Platelet-Rich Fibrin in Periodontal Regeneration

REVIEW
D. Kolgeci, B. Kolgeci, A. Emini, A. Kolgeci

 
For citation: Kolgeci D, Kolgeci B, Emini A, Kolgeci A. Platelet-Rich Fibrin in Periodontal Regeneration. International Journal of Biomedicine. 2025;15(1):31-36. doi:10.21103/Article15(1)_RA4
 
Originally published March 5, 2025

Abstract: 

Background: Periodontal disease is multifactorial regarding potential etiological factors and modifiers of achieved therapeutic effects. The treatment of this disease has been a challenge for periodontists for years. In recent years, new methods have begun to be implemented to regenerate periodontal tissue. One of these methods is platelet-rich plasma therapy in regenerating periodontal tissue. This study aimed to assess the potential benefits of platelet-rich fibrin (PRF) in periodontal regeneration.
Material and Methods: An electronic literature search was conducted using the National Library of Medicine, PubMed/MEDLINE, and the Scopus database, covering articles published from 2000 to 2023. Keywords used included "platelet-rich fibrin (PRF)," "PRF in periodontology," "PRF on gingival recession," and "PRF in infrabony pocket." The articles were selected based on title and abstract, focusing on clinical applications of PRF in periodontology. Inclusion criteria encompassed case reports, case series, original research, review papers, and both in vitro and in vivo studies, including animal studies and controlled clinical trials.
Conclusion: The use of PRF in the treatment of periodontal diseases, especially advanced platelet-rich fibrin, offers additional benefits in periodontal regeneration. Simplicity in the preparation, minor interventions, cost efficiency, and favorable clinical results have made this treatment method attractive for the regeneration of gingival recessions and the treatment of bone defects. The relatively small volume of PRF obtained from a single blood sample and the dependence on accurate handling and preparation are limitations that must be considered.

Keywords: 
platelet-rich fibrin • periodontal disease • gingival recession
References: 
  1. The potential role of growth and differentiation factors in periodontal regeneration. J Periodontol. 1996 May;67(5):545-53. PMID: 8724716.
  2. Greenwell H; Committee on Research, Science and Therapy. American Academy of Periodontology. Position paper: Guidelines for periodontal therapy. J Periodontol. 2001 Nov;72(11):1624-8. doi: 10.1902/jop.2001.72.11.1624. PMID: 11759876.
  3. Sander L, Karring T. Healing of periodontal lesions in monkeys following the guided tissue regeneration procedure. A histological study. J Clin Periodontol. 1995 Apr;22(4):332-7. doi: 10.1111/j.1600-051x.1995.tb00156.x. PMID: 7622641.
  4. Dangaria SJ, Ito Y, Walker C, Druzinsky R, Luan X, Diekwisch TG. Extracellular matrix-mediated differentiation of periodontal progenitor cells. Differentiation. 2009 Sep-Oct;78(2-3):79-90. doi: 10.1016/j.diff.2009.03.005. Epub 2009 May 9. PMID: 19433344; PMCID: PMC2744845.
  5. Dangaria SJ, Ito Y, Luan X, Diekwisch TG. Successful periodontal ligament regeneration by periodontal progenitor preseeding on natural tooth root surfaces. Stem Cells Dev. 2011 Oct;20(10):1659-68. doi: 10.1089/scd.2010.0431. Epub 2011 Mar 9. PMID: 21250830; PMCID: PMC3210028.
  6. Hollander A, Macchiarini P, Gordijn B, Birchall M. The first stem cell-based tissue-engineered organ replacement: implications for regenerative medicine and society. Regen Med. 2009 Mar;4(2):147-8. doi: 10.2217/17460751.4.2.147. Retraction in: Regen Med. 2024 Nov;19(11):579. doi: 10.1080/17576180.2024.2413823. PMID: 19317632.
  7. Choukroun J, Adda F, Schoeffer C, Vervelle A. PRF: An opportunity in perio-implantology. Implantodontie. 2000;42:55–62. [In French].
  8. Chandran P, Sivadas A. Platelet-rich fibrin: Its role in periodontal regeneration. The Saudi Journal for Dental Research. 2014;5(2):117–122. doi:10.1016/j.ksujds.2013.09.001
  9. Del Corso M, Sammartino G, Dohan Ehrenfest DM. Choukroun's platelet-rich fibrin membranes in periodontal surgery: Understanding the biomaterial or believing in the magic of growth factors? (letter to the editor) J Periodontol 2009; 80: 1694–1697; author reply 1697-1699.
  10. Dohan Ehrenfest DM, Diss A, Odin G, Doglioli P, Hippolyte MP, Charrier JB. In vitro effects of Choukroun's PRF (platelet-rich fibrin) on human gingival fibroblasts, dermal prekeratinocytes, preadipocytes, and maxillofacial osteoblasts in primary cultures. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009 Sep;108(3):341-52. doi: 10.1016/j.tripleo.2009.04.020. Epub 2009 Jul 9. PMID: 19589702.
  11. Dohn D, Donsimoni J-M, Navarro G, Gaultier F. Platelet concentrates. Part I: Technologies. Implantodontie.2003;12:5–16.
  12. Choukroun J, Diss A, Simonpieri A, Girard MO, Schoeffler C, Dohan SL, Dohan AJ, Mouhyi J, Dohan DM. Platelet-rich fibrin (PRF): a second-generation platelet concentrate. Part IV: clinical effects on tissue healing. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006 Mar;101(3):e56-60. doi: 10.1016/j.tripleo.2005.07.011. PMID: 16504852.
  13. KINGSLEY CS. Blood coagulation; evidence of an antagonist to factor VI in platelet-rich human plasma. Nature. 1954 Apr 17;173(4407):723-4. doi: 10.1038/173723a0. PMID: 13165629.
  14. Matras H. Die Wirkungen verschiedener Fibrinpräparate auf Kontinuitätstrennungen der Rattenhaut [Effect of various fibrin preparations on reimplantations in the rat skin]. Osterr Z Stomatol. 1970 Sep;67(9):338-59. German. PMID: 4917644.
  15. Dohan Ehrenfest DM, Rasmusson L, Albrektsson T. Classification of platelet concentrates: from pure platelet-rich plasma (P-PRP) to leucocyte- and platelet-rich fibrin (L-PRF). Trends Biotechnol. 2009 Mar;27(3):158-67. doi: 10.1016/j.tibtech.2008.11.009. Epub 2009 Jan 31. PMID: 19187989.
  16. Choukroun J. Advanced PRF and i-PRF: Platelet concentrate or blood concentrate? J Periodontal Med Clin Pract. 2014;1:3.
  17. Dohan Ehrenfest DM, Rasmusson L, Albrektsson T. Classification of platelet concentrates: from pure platelet-rich plasma (P-PRP) to leucocyte- and platelet-rich fibrin (L-PRF). Trends Biotechnol. 2009 Mar;27(3):158-67. doi: 10.1016/j.tibtech.2008.11.009. Epub 2009 Jan 31. PMID: 19187989.
  18. Ghanaati S, Booms P, Orlowska A, Kubesch A, Lorenz J, Rutkowski J, Landes C, Sader R, Kirkpatrick C, Choukroun J. Advanced platelet-rich fibrin: a new concept for cell-based tissue engineering by means of inflammatory cells. J Oral Implantol. 2014 Dec;40(6):679-89. doi: 10.1563/aaid-joi-D-14-00138. PMID: 24945603.
  19. Fujioka-Kobayashi M, Miron RJ, Hernandez M, Kandalam U, Zhang Y, Choukroun J. Optimized Platelet-Rich Fibrin With the Low-Speed Concept: Growth Factor Release, Biocompatibility, and Cellular Response. J Periodontol. 2017 Jan;88(1):112-121. doi: 10.1902/jop.2016.160443. Epub 2016 Sep 2. PMID: 27587367.
  20. Mourão CF, Valiense H, Melo ER, Mourão NB, Maia MD. Obtention of injectable platelets rich-fibrin (i-PRF) and its polymerization with bone graft: technical note. Rev Col Bras Cir. 2015 Nov-Dec;42(6):421-3. English, Portuguese. doi: 10.1590/0100-69912015006013. PMID: 26814997.
  21. Bowen RA, Remaley AT. Interferences from blood collection tube components on clinical chemistry assays. Biochem Med (Zagreb). 2014 Feb 15;24(1):31-44. doi: 10.11613/BM.2014.006. PMID: 24627713; PMCID: PMC3936985.
  22. Simonpieri A, Del Corso M, Vervelle A, Jimbo R, Inchingolo F, Sammartino G, Dohan Ehrenfest DM. Current knowledge and perspectives for the use of platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) in oral and maxillofacial surgery part 2: Bone graft, implant and reconstructive surgery. Curr Pharm Biotechnol. 2012 Jun;13(7):1231-56. doi: 10.2174/138920112800624472. PMID: 21740370.
  23. Dohan DM, Del Corso M, Charrier J-B. Cyto-toxicity analyses of Choukroun’s platelet-rich fibrin (PRF) on a wide range of human cells: The answer to a commercial controversy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007;103:587–593
  24. Choukroun J, Diss A, Simonpieri A, Girard MO, Schoeffler C, Dohan SL, Dohan AJ, Mouhyi J, Dohan DM. Platelet-rich fibrin (PRF): a second-generation platelet concentrate. Part IV: clinical effects on tissue healing. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006 Mar;101(3):e56-60. doi: 10.1016/j.tripleo.2005.07.011. PMID: 16504852.
  25. Kang YH, Jeon SH, Park JY, Chung JH, Choung YH, Choung HW, Kim ES, Choung PH. Platelet-rich fibrin is a Bioscaffold and reservoir of growth factors for tissue regeneration. Tissue Eng Part A. 2011 Feb;17(3-4):349-59. doi: 10.1089/ten.TEA.2010.0327. Epub 2010 Dec 31. PMID: 20799908.
  26. Wu CL, Lee SS, Tsai CH, Lu KH, Zhao JH, Chang YC. Platelet-rich fibrin increases cell attachment, proliferation and collagen-related protein expression of human osteoblasts. Aust Dent J. 2012 Jun;57(2):207-12. doi: 10.1111/j.1834-7819.2012.01686.x. PMID: 22624763.
  27. Anegundi RV, Shenoy SB, Chandran T, Pampani P. Clinical efficacy of subepithelial connective tissue graft and A-PRF in the treatment of gingival recession. Quintessence Int. 2023 Feb 10;54(2):134-141. doi: 10.3290/j.qi.b3512389. PMID: 36421044.
  28. Simonpieri A, Del Corso M, Vervelle A, Jimbo R, Inchingolo F, Sammartino G, Dohan Ehrenfest DM. Current knowledge and perspectives for the use of platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) in oral and maxillofacial surgery part 2: Bone graft, implant and reconstructive surgery. Curr Pharm Biotechnol. 2012 Jun;13(7):1231-56. doi: 10.2174/138920112800624472. PMID: 21740370.
  29. Choukroun J, Diss A, Simonpieri A, Girard MO, Schoeffler C, Dohan SL, Dohan AJ, Mouhyi J, Dohan DM. Platelet-rich fibrin (PRF): a second-generation platelet concentrate. Part IV: clinical effects on tissue healing. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006 Mar;101(3):e56-60. doi: 10.1016/j.tripleo.2005.07.011. PMID: 16504852.
  30. Pini Prato G. Mucogingival deformities. Ann Periodontol. 1999 Dec;4(1):98-101. doi: 10.1902/annals.1999.4.1.98. PMID: 10863381.
  31. AAP's Glossary of Periodontal Terms. Available from: https://members.perio.org/libraries/glossary?ssopc=1. Accessed 6 December 2019.
  32. Starzyńska A, Kaczoruk-Wieremczuk M, Lopez MA, Passarelli PC, Adamska P. The Growth Factors in Advanced Platelet-Rich Fibrin (A-PRF) Reduce Postoperative Complications after Mandibular Third Molar Odontectomy. Int J Environ Res Public Health. 2021 Dec 18;18(24):13343. doi: 10.3390/ijerph182413343. PMID: 34948953; PMCID: PMC8702191.
  33. Tadepalli A, Chekurthi S, Kavassery Balasubramanian S, Parthasarathy H, Ponnaiyan D. Comparative Evaluation of Clinical Efficacy of Leukocyte-Rich Platelet-Rich Fibrin with Advanced Platelet-Rich Fibrin in Management of Gingival Recession Defects: A Randomized Controlled Trial. Med Princ Pract. 2022;31(4):376-383. doi: 10.1159/000525560. Epub 2022 Jun 21. PMID: 35728577; PMCID: PMC9485915.
  34. Ghanaati S, Booms P, Orlowska A, Kubesch A, Lorenz J, Rutkowski J, Landes C, Sader R, Kirkpatrick C, Choukroun J. Advanced platelet-rich fibrin: a new concept for cell-based tissue engineering by means of inflammatory cells. J Oral Implantol. 2014 Dec;40(6):679-89. doi: 10.1563/aaid-joi-D-14-00138. PMID: 24945603.
  35. Öngöz Dede F, Bozkurt Doğan Ş, Çelen K, Çelen S, Deveci ET, Seyhan Cezairli N. Comparison of the clinical efficacy of concentrated growth factor and advanced platelet-rich fibrin in the treatment of type I multiple gingival recessions: a controlled randomized clinical trial. Clin Oral Investig. 2023 Feb;27(2):645-657. doi: 10.1007/s00784-022-04775-5. Epub 2022 Nov 19. PMID: 36401070.
  36. Anegundi RV, Shenoy SB, Chandran T, Pampani P. Clinical efficacy of subepithelial connective tissue graft and A-PRF in the treatment of gingival recession. Quintessence Int. 2023 Feb 10;54(2):134-141. doi: 10.3290/j.qi.b3512389. PMID: 36421044.
  37. Abu-Ta'a M. Advanced Platelet-Rich Fibrin and Connective Tissue Graft for Treating Marginal Tissue Recessions: A Randomized, Controlled Split-Mouth Study. Cureus. 2023 Mar 4;15(3):e35761. doi: 10.7759/cureus.35761. PMID: 36879584; PMCID: PMC9985511.
  38. Tadepalli A, Chekurthi S, Kavassery Balasubramanian S, Parthasarathy H, Ponnaiyan D. Comparative Evaluation of Clinical Efficacy of Leukocyte-Rich Platelet-Rich Fibrin with Advanced Platelet-Rich Fibrin in Management of Gingival Recession Defects: A Randomized Controlled Trial. Med Princ Pract. 2022;31(4):376-383. doi: 10.1159/000525560. Epub 2022 Jun 21. PMID: 35728577; PMCID: PMC9485915.
  39. Bosshardt DD, Sculean A. Does periodontal tissue regeneration really work? Periodontol 2000. 2009;51:208-19. doi: 10.1111/j.1600-0757.2009.00317.x. PMID: 19878476.
  40. Miron RJ, Zucchelli G, Pikos MA, Salama M, Lee S, Guillemette V, Fujioka-Kobayashi M, Bishara M, Zhang Y, Wang HL, Chandad F, Nacopoulos C, Simonpieri A, Aalam AA, Felice P, Sammartino G, Ghanaati S, Hernandez MA, Choukroun J. Use of platelet-rich fibrin in regenerative dentistry: a systematic review. Clin Oral Investig. 2017 Jul;21(6):1913-1927. doi: 10.1007/s00784-017-2133-z. Epub 2017 May 27. PMID: 28551729.
  41. Agarwal A, Gupta ND, Jain A. Platelet rich fibrin combined with decalcified freeze-dried bone allograft for the treatment of human intrabony periodontal defects: a randomized split mouth clinical trail. Acta Odontol Scand. 2016;74(1):36-43. doi: 10.3109/00016357.2015.1035672. Epub 2015 May 14. PMID: 25972081.
  42. Ajwani H, Shetty S, Gopalakrishnan D, Kathariya R, Kulloli A, Dolas RS, Pradeep AR. Comparative evaluation of platelet-rich fibrin biomaterial and open flap debridement in the treatment of two and three wall intrabony defects. J Int Oral Health. 2015 Apr;7(4):32-7. PMID: 25954068; PMCID: PMC4409793.
  43. Sharma A, Pradeep AR. Treatment of 3-wall intrabony defects in patients with chronic periodontitis with autologous platelet-rich fibrin: a randomized controlled clinical trial. J Periodontol. 2011 Dec;82(12):1705-12. doi: 10.1902/jop.2011.110075. Epub 2011 Apr 5. PMID: 21513477.
  44. Martande SS, Kumari M, Pradeep AR, Singh SP, Suke DK, Guruprasad CN. Platelet-Rich Fibrin Combined With 1.2% Atorvastatin for Treatment of Intrabony Defects in Chronic Periodontitis: A Randomized Controlled Clinical Trial. J Periodontol. 2016 Sep;87(9):1039-46. doi: 10.1902/jop.2016.150306. Epub 2016 Jun 13. PMID: 27294433.
  45. Bodhare GH, Kolte AP, Kolte RA, Shirke PY. Clinical and radiographic evaluation and comparison of bioactive bone alloplast morsels when used alone and in combination with platelet-rich fibrin in the treatment of periodontal intrabony defects-A randomized controlled trial. J Periodontol. 2019 Jun;90(6):584-594. doi: 10.1002/JPER.18-0416. Epub 2018 Dec 14. PMID: 30488952.

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Received January 8, 2024.
Accepted February 18, 2024.
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