Platelet Rich Fibrin (PRF)
Platelet rich Fibrin (PRF) is exactly what the name suggests. The substance is a by-product of blood (plasma) that is rich in platelets. Until now, its use has been confined to the hospital setting. This was due mainly to the cost of separating the platelets from the blood (thousands) and the large amount of blood needed (one unit) to produce a suitable quantity of platelets. New technology permits the doctor to harvest and produce a sufficient quantity of platelets from only 55 cc of blood drawn from the patient while they are having outpatient surgery.
Why All The Excitement About PRF?
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 GF (platelet derived growth factors PGDF, 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 sequestered into the wound, the more stem cells stimulated to produce new host tissue. Thus, one can easily see that PRF permits the body to heal faster and more efficiently.
A sub-family of TGF is bone morphogenic protein (BMP). BMP has been shown to induce the formation of new bone in research studies in animals and humans. This is of great significance to the surgeon who places dental implants. By adding PRF, and thus 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
- Bone grafting for dental implants. This includes onlay and inlay grafts, sinus lift procedures, ridge augmentation procedures, and closure of cleft, lip, and palate defects.
- Repair of bone defects created by removal of teeth or small cysts.
- Repair of fistulas between the sinus cavity and mouth.
PRF Also Has Many Advantages
Safety: PRF is a by-product of the patient’s own blood, therefore, disease transmission is not an issue.
Convenience: PRF can be generated in the doctors office while the patient is undergoing an out-patient surgical procedure, such as placement of dental implants.
Faster healing: The supersaturation of the wound with PRF, and thus growth factors, produces an increase of tissue synthesis and thus faster tissue regeneration.
Cost effectiveness: Since PRF harvesting is done with only 30-40 cc of blood in the doctor’s office, the patient need not incur the expense of the harvesting procedure in hospital or at the blood bank.
Ease of use: PRF is easy to handle and actually improves the ease of application of bone substitute materials and bone grafting products by making them more gel-like.
Frequently Asked Questions About PRF
Is PRF safe? Yes. During the out-patient surgical procedure, a small amount of your own blood is drawn out via the IV. This blood is then placed in the PRF centrifuge machine and spun down. In less than 15 minutes, the PRP is formed and ready to use.
Should PRP be used in all bone-grafting cases? Not always. In some cases, there is no need for PRF. However, in the majority of cases, application of PRF to the graft will increase the final amount of bone present in addition to making the wound heal faster and more efficiently.
Will my insurance cover the costs? Unfortunately not. The cost of the PRF application (approximately $400) is paid by the patient.
Can PRF be used alone to stimulate bone formation? No. PRF 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 such as BIO-OSS.
Are there any contraindications to PRF? Very few. Obviously, patients with bleeding disorders or hematologic diseases do not qualify for this in-office procedure. Check with your surgeon and/or primary care physician to determine if PRF is right for you.