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| REVIEW ARTICLE |
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| Year : 2017 | Volume
: 9
| Issue : 5 | Page : 49-52 |
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Platelet-rich fibrin or platelet-rich plasma – which one is better? an opinion
Shweta Bansal, Arun Garg, Richa Khurana, Parul Chhabra
Department of Periodontics, JCD Dental College and Hospital, Sirsa, Haryana, India
| Date of Web Publication | 15-Sep-2017 |
Correspondence Address:
Shweta Bansal
Department of Periodontics, JCD Dental College and Hospital, Sirsa, Haryana
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/IJDS.IJDS_55_17
The healing of hard and soft tissue in mediated by a wide range of intracellular and extracellular events that are regulated by signaling proteins. Platelets can play a crucial role in periodontal regeneration as they are the reservoirs of growth factors and cytokines which are the key factors for regeneration of bone and maturation of soft tissue. Platelet-rich plasma (PRP) is first generation platelet concentrate. However, the short duration of cytokine release and its poor mechanical properties have resulted in search of new material. Platelet-rich fibrin (PRF) is a natural fibrin-based biomaterial prepared from an anticoagulant-free blood harvest without any artificial biochemical modification (no bovine thrombin is required) that allows obtaining fibrin membranes enriched with platelets and growth factors. The slow polymerization during centrifugation, fibrin-based structure, ease of preparation, minimal expense makes PRF somewhat superior in some aspect to PRP. Keywords: Growth factors, periodontal regeneration, platelet concentrates, platelet-rich fibrin, platelet-rich plasma
How to cite this article:
Bansal S, Garg A, Khurana R, Chhabra P. Platelet-rich fibrin or platelet-rich plasma – which one is better? an opinion. Indian J Dent Sci 2017;9, Suppl S1:49-52 |
How to cite this URL:
Bansal S, Garg A, Khurana R, Chhabra P. Platelet-rich fibrin or platelet-rich plasma – which one is better? an opinion. Indian J Dent Sci [serial online] 2017 [cited 2023 Sep 29];9, Suppl S1:49-52. Available from: http://www.ijds.in/text.asp?2017/9/5/49/214932 |
| Introduction | |  |
Wound healing is initiated by clot formation, followed by proliferative stage which comprises of epithelialization, angiogenesis, granulation tissue formation, collagen deposition and finally collagen maturation and contraction.[1] This involves adherence and aggregation of platelets favoring formation of thrombin and fibrin. Platelets contain biologically active proteins, binding of these proteins within a developing fibrin mesh or to the extracellular matrix can create chemotactic gradients favoring recruitment of stem cells, stimulating cell migration, differentiation, and promoting repair. Thus, use of autologous platelet concentrates is a promising application in the field of periodontal regeneration and can be used in clinical situations requiring rapid healing.[2]
| Platelets | | |
Platelets are anucleate cytoplasmic fragments derived from bone marrow megakaryocytes and measure 2–3 μm in diameter. They contain many granules, few mitochondria and prominent membrane structures, the surface-connected canalicular system and the dense tubular system. The α granules are spherical or oval structures with diameters ranging from 200 to 500 nm each, enclosed by a unit membrane. They form an intracellular storage pool of proteins vital to wound healing, including platelet-derived growth factor (PDGF), transforming growth factor (TGF-β), and insulin-like growth factor (IGF-I).[3] Biologic action of PDGF is stimulation of DNA and protein synthesis in osseous tissues; mitogenic effects on mesenchymal cells; angiogenic effect on endothelial cells. TGF-β stimulates angiogenesis and matrix synthesis; enhanced woven bone formation; chemotactic effect on osteoblastic cells; stimulates endothelial chemotaxis and bone formation by inhibitory effects on osteoclasts. IGF-1 stimulates proliferation of osteoblasts and matrix synthesis, increases expression of bone matrix proteins, such as osteocalcin; in combination with PDGF it enhances the rate and quality of wound healing.[4] The α granules fuse with the platelet cell membrane after activation. At least, some secretory proteins are transformed to a bio-active state. The active proteins are then secreted, allowing them to bind to transmembrane receptors of the target cells. Once bound, intracellular signal proteins are activated. This results in the expression of a gene sequence that directs cellular proliferation, collagen synthesis, and osteoid production.[4]
Platelet concentrates are developed as bioactive surgical additives that are applied locally to promote wound healing. Platelet concentrate has a higher number of platelets per millimeter and, therefore, contain a higher concentration of growth factors to enhance regeneration.
| Platelet-rich Plasma – first Generation Platelet Concentrates | | |
Platelet-rich plasma is obtained from autologous blood and is a platelet-rich fraction of plasma and is clinically used to deliver growth factors in high concentrations to the site of bone defect or a region requiring augmentation.[3]
| Platelet-rich Fibrin – second Generation Platelet Concentrates | | |
Choukroun's platelet-rich fibrin (PRF) is an autologous leukocyte and platelet-rich fibrin biomaterial with a specific composition and three-dimensional architecture. PRF is classified as a second generation platelet concentrate as it is prepared as a natural concentrate without the addition of any anticoagulants [3] to eliminate the risk associated with the use of bovine thrombin.[3]
Platelet-rich fibrin affects cellular activities at genetic and cellular levels. PRF membrane consists of a fibrin three-dimensional polymerized matrix in a specific structure, with the incorporation of almost all the platelets and more than half of leukocytes along with growth factors and circulating stem cells. Fundamental differences between PRP and PRF, Merits and demerits of PRF and PRP have been summarized in [Table 1], [Table 2] and [Table 3] respectively.[5] | Table 1: Difference between platelet rich plasma and platelet rich fibrin
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| Conclusion | | |
It is a long time that soft tissue maintenance, wound healing and protecting tissue from bacterial infection is the clinician's primary intention. PRF belongs to a new generation of platelet concentrate, it represents a new step in the platelet gel therapeutic concepts with simplified processing with no artificial biochemical modification. PRF includes an cytokines, glycanic chains, and structural glycoproteins enmeshed within a slowly polymerized autologous fibrin network. PRF releases high quantities of three main growth factors TGF-β1, PDGF-AB, vascular endothelial growth factor, and an important coagulation matricellular glycoprotein (TSP-1) during 7 days. Apart from this PRF also secrete EGF, FGF, and three important proinflammatory cytokines - interleukin (IL)-1b, IL-6, and TNF-α. The easily applied fibrin acts much as a fibrin bandage with biochemical components that already have well known synergistic effects on healing processes. The presence of fibrin network composed up of leukocytes and cytokines play a significant role in self-regulation of the inflammatory and infectious phenomenon within the grafted material. Apart from its application in various disciplines of dentistry PRF is also been used all over the world in a various medical field that too includes orthopedic and plastic surgery. Although many merits and demerits of PRF is in front of us still numerous prospective of this new generation platelet concentrate, have to be obtained and searched for. The results obtained from PRF for various treatments are quite encouraging but still further studies are necessary to support its common use in day today practice with its clinical efficacy and long-term stability. Most importantly, establishing a scientifically sound, evidence-based rationale is critical to have the ultimate success of PRF.[11]
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
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| 7. | Pontoriero R, Lindhe J, Nyman S, Karring T, Rosenberg E, Sanavi F. Guided tissue regeneration in degree II furcation-involved mandibular molars. A clinical study. J Clin Periodontol 1988;15:247-54. |
| 8. | Vinayak S, Naik R. Platelet rich fibrin as a biofuel for tissue regeneration. ISRN Biomaterials. Volume 2013, Article ID 627367, p. 6. |
| 9. | Patel J, Deshpande N, Shah M, Dave D, Shah C, Shah S. PRF-from self to self. Res Rev J Dent Sci 2013;2:30-4. |
| 10. | Mourao CF, Valiense H, Melo ER, Mourao NB, Mala MD. Obtention of injectable platelets rich fibrin (i-PRF) ans its polymerization with bone graft: Technical note. Rev Col Bras Cir 2015;42:421-3. |
| 11. | Dohan Ehrenfest DM, Del Corso M, Diss A, Mouhyi J, Charrier JB. Three-dimensional architecture and cell composition of a Choukroun's platelet-rich fibrin clot and membrane. J Periodontol 2010;81:546-55. |
[Table 1], [Table 2], [Table 3]
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