Platelet-Rich Fibrin Progressive Protocol: Third Generation of Blood Concentrates

Abstract

Purpose: Platelet-rich fibrin (PRF) has been used in several fields of dentistry to improve tissue healing. However, PRF from glass tubes results in a limited number of small membranes, increasing clinical difficulty and work time. The aim of this study was to evaluate cell and platelet amounts and biomechanical strength of PRF-giant membranes produced from plastic tubes without additives.

Material and methods: The investigators designed an ex vivo study, to compare 3 different centrifugation protocols for obtaining PRF: 700 × g/12 minutes (leukocyte and PRF [L-PRF]), 350 × g/14 minutes (GM350), and 60-700 × g more than 15 minutes total (progressive PRF [PRO-PRF]). We collected blood samples from 5 volunteers aged 25-54 years, over 3 different time periods (triplicate and paired study). From each venipuncture, 4 mL of blood was collected in vacutainers with ethylenediamine tetraacetic acid (EDTA) and approximately 104 mL in 12 plastic tubes without additives, which were separated into 3 groups, as per the centrifugation protocols (n = 5): L-PRF, GM350, and PRO-PRF. The PRF from the tubes of the same protocol was aspirated and 9 mL were placed in polylactic acid (PLA) forms and 3 mL were placed in a glass receptacle. The membranes from PLA forms were tested for tensile strength and the membranes from glass receptacles were evaluated by histomorphometry, while platelets and leukocytes were counted for those in tubes with EDTA. Statistical analyses were performed using Shapiro-Wilk normality test and then a one-way repeated measures analysis followed by Tukey multiple comparisons test (α < 0.05).

Results: In tensile analyses, PRO-PRF (0.85 ± 0.23 N) showed a significantly higher maximum breaking strength than L-PRF (0.61 ± 0.26 N, P = .01) and GM350 (0.58 ± 0.23 N, P < .01). The histomorphometry revealed no significant statistical difference in cell counts between the groups (P = .52). Furthermore, there was no significant difference between the leukocyte (P = .25) and platelet counts (P = .59) in whole blood between the groups.

Conclusion: The progressive protocol (PRO-PRF) enabled the production of PRF giant membranes with greater tensile strength and adequate cell distribution. Moreover, it allows biomaterial incorporation during production and enables clinical control of membrane thickness and size as per the surgical procedure.