Platelet Rich Plasma and Platelet Rich Fibrin

Platelet rich plasma (PRP), and the more recently developed platelet rich fibrin (PRF), are both by-products of blood that are rich in platelets. In the past, the use of PRP was confined to the hospital setting due to the cost and equipment needed to separate the various blood components. New technology now permits doctors to harvest and produce a sufficient quantity of platelets from less than 50cc of blood, which is drawn from the patient while they are having outpatient surgery. Both PRP and PRF can now be produced in the office in less than 15 minutes.

Why all the excitement about PRF?

PRF, a second generation platelet concentrate similar to PRP, permits the body to take advantage of the normal healing pathways at a greatly accelerated rate. During the healing process, the body rushes many cells and cell-types to the wound in order to initiate the healing process. One of those cell types is platelets. Platelets perform many functions, including formation of a blood clot and release of growth factors (GF) into the wound. These growth factors; platelet derived growth factors (PDGF), transforming growth factor beta (TGF), and insulin-like growth factor (ILGF), function to assist the body in repairing itself by stimulating stem cells to regenerate new tissue. The more growth factors released and sequestered into the wound, the more stem cells are stimulated to produce new tissue. Using a special kit, PRF is condensed into rectangular-shaped membranes which can be placed directly over bone grafts and other areas to permit the body to heal faster and more efficiently.

A subfamily of TGF, is bone morphogenic protein (BMP). BMP has been shown to induce the formation of new bone in research studies in both animals and humans. This is of great significance to the surgeon who places dental implants. By adding PRP, and BMP, to the implant site with bone substitute particles, the implant surgeon can now grow bone more predictably and faster than ever before.

PRF Has Many Clinical Applications

PRF can be used to aid bone grafting for dental implants. This includes onlay grafts, sinus lift procedures, ridge augmentation procedures, and closure of cleft palate defects. It can also assist in repair of bone defects created by removal of teeth or small cysts and the repair of fistulas between the sinus cavity and mouth.

PRP and PRF Have Many Advantages

• Safety: PRP is a by-product of the patient’s own blood. Therefore, disease transmission is not an issue.
• Convenience: They can be generated in the doctor’s office while the patient is undergoing an outpatient surgical procedure such as the placement of dental implants.
• Faster healing: The supersaturation of the wound with PRP, and thus growth factors, produces an increase of tissue synthesis and faster tissue regeneration.
• Cost effectiveness: Since PRF harvesting is done with less than 50cc of blood in the doctor’s office, the patient need not incur the expense of the harvesting procedure in hospital or at a blood bank.
• Ease of use: PRF is easy to handle and actually improves the ease of application of bone grafting materials by making them more gel-like.

Frequently Asked Questions

Is PRF safe? Yes. During the outpatient surgical procedure a small amount of your own blood is drawn out via the IV. This blood is then placed in a centrifuge machine and spun down. In less than 15 minutes, the PRF is formed and ready to use.

Should PRF be used in all bone-grafting cases? Not always. In some cases, there is no need for PRF. However, in other cases, the use of PRF membranes can eliminate the need to use more costly pre-packaged collagen membranes, and can actually increase the final amount of bone present, in addition to helping the wound heal faster.

Will my insurance cover the costs? Since this is still a relatively new technology, most insurance plans do not cover it. The cost of the PRF application (approximately $300) is paid by the patient.

Can PRP or PRF be used alone to stimulate bone formation? No, they must be mixed with either the patient’s own bone, a bone substitute material such as demineralized freeze-dried bone, or a synthetic bone product.

Are there any contraindications to PRP or PRF? Very few. In general, patients with bleeding disorders, severe anemia, or other hematologic diseases are not good candidates for this procedure.