International Journal of Dental Research

Online ISSN: 2664-9055, Print ISSN: 2664-9047

Received: 23-12-2020; Accepted: 07-01-2021; Published: 28-01-2021
www.dentaljournal.net
Volume 3; Issue 1; 2021; Page No. 07-09

Platelet rich fibrin and its applications in dentistry: An update

Aratrika Mukherjee1, Chinmayee Dighraskar2, Shikha Sharma3, Manisha Kashyap4, Sreejith S4, Apexa Yadav5
1
MDS (Periodontology and oral Implantology), Medical officer-dental surgeon, District hospital, Sundargarh, Odisha, India
2
Postgraduate student, Department of Pedodontics and preventive dentistry, Maharishi Markandeshwar College of dental
sciences and research, MMDU, Mullana, Ambala, Haryana, India
3
Postgraduate student, Department of Conservative dentistry and endodontics, Triveni Institute of Dental Sciences Hospital
and Research Centre, Bilaspur, Chhattisgarh, India
4
Postgraduate student, Department of Oral pathology, microbiology and forensic odontology, Maitri College of dentistry and
research centre, Durg, Chhattisgarh, India
5
MDS (Pedodontics and preventive dentistry), KM Shah Dental College and hospital, Varodara, Gujarat, India

Abstract
Platelet rich fibrin (PRF) is an autogenous biomaterial consisting of growth factors and cytokines entrapped in a fibrin matrix.
It combines the fibrant sealant properties along with growth factors thereby providing an ideal environment for wound healing
and regeneration of tissues. PRF is a second-generation platelet concentrate which is prepared from the patient’s own blood
free of any anticoagulant. Present review of literature aims to provide details of PRF preparation and its application in
dentistry.

Keywords: platelet rich fibrin (PRF), platelet rich plasma (PRP), growth factors, wound healing, dentistry

Introduction After collection of blood, it is immediately centrifuged on a

In the last few decades a variety of biomaterials have been table-top centrifuge at a rate of 3000 rpm for 10 minutes.
introduced in dentistry that can be used to treat osseous After centrifugation, 3 layers are obtained in the test tube.
defects and promote wound healing. Materials like bioactive The top most layer consisting of acellular PPP (platelet poor
glass, freeze dried bone graft, hydroxyapatite, tricalcium plasma), PRF clot in the middle and RBCs at the bottom of
phosphate, etc. have been widely used to promote healing the test tube. The middle layer of PRF clot is then removed
and regeneration of soft and hard tissues [1]. Platelet rich with sterile tweezers and separated from the underlying
fibrin (PRF) is a fibrin matrix in which platelet cytokines, RBC layer using scissors and then transferred on a sterile
growth factors and cells are trapped and may be released dish and stored in a refrigerator. It is supposed that the
after a certain time period and that can serve as a scaffold of junction of PRF to the RBC layer is rich in growth factors
resorbable membrane [2]. It can be obtained from patient’s and therefore this region is preserved [6]. PRF membrane can
own blood with the help of a simple process. PRF is be obtained by squeezing out the liquids present in the fibrin
basically a concentrate of growth factors that promote clot. Liquid removal from the PRF fraction can be done
wound healing and regeneration which is used in various through mechanical pressure between gauze layers resulting
disciplines of dentistry to repair various lesions and in a fairly solid, gel-like material that can be used in various
regenerate dental and oral tissues [3]. PRF is superior to clinical applications as a filling material or as a suturing
other blood products like PRP due to its ease and membrane. PRF membrane can also be prepared by
inexpensive method of preparation and also it does not need compressing PRF clot in special tools like “PRF Box”
any addition of exogenous compounds like bovine thrombin resulting in standardized membranes of constant thickness
and calcium chloride. Thus PRF has emerged as one of the and size along with PRF exudates. PRF exudates contains
promising regenerative materials in the field of dentistry [4]. good amount of growth factors (TGF-b1, PDGF-AB, VEGF
Present review of literature aims to provide details of PRF etc.), matrix glycoproteins (fibronectin, vitronectin etc.) and
preparation and its application in dentistry. proteins specialized in increasing cell attachment to
biomaterials and titanium; therefore can be used for
Method for formation of platelet-rich fibrin biomaterial impregnation, rinsing surgical sites, hydration of
It was first described by Dr. Joseph Choukroun in France to graft materials and for storage of autologous grafts [7].
promote wound healing in implants [5]. For preparation of
PRF, blood sample is collected from the patient without
Difference between PRP and PRF [8]
anticoagulant using a butterfly needle and 10 ml blood
collection tubes.

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Table 1: Difference between PRP and PRF

PRP PRF
Generation First generation Second generation
Based on processing
Use of bovine thrombin and calcium chloride (anticoagulants) No anticoagulant used
technique
Slow natural polymerization on contact with glass
Sudden fibrin polymerization depending on the amount of
Based on architecture particles of the test tube results in physiologic
surgical additives (thrombin and calcium chloride)
thrombin concentration
Based on biological Growth factors are released slowly over a period of 7
There is immediate release of growth factors
property or more days
Concern over the use of bovine thrombin, bovine factor Va No coagulopathies and no bleeding episodes An in
may be a contaminant in certain bovine thrombin commercial vitro study showed that PRF is superior to PRP,
Based on therapeutic
preparations, antibodies to bovine factor Va may cross react considering the expression of alkaline phosphatase
concern
with human factor Va and may produce coagulopathies and and induction of mineralization, caused markedly by
rare bleeding episodes release of TGF-β, and PDGF-AB

Application of PRF in dentistry

Table 2: Application of PRF in dentistry

Endodontics Oral and maxillofacial surgery Periodontics Pedodontics Tissue engineering Implant
In treatment of open apex For
Filling material in avulsion For treatment of
regeneration of pulp-dentin
sockets, bony defects etc. Bone intrabony defects
complex In combination with For in vitro
augmentation in sinus lifts for For treatment of Pulpotomy To enhance
MTA to create root end barriers cultivation of human
posterior maxilla augmentation gingival recession agent in osseointegration
in apexification procedures to periosteal cells for
for implants, bony defects etc. Guided tissue primary teeth of implant
prevent extrusion of material In bo
Ridge preservation guided bone regeneration
regenerative pulpotomy To fill
regenetration Periapical lesions
in bony defect after

Use of PRF in Periodontics human periosteal cell proliferation and PRF membranes can
In periodontics, PRF has been used to treat gingival be used for in vitro cultivation of periosteal cells for bone
recession, intra-bony defects and periapical lesions. Some tissue engineering. Thus PRF is a potential tool in tissue
case reports show the use of a combination of PRF gel, engineering but clinical aspects of PRF in this field requires
hydroxyapatite graft and guided tissue regeneration (GTR) further investigation [3].
membrane to treat intra bony defect [9].
Advantages of PRF [13]
Use of PRF in Endodontics 1. Simple and cost effective method of preparation of
PRF can be used as a scaffolding material in an infected PRF.
necrotic immature tooth for pulpal regeneration and tooth 2. No need of addition of anticoagulant thereby no
revitalization. Also, some case reports show that the biochemical handling of blood.
combination of PRF membrane as a matrix and MTA in 3. Slow natural polymerization leading to favourable
apexification procedures prove to be an effective alternative healing.
for creating artificial root-end barriers and to induce faster 4. PRF helps in hemostasis.
periapical healing in cases with large periapical lesions [10]. 5. PRF has supportive effect on immune system.
6. Standard preparation protocol.
Use of PRF in Pediatric dentistry 7. 3-D structure gives elasticity and flexibility to the PRF
Patidar S et al. (2017) evaluated effectiveness of platelet- membrane.
rich fibrin and mineral trioxide aggregate as pulpotomy
agent in primary molars. In radiographic and clinical Disadvantages of PRF [13]
evaluation PRF group found to be an acceptable alternative 1. Only limited volume of PRF can be used as it is
in pulpotomy of primary teeth. PRF holds a promising obtained from autologous blood sample, the quantity of
future in the area of primary tooth vital pulp therapy [11]. PRF produced is low and this limits its use for general
surgery.
Use of PRF Oral and Maxillofacial surgery 2. Its storage for longer duration is also not possible
PRF can be used as filling material in extraction sockets because of the shrinkage and altering the structural
specially during filling material in extraction sockets; PRF integrity of PRF.
will act as a stable blood clot for neovascularization and 3. Quick handling is required immediately after collection.
accelerated the tissue regeneration. This can be used to The technique entirely depends on the speed of blood
improve wound healing in immunocompromised patients collection and transfer to the centrifuge.
[12]
.
Conclusion
Use of PRF in Tissue engineering Platelet rich fibrin (PRF) is an autogenous biomaterial
The use of PRF as a tissue engineering scaffold was consisting of growth factors and cytokines entrapped in a
investigated by many researchers for the past few years. fibrin matrix. It combines the fibrant sealant properties
PRF appears to be superior to collagen as a scaffold for along with growth factors thereby providing an ideal

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environment for wound healing and regeneration of tissues.

PRF contains cytokines, glycanic chains, and structural
glycoproteins which are enmeshed within the slowly
polymerizing fibrin network. These biochemical
components have well known synergetic effects on healing
processes. The ease of PRF formation and its application
has various beneficial outcomes, which also includes
reduction in bleeding, graft stabilization and bone growth.
More long term studies are required to evaluate deeper
knowledge about the efficacy of this biomaterial and to
optimize its use in routine clinical dentistry.

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