The 3 R's for Platelet-Rich Fibrin: A "Super" Tri-Dimensional Biomaterial for Contemporary Naturally-Guided Oro-Maxillo-Facial Soft and Hard Tissue Repair, Reconstruction and Regeneration

Abstract

Platelet-Rich fibrin (PRF) is a three-dimensional (3-D) autogenous biomaterial obtained via simple and rapid centrifugation from the patient's whole blood samples, without including anti-coagulants, bovine thrombin, additives, or any gelifying agents. At the moment, it is safe to say that in oral and maxillofacial surgery, PRFs (particularly, the pure platelet-rich fibrin or P-PRF and leukocyte and platelet-rich fibrin or L-PRF sub-families) are receiving the most attention, essentially because of their simplicity, cost-effectiveness, and user-friendliness/malleability; they are a fairly new "revolutionary" step in second-generation therapies based on platelet concentration, indeed. Yet, the clinical effectiveness of such surgical adjuvants or regenerative platelet concentrate-based preparations continues to be highly debatable, primarily as a result of preparation protocol variability, limited evidence-based clinical literature, and/or poor understanding of bio-components and clinico-mechanical properties. To provide a practical update on the application of PRFs during oral surgery procedures, this critical review focuses on evidence obtained from human randomized and controlled clinical trials only. The aim is to serve the reader with current information on the clinical potential, limitations, challenges, and prospects of PRFs. Accordingly, reports often associate autologous PRFs with early bone formation and maturation; accelerated soft-tissue healing; and reduced post-surgical edema, pain, and discomfort. An advanced and original tool in regenerative dentistry, PRFs present a strong alternative and presumably cost-effective biomaterial for oro-maxillo-facial tissue (soft and hard) repair and regeneration. Yet, preparation protocols continue to be a source of confusion, thereby requiring revision and standardization. Moreover, to increase the validity, comprehension, and therapeutic potential of the reported findings or observations, a decent analysis of the mechanico-rheological properties, bio-components, and their bioactive function is eagerly needed and awaited; afterwards, the field can progress toward a brand-new era of "super" oro-dental biomaterials and bioscaffolds for use in oral and maxillofacial tissue repair and regeneration, and beyond.

Keywords: dentistry; fibrin; grafts; growth factors; leukocyte; oral surgery; osteogenesis; periodontology; platelet; regeneration; tissue engineering.

Figure 1

Platelet concentrates’ clinical preparation, types/classes, and clinical illustration/presentation of several platelet-rich fibrin (PRF) and leukocyte and platelet-rich fibrin (L-PRF) preparations (membranes).

Figure 2

PRF Composition/Architecture Illustration. Schematic representation of PRF bio-components and SEM (scanning electron microscope) micrographs of the PRF membranes displaying its polymerized interconnected fibrin network and large living cell population content.

Figure 3

Flow chart of literature search strategy, hits, and included studies for data extraction and analysis. A clinical example illustrating the benefits of PRF application in treating gingival recession is displayed.

Figure 4

Clinical illustration of L-PRF application in oro-maxillo-facial surgery defect regeneration: natural guided tissue bio-engineering using L-PRF as a “bio-scaffold”. (A) L-PRF membrane preparation; (B) clinical application in IBDs or for the treatment of periodontal intra-bony defects; (C) Clinical application under CAF or coronally advanced flaps in the treatment of gingival tissue recession; (D) clinical application in PAOO, or periodontally accelerated osteogenic orthodontics—an orthognathic procedure.