platelet concentrates

1. GOOD MORNING

2. Platelet concentrates
Presented by : Dr. Fatima Gilani
Moderator : Dr. Shivjot Chhina
Perceptor : Dr. Kumar Saurav

3. Contents
Introduction
History
Platelets
Wound healing
Classification of PRP & PRF
What is PRP.?
Technique to prepare PRP
Merits of platelet rich plasma
What is PRF.?
Technique to prepare PRF
Merits of platelet rich fibrin
Applications of Platelet Rich Fibrin & Platelet Rich Plasma
Conclusion
References

4. Introduction1
Biological intervention in regenerative medicine fall into three main categories
I. Gene therapy
II. Tissue engineering
III. Cell based therapies
Platelets had been proven to be a good source of growth releasing factors such as PDGF,
TGF, IGF etc.
Using platelet concentrates, is a way to accelerate and enhance the body’s natural wound
healing mechanisms.

5. History1
Regenerative potential of platelets was introduced in 1970’s
Its clinical applications began in the field of medicine in 1987 in an open heart surgery by
M.Ferrari
Whitman et al first introduced Plasma rich plasma(PRP) in dentistry in 1997.
Platelet rich fibrin(PRF) was first developed in France by Choukroun et al in 2001.

6. PLATELETS2
They are anucleate cytoplasmic fragments derived from
Bone Marrow Megakaryocyte
They measure 2–3 μm in diameter.
They contain many granules,mitochondria,
surface connected canalicular sytems, dense tubular systems
 Alpha granules are spherical or oval structures that has a diameter of 200-300 nm each
They have growth factors such as platelet derived growth factors (PDGF), transforming
growth factors (TGF), insulin like growth factors (IGF), platelet activating factor (PAF),
vascular endothelial growth factor (VEGF).
https://www.thrombosisadviser.com

7. Wound healing
https://www.jci.org/articles/view/314
87/figure/1

8. Functions and role of fibrin matrix2
• Fibrin is an activated form of fibrinogen molecule present in plasma as well as
the α-granules of platelets. It plays a significant role in platelet aggregation
and achievement of hemostasis. The soluble fibrinogen is transformed into
insoluble fibrin that polymerizes to a cicatricial matrix.
• This leads to the intrinsic incorporation of platelet cytokines and glycan
chains in the fibrin meshes.

9. • The fibrin matrix present in PRF is flexible, elastic, and very strong. It consists of weak
thrombin concentrations which entails equilateral junctions.
• These connected junctions permit the ecesis of a fine and flexible fibrin network
capable of supporting cytokines and cellular migration that occurs.
• This results in an increase in the life span of these cytokines as their release and use will
occur at the time of initial cicatricial matrix remodeling.

10. CLASSIFICATION OF PLATELET CONCENTRATES
PLATELET RICH
PLASMA
PLATELET RICH FIBRIN
P-PRP L-PRP
P-PRF L-PRF

11. PLATELET RICH PLASMA- FIRST GENERATION PLATELET
CONCENTRATES3
• Platelet-rich plasma is obtained from autologous blood.
• It is a platelet-rich fraction of plasma .
• It is clinically used to deliver growth factors in high concentrations to the site
of bone defect or a region requiring augmentation.
• Bone Morphogenic Proteins, a subtype of TGF, has been shown to induce
formation of a new bone at the implant site with bone substitute particle.
• PRP acts through stimulation of normal healing.
• A PRP blood clot consists of 4% RBCs, 95% Platelets, 1% WBCs.

12. TECHNIQUE OF PRP
PREPARATION2

14. MERITS OF PRP DEMERITS OF PRP
Soft autologous preparation, free from concerns over
transmissible disease such as HIV, hepatitis etc
Concern over the use of bovine thrombin, the fact that bovine
thrombin has been associated with development of antibodies
to clotting factorsV, XI and thrombin, which had occasionally
lead to life threatening coagulopathies
Convenient for patient, blood is collected in the immediate
preoperative period
Presence of platelets brings cytokines and growth factors to
the site of surgery which helps in rapid regeneration in a
manner that would not occur with fibrin glue
Lack of uniformity in PRP preparation protocol as different
platelet concentration has different storage time
Merits and demerits of platelet rich plasma4

15. APPLICATIONS OF
PLATELET RICH
PLASMA10

16. In Oral And Maxillofacial Surgery
In a Study by RUKTOWSKI et al ( 2010) used digital radiography and Computer Tomography (CT)
scan analysis to track changes in radiographic density at PRP- treated sites in comparison to
ipsilateral not-PRP treated sites.
The PRP- treated sites demonstrated early and a significant increased radiographic density over
baseline measurements following tooth removal.
In a prospective split-mouth study conducted by Arenaz-Bua et al. (2010) the efficacy of PRP in
promoting bone regeneration after third molar extraction was analyzed. The Authors observed no
further acceleration in bone formation at 6 months nor did they observe statistically significant
differences between the groups regarding pain, swelling, trismus and infection throughout the post-
operative period.

17. In Periodontology
• Pradeep et al. (2009), who conducted a study on the treatment of mandibular furcation defects, have
reported the lack of complete closure of furcation defects despite a significant improvement; this
implies a limited role for autologous PRP as a regenerative material.
• Del Fabbro et al. (2011) revealed that PRP may exert a positive adjunctive effect when used in
combination with graft materials for the treatment of intrabony defects. However, no significant
benefit of PRP was found for the treatment of gingival recession

18. In Implantology
• The preparation of PRP, as applied to an implant surface, adheres to metal and might create a new
dynamic surface which could potentially show biological activity
• Anitua showed that the osseointegration of implants was enhanced by coating the implant surface
with PRP prior to insertion into the alveolus
• Gentile et al. (2010) reported their experience on 15 cases, including reconstructive surgery of the
jaw, post-extraction alveolar bone regeneration, and oral implantology. The results of their study
revealed the efficacy of the PRP treatment in terms of post-operative patients' satisfaction and low-
morbidity

19. PLATELET RICH FIBRIN – SECOND GENERATION
PLATELET CONCENTRATES5
Choukroun’s platelet-rich fibrin (PRF) is an autologous leukocyte and platelet-rich fibrin
biomaterial with a specific composition and three-dimensional architecture.
PRF is classified as a second generation platelet concentrate as it is prepared as a natural
concentrate without the addition of any anticoagulants to eliminate the risk associated with
the use of bovine thrombin.
Platelet-rich fibrin affects cellular activities at genetic and cellular levels.
PRF membrane consists of a fibrin three-dimensional polymerized matrix in a specific
structure, with the incorporation of almost all the platelets and more than half of leukocytes
along with growth factors and circulating stem cells.

20. TECHNIQUE OF PLATELET RICH FIBRIN
PREPARATION

23. MERITS OF PRF DEMERITS OF PRF
Ease of preparation/application Low quantity of PRF is obtained,because of autologous blood so
application in general surgery is limited
Lack of biochemical modification The clinical benefit of PRF depends on time interval between speed of
handling between blood collection and centrifugation as PRF is
prepared without any addition anticoagulants
Simplified and cost effective process The fibrin matrix contains the circulating immune cells and all the
highly antigenic plasmatic molecules, that is why PRF is totally specific
to the donor
Able to support cytokines enmeshment and cellular migration PRF membrane should be used immediately after preparation as it will
shrink resulting in dehydration altering the structural integrity of PRF
and leukocyte viability will be adversely affected altering its biologic
properties.
PRF when stored in refrigerator can result in risk of bacterial
Contamination
Merit and demerits of platelet rich fibrin5

24. APPLICATIONS OF
PLATELET RICH
FIBRIN6

25. In Endodontics
• The use of triple antibiotic paste for canal disinfection along with PRF
strengthens the effectiveness of sterilization in carious teeth, infected
dentin,periapical lesions and necrotic pulp.
• PRF causes proliferation of pulp cells and also increases the expression of
osteoprotegerin and Alkaline phosphatase activity.
• PRF and tricalcium phosphate(TCP) bone graft have synergistic effect in
treating periapical cysts.

26. Periapical cyst treated
with PRF7
PRF IN PULP REGENERATION
Mishra N,Mittal N,Narang I.
Platelet-rich fibrin-mediated revitalization of immature necrotic tooth

27. IN PERIODONTICS
• Healing biomaterial in implant and periodontal
surgical procedure.
• Osteo conductive and Osteo inductive properties.
• Good bone fill along with gain in clinical
attachment was seen when PRF was used in
addition to hydroxyapatite.
• Treating intrabony defects and furcations.
• Sinus lift procedures.
PRF IN ROOT COVERAGE

28. FURCATION TREATED WITH PRF
Surgical re-entry evaluation of regenerative efficacy of bioactive Gengigel™ and platelet-
rich fibrin in the treatment of grade II furcation: A novel approach
Sandhu G.K,Khinda P.K.,Gill A.S.,Kalra H.S.8

29. IN IMPLANTOLOGY
• Better osseointegration capability.
• PRF as sinus augmentation adjunct
and suggested simultaneous sinus lift
implantation using PRF as a sole grafting
material.
Enhance the Natural Healing Potentials - PRF (Platelet-Rich Fibrin)
JinY. Kim

30. Conclusion7
Platelet concentrates are a novel ingress of tissue engineering to clinicians
and researchers in the field of dentistry.
Being a completely natural, physiologic, and economical source of
autologous product, it possesses beneficial effects of eliminating concerns
about immunogenic reactions and disease transmission.
However, since knowledge on this topic is still in its preliminary stage, the
effectiveness of these platelet concentrates in regenerative procedures should
be evaluated in studies comprising of large samples and their clinical
applications in randomized control trials has to be encouraged.

31. References
• 1. Agrawal M, Agrawal V. Platelet rich fibrin and its applications in dentistry -Natl J Med Dent Res
2014;2:51-8.
• 2. Chandran P, Sivadas A. Platelet-rich fibrin: Its role in periodontal regeneration. Saudi J Dent Res
2014;5:117-22.
• 3. Prakash S, Thakur A. Platelet concentrates: Past, present and future. J Maxillofacial Oral Surg
2011;10:45-9.
• 4. Sunitha Raja V, Munirathnam Naidu E. Platelet-rich fibrin: Evolution of a second-generation platelet
concentrate. Indian J Dent Res 2008;19:42-6.
• 5. Raaj V, GautamA, Kumar A, Kumari P. Platelet-rich fibrin (PRF): A new generation platelet
concentrate. Int J Dent Med Res 2015;1:164-7.
• 6. Kumar RV, Shubhashini N. Platelet rich fibrin: A new paradigm in periodontal regeneration. Cell
Tissue Bank 2013;14:453-63.
• 8.Surgical re-entry evaluation of regenerative efficacy of bioactive Gengigel™ and platelet-rich fibrin
in the treatment of grade II furcation: A novel approach;Sandhu G.K,Khinda P.K.,Gill A.S.,Kalra H.S. ;
Indian Journal Of Dental Research
• 9. Mishra N,Mittal N,Narang I.Platelet-rich fibrin-mediated revitalization of immature necrotic tooth.
The Journal Of Clinical Research

32. • A.,Maria E Licata M. E,Polizzi B,and Campisi G. Platelet-rich plasma (PRP) in
dental and oral surgery: from the wound healing to bone regeneration-Immun
Ageing. 2013; 10: 23.

33. Thank you