Utilizing Plasma-Rich Fibrin by Drs. Jarron Tawzer and Joshua Nagao

Categories: Implant Dentistry;
Utilizing Plasma-Rich Fibrin 

4 advantages of adding PRF therapy to your practice


by Drs. Jarron Tawzer and Joshua Nagao


Overview
Plasma-rich fibrin (PRF) is an autogenous biomaterial consisting of platelet concentrate produced from the patient’s collected blood. It is used to promote and aid in bone and soft-tissue healing and regeneration, primarily through the release of specific growth factors such as platelet-derived growth factor, vascular endothelial growth factor and transforming growth factor. After blood collection, vacutainer tubes (usually four to eight tubes) are placed in a centrifuge and spun to separate the platelets, leukocytes, and fibrin from the red blood cells based on weight (Fig. 1). The separated PRF can then be used to make “sticky bone” or PRF clots, which can be used as plugs or flattened into membranes (Fig. 2).

Utilizing Plasma-Rich Fibrin
Fig. 1: Blood separation after centrifuge, showing the plasma-rich layer (yellow) and the red blood cell layer.
Utilizing Plasma-Rich Fibrin
Fig. 2: A plasma-rich layer mixed with bone particulate to form dense “sticky bone.”


1: Improved healing
The rich concentration of growth factors released from the activated platelets contained in PRF over 5–7 days is important to the overall healing of a surgical site. These growth factors are crucial in signaling cellular differentiation and for new vascular growth in the site. Because of the increase in growth factors, sites treated with PRF have shown to exhibit faster soft-tissue closure and faster bone remodeling.1

2: Infection prevention
PRF has an immunologic effect on grafted areas, demonstrably lowering the incidence of postoperative infections because of the high concentration of leukocytes. Numerous studies have noted that PRF releases growth factors over a long period of time, particularly in the critical time between soft tissue healing and early bone growth.2

3: Versatility

Utilizing Plasma-Rich Fibrin
Fig. 3: A plasma-rich fibrin (PRF) membrane layer
after being pressed thin in the expression box.

PRF has a broad spectrum of use. Two of the most common uses:

1. “Sticky bone.” This is the combination of PRF with bone particulate or autograft bone particulate. Vacutainer tubes are spun for a short time in a centrifuge until blood components separate. PRF liquid can then be removed with a syringe and injected into particulate. After 10–15 minutes, the fibrin becomes fully activated and the particulate becomes a sticky complex that can be manipulated and shaped, improving handling.

2. PRF membrane. These membranes are made by spinning the collected tubes until the fibrin is fully activated in the collection tube. The clot can then be removed from the tube and separated from the red blood cell component. Sometimes referred to as “PRF slugs,” the clots can be placed in an expression box, which will act as a press to flatten the clots into thin membranes. These membranes can then be used over grafted bone sites or sinus exposures, and covering resorbable or nonresorbable membranes. PRF slugs can also be placed into the vertical cylinders of the expression box, which can be used in nongrafted extraction sites such as third molars.

Utilizing Plasma-Rich Fibrin
Fig. 4: PRF “slugs” after being removed from the tubes.

4: Affordability
Most dentists are especially excited about the potential for cost savings. The initial setup would require the purchase of the following:
  • Centrifuge
  • Collection tubes
  • Butterfly needles
  • Arm tourniquet
  • Expression box
  • Tube rack
A popular centrifuge for PRF fabrication is the Intra-Spin made by Intralock. It is made specifically for dentists and seems to be the most user-friendly with basic instructions. Once all equipment is acquired, only collection tubes and butterfly needles are required for future PRF extraction. The average price of four to eight collection tubes and a butterfly needle can range from $10 to $15. A single blood draw can make as many membranes and/or sticky bone as your centrifuge will allow, typically resulting in five to seven large membranes and a large amount of liquid available for sticky bone. Consequently, it is normal for a standard resorbable membrane to cost $75–$250, depending on size, making PRF a significant cost saving.

Conclusion
Incorporating PRF therapy into your skill set is advantageous not only to your patients’ overall healing but also financially for your practice. This article is an overview of the benefits and protocol of PRF therapy, but a more comprehensive, hands-on training course is imperative to perform such treatment properly and safely.

References
1. Borie, E., et al. “Platelet-Rich Fibrin Application in Dentistry: A Literature Review.” International Journal of Clinical and Experimental Medicine 8(5); 7922–9.
2. Kobayashi, E., et al. “Comparative Release of Growth Factors from PRP, PRF and Advanced PRF.” Clinical Oral Investigations 20(9); 2353–2360.


Author Bio
Dr. Thomas Paumier
Dr. Jarron Tawzer earned his undergraduate degree from Utah State University and graduated from Oregon Health and Science University School of Dentistry. He lives and practices in Logan, Utah, focusing on implants and cosmetic dentistry. Tawzer is on the faculty at the University of Utah School of Dentistry and mentors at the Implant Pathway dental implant center in Phoenix. In this capacity, he trains dentists in complicated atraumatic extractions, bone grafting and dental implants. He has dedicated much of his career to advancements in dentistry, particularly dental implants and cosmetic dentistry.


Dr. Thomas Paumier
Dr. Joshua Nagao earned his DDS from The Ohio State University School of Dentistry, graduating first in his class clinically. Nagao is particularly passionate about dental surgery, including implant placements, sedation dentistry and complex reconstructions. He is a faculty member and mentor at Implant Pathway, which focuses on the surgical placement of dental implants, as well an an associate fellow in the American Academy of Implant Dentistry and a candidate for diplomate status in the American Board of Oral Implantology.

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