Platelet-Rich Fibrin as a Bone Graft Material in Oral and Maxillofacial Bone Regeneration: Classification and Summary for Better Application

Abstract

Platelet-rich fibrin (PRF) is an autologous platelet concentrate that consists of cytokines, platelets, leukocytes, and circulating stem cells. It has been considered to be effective in bone regeneration and is mainly used for oral and maxillofacial bone. Although currently the use of PRF is thought to support alveolar ridge preservation, there is a lack of evidence regarding the application of PRF in osteogenesis. In this paper, we will provide examples of PRF application, and we will also summarize different measures to improve the properties of PRF for achieving better osteogenesis. The effect of PRF as a bone graft material on osteogenesis based on laboratory investigations, animal tests, and clinical evaluations is first reviewed here. In vitro, PRF was able to stimulate cell proliferation, differentiation, migration, mineralization, and osteogenesis-related gene expression. Preclinical and clinical trials suggested that PRF alone may have a limited effect. To enlighten researchers, modified PRF graft materials are further reviewed, including PRF combined with other bone graft materials, PRF combined with drugs, and a new-type PRF. Finally, we will summarize the common shortcomings in the application of PRF that probably lead to application failure. Future scientists should avoid or solve these problems to achieve better regeneration.

Figure 1

The alkaline phosphatase (ALP) activities of the periodontal ligament stem cells (PDLSCs) from the different experimental groups during a 14-day culture period (α-minimum essential medium supplemented with 10% fetal bovine serum, 50 μg/mL ascorbic acid, 10 nm dexamethasone, and 10 mm β-glycerophosphate). (a) Representative images for the ALP staining of the PDLSCs cocultured with different doses (1/8, 2/8, or 3/8) of platelet-rich fibrin at different time intervals (scale bar = 200 μm). (b) Data analysis of the ALP activity by means of the integrated optical density (IOD) of representative images (^∗p < 0.05; ^∗∗∗p < 0.001).

Figure 2

(a) Histological view of newly formed bone at the third month. (b) Cartilage tissue gradually replaced with new bone trabecules in connective tissue at the sixth month. (c) New bone could not be distinguished from the host bone at the ninth month in graft groups. (d) Platelet-rich fibrin (PRF) particles surrounded by compact fibrous capsules at the third month. (e) Newly formed bone was seen between the connective tissue and the host bone at the sixth month. (f) New bone formation is still continuing at the ninth month in PRF groups. S, sinus cavity; SE, sinus epithelium; LP, lamina propria; P, periosteum; PR, PRF remnants; HB, host bone; NB, new bone; MG, mucous glands; ED, edema.