Injectable platelet rich fibrin (i-PRF): opportunities in regenerative dentistry?
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Platelet rich plasma (PRP) has been utilized in regenerative dentistry as a supra-physiological concentrate of autologous growth factors capable of stimulating tissue regeneration. Despite this, concerns have been expressed regarding the use of anti-coagulants, agents known to inhibit wound healing. In this study, a liquid formulation of platelet rich fibrin (PRF) termed injectable-PRF (i-PRF) without the use of anti-coagulants was investigated.
Materials and methods
Standard PRP and i-PRF (centrifuged at 700 rpm (60G) for 3 min) were compared for growth factor release up to 10 days (8 donor samples). Furthermore, fibroblast biocompatibility at 24 h (live/dead assay); migration at 24 h; proliferation at 1, 3, and 5 days, and expression of PDGF, TGF-β, and collagen1 at 3 and 7 days were investigated.
Growth factor release demonstrated that in general PRP had higher early release of growth factors whereas i-PRF showed significantly higher levels of total long-term release of PDGF-AA, PDGF-AB, EGF, and IGF-1 after 10 days. PRP showed higher levels of TGF-β1 and VEGF at 10 days. While both formulations exhibited high biocompatibility and higher fibroblast migration and proliferation when compared to control tissue-culture plastic, i-PRF induced significantly highest migration whereas PRP demonstrated significantly highest cellular proliferation. Furthermore, i-PRF showed significantly highest mRNA levels of TGF-β at 7 days, PDGF at 3 days, and collagen1 expression at both 3 and 7 days when compared to PRP.
i-PRF demonstrated the ability to release higher concentrations of various growth factors and induced higher fibroblast migration and expression of PDGF, TGF-β, and collagen1. Future animal research is now necessary to further validate the use of i-PRF as a bioactive agent capable of stimulating tissue regeneration.
The findings from the present study demonstrate that a potent formulation of liquid platelet concentrates could be obtained without use of anti-coagulants.
KeywordsFibrin Blood platelets Regeneration Wound healing Fibroblasts Platelet rich fibrin
Compliance with ethical standards
Conflict of interest
Joseph Choukroun is the founder of Process of PRF company and the developer and inventor of the PRF protocol in Nice, France. All other authors declare no conflict of interests.
This work was fully funded by the Cell Biology Laboratory at Nova Southeastern University, College of Dental Medicine.
No ethical approval was required for this study as human samples were not identified in this study.
For this type of study, informed consent was not required as no human or animal subjects were utilized.
- 6.Meheux CJ, McCulloch PC, Lintner DM, Varner KE, Harris JD (2016) Efficacy of intra-articular platelet-rich plasma injections in knee osteoarthritis: a systematic review. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association 32:495–505. doi: 10.1016/j.arthro.2015.08.005 CrossRefGoogle Scholar
- 10.Choukroun J, Adda F, Schoeffler C, Vervelle A (2001) Une opportunité en paro-implantologie: le PRF. Implantodontie 42:e62Google Scholar
- 11.Toffler M (2014) Guided bone regeneration (GBR) using cortical bone pins in combination with leukocyte-and platelet-rich fibrin (L-PRF). Compendium of continuing education in dentistry (Jamesburg, NJ : 1995) 35:192–198Google Scholar
- 14.Sammartino G, Dohan Ehrenfest DM, Carile F, Tia M, Bucci P (2011) Prevention of hemorrhagic complications after dental extractions into open heart surgery patients under anticoagulant therapy: the use of leukocyte- and platelet-rich fibrin. The Journal of oral implantology 37:681–690. doi: 10.1563/aaid-joi-d-11-00001 CrossRefPubMedGoogle Scholar
- 19.Jankovic S, Aleksic Z, Klokkevold P, Lekovic V, Dimitrijevic B, Kenney EB, Camargo P (2012) Use of platelet-rich fibrin membrane following treatment of gingival recession: a randomized clinical trial. The International journal of periodontics & restorative dentistry 32:e41–e50Google Scholar
- 23.Femminella B, Iaconi MC, Di Tullio M, Romano L, Sinjari B, D'Arcangelo C, De Ninis P, Paolantonio M (2016) Clinical comparison of platelet-rich fibrin and a gelatin sponge in the management of palatal wounds after epithelialized free gingival graft harvest: a randomized clinical trial. J Periodontol 87:103–113. doi: 10.1902/jop.2015.150198 CrossRefPubMedGoogle Scholar
- 24.Ajwani H, Shetty S, Gopalakrishnan D, Kathariya R, Kulloli A, Dolas RS, Pradeep AR (2015) Comparative evaluation of platelet-rich fibrin biomaterial and open flap debridement in the treatment of two and three wall intrabony defects. Journal of international oral health : JIOH 7:32–37PubMedPubMedCentralGoogle Scholar
- 25.di Lauro AE, Abbate D, Dell'Angelo B, Iannaccone GA, Scotto F, Sammartino G (2015) Soft tissue regeneration using leukocyte-platelet rich fibrin after exeresis of hyperplastic gingival lesions: two case reports. J Med Case Rep 9:252. doi: 10.1186/s13256-015-0714-5 CrossRefPubMedPubMedCentralGoogle Scholar
- 32.Anitua E, Prado R, Troya M, Zalduendo M, de la Fuente M, Pino A, Muruzabal F, Orive G (2016) Implementation of a more physiological plasma rich in growth factor (PRGF) protocol: anticoagulant removal and reduction in activator concentration. Platelets 27:459–466. doi: 10.3109/09537104.2016.1143921 CrossRefPubMedGoogle Scholar
- 33.Ghanaati S, Booms P, Orlowska A, Kubesch A, Lorenz J, Rutkowski J, Landes C, Sader R, Kirkpatrick C, Choukroun J (2014) Advanced platelet-rich fibrin: a new concept for cell-based tissue engineering by means of inflammatory cells. The Journal of oral implantology 40:679–689. doi: 10.1563/aaid-joi-D-14-00138 CrossRefPubMedGoogle Scholar
- 34.Fujioka-Kobayashi M, Miron RJ, Hernandez M, Kandalam U, Zhang Y, Choukroun J (2016) Optimized platelet rich fibrin with the low speed concept: growth factor release, biocompatibility and cellular response. J Periodontol:1–17. doi: 10.1902/jop.2016.160443
- 36.Miron RJ, Bosshardt DD, Hedbom E, Zhang Y, Haenni B, Buser D, Sculean A (2012) Adsorption of enamel matrix proteins to a bovine-derived bone grafting material and its regulation of cell adhesion, proliferation, and differentiation. J Periodontol 83:936–947. doi: 10.1902/jop.2011.110480 CrossRefPubMedGoogle Scholar