Platelet-Rich Fibrin (PRF) is a new second-generation platelet concentrate, with simplified processing, and no biochemical blood handling. It has several advantages over traditionally prepared PRP, which has been widely used for accelerating soft tissue and hard tissue healing for years. Strictly autologous preparation, the amount of PRF obtained is limited, includes its disadvantages. Choukroun's PRF incorporates leucocytes, platelets and a wide range of healing proteins within a dense fibrin matrix. It is a natural bioactive membrane, which can enhance soft/hard tissue healing, at the same time, can also protect surgical sites, grafted materials from external aggressions. This article describes the evolution of this second-generation platelet concentrate and its multiple uses in various surgical procedures.
Platelet rich fibrin | Dental Implants with PRF | PRF In regenerative surgeri...Dr. Rajat Sachdeva
PRF is a by product of blood that is exceptionally rich in platelets.
PRF is a second generation PRP where autologous platelets and leucocytes are present in a complex fibrin matrix to accelerate the healing of soft and hard tissue and used as a tissue engineering scaffold for endodontics .
PRF has been used to accelerate the body's own healing process.
Call us regarding Dental Treatment:-
Dr. Rajat Sachdeva
+919818894041,01142464041
drrajatsachdeva@gmail.com
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• www.sachdevadentalcare.com
• www.dentalclinicindelhi.com
• www.dentalimplantindia.co.in
• www.dentalcoursesdelhi.com
• www.facialaestheticsdelhi.com
Platelet Rich Fibrin (PRF) in Dentistry, What is PRF ? , What are the difference between PRP,PRGF and PRF ?, Preparation of PRF , shapes of PRF, Role of PRF in wound healing, APPLICATIONS OF PRF, Applications of PRF In Oral and Maxillofacial Surgery, Applications of PRF In Periodontics, Applications of PRF In Endodontics, Applications of PRF In Tissue Engineering
Platelet rich fibrin | Dental Implants with PRF | PRF In regenerative surgeri...Dr. Rajat Sachdeva
PRF is a by product of blood that is exceptionally rich in platelets.
PRF is a second generation PRP where autologous platelets and leucocytes are present in a complex fibrin matrix to accelerate the healing of soft and hard tissue and used as a tissue engineering scaffold for endodontics .
PRF has been used to accelerate the body's own healing process.
Call us regarding Dental Treatment:-
Dr. Rajat Sachdeva
+919818894041,01142464041
drrajatsachdeva@gmail.com
Follow us here:-
• Google+ link: https://goo.gl/vqAmvr
• Facebook link: https://goo.gl/tui98A
• Youtube link: https://goo.gl/mk7jfm
• Linkedin link: https://goo.gl/PrPgpB
• Slideshare link : http://goo.gl/0HY6ep
• Twitter Page : https://goo.gl/tohkcI
• Instagram page : https://goo.gl/OOGVig
Learn more:-
• www.sachdevadentalcare.com
• www.dentalclinicindelhi.com
• www.dentalimplantindia.co.in
• www.dentalcoursesdelhi.com
• www.facialaestheticsdelhi.com
Platelet Rich Fibrin (PRF) in Dentistry, What is PRF ? , What are the difference between PRP,PRGF and PRF ?, Preparation of PRF , shapes of PRF, Role of PRF in wound healing, APPLICATIONS OF PRF, Applications of PRF In Oral and Maxillofacial Surgery, Applications of PRF In Periodontics, Applications of PRF In Endodontics, Applications of PRF In Tissue Engineering
Platelet rich fibrin: an autologous bioactive membraneApollo Hospitals
Platelet-Rich Fibrin (PRF) is a new second-generation platelet concentrate, with simplified processing, and no biochemical blood handling. It has several advantages over traditionally prepared PRP, which has been widely used for accelerating soft tissue and hard tissue healing for years. Strictly autologous preparation, the amount of PRF obtained is limited, includes its disadvantages. Choukroun’s PRF incorporates leucocytes, platelets and a wide range of healing proteins within a dense fibrin matrix. It is a natural bioactive membrane, which can enhance soft/hard tissue healing, at the same time, can also protect surgical sites, grafted materials from external aggressions. This article describes the evolution of this second-generation platelet concentrate and its multiple uses in various surgical procedures.
It is sometimes difficult in clinical and experimental situations to determine whether regeneration or new attachment has occurred and the extent to which it has occurred.
Although there are various evidences of reconstruction, the proof of principle for the type of healing is determined by histological studies.
The future of dentistry and periodontics lies in regeneration. The goals of periodontal therapy lies in not only the arrest of periodontal disease progression but also regeneration of the lost periodontal structures. This presentation provides a review of the current understanding of the regeneration of the periodontium and the procedures involved to restore the periodontal tissues around the teeth.
Platelet Rich Fibrin (PRF) is an autologous fibrin based biomaterial derived from human blood discovered by Choukroun and coworkers in the year 2006. The future of PRF has enormous therapeutic implications. Therefore, more clinicians should adopt this technology for the benefit of the patients.
Platelet rich fibrin: an autologous bioactive membraneApollo Hospitals
Platelet-Rich Fibrin (PRF) is a new second-generation platelet concentrate, with simplified processing, and no biochemical blood handling. It has several advantages over traditionally prepared PRP, which has been widely used for accelerating soft tissue and hard tissue healing for years. Strictly autologous preparation, the amount of PRF obtained is limited, includes its disadvantages. Choukroun’s PRF incorporates leucocytes, platelets and a wide range of healing proteins within a dense fibrin matrix. It is a natural bioactive membrane, which can enhance soft/hard tissue healing, at the same time, can also protect surgical sites, grafted materials from external aggressions. This article describes the evolution of this second-generation platelet concentrate and its multiple uses in various surgical procedures.
It is sometimes difficult in clinical and experimental situations to determine whether regeneration or new attachment has occurred and the extent to which it has occurred.
Although there are various evidences of reconstruction, the proof of principle for the type of healing is determined by histological studies.
The future of dentistry and periodontics lies in regeneration. The goals of periodontal therapy lies in not only the arrest of periodontal disease progression but also regeneration of the lost periodontal structures. This presentation provides a review of the current understanding of the regeneration of the periodontium and the procedures involved to restore the periodontal tissues around the teeth.
Platelet Rich Fibrin (PRF) is an autologous fibrin based biomaterial derived from human blood discovered by Choukroun and coworkers in the year 2006. The future of PRF has enormous therapeutic implications. Therefore, more clinicians should adopt this technology for the benefit of the patients.
"Exploring Regenerative Endodontics: A Paradigm Shift in Root Canal Therapy" aims to delve into the groundbreaking approach of regenerative endodontics, which has revolutionized traditional root canal treatments. This presentation serves as a comprehensive guide for dental professionals, researchers, and students who are keen on understanding the shift towards biologically-based procedures designed to replace damaged tooth structures, including dentin and root structures, as well as cells of the pulp-dentin complex.
Key Points Covered:
Introduction to Traditional Endodontics: A brief overview of conventional root canal treatments, setting the stage for the limitations that regenerative endodontics aims to address.
Fundamentals of Regenerative Endodontics: Understand what regenerative endodontics is, its aims, and the principles guiding this new approach.
Materials and Techniques: Discover the novel materials and technologies used in regenerative endodontics including scaffolds, growth factors, and stem cells.
Clinical Applications and Benefits: Discuss various case studies and clinical trials that demonstrate the effectiveness and benefits of regenerative procedures.
Challenges and Future Prospects: A balanced view on the hurdles facing regenerative endodontics and what the future holds.
This presentation is essential viewing for anyone interested in the future of dental science and how regenerative approaches can offer effective and more natural alternatives to traditional endodontic treatments."
Feel free to modify this description to better suit your specific needs and focus points.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
00919248678078
Ortho: to make straight or right. The use of biologic substances to prompt, stimulate or support a “healing event” within the body.The use of biologic substances to promote healing or reduce pain.The use of platelets and stem cells in treatment and management of musculoskeletal conditions
A current review by Milano G et al. (http://dx.doi.org/10.1136/jisakos-2019-000274) has duly indicated the safe, cost-effective, and pain-relieving benefits of Platelet Rich Plasma (PRP) in orthopedic sports injuries and several other musculoskeletal conditions.
With several other publications supporting regenerative therapies, S.T.A.R 2020 workshop on the applications of regenerative medicine products in the field of orthopedics helps you understand the medical benefits of PRP and other regenerative therapies like BMAC and SYNOJEL, with advanced hands-on training under the guidance of professional experts.
Register now
www.advancells.com/star-2020/
Malignant Mixed Mullerian Tumor – Case Reports and Review ArticleApollo Hospitals
Malignant mixed mullerian tumors are very rare genital tumors. They are biphasic neoplasms composed of an admixture of malignant epithelial and mesenchymal elements. In descending order of frequency they originate in the uterus, ovaries, fallopian tubes, cervix and vagina. Also they arise denovo from peritoneum. They are highly aggressive and tend to occur in postmenopausal low parity women. Because of rarity, there is as such no treatment guidelines available. Multimodality treatment in the form of radical surgery followed by adjuvant chemotherapy or radiotherapy or combined chemoradiation gives a better prognosis & outcome. Two case reports of such tumors, one from ovary and other from penitoneum are presented along with the review of literature.
Intra-Fetal Laser Ablation of Umbilical Vessels in Acardiac Twin with Success...Apollo Hospitals
To interrupt blood supply to the acardiac twin in a case of TRAP sequence of monochorionic diamniotic multiple pregnancy to allow for continuation of the normal twin.
Breast Cancer in Young Women and its Impact on Reproductive FunctionApollo Hospitals
Breast cancer is the most common cancer in women in developed countries. Chemotherapy for breast cancer is likely to negatively impact on reproductive function. We review current treatment; effects on reproductive function; breastfeeding and management of menopausal symptoms following breast cancer.
Turner syndrome (gonadal dysgenesis) is one of the most common chromosomal abnormalities occuring 1 in 2500 to 1 in 3000 live-born girls. It is an important cause of short stature in girls and primary amenorrhea in young women that is usually caused by loss of part or all of an X chromosome. This review briefly summarises the current knowledge about the syndrome and the management strategies.
Due to pregnancy thyroid economy is affected with changes in iodine metabolism, TBG and development of maternal goiter. The incidence of hypothyroidism in pregnancy is quite common with autoimmune hypothyroidism being the most important cause. Overt as well as subclinical hypothyroidism has a varied impact on maternal and neonatal outcome. After multiple studies also, routine screening in pregnancy for hypothyroidism can still not be recommended. Management mainly comprises of dosage adjustments as soon as pregnancy is diagnosed based on results of thyroid function tests. The aim should be to keep FT4 at the upper end of normal range.
Growth Hormone Deficiency (GHD) can persist from childhood or be newly acquired. Confirmation through stimulation testing is usually required unless there is a proven genetic/structural lesion persistent from childhood. Growth harmone (GH) therapy offers benefits in body composition, exercise capacity, skeletal integrity, and quality of life measures and is most likely to benefit those patients who have more severe GHD. The risks of GH treatment are low. GH dosing regimens should be individualized. The final decision to treat adults with GHD requires thoughtful clinical judgment with a careful evaluation of the benefits and risks specific to the individual.
Advances in the management of thalassemia have led to marked improvements in the life span and quality of life of children and young adults. This poses new challenges for the treating physicians. There is now increasing recognition that thalassemics have impaired bone health which is multifactorial in etiology. This paper aims to highlight the factors that predispose these patients to osteoporosis and suggests measures to minimise the impact on bone health.
Laparoscopic Excision of Foregut Duplication Cyst of StomachApollo Hospitals
Retroperitoneal gastric duplication cysts lined by ciliated columnar epithelium are extremely rare lesions and its presentation during adulthood is a diagnostic challenge for treating clinicians. This entity often resembles cystic pancreatic neoplasm, retroperitoneal cystic lesions and sometimes as an adrenal cystic neoplasm. Correct diagnosis on the basis of radiological investigation is difficult and histopathologic analysis. We report a case of gastric duplication cyst in a 16year old girl that mimicked as a retroperitoneal /pancreatic /adrenal cystic lesion and was successfully managed by laparoscopy.
Occupational Blood Borne Infections: Prevention is Better than CureApollo Hospitals
Viral infections like HIV, hepatitis Band C virus pose a big risk to the contacts of individuals with high risk behaviour as well as to the attending health care workers. Blood, semen, vaginal and other potentially infectious materials can transmit the infection to the susceptible contacts. Universal precautions should be strictly implemented during clinical examination, laboratory work and surgical procedures to prevent transmission to the health care providers. Health care workers should receive vaccination for hepatitis B infection. An inadvertent exposure should be managed with proper first aid and infectivity of the source and severity of exposure should be assessed. Severity of exposure is based on the nature and area of exposed surface, mode of injury and volume of infective material. Post-exposure prophylaxis (PEP) should be started as soon as possible after a proper counseling about the effectiveness of post-exposure prophylaxis, side effects and risk of carrying the infection to his familial contacts and its prevention.
Evaluation of Red Cell Hemolysis in Packed Red Cells During Processing and St...Apollo Hospitals
Storage of red cells causes a progressive increase in hemolysis. Inspite of the use of additive solutions for storage and filters for leucoreduction some amount of hemolysis is still inevitable. The extent of hemolysis however should not exceed the permissible threshold for hemolysis even on the 42nd day of storage.
Efficacy and safety of dexamethasone cyclophosphamide pulse therapy in the tr...Apollo Hospitals
Various drugs used to treat pemphigus can cause remission, but none can provide permanent remission as relapses are common. With the introduction of DCP in pemphigus in 1984, patients started being in prolonged/permanent remission. This study was done to compare the efficacy of DCP to oral corticosteroids and cyclophosphamide in combination.
Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)Apollo Hospitals
Severe skin adverse drug reactions can result in death. Toxic epidermal necrolysis (TEN) has the highest mortality (30–35%); Stevens-Johnson syndrome and transitional forms correspond to the same syndrome, but with less extensive skin detachment and a lower mortality (5–15%). Hypersensitivity syndrome, sometimes called Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS), has a mortality rate evaluated at about 10%. It is characterised by fever, rash and internal organ involvement. Prompt diagnosis is vital, along with identification and early withdrawal of suspect medicines and avoidance of re-exposure to the responsible agent is essential. Cross-reactivity to structurally-related syndrome caused by Carbamazepine medicines is common, thus first-degree relatives may be predisposed to developing this syndrome. We report a case of DRESS secondary to use of Carbamazepine.
Difficult Laparoscopic Cholecystectomy-When and Where is the Need to Convert?Apollo Hospitals
Laparoscopic cholecystectomy has now become the treatment of choice for the gall bladder stone. With increasing experience, surgeon has started to take more difficult cases which were considered relative contra indications for laparoscopic removal of gall bladder few years back.
We conducted this study at our hospital and included all laparoscopic cholecystectomy done from May'08 to January'10. Total time taken in surgery, conversion rate and complication rate were analysed. Factors making laparoscopic cholecystectomy difficult were also analysed. We defined difficult laparoscopic cholecystectomy when we found -dense fibrotic adhesions in and around Callot's triangle, gangrenous gall bladder, empyma, large stone impacted at gall bladder neck, contracted gall bladder, Mirrizi's syndrome, h/o biliary pancreatitis, CBD stones, acute cholecystitis of <72 hrs duration.
Out of 206 cases done during above period, 56 cases were considered difficult. Only two cases were converted to open.
With growing experience and technical advancement surgery can be completed in most of the difficult cases. This is important because recently it is shown in literature that laparoscopic cholecystectomy is associated with less morbidity than open method irrespective of duration of the surgery.
Deep vein thrombosis prophylaxis in a tertiary care center: An observational ...Apollo Hospitals
Deep vein thrombosis (DVT) is a major health problem with substantial mortality and morbidity in medically ill patients. Prevention of DVT by risk factor stratification and subsequent antithrombotic prophylaxis in moderate- to severe-risk category patients is the most rational means of reducing morbidity and mortality.
The spread of dengue and dengue haemorrhagic fever is increasing, atypical manifestations are also on the rise, although they may be under reported because of lack of awareness. We report two such cases of dengue hemorrhagic fever with hepatitis, intraocular hemorrhage, ARDS and myocarditis.
A 71-year-old male presented in ENT department with dysphagia for last three weeks, more to solids than liquids. He had a hard bony bulge in the posterior pharyngeal wall on palpation and hence was referred for an Orthopaedic opinion. Lateral radiograph of the cervical spine revealed diffuse ossification of the anterior longitudinal ligament. This ossification was extending almost half the width of the cervical body from its anterior body at C1 and C2 vertebra level.
Pediatric Liver Transplant (LT) is now an established procedure for End Stage Liver Disease (ESLD) with biliary atresia being the commonest indication. Intensive pre-transplant evaluation, nutritional buildup and immunization are the fundamental pre-requisites of a successful LT. With improvement in surgical micro-anastomotic techniques and superior immunosuppressive regimens the success rate of pediatric LT is in excess of 90%. Most of the transplants in our country however are Living related, due to which a fairly large number of children expire awaiting a donor liver. There should be a concerted effort to evolve the cadaveric donation program, so that majority of the children are benefitted.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
2. Review Article
Platelet rich fibrin: an autologous bioactive
membrane
Anirban Chatterjee a,
*, Prerna Agarwal b
, Shobha Krishna Subbaiah b
a
Sr. Consultant, Periodontist & Implantologyst, Apollo Hospital, Bangalore 560038, India
b
Consultant, Periodontist, Apollo Clinic, Bangalore 560038, India
a r t i c l e i n f o
Article history:
Received 26 December 2013
Accepted 30 January 2014
Available online 12 March 2014
Keywords:
PRF
PRP
Growth factors
a b s t r a c t
Platelet-Rich Fibrin (PRF) is a new second-generation platelet concentrate, with simplified
processing, and no biochemical blood handling. It has several advantages over traditionally
prepared PRP, which has been widely used for accelerating soft tissue and hard tissue
healing for years. Strictly autologous preparation, the amount of PRF obtained is limited,
includes its disadvantages. Choukroun’s PRF incorporates leucocytes, platelets and a wide
range of healing proteins within a dense fibrin matrix. It is a natural bioactive membrane,
which can enhance soft/hard tissue healing, at the same time, can also protect surgical
sites, grafted materials from external aggressions. This article describes the evolution of
this second-generation platelet concentrate and its multiple uses in various surgical
procedures.
Copyright ª 2014, Indraprastha Medical Corporation Ltd. All rights reserved.
1. Introduction
Regenerative potential of platelets was introduced in 1974,
and Ross et al1
were amongst the pioneers who first described
a growth factor from platelets. A new family of platelet
concentrate, which is neither a fibrin glue nor a classical
platelet concentrate, discovered in France because of legal
complications of biochemical blood handling. This new
biomaterial is called as PRF, looks like an autologous cicatricial
matrix.2
PRF is a fibrin matrix of trapped platelets, cytokines
and other cells, which are released after a certain time,3
to act
as a resorbable biomembrane. More recently, Gassling et al4
have shown that PRF is a suitable scaffold for breeding
human periosteal cells in vitro, which may be suitable for
bone tissue engineering applications.5
2. What is fibrin?
Fibrin is the activated form of a plasmatic molecule called
fibrinogen.6
This soluble fibrillary molecule is massively
present both in plasma and in the platelet a-granules and
plays a determining role in platelet aggregation during he-
mostasis. It is transformed into a kind of biologic glue
capable of consolidating the initial platelet cluster, thus
constituting a protective wall along vascular breaches dur-
ing coagulation. In fact, fibrinogen is the final substrate of
all coagulation reactions. Being a soluble protein, fibrinogen
is transformed into an insoluble fibrin by thrombin while
the polymerized fibrin gel constitutes the first cicatricial
matrix of the injured site.7e9
* Corresponding author. Tel.: þ91 9845003721.
E-mail address: dranirbanchatterjee@yahoo.com (A. Chatterjee).
Available online at www.sciencedirect.com
ScienceDirect
journal homepage: www.elsevier.com/locate/apme
a p o l l o m e d i c i n e 1 1 ( 2 0 1 4 ) 2 4 e2 6
http://dx.doi.org/10.1016/j.apme.2014.01.007
0976-0016/Copyright ª 2014, Indraprastha Medical Corporation Ltd. All rights reserved.
3. 3. Biological aspect
PRF was developed in France by Choukroun et al10
Basically
the platelets and released cytokines are accumulated in a
fibrin clot. Platelet granules contain many platelet specific (eg.
beta-thromboglobulins) & non-platelet specific proteins (eg.
fibronectin, thrombospondin, fibrinogen, growth promoters,
fibrinolysis inhibitors, immunoglobulins etc), calcium and
serotonin etc.11
Growth factors released by alpha-granules
encompass a group of cytokine polypeptides with relatively
low molecular weight ranging from 6 to 45 kDa.12
After acti-
vation and degranulation platelets aggregates at the healing
site and release the cytokines (IL-1 beta, IL-6, tumor necrosis
factor (TNF)-alpha)13
and growth factors (transforming growth
factor (TGF) beta 1, platelet derived growth factor (PDGF),
vascular endothelial growth factor (VEGF), epidermal growth
factor (EGF)) that stimulates cell migration and proliferation
within the fibrin matrix and thus begins the first stage of
healing.11
According to Dohan et al13
PRF may decreases many
harmful effects at inflammatory site natural to surgical act
and thus could be an immune regulation node with inflam-
mation retro-control abilities and explained the reduction of
post-operative infections.
4. Platelet-rich fibrinda natural fibrin matrix
Platelet-rich fibrin (PRF) requires neither anticoagulant nor
bovine thrombin (nor any other gelling agent). It is nothing
more than centrifuged blood without any addition, which
makes it possible to avoid all the restrictions. The PRF protocol
is very simple: A blood sample is taken without anticoagulant
& immediately centrifuged at 3000 rpm for 10 min. Due to the
absence of anticoagulant, most of the platelets activates
within few minutes and release the coagulation cascades.
Acellular plasma is initially accumulated in the upper part of
the tube, before the circulating thrombin transforms it into
fibrin. A fibrin clot is then obtained in the middle of the tube,
just between the red corpuscles at the bottom and acellular
plasma at the top (Fig. 1).2
Quick handling is the only way to obtain a clinically usable
PRF clot. If the duration required to collect blood and launch
centrifugation is overly long, failure will occur: The fibrin will
polymerize in a diffuse way in the tube and only a small blood
clot without consistency will be obtained. In conclusion, the
PRF protocol makes it possible to collect a fibrin clot charged
with serum and platelets. By driving out the fluids trapped in
the fibrin matrix, practitioners will obtain very resistant
autologous fibrin membranes.2,10
5. Clinical implications
Choukroun et al10
were amongst the pioneers for using
autologous PRF to improve bone healing in implant dentistry.
They evaluate the potential of PRF in combination with freeze-
dried bone allograft (FDBA) to enhance bone regeneration in
sinus floor elevation and sinus floor augmentation. In their
study, PRF was added to FDBA particles (test group), and FDBA
without PRF was used (control group). In results they found,
the maturation & quantities of newly formed bone were
equivalent between the two groups.14
Mazor et al15
assessed
the relevance of PRF concentrate and biomembranes as the
sole filling material during a lateral sinus lift with immediate
implantation in a case series. From a radiologic and histo-
logical point of view at 6 months after surgery, they found a
high volume of regenerated bone in the subsinus cavity up to
the tip of the implants. Toffler et al16
advocated membrane
insurance by possibly sealing an undetected perforation dur-
ing lateral window osteotomy procedure using PRF mem-
brane. In a multicenteric study by Kfir et al,17
minimally
invasive antral membrane balloon elevation (MIAMBE) done
using PRF and bone substitutes, injected under the antral
membrane and implant placement along with primary
closure executed at the same sitting, revealed that MIAMBE
can be applied to all patients in need of posterior maxilla bone
augmentation with high procedural success, low complication
rate, and satisfactory bone augmentation and implant sur-
vival. Simonpieri et al18,19
reported maxillary reconstruction
using FDBA, PRF membranes and 0.5% metronidazole solution
in twenty patients case series. Toffler20
advocated osteotome-
mediated sinus floor elevation (OMSFE) or crestal core eleva-
tion (CCE)21
with simultaneous implant placement using PRF
plugs. Thick PRF plugs or small disks of 1 cm diameter can also
be easily inserted into the residual extraction sockets.16
Aroca
et al22
evaluate the modified coronally advanced flap alone or
in combination with PRF for the treatment of adjacent Miller
Class I and II multiple gingival recession, & discovered inferior
root coverage of about 80.7% as compared to about 91.5%
achieved at control site, but an additional gain in gingival/
mucosal thickness compared to conventional therapy.
6. Conclusion
Thus, with this article we can conclude that the new and
recent generation of platelet concentrate-PRF, would be a
good friend to Periodontists in the near future. It has a list of
its benefits, & intraoral applications. This material is already
being used widely in France, and considering its advantages,
its popularity should increase here too. More clinical, histo-
logical and statistical studies are now required to understandFig. 1 e Different layers after blood centrifugation.
a p o l l o m e d i c i n e 1 1 ( 2 0 1 4 ) 2 4 e2 6 25
4. the benefits of this new platelet concentrate better. However,
it cannot be ignored that since it is obtained from an autolo-
gous blood sample, the quantity of PRF produced is low and
only a limited volume can be used. This fact limits the sys-
tematic utilization of PRF, as in general surgery. Also though
the potential applications of PRF are broad, however, an ac-
curate working knowledge of the biomaterial, its biology, ef-
ficiency & limits are necessary to optimize its use in daily
practice. Hence additional randomized clinical trials evalu-
ating the use & performance of PRF are warranted.
Conflicts of interest
All authors have none to declare.
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