Evaluation of 24 protocols for the production of platelet-rich fibrin

Abstract

Background The aim of this study was to evaluate 24 protocols for the production of platelet rich fibrin (PRF) produced via horizontal centrifugation to better understand cell separation following protocols at various times and speeds. Methods All protocols were compared utilizing a recent method to quantify cells in PRF in 1 mL sequential layers pipetted from the upper layer downwards until all 10 mL were harvested. In total, 960 complete blood counts (CBCs) were investigated. Both solid and liquid-based PRF protocols were investigated following 24 protocols involving 6 relative centrifugal force (RCF) values (100,200,400,700,1000 and 1200g) at 4 centrifugation times (3,5,8 and 12 minutes). Results In general, platelets could more easily accumulate in the upper 4 layers when compared to leukocytes owing to their lower cellular density. Protocol time seemed to have a greater impact on the final cell layer separation when compared to the effect of speed. Protocols of greater than 8 minutes at 400 g led to no leukocyte accumulation in the upper PRF layers (found specifically within the buffy coat). Protocols at or below 200 g were unable to effectively accumulate platelets/leukocytes. The optimal centrifugation speed and time for solid-PRF ranged between 400 -700 g for 8 minutes. It was noted that variability in patient baseline platelet/leukocyte/erythrocyte counts (hematocrit) significantly affected cell layer separation. This finding was more pronounced at lower centrifugation speeds. Conclusions Within the investigated ranges, a protocol of 700 g for 8 minutes presented the highest yield of platelets/leukocytes evenly distributed throughout the upper PRF layers.

Effect of leukocyte‐platelet‐rich fibrin in bone healing around dental implants placed in conventional and wide osteotomy sites: A pre‐clinical study

“…Furthermore, it has been reported that different protocols and equipment may affect dramatically the biological signature and bone regeneration potential of platelet concentrates. 68,69 Such variability along with the high heterogeneity of clinical studies and the limitations of in vitro to in vivo extrapolations, warrants further well-designed pre-…”

“…Although L‐PRF have been extensively used in dentistry since first described by Choukroun and Dohan, 25 the exact biological mechanism of platelets derivates remains unclear in bone regeneration. Furthermore, it has been reported that different protocols and equipment may affect dramatically the biological signature and bone regeneration potential of platelet concentrates 68,69 . Such variability along with the high heterogeneity of clinical studies and the limitations of in vitro to in vivo extrapolations, warrants further well‐designed pre‐clinical and clinical investigations to further assess the biological effect of L‐PRF to promote bone regeneration and enhance the outcomes of implant therapy.…”

Autologous platelet concentrates in oral surgery: protocols, properties, and clinical applications

“…These subcategories represent the range of formulations produced by altering centrifugation protocols, with up to 24 protocols described in the literature for PRF alone. 46 The superfluous terminologies have been described as "disingenuous" by some experts who claim "PRP is PRP, whatever way you look at it." 47 There is concern in the scientific community that underlying commercial interests may lead to a cycle of reinventing the wheel.…”

Systematic review of platelet-rich fibrin (PRF) centrifugation protocols in oral and maxillofacial surgery and the introduction of AR2T3: an easy to remember acronym to correctly report vertical and horizontal PRF centrifugation

“…Two from these did not report the centrifuge machine used (136,138). Two studies described two different protocols of centrifugation of solid/clot PRF in the high range using a fixed-angle centrifuge (132,133) or horizontal centrifugation (144). The protocol with the highest g-force was "1,000 g × 10 min'' (132).…”

“…For example, based on the mathematical formulas stated in Table 9 (147), a slight increase in the r-max will significantly increase the g-force, ultimately affecting the final PRF generated in terms of cell content, size of clot, the distribution of the cells within the clot and indeed the entire morphology of the PRF clot. This was assessed by Miron et al who recently described that horizontal centrifugation yielded PRF with more accumulations of leukocytes and platelets in comparison to the PRF produced via the fixedangled technique (144).…”