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CASE REPORT |
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Year : 2016 | Volume
: 6
| Issue : 1 | Page : 42-44 |
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Platelet-rich fibrin: A boon as healing and filling material
Amita Rani1, Sujata Mohanty2
1 Senior Resident, Department of Dentistry, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India 2 Department of Oral and Maxillofacial Surgery, Maulana Azad Institute of Dental Sciences, New Delhi, India
Date of Web Publication | 11-Aug-2016 |
Correspondence Address: Amita Rani Department of Dentistry, University College of Medical Sciences and Guru Teg Bahadur Hospital, Dilshad Garden, New Delhi - 110 095 India
Source of Support: None, Conflict of Interest: None | Check |
DOI: 10.4103/2229-6360.188230
After surgical procedure, healing usually occurs by repair or regeneration. Regenerative surgery including the use of barrier membrane, graft material, can support the formation of tissue and allow regenerative rehabilitation and also functional reconstruction. Enhancement of the regenerative process of the human body by utilizing the patient's own blood is a unique concept in oral surgery. In this paper, we are discussing application of platelet-rich fibrin as healing material on partial thickness excisional wounds and as a filling material in cystic cavity. Keywords: Healing; partial thickness wound; regeneration
How to cite this article: Rani A, Mohanty S. Platelet-rich fibrin: A boon as healing and filling material. Indian J Multidiscip Dent 2016;6:42-4 |
Introduction | | |
Postsurgically, blood clots initiate the healing and regeneration of hard and soft tissues. Platelet-rich fibrin (PRF) is coming up as a biological revolution in oral surgery field. Using PRF is a way to accelerate and enhance the body's natural wound-healing mechanisms. Platelets primarily are involved in wound healing through clot formation and the release of growth factors that initiate and support wound healing. [1] PRF contains and releases (through degranulation) at least seven different growth factors (cytokines) that stimulate bone and soft tissue healing. An easy, cost-effective way to obtain high concentrations of growth factors for tissue healing and regeneration is autologous platelet storage via PRF.
Case Report | | |
Application of platelet-rich fibrin in partial thickness excisional wound
A young male patient reported with a complaint of burning sensation in cheek region for the last 6 months. History revealed bidi smoking history. On intraoral examination, there was a thick white patch of approximately 2 cm × 2 cm in the left buccal mucosa of molar region. Initial treatment of lesion was done with the help of antioxidants and quitting the smoking habit. After 3 months, the remaining lesion was surgically removed with partial thickness excision; the resultant wound thus created was protected with PRF membrane using 3-0 vicryl sutures [Figure 1] and [Figure 2]. Follow-up was done clinically at 1 week, 15 days, 1 month, and 3 months postoperatively. There was no evidence of recurrence thereafter. | Figure 1: Partial thickness excisional wound in the left buccal mucosa in molar region
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Application of platelet-rich fibrin in cystic cavity
A 55-year-old male patient reported with complaint pain in lower left back edentulous region for the last 1 month. There was history of teeth extraction 4 years back. On clinical examination, involved edentulous ridge was mildly tender to palpation. Orthopantomogram revealed approximately 1.5 cm × 1.5 cm radiolucency in edentulous premolar-molar region [Figure 3]. Diagnosis of residual cyst was made. Treatment consisted of cyst enucleation and obliteration of defect thus created was done with PRF and primary closure was done with 3-0 vicryl [Figure 4]. Six-month radiographic follow-up showed almost complete bone fill in the defect [Figure 5]. | Figure 3: Orthopantomogram showing residual cyst in the left mandibular edentulous region
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Preparation of platelet-rich fibrin
The protocol for PRF preparation simulates that of PRP. It includes collection of whole venous blood (around 5 ml) in each of the two sterile vacutainer tubes (6 ml) without anticoagulant, and the vacutainer tubes are then placed in a centrifugal machine at 3000 revolutions/min for 10 min, after which it settles into the following three layers: Upper straw-colored acellular plasma, red-colored lower fraction containing red blood cells, and the middle fraction containing the fibrin clot [Figure 6]. The upper straw-colored layer is then removed, and middle fraction is collected, which is the PRF. The mechanism involved in this is, the fibrinogen concentrated in upper part of the tube, combines with circulating thrombin due to centrifugation to form fibrin. A fibrin clot is then formed in the middle between the red corpuscles at the bottom and acellular plasma at the top. In the middle part, platelets are trapped massively in fibrin meshes. This PRF can be used either as PRF as such or as membrane. For membrane preparation, gel is pressed between two gauge pieces covered glass slabs.
Discussion | | |
Choukroun et al. first introduced PRF in France in 2001. The PRF production protocol attempts to accumulate platelets and released cytokines in a fibrin clot. Earlier the use of PRF has been restricted to hospital settings due to the high cost of separating the platelets from the blood and the large amount of blood needed (1 unit) to produce a suitable quantity of platelets. New technology permits to safely harvest and produces a sufficient quantity of platelets from only 8-10 ml of blood drawn from patients in the dental office. PRF is a by-product of the patient's own blood; therefore, chance of infectious disease transmission is rare. Since PRF harvesting is done with only 8-10 ml of blood, the patient need not to bear the expense of the harvesting procedure in hospital or at the blood bank.
The present case report evaluated the clinical efficacy of PRF in the treatment of intrabony defect and soft tissue healing. PRF is a matrix of autologous fibrin, in which are embedded a large quantity of platelet and leukocyte cytokines during centrifugation. The intrinsic incorporation of cytokines within the fibrin mesh allows for their progressive release over time (7-11 days), as the network of fibrin disintegrates. [2] The main component of PRF is a high concentration of growth factor present in the platelets, which are required for wound healing. [3] The PRF acts much like a fibrin bandage, serving as a matrix to accelerate the healing of wound. [4]
Surgical sites enhanced with PRF heal at rates two to three times that of normal surgical sites. [5] Thus, PRF can be a great adjunct to many oral surgical procedures such as bone grafts, implants, and maxillofacial reconstructions. The PRF preparation process creates a gel-like fibrin matrix polymerized in a tetramolecular structure that incorporates platelets, leukocyte, and cytokines, and circulating stem cells. Release of growth factors from PRF through in vitro studies and good results from in vivo studies led to optimize the clinical application of PRF. It was shown; there are better results of PRF over PRP. Dohan et al. observed better healing properties with PRF. [6] It was observed and shown that the cells are able to migrate from fibrin scaffold, while some authors demonstrated the PRF as a supportive matrix for bone morphogenetic protein as well.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References | | |
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
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