Platelet Rich Fibrin (PRF) for extraction site preservation
Platelet rich fibrin (PRF) is a second generation platelet concentrate widely used to accelerate soft and hard tissue healing. Its advantages over the better known platelet-rich plasma (PRP) include ease of preparation/application, minimal expense, and lack of biochemical modification (no bovine thrombin or anticoagulant is required). PRF is a strictly autologous fibrin matrix containing a large quantity of platelet and leukocyte cytokines.
This case presentation demonstrates how PRF may be used in site preservation procedures. Additional uses for PRF and detailed explanations of the science behind PRF may be obtained at the official Choukroun PRF Lecture Series
Pre-Op Presentation
Patient presented with a nonrestorable tooth #8.
Pre-Op Preparation of PRF
Blood is drawn from the patient and spun down in the Process(c) PRF centrifuge.
The PRF is then converted to PRF membranes.
Site Preservation of Site 8
Tooth 8 is atraumatically extracted and grafted.
The grafted site 8 is covered with PRF membranes.
Healing of Site 8
After an 8 week healing period, site 8 is ready to receive a dental implant.
Delivery of Dental Implant to Site 8
Implant fixture is delivered to site 8 and covered with another PRF membrane to facilitate and enhance soft tissue closure.
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Comments
PRF RPM
DR CHOUKROUN/TOFFLER,
Repeat question for either of you. What is the rpm of the centrifuge please????
PRF spin
To attain PRF, 2 to 8 9-ml tubes of blood are spun immediately at 2700 RPM for 12 minutes. PRF membranes and plugs remain hydrated in the PRF Box for up to 2 or 3 hours prior to use. See article September issue and review bibliography
rpm for prf
3000 rpm is required
Dr. Watkins, Very nice case in the rotator box
Dr. Watkins,
That is a very nice case you have in the rotator box on the bottom of the homepage.
Great management of a misplaced implant. I am sure that your surgeon is thanking you profusely!
Good job.
Prosthetic Correction of a Malplaced Implant Placement
Thanks for your comments. This was a very challenging correction of a malpositioned implant and fortunately it turned out well. Funny, I never heard back from the surgeon that placed this implant but I made the patient well aware of the difficulties of restoring this near impossible situation. I wish that all surgeons had the knowledge not to place implants like this. If only they grafted the site first or used a properly designed and fabricated surgical guide that gave them the type of feedback necessary to make the correct clinical decision. If they had used one then I would not have had to go through restorative gymnastics to restore this single maxillary premolar. I am just glad that the patient didn't need to have this implant trephined out and restarted.
implant placement
why You place implant so buccul(may be picture is not clear, but it seems to me implant has to be placed more palatal)???
please explain.THANK YOU
Dr. Choukroun some questions on PRF technique.
What is the RPM of the centrifuge ?
Is there a time delay between withdrawal of blood and the centrifuging process ?
Is there any relation between the Blood profile of the patient and the amount of Fibrin clot obtained ? (As in Hb/MCV/PCV etc.)
PRF preparation
Hi Dr Toffler,
How long between withdrawing the blood and starting the centrifuge??
Is it immediate?
What is the RPM of the centrifuge?
Thanks
Ooh, I had some nice PRF results today
Had a PRF site preservation case come back today for the implant. Niiiiiiiice result. Good bone and nice keratinized gingiva.
I would love to post some pics. When are you guys gonna let us post pics? That would be a GREAT feature. Can you make it happen?
Thanks
yazadgandhi article on PRF
yazadgandhi Dr. Toffler has an nice artilce in the Sept issue of this jounral that explains the PRF protocol nicely. I encourage you to check it out.
PRF question for Dr. Toffler
Do you find the PRF asks as a nice cushion to your graft material to prevent sinus membrane tears doing an osteotome lift?
PRF and osteotome
Hey Dr X
PRF is my only graft material in osteotome mediated sinus floor elevation (OMSFE). There is no need to use particulate graft material in OMSFE. Study results with or without graft material are equivocal, PRF introduces element of safety and may also expedite apical healing (my article is now in review at Implant Dentistry).
Best
MT
Dr. Toffler another question on PRF
Dr. Toffler while you say improved healing and reduced concentration with PRF.
What are you seeing with the nature of your bone grafts?
I think all the platelet concentrates improve soft tissue aspects, but would like to know if you are seeing improved hard tissue healing?
PRF
In my experience, improved soft tissue healing and primary coverage of grafted sites always translates into better hard tissue healing and PRF has certainly been helpful in this arena.
Prior to using PRF mixed with the graft and to cover the graft, I would more frequently see a softer quality to the superficial aspect of the graft at a ridge augmentation site and also the crestal aspect of the graft at the extraction site. I believe the addition of PRF is expediting hard tissue healing, attaining the same or improved quality of the graft in a shorter time period.
Dr. Toffler couldnt agree more on PRF
Dr. Toffler I agree with your rational. Better soft tissue response definetly will result in better hard tissue healing.
But do you feel that the PRF improve the bone wound healing beyond what it does for soft tissue?
Can you mix the prf within the graft and will it improve osseous formation? Have you taken any histo?
Brooke
platelet concentrates
Dr Cohen
I can appreciate your confusion and desire to sort through the maze of platelet concentrates. One has to wonder will they all follow the same path as PRP which was initially so "hot" and then seemeed to disappoint in controlled studies.
I have no experience with PRGF or CGF only with PRP and PRF which I have used daily for the last 15 months.
I was attracted to PRF because it involves no additives to prevent clotting and then in turn to stimulate clotting. Newer concentrates such as PRF and PRGF have intentionally eliminated the use of bovine thrombin for safety reasons. I was intrigued by the PRF concept incorporating natural clotting and matrix formation along with slow growth factor release. There is an ongoing disagreement on the relative value of inclusion (PRF) or exclusion(PRGF) of leukocytes in platelet concentrates.
I have clearly seen improved healing with reduced complications in my extraction, sinus and ridge augmentation procedures using PRF.
Hope this is helpful.
Best
Michael
Dr. Toffler nice case....Can you shread some light?
Dr. Toffler,
There seems to be much controversy in this forum on the different Platelet concentrates...PRF, CGF, PRP, PRGF. I am not a user but have interest, yet there are so many its confusing.
You seem to be more a clinician. What attracted you to PRF over there others? Have you used the others and what is your overall experience?
Thank you Dr. Cohen
Atlanta Course with Ziv Mazor April 16-17th at DentalXP
A lot of attention on this forum regarding bioactive blood concentrates and Balloon Sinus Lift procedures amongst other novel and new techniques.
Ziv himself has stated in this forum;
"I know there is a big misunderstanding in all blood concentrates.
I will be discussing in details the controversies in between the blood concentrates during my two day course in Dentalxp in Atlanta on April 16-17th."
http://www.dentalxp.com/ContinuingEducationCourse.aspx?a=10
PRF CGF PRGF.....Where is the hard research
All I see is people trying to sell courses. Having been involved with PRP I have been burned by the hype.
How are these different? Where is the hard research? Where is the clinical experience to support the research claims?
PRF, CGF, PRGF.....Research and clinical experience
I too would like to see the research. But I would also like to see the clinical results and hear from peoples experience. Research is crucial but you cant discount what people are seeing in the clinical practice with improved results with using these items.
next courses
i'm looking to organize a new tour in USA. Around May. I'll post in this forum the next courses.
PRF VS CGF VS PRGF: Courses and questions
Whats the course schedule on these platelet concentrates?
Any new literature on advantages and disadvantages of each?
To people that are using them: Where are you seeing the best results? What procedures are you using them in? Can you get the same results without them?
I am eager to hear some answers.
Logan
PRF Vs Other blood concentrates- courses
Logan
I know there is a big misunderstanding in all blood concentrates.
I will be discussing in details the controversies in between the blood concentrates during my two day course in Dentalxp in Atlanta on April 16-17th. http://www.dentalxp.com/ContinuingEducationCourse.aspx?a=10
NY course
Hello Dr. Mazor
Will you be covering blood concentrates in your balloon sinus lift course on April 11?
Thanks
NY course
Indeed blood concentrates will be covered in the course.
Dr.Choukroun when is your next PRF course?
PRF looks exciting when and where are the next courses?
Reply to Tim Grant
Growth factors released by PRF are TGF Beta, PDGF, VEGF, Thrombospondin. We did'nt study other GF yet. Concentrations are published already in "Growth Factors journal".
In the exsudate, we have also the same GF, in less concentrations and adhesive proteins (fibronectin, vitronectin). It's better to hydrate the biomaterials with the exsudate than with saline solutiion and mix with small pieces of fibrin. to enhance the new vessels formation. Because the new vessels born into the fibrin under the action of leukocytes and VEGF... The main advantage of the PRF resides into the natural fibrin of the PRF,high concentration of leukocytes and slow release of growth factors (more than 1 week..)
Dr. Choukroun some questions for you on PRF.
What Growth Factor concentrations are you seeing in PRF? What type of Growth factors?
Is there any Growth factor in the exudate after the membranes are made and do you feel mixing the exudate with your bone graft will enhance the graft?
I have used PRP for years and seen little gain. What are the advantages of PRF over the other concentrates?
Thanks,
Tim
PRF and clinical using
I'll try to answer to the questions posted:
1. About bleeding control: the PRF release in the site Thrombospondin 1, reducing the bleeding.
2. Sinus healing: the understanding key of bone regeneration is the cell stimulation: Growh factors stimulate intensively the cells present in the sinus.(Progenitor cells ans periosteum cells). This is the reason of the good results published by Ziv Mazor and Alain Simonpieri
With long term release of growth factors by the PRF, the cells are stimulated as well: you 'll get obligatory better results in bone regeneration..and faster.
3. Using growth factors is indicated in all indications. Good results are published in soft tissue engineering. Because cells are available immediately. In bone regeneration, we need cells in the site to be efficient. It depends of the nature of the biomaterial used: the cell attraction is not the same with minerals or organics..May be it's the key of the better using of biomaterials added to PRF.
Dr. Toffler are you seeing differences in your extraction cases.
Is PRF enhancing the healing of your extraction cases?
PRF EXT
I am returning to place implants at most of my ext sites in less time (10 to 12 weeks vs 16 to 20 weeks). As far as improved bone quality I can not accurately say, but I am seeing a more rapid soft tissue closure and graft coverage in MOST ext sites and certainly a more advanced early healing at more compromised sites where I have attained primary closure. In addition, I use much less graft material incorporating PRF fragments into the socket graft and using PRF as the only membrane.I have also reduced my incidence of postsurgical complications (dry socket, pain, delayed healing and loss of graft materials).
Working on some studies in the near future that will be able to answer your question more scientifically.
Hope this honest response is helpful
Best
Michael
When and where are the next PRF courses?
When and where are the next PRF courses?
PRF Courses
We are currently working on the next venues for PRF lectures. Both the New York and Florida conferences were sold out. We are considering doing a second round in the same locations and then a lecture series including Atlanta, Chicago, Boston, Dallas, Los Angeles, and Las Vegas. The lecture schedule will be posted to the Intra-Lock website (www.intra-lock.com)in the next one to two weeks.
RJM
PRF
PRF is used in all my reconstructive surgery. In simple ridge augmentation or extraction defects,I am using no additional membrane other than PRF. In larger and more anatomically unfavorable defects I believe as Dr Mazor previously stated, additional slowly resorbing collagen membrane use is warranted.I never use less than 2 PRF membranes placed in opposite directions (due to higher concentration of platelets in close proximity to discarded RBCs. In mucogingival procedures I will use PRF up to 4 membrane thickness, but realize the thickening does increase the complexity of closure.
I use no graft materials other than PRF plugs for crestal sinus floor elevation (osteotome-mediated (OMSFE) or crestal core elevation (CCE). The mere tenting of the membrane with either an implant and PRF or with a core and PRF will induce apical bone formation.PRF introduces an element of safety in both the crestal and lateral approach with a cushioning affect as well as the potential to heal small perfs.
As a sole method for bleeding control...no
Although fibrin glues were originally introduced for this purpose and PRF could certainly assist.
So much yet to learn about PRF but the last 14 months have produced favorable results and PRF has been eagerly accepted by patients.Please follow postings on JIACD.com for future presentations.
If you need help, as I do,understanding the differences between platelet concentrates, please see:
David M. Dohan Ehrenfest, Lars Rasmusson and Tomas Albrektsson. Classification of platelet concentrates:from pure platelet-rich plasma (P-PRP) to leucocyte- and platelet-rich fibrin (L-PRF)
Trends in Biotechnology 2009 Vol.27 No.3 158 - 167
PRF Courses....Any other course offered?
Dr. Miller I wanted to attend the courses but could get away? Are you offering any more and what was the response to the courses?
Dr. Toffler How many PRF membranes do you use?
How many PRF membranes will you use in a specific procedure?
Dr. Toffler doesnt PRF control bleeding issues
Extremely nice surgery. Bleeding can be an issue when doing any surgery. Since PRF is fibrin can it be used to control a bleeding issue?
PRF for bleeding
I use PRF in my palatal donor sites. Stops bleeding instantly and seems to provide nice healing. Have tried to use PRF alone for root coverage and the results have been sketchy at best. Sticking with good old fashioned CTG, but the PRF is nice for the palate. Only takes a few extra total minutes.
Dr. Toffer I opening case....Has it help sinus healing
What is your results with Sinus lifts. Has it enhanced healing?
Dr. Toffler what is your feeling on PRF and GBR
Dr. Toffler Have you used PRF in GBR and what do you feel about the results. I am looking forward to taking a course from you.
Brooke
PRF Course
Only a few spots left for the PRF course at the Grand Hyatt New York on the 29th. The Florida course is sold out. Dr. Toffler will be lecturing along with Dr. Joseph Choukroun. This is an ideal workshop for all those seeking to implement PRF into their surgical practice. Course will cover perio as well as implant techniques.
RJM
Is PRF the same as PRGF...Nice documentated case Dr. Toffler
Nice case Doc. Great Pics.
I have not seen PRF before. My suspicion is its no different for PRGF. I been using PRGF for over a year from BTI. Its easy to use, and I get great healing with it.
Is PRF another name for PRGF. So many terms its confusing.
Dr. Toffler great surgery, another question
Very nice surgery, you have skills. As far as PRF in extraction sockets if you are using bone graft with PRF arent sacrificing graft in order to place the prf? Do you have any histo?
TY
Dean
PRF ext sockets
Dean
you are so right, the PRF does take a fair amount of space and to be honest I am not yet sure about the proper proportion of graft and PRF. PRF is said to act as a "biologic connector" between graft particles, but we must prove this with additional publications. I have grafted with or without PRF but always covered with a PRF plug or membrane.I hope to begin to compare these sites so that I may answer your question accurately. I believe that Dr Del Corso and Dr Choukroun do have histo and I am sure they will share it at one of the PRF courses.
All the Best Dean
Michael
Great Case Toffler and another question on PRF
Mike great case. Well documentated and great surgical techniques, one can learn alot just from these photos. My question is on extraction sockets, most lit points to a stable clot in the socket will give you the greatest bone fill.
Have you used prf alone in the socket and what have you found on re-entry?
PRF ext sockets
Dr 90210,
Thank you for you kind comments.
I have used PRF alone in sockets but these would be the same sockets that might not require grafting at all (4-wall defects). At such sites it is used to expedite healing and hopefully curtail the time to implantation. I cannot agree more about the stability of the clot and its influence on ext site healing. Why is it that in some patients no matter what we place in the socket they come back in one week and they are more uncomfortable and it appears you have lost all the grafted materials? If PRF can contribute to the stability of the clot, accelerate neogenesis and graft turnover then it would be a very valuable adjunct. Comparative extraction studies with or without PRF would provide the answers, I hope to be a part of such a study in the near future so I may more accurately and confidently answer your question.
Best Regards
Michael
Hands-on Sinus Lift Course, Balloon and PRF....
I personally plan on taking Ziv Mazor's Hands-on Sinus Lift course in Atlanta April 16th-17th.
He will be covering PRF and Balloon Sinus Lift procedures as well. If anyone else is interested here is the link at www.DentalXP.com;
http://www.dentalxp.com/ContinuingEducationCourse.aspx?a=10
Dr. S
Using PRF for mucogingival coverage?
Everyone is still looking for the magic bullet to replace palatal CTG for mucogingival grafts. Have you used PRF for such cases? Results?
PRF for CTG
I have attempted PRP and now PRGF alone in the past for root coverage with unsatisfactory results. I do not believe that PRF will make a difference either.
Having said that, I do believe that PRGF or PRF has beeen an excellent adjunct to processed allograft tissues such as alloderm, dermis or pericardium when used for CTG. One caveat, only use these tissues when there remains at least a small band of keratinized host tissue to close over the allograft and do not leave any of these materials exposed.
I have a lecture on this topic on www.dentalxp.com at the below link
http://www.dentalxp.com/video/periodontal-plastic-surgery-112144.aspx
Dr. S
PRF for mucogingival coverage
I have and been using PRF for mucogingival coverage for a long time with satisfactory results.I use it with a combination of coronally repositioned flap .The results are similar to those with CTG.Yet the PRF should not be exposed as we sometimes do with CTG.