The evolution of dental implantology will only progress as much as the field of bone augmentation allows. For most of the history of dental implantology, the field's primary goal was to design products and procedures the maximize function and esthetics in existing alveolar bone. However, the last several decades have brought us significant advances in bone grafting procedures and materials, such that now we would prefer to grow bone in order to maximize the success and utility of implant-restored teeth, rather than place whatever implants we can in what available bone there is. One such development is the incorporation of Platelet Rich Fibrin (PRF) in bone grafting procedures. The implementation of concentrated growth factors constitutes a breakthrough in clinical therapy and
has revolutionized medicine and dentistry in theses areas.
PRF's chief contribution to bone grafting is its rich supply of growth factors which augment the body's ability to grow new bone tissue. Platelets naturally provide these growth factors, along with helping blood clot, in their role of helping the body heal wounds. Studies show that using PRF in bone grafting procedures decreases healing time and increases the quality of the grafted bone. PRF can also reduce the risk of infection inhealing wounds by keeping away infectious agents and accelerating wound healing time. Finally, because most bone graft materials consist of fine granules, the thick PRF material provides stability to bone grafts by acting as the "glue" that holds it all together.
On a technical level, the mechanism of action of PRF on tissue healing and bone graft maturation in particular, is multi-faceted. First, the growth factor PDRF contained within PRF enhances mitogenesis (accumulation of healing cells), angiogenesis (formation of blood supply) and activation of macrophages (the immune response to fight bacterial invasion). Platelet Derived Growth Factor (PDGF) is one of the key growth factors essential to wound healing. Transforming
Growth Factor Beta (TGF-B) helps the transportation of bone-forming cells (osteoblasts) to the bone graft site, as well as stimulating bone cell formation into the collagen matrix of the bone graft. Epidermal Growth Factor (EGF) is more helpful in wound and mucosa healing as it assists in epithelial regeneration as well as angiogenesis. Finally, Vascular Endothelial Growth Factors (VEGF) aides in angiogenesis, mitogenesis and epithelial healing. All of the factors have
been shown to accenuate bone growth and development, bone graft stabilization and maturation, wound sealing and healing, and blood clot control.
Patients often wonder why a dentist needs to draw their blood before a bone graft procedure. We harvest the PRF by drawing your blood, and then spinning it in a centrifuge in order to separate the platelets. The separated fibrin appears as almost a "snot-like" material in a glob. This glob is then smashed flat and subsequently incorporated into the bone graft. For patients who will undergo IV sedation for their procedure, this blood sample is easily procured. If no IV is being placed, then the procedure is just like when blood is taken at the hospital.
The extra prick to harvest the PRF from the blood is well worth it in terms of clinical benefits. As we continue to be able to growth alveolar bone more efficiently, implant dentistry will undoubtedly progress alongside.