The world of medicine was acquainted with the regenerative potential of platelets in 1974. The platelet concentrates have been used in tissue regeneration for many various procedures. Using platelet concentrates is a simple way to accelerate and enhance the body’s natural healing mechanisms. PRF is a second-generation platelet concentrate widely used to accelerate soft and hard tissue healing and is a strictly autologous fibrin matrix containing a large quantity of platelets. Growth factors are released after activation from the platelets trapped within fibrin matrix and have been shown to stimulate the healing responses in the cartilage/bone repair during normal healing. This article looks at the potential of PRF in the field of tissue regeneration.
Autologous platelet concentrates are simple and cost-effective methods that allow high local concentrations of growth factors at a target tissue.
The first generation incorporates the platelet-rich plasma while the second generation involves the platelet-rich fibrin.
Platelet Rich Plasma (PRP)
Platelet-rich plasma was introduced in the late 90’s and was used in reconstruction along with bone marrow grafts. The data reported that PRP addition accelerated the rate and degree of healing and tissue regeneration. PRP releases growth factors that promote and modulate cellular functions involved in tissue healing, regeneration, and cell proliferation
Clinical Applications:
PRP accelerates the healing and reduces the healing time.
PRP of accelerating soft tissue healing.
Platelet-Rich Fibrin (PRF)
Concept and Evolution of PRF: A Second-Generation Platelet concentration
PRF is a second-generation platelet derivative because, unlike other platelet concentrates like PRP, this technique does not require anticoagulants nor other platelet activators or additives like thrombin or calcium chloride. PRF is a strictly autologous fibrin matrix containing a large quantity of platelet and leukocyte cytokines.
The crux of PRF synthesis lies in the attempt to accumulate platelets and release cytokines in a fibrin clot. The PRF clot is yielded by a natural process, and its natural fibrin architecture is responsible for a slow release of growth factors during ≥7 days. This is not possible in most PRP techniques because of its fast platelet activation, contiguous release of growth factors, and very light fibrin network produced to sustain the concentrate injection. PRF contains platelets, leukocytes, cytokines and adhesive proteins. The presence of white blood cells (WBCs), that secrete a large quantity of healing growth factors, is a key feature of PRF which is named for this reason leukocyte-PRF.
Biologic Features of PRF
PRF jump-starts the healing process to maximize predictability. It consists of the platelets, cytokines, and the fibrin matrix. Platelets and leukocyte cytokines play an important part in the biology of this biomaterial and the first stages of healing. Fibrin matrix supporting them is responsible for the real therapeutic potential.
Key features:
Role in the creation of new blood vessels
Facilitated Immune Response
Recruitment of new Stem Cells
Attraction of the new bone Tissue
Why Use PRF?
PRF has the capability and capacity to facilitate the natural healing process. The fibrin clot acts as a support through its mechanical properties which involve the protection of graft materials and also acts as a biological connector between the bone. Furthermore, engaged in cellular migration, increased vascularity and the survival of new grafts. The process of healing is carried along and aided by the persistent release of various growth factors. Leukocytes and various cytokines enables the self-regulation of the infectious and inflammatory processes.
Muscle Injury and Repair
Despite the detailed process and effectiveness of the muscle injury repair mechanism, advanced injuries that result in an increased loss of muscle tissue and/or a loss of tissue function overwhelm the repair process and require therapeutic treatment to aid repair and recovery.
The World Health Organisation reports that musculoskeletal injuries affect the lives of hundreds of millions of people across the world, and are of worldwide cause of chronic pain, trauma and physical disability. Soft tissue injuries comprise of half of musculoskeletal problems and are typically the result of cartilage, ligament and tendon injuries. Traumatic injuries, arthritis and osteoporosis are examples of chronic and degenerative musculoskeletal conditions that come with many challenges. Chronic injuries can sometimes require surgery leading to prolonged recovery times and mixed success. Hope has been offered through the discovery of regenerative forms of treatment. These refer to the use of biological treatments that are used to stimulate and improve the healing of injured musculoskeletal tissue. Regenerative treatment include bone grafts, PRP, and stem cells. The benefits of using these treatments are the reduced need for surgery.
PRF Growth Factors
When looking at the comparison of growth factor release for PRP, PRF, and A-PRF over time, various platelet concentrates were shown to have differing growth factor releases. PRP released significantly higher levels of growth factors in the initial stages, whilst PRF displayed continual and steady release over a 10-day period. The results revealed that the levels of basic tissue generating growth factor in PRF was significantly higher than that in activated PRP.
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