry
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 03 December 2012
                Date revision received : 21 March 2013
                Date accepted : 22 April 2013
                Categories
                Subject: Review Article

                ScienceOpen disciplines: Dentistry
                Keywords: growth factors,platelet rich fibrin,platelet rich plasma,wound healing
                Data availability:
                ScienceOpen disciplines: Dentistry
                Keywords: growth factors, platelet rich fibrin, platelet rich plasma, wound healing

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