PLATELET RICH FIBRIN GEL

A NEW MANTRA FOR WOUND HEALING

Dr. Irfanul Haque(Resident)

Dr. S.Girish Rao
Consultant Faciomaxillary Surgeon
Introduction
Healing of hard and soft tissue is a complex procedure
1. Scaffold (collagen and bone minerals)
2. Signal molecules (growth factors)
3. Cells (osteoclast,osteoblast,and fibroblast).
HEALING PROCESS.
Hemostatic
Phase

Controlled
Remodelling Inflammatory
Phase Tissue Phase
Injury

Proliferative
Phase
Require growth factors like
a)Platelet derived growth factors
b)Transforming growth factors beta
c)Vascular endothelial growth factors
d) Epithelial growth factors (EGF)
e)Insulin-like growth factor-1(IGF-1)
With an overview of the healing cascades in mind
A natural human blood clot contains
95% red blood cells (RBCs),
5% platelets

on the other hand, PRF blood clot contains

4% RBCs,
95% platelets

Lindeboom J AH, Mathura KR, Aartman I HA, Kroon F HM, Milstein D M, Ince C.
“Influenceof the application of platelet-enriched plasma in oral mucosal wound healing.
Clin. Oral. Impl.Res.2007;18; pg 133-139
Role of factors in wound healing:
Increased numbers of degranulating platelets

increased concentration of GF or signal proteins

Undifferentiated stem cells migrate toward the GF

proliferation of cells required for healing

faster healing

The Journal of Lancaster General Hospital • Summer 2007 • Vol. 2 – No. 2

 AIMS AND OBJECTIVE

• Evaluation of soft tissue healing and bone

regeneration using platelet rich fibrin gel in post
surgical bony cavity.
 200 patients who underwent extraction of impacted lower
wisdom teeth were included in the following study.
M
ATE
R
M
A
&
ILE
THOD

 Out of them 100 were chosen as the test group and 100 as
control group.

(THIS STUDY WAS FUNDED BY ICMR)

Criteria For Inclusion Of Patients

 Patients willing to give informed consent

 Patients between18 to 40 years of age.
 Patients with blood concentration of thrombocytes
within the normal range (1.5 to 3.5 lakh cells/cubic cm)
 Criteria For Exclusion Of Patients
 uncontrolled diabetes, immune disease, or other contraindicating
systemic conditions
 Radiation therapy
 Presence of any local infection
 Patient with poor oral hygiene
 A smoker
 A psychological problem
 An unwillingness to commit to a long-term post-therapy maintenance
program
PREPARATION OF PRF
The required quantity of blood is drawn .

5 ml is used for routine blood investigation.

5ml is transferred to tube containing 0.5mlanticoagulant(acidulated citrate

dextrose-ACD) and centrifuged using a tabletop centrifuge for 20 min at 3400-4000
rpm.
 
The resultant product consists of the following layers:
•Top most layer consisting of a cellular Platelet Poor Plasma (PPP).
•The second layer consists of Platelet rich fibrin (PRF).
•RBC at the bottom.

•After which the top layer consisting of Platelet Poor Plasma (PPP) will be discarded as
Platelet count is minimal.

•The second layer will be transferred to a neatly incubated test tube.

• Calcium Gluconate is added to this solution (PRF).

• For 2ml of PRF, 0.5 ml of Calcium Gluconate is added and allowed to stand for 10
min for the standardization of the gel.
 PRF thus prepared is in the form of
a gel.
 METHOD FOR GEL PREPERATION

10ml venous blood Blood placed in table top Centrifuged at 3400rpm for Central layer of PRF obtained
drawn centrifuge 20 mins

USAGE

Exposure of impacted Tooth removed PRF gel Sutures placed

tooth
ANALYSIS
SOFT TISSUE HEALING:

 Soft tissue healing was assessed clinically at one week

interval post operatively and recorded in a questionnaire for
the same.

 The soft tissue parameters assessed qualitatively were:

 Postoperative swelling
 Erythema
 Wound dehiscence
 On the scales of: absent(0),mild(1),moderate(2) and severe(3).

 These readings were then tabulated statistically and the results

compiled.
 POST OPERATIVE SWELLING
Post operative swelling Cases Control

(a)absent (0) 46 38
(m)mild (1) 34 38

(mo)moderate (2) 17 20

(s)severe (3) 3 4

100
90
80
70
60
50 case

40 control
30
20
10
0
absent mild moderate severe
 ERYTHEMA
Erythema Cases Control
(a)absent (0) 7 3

(m)mild (1) 72 36

(mo)moderate (2) 20 44

(s)severe (3) 1 17

100
90
80
70
60
case
50
control
40
30
20
10
0
ABSENT MILD MODERATE SEVERE
 WOUND DEHISCENCE
Wound dehiscence Cases Control
(a)absent (0) 89 67

(m)mild (1) 10 22

(mo)moderate (2) 0 7

(s)severe (3) 1 4

100
90
80
70
60
50 case
40 control
30
20
10
0
ABSENT MILD MODERATE SEVERE
Comparison of healing parameters between control group and test group:

Mean
n Mean t P-Value
difference
Group Std dev
Control 100 6.90 1.42
2.600 14.227 <0.0001*
Test 100 4.30 1.92

The difference in mean soft tissue healing recorded between control group
and test group is found to be statistically significant (P<0.001). Higher
mean soft tissue healing in recorded in control group compared to test
group and this difference is found to be statistically significant
 Radiographs were assessed for amount of radiologic
bone filling.

• RVG (Radio Visuo Graphs) is taken to study

the bone maturation.

• Further follow up of the Patients is done in the

next consultation with RVGs regularly for 1st
month, 3RD month, 6TH month.
 IMMEDIATE
CASE with PRF CONTRO L without PRF

AT 1 MONTH FOLLOW UP:

 3RD MONTH FOLLOW UP:
CASE CONTROL

6TH MONTH FOLLOW UP:

  The size of the residual defect is calculated by the technique
described by Matteo Chiapasco et al.

 The radiographs were converted to a digital format by a scanner

using the Corel Draw software. They were then converted to gray
scale tonalities of 256 using Corel Photo paint Software.

 The residual cavity area marked was converted into a histogram

which gave the number of pixels in the residual cavity.

 The decreasing number of pixels in the surgical defect over time

gave us the absolute bone filling in the area of the lesion. The
percentage of bone filling was then calculated.

Matteo Chiapasco, Alessandro Rossi, Jason Jones Motta and Michele Crescentini , Spontaneous Bone
Regeneration After Enucleation of Large Mandibular Cysts: A Radiographic Computed Analysis of 27
Consecutive Cases J Oral Maxillofac Surg 58:942-948, 2000
 GROUP 1: Cases (With PRF Gel) Group 2: control ( without PRF
Gel)
 
Descriptive pixel values
N Mean Std. Mean Std.
P value
Deviation Deviation

Immediate 100 1232.59 260.70 1241.35 203.43 0.79

(Not
significant)

1 month 100 1127.00 237.43 1199.60 191.22 0.02

(Significant)

3 months 100 1023.03 203.40 1158.95 189.57 0.001

(Significant)

6 months 100 935.51 204.55 1120.94 191.33 <0.0001

(Significant)
On the basis of pixels value bone density at different time points relative

to baseline

Percent increase T value P value

(Bone density)
Time periods Control
Test (Mean + SD)
(Mean + SD)
After 1 Month 2.6 0.01
7.1 + 6.4 5.2 + 3.4
After 3 months 4.7 <0.001
14.4 + 8.7 9.7 + 4.6
8.9 <0.001
After 6 months
23.7 + 11.1 12.8 + 4.8
BONE REGENERATION:
 ANOVA (Analysis of Variance) method was applied and
Scheffe test was used within the groups.

 The tests applied were found to be statistically

significant.
DISCUSSION
 DISCUSSION
 In our study we achieved a 19 fold increase in the
platelet concentration in PRF constitution.

 Clinical observation showed that oral mucosa healed

faster in patients after using PRF gel as compared with
control sites where gel was not added.

 Also, the sites of the experimental group experienced

less discomfort 1 week post operatively compared to the
control group.
 Bone maturation is faster in PRF group.
A study done to assess the ability of novel autologous platelet-rich fibrin matrix
membrane (PRFM) to facilitate healing in patients with chronic lower-extremity
ulcers.  From the results of this small-scale pilot study, they found PRFM shows
significant healing potential for closing of chronic leg ulcers.

Autologous platelet-rich fibrin matrix as cell therapy in the healing of chronic

lower-extremity ulcers .Wound Repair and Regeneration volume 16, issue 6,  
pages 749–756, November–December 2008

A study was conducted ,where they placed PRF gel during closure following total
knee arthoplasty, they found that rate of wound healing was faster.

William J. Berghoff, William S. Pietrzak, Richard D. Rhodes, platelet rich fibrin application during closure
following total knee arthoplasty. Clin Orthop 2006 ;29 :7
 A retrospective study found that use of autologous platelet-rich fibrin on a
range of hard-to-heal wounds (chronic leg ulcers) achieved full healing or a
significant reduction in wound diameter with no adverse effects.

P. Steenvoorde, L.P. Van doorn, C. Naves, oskam, use of autologous platelet-rich fibrin on
hard-to-heal wounds, Journal Of Wound Care , Vol 1 7 , No 2 , F ebruary 2 0 0 8

Study conducted to evaluate the effectiveness of platelet-rich fibrin (PRF )on the
regeneration of autogenous cancellous bone and marrow grafted in the alveolar
cleft. Autogenous cancellous bone grafting with PRF, which significantly reduces
postoperative bone resorption, is a reliable technique for alveolar bone grafting of
cleft patients.

Eriko Marukawa*, Hidekazu Oshina, Gaichi Iino, Keiichi Morita, Ken Omura Reduction of bone
resorption by the application of platelet-rich fibrin(PRF )in bone grafting of the alveolar cleft .
Journal of Cranio-Maxillo-Facial Surgery 39 (2011) 278e283
CONCLUSION
 CONCLUSION
In summation the PRF GEL :

 Accelerates soft tissue healing and bone maturation.

 Eliminates the need of secondary surgery to remove carriers as it is fully

biocompatible and biodegradable

 Is autologous .

 Is convenient for patients as visit to the blood bank is avoided

TAKE HOME MESSAGE…
In the modern surgical practice, PRF is boon for faster
healing as it is autologous, easy to procure and is cost
effective too…
REFERENCES
1). S.Girish Rao et al , Bone Regeneration in Extraction Sockets with Autologous Platelet Rich Fibrin Gel
JMOSI(2013)Vol 12,Issue 1,Page11-16

2) Marx R, Carlson ER, Eichstaedt RM, et al. Platelet Rich Plasma growth factors
enhancement for bonegrafts.(1998) Oral Surg Oral Med Oral Pathol Oral Radiol Endod 85:
638-46.

3) O‟Connell S, Carroll R, Beavis A, et al. Flow cytometric characterization of Cascade

platelet-rich fibrin matrix (PRFM); The impact of exogenous thrombin on platelet
concentrates (PC). Musculoskeletal Transplant Foundation. Edison, N. J. 2006.

4) Lucarelli E, Beretta R, Dozza B, Tazzari TL, O‟Connell S ,Ricci F, Pierini M, Squarzoni

S, Pagliaro PP, Oprita EI, and Donati D (2010) A recently developed bifacial platelet-rich
fibrin matrix.European cells and materials 20;13-23

5) Carroll RJ, Amoczky SP, Graham S, O‟Connell SM. Characterization of autologous

growth factors in Cascade platelet rich fibrin matrix (PRFM). Edison, NJ: Musculoskelatal
Transplant Foundation 2005.

6) Simon BI, Zatcoff AL, Kong JJW and O‟Connell SM. (2009) Clinical and Histological
Comparison of Extraction Socket Healing Following the Use of Autologous Platelet-Rich
Fibrin Matrix (PRFM) to Ridge Preservation Procedures Employing Demineralized Freeze
Dried Bone Allograft Material and Membrane The Open Dentistry Journal 3; 92-99
7) Kuo TF , Lin MF, Lin YH, Lin YC, Su RJ, Lin HW, Wing P (2011) Implantation of
platelet-rich fibrin and cartilage granules facilitates cartilage repair in the injured rabbit
knee:
preliminary report .CLINICS;66(10):1835-1838.
Thank You!