From Platelet-Rich Plasma to Advanced Platelet-Rich Fibrin: Biological Achievements and Clinical Advances in Modern Surgery

Abstract

In the past 20 years, the platelet concentrates have evolved from first-generation products, i.e., platelet-rich plasma (PRP) and plasma rich in growth factors to the second-generation products such as leukocyte-platelet-rich fibrin (L-PRF) and advanced platelet-rich fibrin (A-PRF). These autologous products with a higher leukocyte inclusion and flexible fibrin mesh act as a scaffold to increase cellular migration in the angiogenic, osteogenic, and antimicrobial potential of these biomaterials in tissue regeneration. In the second-generation platelet concentrates, the protocols are easier, cheaper, and faster with an entire physiological fibrin matrix, resulting in a tridimensional mesh, not as rigid as one of the first generations. This allows the slow release of molecules over a longer period of time and triggers the healing and regenerative process at the site of injury. The potential of A-PRF to mimic the physiology and immunology of wound healing is also due to the high concentration of growth factors released as follows: vascular endothelial growth factor, platelet-derived growth factor, transforming growth factor-β, and anti-inflammatory cytokines that stimulate tissue cicatrization, vessels formation, and bone cell proliferation and differentiation. Furthermore, the number of neutrophils and monocytes/macrophages is higher releasing important chemotactic molecules such as chemokine ligand-5 and eotaxin. Thus, L-PRF and A-PRF have been used, especially in implantology, periodontology, and maxillofacial surgery. Future clinical applications include tissue regeneration/grafts, ulcers/skin necrosis in the diabetic patient and others, plastic surgery, and even musculoskeletal lesions.

Effects of autologous platelet‑rich plasma injections on facial skin rejuvenation

“…Physiologically, the growth factors in PRP have important roles in reducing the rate of aging by restoring the declining DNA synthesis that occurs with aging, resisting cell death and enhancing gene expression for tissue repair (25,26). A positive correlation between PRP and skin anti-aging has also been reported in both pre-clinical and clinical practice (25)(26)(27)(28). Consistent with previous studies (17,26), the present clinical study showed that PRP treatment improved skin conditions, including increased skin thickness, enhanced collagen content and reduced pigmentation.…”

Platelet-Rich Fibrin in Coverage of Gingival Recession: A Systematic Review and Meta-Analysis

“…10,13 PRF membranes enable the gradual and continual release of growth factors, a process which contributes to the healing of soft tissues. 41 This process includes a variety of cell types regulated by molecules which are themselves produced as part of the recipient's immunological response. These molecules include metalloproteases (MMPs) and their tissue inhibitors (TIMPs), which are responsible for remodeling the tissue collagen matrix.…”

[Retracted] Effect of Platelet‐Rich Plasma on Bone Healing in Immediate Implants Analyzed by Cone Beam Computerized Tomography: A Randomized Controlled Trial

“…Platelet-rich plasma (PRP) is an autologous concentrate of platelets in a minute amount of plasma [ 9 ]. It is considered a first-generation concentrate using calcium glutamate/thrombin to activate coagulation and an anticoagulant solution of citrate phosphate dextrose adenine (CPDA) [ 10 , 11 ]. After activation by thrombin or calcium chloride, the platelets in PRP release various essential growth factors documented to be produced by platelets [ 12 ].…”