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Table of Contents
Year : 2022  |  Volume : 11  |  Issue : 4  |  Page : 251-260

Platelet concentrates: An elixir of periodontal regeneration

Department of Periodontology and Oral Implantology, Kanti Devi Dental College and Hospital, Mathura, Uttar Pradesh, India

Date of Submission18-Jan-2022
Date of Decision24-Jan-2022
Date of Acceptance31-Jan-2022
Date of Web Publication08-Jun-2022

Correspondence Address:
Deepika Chandel
Department of Periodontology and Oral Implantology, Kanti Devi Dental College and Hospital, Mathura - 281 001, Uttar Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jcsr.jcsr_53_21

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Platelet concentrates (PCs) such as platelet-rich plasma and platelet-rich fibrin (PRF) are commonly used in various surgical procedures in medical as well as dental fields, oral and maxillofacial surgery, plastic surgery and sports medicine. The main motive is to elicit all the components of a blood sample that can be used to promote healing and regeneration. PCs came a long way since their existence in 1954 from titanium-PRF, advanced-PRF and injectable-PRF being introduced newly. These concentrates have been successfully applied in periodontal regenerative procedures and implantology. However, the preparation techniques, methodology, standing time, transfer process, temperature of centrifuge, vibration and other factors tend to produce mixed results. This review is designed to sort out all the confusions by introducing the exact origination of PCs, preparation techniques along with recent trends and clinical applications in periodontology.

Keywords: platelet-rich fibrin, advanced, platelet–rich fibrin, injectable, platelet concentrate, platelet-rich plasma, titanium platelet–rich fibrin

How to cite this article:
Chandel D, Sinha A, Chauhan SS, Sharma S, Garg A. Platelet concentrates: An elixir of periodontal regeneration. J Clin Sci Res 2022;11:251-60

How to cite this URL:
Chandel D, Sinha A, Chauhan SS, Sharma S, Garg A. Platelet concentrates: An elixir of periodontal regeneration. J Clin Sci Res [serial online] 2022 [cited 2022 Dec 5];11:251-60. Available from: https://www.jcsr.co.in/text.asp?2022/11/4/251/347042

  Introduction Top

The main goal of the periodontal therapy is the elimination of the inflammatory process, which leads to progression of periodontal disease and second aim being the regeneration of the lost periodontal structures. Certain biologic occurrences such as cell adhesion, migration, proliferation and differentiation is involved in periodontal regeneration in an organised pattern.[1] Periodontal regenerative procedures comprises soft tissue grafting, bone grafts, root biomodifications, guided tissue regeneration and combinations of these.[2] They are either sourced from the nature or synthesised in the laboratories by certain chemical processing. Regenerative periodontal therapies are able to reconstruct only a fragment of the lost periodontal tissues till date with restricted prospective for achieving absolute periodontal rehabilitation.[3] To achieve complete periodontal tissue regeneration, numerous biomaterials are utilised in addition with autogenous/allogenic/xenogenous/synthetic bone grafts but not a single graft material has been declared as the gold standard in treating periodontal osseous defects.

Periodontal regeneration is the rehabilitation of the lost periodontal structures due to trauma or illnesses to repair the unique structure and characteristic of the periodontium. The main goal is to restore the lost periodontal attachment and bone loss of periodontally compromised tooth, lower depth of the pocket along with gingival recession. In American Academy of Periodontology (AAP) 1996 workshop, periodontal treatment is taken into consideration for regeneration when it fulfils certain protocol: Proof for human histological which signifies new cementum, periodontal ligament and alveolar bone, significance of controlled human medical trials signifying gain in clinical attachment and bone fill.

Wound healing remains an important topic in dentistry and other medical fields till now. Dohan et al.[4] were the first to have described utilisation of platelet concentrates (PCs). Constant attempts are being made to search for a specific bioactive additive that will promote and improve regenerative process, accelerate the healing process and reduce the inflammatory processes. There is succession of interconnection between epithelial cells, gingival fibroblasts, cells of the periodontal ligament and osteoblasts. During wound healing, disruption of vasculature leads to the formation of fibrin, platelet aggregation and certain growth factors are released into tissues[5] through molecular signals into platelets, foremost mediated by cytokines and growth factors. Evidence of availability of the growth factors and cytokines plays a major role in during inflammation and wound healing.[6] For efficient cell migration, platelets produce vitronectin, fibronectin and fibrin all acting as a well-organised matrix in the connective tissue as adhesive molecules.[4] These factors led to the use of platelets as therapeutics in periodontal wound healing. PRF also known as 'platelet-rich fibrin'[7] being a second-generation PC accommodates platelets and several growth factors manifesting as fibrin membranes developed from the patient's own blood, anticoagulant free or any other artificial modified biochemicals. Both the platelet-rich plasma (PRP) and PRF have unique healing natural fibrin matrix with complex architecture and peculiar mechanical properties due to the presence of growth factors and platelets formed from a clot, making it exceptional from other concentrates.[8],[9] Various studies have shown accelerated wound healing and rapid regeneration potential with PCs.[10],[11] Being inexpensive and easy to use, PRF has shown remarkable effects due to its preparation method and it does not require any additional compounds such as bovine thrombin as well. In the field of periodontology, PRF came out as one of the favourable regenerative materials.

Tissue adhesives (fibrin glues) were the precursors of PCs. Afterward, different types of PCs were developed lately.[12] This review article analyses the benefits of PCs along with its preparations, recent advances and their various clinical and technical aspects and applications.

  Evolution of Platelet Concentrates Top

Platelet concentrates are classified[4] based on The Periodontology, Oral Surgery, Esthetic and Implant Dentistry Organization (POSEIDO) recommendation with their biological actions [Figure 1] as: (i) pure-platelet rich plasma (P-PRP) without leucocytes (low-density fibrin network after activation); leukocyte-platelet rich plasma (L-PRP) with leucocytes (low-density fibrin network after activation; leukocyte-platelet rich fibrin (P-PRF) without leucocytes (high-density fibrin network); and L-PRF with leucocytes (high-density fibrin network).
Figure 1: Biological actions of platelet concentrates
(Kind courtesy: Periobasics: Dr Nitin Saroch)

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  Platelet Concentrates: An Overview Top

Platelets are small (2–4 μm) irregularly shaped cells, enucleated haematologic component derived from bone marrow precursor cells, i.e., megakaryocytes constituting granules, mitochondria and prominent membrane structures with a well-connected canalicular and tubular system,[13] which expulses the growth factors when triggered which are located in one of the three different types of secretory granules present in platelets, i.e., α-granules, dense granules and lysosomes which are also known as: primary granules, secondary granules and tertiary granules. The α granules are spherical/oval membrane-enclosed units contained in the cytoplasm with diameter ranging from 200 to 500 nm each. These macromolecules are a storage bag of proteins constituting 15% of the total platelet volume crucial for wound healing.[14],[15] In case of tissue damage or trauma, the platelets get activated and comes in contact with the exposed endothelium, thus releasing wound-healing factors such as platelet-derived growth factor (PDGF), vascular endothelial growth factor (VEGF), transforming growth factor (TGF) and epidermal growth factor (EGF)[12] as shown in [Table 1].[16],[17] The primary granules or alpha granules contain factors that are released after the clot formation after an injury. These granules begin degranulation within 10 min of clot formation and produce 95% of their pre-packaged growth factors that are released within 1 h. Platelets are primarily responsible for the aggregation process. The main function is to contribute to homoeostasis through three processes: adhesion, activation and aggregation. During a vascular lesion, platelets are activated, and their granules release factors that promote coagulation.[15] Certain growth factors and other bio-active molecules bind immediately to transmembrane receptors of the osteoprogenitor cells, endothelial cells and mesenchymal stem cells and exert their intracellular effects. PRF being superior to PRP can be used to promote wound healing, bone regeneration, graft stabilisation, wound sealing and haemostasis. Because the fibrin matrix is more organised, it can control stem cell migration and the healing program more efficiently. PRF growth factors from in vitro studies and good results from in vivo studies as well have led to an optimisation of the clinical application of PRF. It was found that PRF gave better results than PRP. It has been proposed that PRP accelerates wound maturity and epithelialisation, hence decreasing scar formation. PDGF and EGF are the main growth factors involved in fibroblast migration, proliferation and collagen synthesis. It is observed that the release of growth factors from PRF is lower than that of PRP and that PRF has better healing properties while the cells are able to migrate from fibrin scaffold; some authors showed that PRF is also a carrier matrix for the bone morphogenetic protein. Increased concentrations of these growth factors are likely to be the reason for accelerated soft tissue wound healing, which is suggested to be at least 2–3 times faster than normal. Platelets in PRP also play a role in the host's defense mechanism at the wound site by producing signaling proteins to attract macrophages which arrive through vascular ingrowth stimulation by the platelets, hence repairing the site of injury by releasing their growth factors ultimately leading to wound repair.
Table 1: Growth factors secreted by platelets and functions

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  Growth Factors Secreted by Platelets and Functions Top

PCs such as PRP and PRF have been utilised in various surgical procedures. The main goal is to extract all the vital elements from the blood sample taken through the process of centrifugation in promoting tissue regeneration[18] and wound healing. The healing process of the wound initiates by coagulation of blood, leading to formation of platelet/fibrin clot and matrix;[19] therefore, PCs strengthen the natural process of wound healing where platelets, leucocytes,[20] fibrin, growth factors and other viable cells act as active primary players in the physiological wound healing, thus forming an engineered tissue.

  Role of Platelet Factors in Wound Healing Top

While doing bone grafting by using autogenous bone graft, a cancellous cellular marrow graft is placed in a dead space filled with clotted blood. This dead space gets hypoxic, acidotic and contains platelets and leucocytes, red blood cells and fibrin in complex network around the transferred osteocytes, endosteal osteoblasts and marrow stem cells. From 3rd day, capillaries penetrate the graft, and around 17–21 days, the capillary penetration of the graft gets completed and there is increase in osteoprogenitor cells. During 5–7 days, the wound matures, there is downregulation of PDGF and macrophage-derived growth factor and angiogenic factors takes place. In the 4th week, most of the revascularisation of the healing area is over and oxygen gradient fades away and immature bone starts forming. Remodelling of the newly formed bone starts to continue for years.

  The First Generation of Platelet Top

Concentrates: Platelet-rich plasma

Four types of PRP based on the presence or absence of leucocytes and PRP activation have been described.[21] These included (i). platelets >5× baseline; or (ii). platelets <5× baseline. In all the following types, 'solution' means non-activated PRP and gel means activated PRP: Type 1 L-PRP solution; Type 2 L-PRP gel; Type 3: P-PRP solution; and Type 4: P-PRP gel. Another classification[22] known as platelet's quantity, activation mode and presence of white cells (PAW) has also been proposed. PRP is manufactured using two techniques differing in technical aspects: (i) general-purpose cell separators; and (ii) platelet concentrating cell separators.

This technique requires around 400–450 mL of blood and a hospital setting. An anticoagulant known as 'adenosine-citrate-dextrose acid' (ACD-A) is added to the blood with 1:5 ratio which serves as anticoagulation process through calcium binding followed by a two-spin centrifugation. In the first cycle, centrifugation is done at 5600 rotations per minute (Rpm) to separate RBCs, platelet-poor plasma (PPP) and PRP gradually reducing the centrifugation speed to 2400 Rpm to get the final separation of 30 mL of PRP from the RBCs, and remaining PPP can be discarded or restored back to patient's circulation. It provides ideal growth factor delivery system at the site of injury especially in hard and soft tissue repair mechanisms, has chemotactic and mitogenic properties and hence promotes and modulates cellular functions involved in tissue healing, regeneration and cell proliferation.[23]

Venous blood is taken and anticoagulant is added to prevent platelet activation and degranulation. The first centrifugation known as 'soft spin' separates the blood in three distinct layers. Aspiration was done using a sterile syringe, PPP, PRP and some red blood corpuscles. Contents are transferred to another tube, and centrifugation of the second tube is done for 1900 Rpm at 15 min, being longer and faster than the first 'hard spin' making platelets concentrate to settle at the bottom of the tube and three layers are obtained. In collection of PRP, major parts of poor platelet plasma are discarded, where serum to be placed in the suspension. The unit is then gently shaken for a ready-to-use concentrated PRP. PRP is mixed with bovine thrombin and calcium chloride during clinical application with a mix syringe. PC then gel up quickly: During PRP preparation, fibrinogen is also concentrated constituting a fibrin matrix with haemostatic and adhesive properties. The time between centrifugation and clinical application is approximately 45 min.

Commonly used cell separator used for this technique is ELMD-500 (Medtronic Electromedic, Auto Transfusion System, Parker, CO, United States). For the second technique, most widely used in dental clinic setup is 'platelet-concentrating cell separator', which procures PRP with less quantity of blood.

Currently approved systems by FDA and commercially available are Harvest SmartPrep PC System (HSPCS; Harvest Technologies, Plymouth, MA, United States) and the 3i PC Collection System (3i PCCS; 3i Implant Innovations, Palm Beach Gardens, FL, United States). Eby[24] has demonstrated 'single spin technique'.

A cost-effective technique for procuring PRP by taking patient's blood using syringe/vacutainer tubes containing 10 mmol/L 3.8% citrate being transferred to 50 mL Falcon centrifuge tube and centrifuged for 15 min at 280 G at room temperature has been introduced in 2012.[17] After centrifugation, platelets and plasma are being removed by 5 mL pipette and transferred to a new 50 mL falcon centrifuge tube and centrifuged again for 15 min at 280 g. The pellet with 1–2 mL of plasma is transferred to new syringe for applying injection or topically.

Fukaya et al.,[25] 2014 suggested addition of platelet aggregation inhibitor 'prostaglandin E1' to anticoagulant ACD-A to prepare PRP with dense PDGF-BB.

  Current Status of Platelet-Rich Plasma Top

The biological efficacy and outcomes for clinical trial are affected by PRP content, purity and its biological properties. In clinical regeneration, practitioners mainly use two types of PRP devices and methods. One method utilises standard blood cell separators operating on a full unit of autologous harvested blood from the patient. This technique has continuous-flow centrifuge bowl or disk separating technology coupled with hard and soft centrifugation process. These apparatuses are mostly used intra-operatively. Second technique utilises gravitational centrifugation techniques and devices.[26] Centrifugation at high G-force isolates the buffy coat layer from a unit of blood, containing platelets and leucocytes. These devices are much smaller than the blood cell separators and handled with care. There are differences in the G-force and centrifugation time, resulting in remarkable differences in yields, concentration, purity, viability and activation of the isolated platelets.[27]

PRP attracts cytokines and growth factors to the wound area, which helps in rapid regeneration due to its limitations such as lack of standardisation in protocol, storage time differences of different platelet concentration and life-threatening coagulopathies (bovine thrombin can cause antibodies to clot factors).

Evidence for positive effects of PRP in treating periodontal osseous defects has been reported.[28] On the other hand, another study[29] suggested that the efficacy of PRP with various therapeutic bioactive agents combined with PRP showed positive outcomes. Evidence for use of PRP in bone formation on a sinus bone graft has been favourable, whereas its effect on the implant survival was less significant.[30]

Pure platelet-rich plasma

PPP has superficial blood cells that are transferred to another tube. After hard spinning centrifugation, mostly, the layer of PPP is discarded. The final P-PRP consisting of undetermined fraction of blood cells (platelets) gets suspended in fibrin-rich plasma. The method of collection is referred as 'plasmapheresis' that is used as a cell separator. The machine utilises an optical reader to detect the serum elements. As soon as the optical reader detects the first buffy elements in the serum, these are automatically collected into separate bags as PRP. This process allows 40 mL of PRP to be obtained from 450 mL of whole blood. Blood is drawn into collection bag containing citrate phosphate dextrose anticoagulant centrifuged at 2400 Rpm.

Leucocyte and platelet-rich plasma

L-PRP contains high concentrations of platelets, leucocytes and other bioactive molecules which play a major role in both bone and soft tissue healing process. To obtain L-PRP, the entire layer of buffy coat and few RBCs are transferred. The second spin is done. 'G' for second spin supports for the formation of soft pellets (erythrocyte-platelet) to settle at the bottom of the tube. The upper portion comprising of PPP is discarded. Obtained pellets are homogenised in lower one-third (5 mL of plasma) to generate PRP. Therefore, it produces low-density fibrin network on activation. The final L-PRP consists of platelets and leucocytes and residual RBCs gets suspended in fibrin-rich plasma. This branch has maximum number of commercially available systems for PCs. However, several protocols have been developed for automated technology requiring specific kits for minimum blood handling and standardisation of the procedure.

Commercially available kits include (i). SmartPReP PRP, USA (automated),[31] multifunctional system used to concentrate stem cells from the bone marrow transplant as shown in [Figure 2], has two compartments, optimises platelet recovery, provides consistent results, high platelet concentration, fast processing time <15 min and requires less manipulation; (ii) Curasan, Lindigstrab, Germany, is a partially automated system; PPP and buffy coat put in separate containers for 3600 Rpm, 15 min in 8 mL of blood, P-PRP or L-PRP either can be obtained;[31] (iii) Friadent–Schütze PRP kit, Austria (manual)[31] is a partially automated system which can obtain a high amount of PC. Citration of 8.5 mL blood to prevent coagulation for 2400 Rpm for 10 min is done. Yellow plasma was taken by monovette using long air intake cannula and centrifugation for 3600 Rpm for 15 min; (iv) GPS PRP[32] variation of 2 chambers and 2-stage centrifuge protocol; (v) Megalian APS PRP (automated)[33] Advanced cell separator with optical readings, compact size and high efficacy; (vi) autoloGel (automated):[34],[35] the final product being obtained is 'autologous PRP gel'; (vii) Regen PRP (manual)[34] utilises jelly-like agents such as calcium gluconate and lyophilised purified batroxobin in about 10 min; (viii) Plateltex PRP (manual)[3] employs a gel separator as well to improve collection of platelets and leucoocytes; Ace PRP (Manual)[36] differs in centrifugation time and type of anticoagulant.
Figure 2: SmartPRePTM platelet-rich plasma, USA

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  The Second Generation of Platelets Top

Concentrates: Platelet-rich fibrin: The highest platelet concentration

PRF introduced in 2001 is a second-generation PC, which contains platelets and growth factors in the form of fibrin membranes obtained from the patient's own blood, anticoagulant-free/artificial biochemical modifications.[7] It became popular as it initiates healing of soft and hard tissues.[7] Its advantages are the ease of preparation/application, less expensive and no need of biochemical modification (bovine thrombin or anticoagulant). It is more homogeneously stable and easy to handle.[36] The PRF clot forms a strong natural fibrin matrix, which extracts all the platelets and necessary growth factors of the blood harvesting[4],[8] and shows a complex architecture as a healing matrix with unique mechanical properties, making it different from other PCs. PRF enhances wound healing and regeneration and several studies have shown better and faster accelerated wound healing.[9],[20]

Leucocytes concentrated in the PRF scaffold play a vital role in release of growth factors, immune regulation, anti-infectious processes and remodelling of the matrix, as the polymerisation mode is slow, which creates physiologic architecture suitable for wound healing. Thus, PRF came out as one of the most favourable regenerative materials in the field of periodontics.

A PC without coagulation factors is gathered (750 g) from the superficial layer of centrifugation tubes, following single centrifugation cycle (2700 Rpm, 12 min).[37] Initially developed PRF is composed of 97% platelets and more than 50% leucocytes in high-density fibrin network when compared to white blood. The protocol accumulates platelets and the cytokines released in a fibrin clot.[38] To prepare PRF, only centrifuged blood is used without adding any anticoagulant and bovine thrombin. Blood sample is taken from the patient without anticoagulant in 10 mL tubes in a glass or glass-coated plastic tube and centrifuged immediately for 10 min at 3000 Rpm. The end product comprises the following layers: top-most layer of an acellular plasma, PRF clot in the middle and a red corpuscle base settled at the bottom.[39],[40] Compressing the PRF between two sterile gauzes or in a specific PRF tool to obtain the clot into a membrane.[39] When the blood comes in contact with silica surface, it activates the process of clot polymerisation, thus reducing the risk of cytotoxicity.

There are certain limitations with PRF that is it requires immediate use as it loses its structural integrity due to dehydration and shrinkage.[4] 'Natural bone regeneration' which indicates reshaping of the alveolar bone and the gingival volume restoration with implant bone.[37] Favourable results with PRF in the treatment of periodontal infrabony defects has been reported.[42] Combination of PRF and bone graft reduces the volume of bone substitute and improves revascularisation by its property of angiogenesis. PRF has been shown to be superior to collagen as a scaffold for cell proliferation, and in vitro cultivation of periosteal cells for bone tissue engineering with PRF membranes.[41],[42],[43],[44],[45],[46] PRF has been initially used in implant surgery to enhance the healing properties of the bone.[7] PRF promotes healing of osseous defects; promotes the expression of phosphorylated extracellular signal-regulated protein kinase and stimulates osteoprotegerin production which affects osteoblasts proliferation.[42]

PRF also releases certain growth factors such as PDGF and TGF which helps in periodontal regeneration. It has been reported that PRF stimulates cell proliferation in a specific manner.[42],[45] PRF induces cell proliferation of osteoblasts, periodontal ligament cells and growth factors during a 3-day culture period and suppresses oral epithelial cell growth. These cell type-specific actions may be beneficial for periodontal regeneration. When PRF is used as a membrane for guided tissue regeneration as a grafting material, it initiates cell events by creating space, leading to periodontal regeneration which leads to mineralised tissue formation. PRF has an osteoconductive and/or osteoinductive property. A study assessing the treatment of three-wall intrabony defects in chronic periodontitis patients with PRF and showed significant improvement in pocket depth reduction of pocket depth and bone fill in test group than in controls.[10]

The major drawback of PRF is its storage and preparation. The benefits of PRF are its quick handling between blood collection and centrifugation as it does contain any anticoagulants. One of the most important benefits is the dehydration which causes decrease in the growth factor content in PRF and leucocyte viability gets adversely altered its biologic properties. PRF is obtained as a gel to be injected which is not conducive. To overcome the limitations, several modifications were done and newer forms of PRF are introduced.

Kobayashi et al.[44] in 2016 introduced another modification where they reduced the centrifugation time up to 1300 Rpm for 8 min. They called this modification as 'A-PRF+' and found that less time would result in decrease in the number of forces in the blood cells were exposed and hence increased the number of cells in the PRF matrix.[44]

Another introduction is I-PRF to overcome certain limitations. I-PRF is drawn without adding any anticoagulant in plastic tubes without coating, and the time is considerably shorter than other two protocols. Blood separation happens in 2–4 min. Plastic tubes are used in the process because its surface is hydrophobic and does not activate the coagulation process efficiently. Currently, it is used in bone grafts mixing which forms a gel-like putty consistency with the particles of the graft incorporated in it. The graft hence formed has a good workable consistency which leads to the decreased leaching of graft as it gets tightly encapsulated within the fibrin matrix.

  The Third-Generation Platelet Concentrate Top

Another modification of PRF is titanium-PRF (T-PRF), which is considered to be the third-generation PC, obtained by centrifugation of blood at 2800 Rpm for 12 min in titanium tubes. T-PRF provides tighter woven and thicker fibrin than classic L-PRF and has a better titanium haemocompatibility as compared to glass.

  Recent Advances in Platelet Concentrates Top

Concentrated growth factor

The concept of concentrated growth factor and a second-generation PC was proposed in 2006.[46] Concentrated growth factor (CGF) is a fibrin tissue adhesive which provides good haemostasis and tissue-sealing properties. It accelerates osteogenesis and aids in wound healing by improving the stability of the wound needed for the attachment of a new connective tissue to the root surface. It promotes epithelial, endothelial and epidermal regeneration and reduces scarring. It also has antimicrobial properties due to high concentration of leucocytes and acts as an anti-antigenic agent on chronic non healing wounds. This newer technique allows the separation of a much denser fibrin matrix with large and richer growth factors. The preparation protocol with phases for CGF's consists of following sequelae as shown in [Table 2] with phases of concentrated growth factor shown in [Table 3].
Table 2: Preparation protocol for concentrated growth factor

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Table 3: Phases of concentrated growth factor

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The predictability of a new bone formation in the maxillary sinus using autologous fibrin-rich blocks with CGF alone as an alternative to the graft material.[47] The authors[47] have concluded fibrin-rich blocks with CGFs act as an alternative to bone grafting and can be a predictable procedure for sinus augmentation. The effects of CGF on implant stability and osteointegration revealed that the application of CGF enhanced the stability of implants and accelerated osseointegration in the early period; CGF showed positive effects on the ISQ value at the 1st week and 4th week.[48] CGF can enhance wound healing and reduce the depth of periodontal intrabony defects, proving that it might be a superior scaffolding material.[49] The summary of platelet concentrates and their following protocols shown in [Table 4].
Table 4: Summary of platelet concentrates and their protocol

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Titanium-prepared platelet-rich fibrin

A new product called T-PRF (third-generation) has been used.[50] During the conventional preparation proceed, some researchers have pointed out the possible health hazards caused by silica particles which are small enough for a fraction to remain suspended colloidally in the buffy coat, fibrin and platelet poor layers of plasma.[50] These particles get entered into the patient's body when the product is used in the treatment.

Advanced plasma-rich fibrin

A-PRF that incorporates the monocytes within the PRF has been used.[7] The macrophages get improved in the PRF in lower centrifugation protocol. Hence, monocytes also play a pivotal role in angiogenesis and bone regeneration and are good source of VEGF and bone morphogenetic protein.

Advanced platelet-rich fibrin+

With the low-speed concept, it is seen that A-PRF+ has significantly higher total growth factors release as compared to A-PRF and L-PRF. The authors correlated the findings with the presence of higher number of leucocytes contained within A-PRF+ scaffolds centrifuged using lower G forces and centrifugation times.

Injectable platelet-rich fibrin

The injectable form of PRF is obtained by centrifugation of whole blood. When a particulate bone graft is added to I-PRF, the results is the formation of well-agglutinated red-coloured 'sticky bone'.

Advanced fibrin glue and sticky bone

Fibrin glue is a two-component adhesive of fibrinogen and thrombin based on imitating the coagulation process of the body. In the last step of coagulation, thrombin facilitates the conversion of fibrinogen into fibrin, thereby forming a 3D fibrin network. Fibrin glue is obtained by initiating the clotting process and is used to stop bleeding, seal wound edges with reduced scarring and for scaffolds in tissue engineering. Autologous fibrin glue offers advantages of reduced risk of contamination and immunological responses, as well as economic factors. To obtain autologous fibrin glue, 20–60 mL of blood in non-coated tubes is centrifuged at 2400–2700 rpm for 2 min. Sticky bone is based on the concept of fabricating growth factors enriched bone grafts matrix using autologous fibrin glue as shown in [Figure 3].
Figure 3: Sticky bone

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  Advancement in Platelet Concentrates and Procedure Top

Clinical applications of platelet concentrate are shown in [Table 5].
Table 5: Clinical applications

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Advancement in technology in this specific field has demonstrated promising resulting in periodontal regeneration. Many researches were achieved to decide PRF usage in numerous strategies in periodontology, oral surgery and implant dentistry and inspiring outcomes have received in both soft and hard tissue regeneration.

The use of PCs has shown positive clinical outcomes in various fields of regeneration. Certain methods for obtaining PCs has shown positive outcome as a multifunctional medical procedure, thus meeting the required complex clinical issues.

In addition, the properties of PCs play a crucial for clinical use. Thus, more additional data on modified strategies using PCs and prospects for clinical use are required. Thus, extra information on more advanced techniques, the usage of PCs and possibilities for scientific usage are still required. Certain elements such as speed, period of centrifugation, temperature and blood haematocrit impact the fibrin scaffold's quality.

At last, the outstanding function of leucocytes or fibrin in PRF scaffolds is mentioned as capability avenues for future research.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

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  [Figure 1], [Figure 2], [Figure 3]

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]


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