Whatever we do in biological dentistry, we want it to be in harmony with human physiology and each individual’s unique biochemistry. It needs to be biocompatible – compatible with life. That goes for materials and techniques alike.
There’s one tool that we frequently use that is 100% biocompatible for every patient we see: platelet rich fibrin, or PRF for short.
Platelet Rich Fibrin (PRF): What It Is & How It’s Made
As its name suggests, PRF consists of two main parts: fibrin and platelets. Fibrin is a protein that’s involved in blood clotting, while platelets are a component of blood that play an important part in healing. They’re also a natural source of growth factors.
What makes PRF inherently biocompatible is that it comes directly from you. It’s made from a small sample of your own blood. Once it’s drawn, we place it in a special centrifuge that spins it in a way that separates the blood into three layers:
- Platelet-rich plasma (PRP)
- Platelet-rich fibrin (PRF)
- Red blood cells (RBCs)
The PRF can be used in the form of a membrane to be placed on a surgical site. The membrane creates a kind of scaffold that both protects the site and delivers platelets to it. When those platelets come into contact with the tissues at the site, the platelets release growth factors and cytokines to promote the growth of new blood vessels, skin cells, and connective tissue. This, in turn, helps speed up the healing process and reduce inflammation. When we use PRF, post-op pain and swelling are typically reduced, as well.
Also able to be used as an injectable, PRF requires no gelling agents, synthetic materials, or animal-derived products. It simply uses your own blood plasma to deliver stem cells and other components that enhance your body’s natural healing abilities.
How PRF Is Used in Dentistry
PRF is used in a wide array of dental procedures – from extractions to implants; from treating dry socket to treating cavitations (jawbone osteonecrosis) – with a solid and growing body of science supporting its effectiveness. Indeed, the results closely match what we’ve observed in the years since Dr. Montgomery first added the protocol to her surgical procedures.
Consider dry socket, for instance. This is a painful condition that can occur after you have a tooth extracted, if the blood clot is lost or fails to fully form in the first place.
A 2021 review of the science looked only at double-blinded randomized controlled trials (RCTs) that involved the use of PRF in third molar (wisdom tooth) extractions. (RCTs have long been considered the gold standard in medical research, as they’re designed to eliminate as much bias as possible.) The authors also included only studies determined to be of moderate or good quality.
In the end, six studies made the grade. Those six studies “indicated an advantageous effect of PRF in reducing the frequency of alveolar osteitis” – a/k/a dry socket. And this makes sense, considering that one of the things PRF does is increase blood flow to the surgical site.
Other types of studies have shown this, as well. One in the International Journal of Dentistry, for instance, found that when PRF was used, only 1% of patients developed dry socket – versus 9.5% when PRF wasn’t used. Another study found that pain was also reduced when PRF was used – and so was the use of painkillers.
Studies have also shown that PRF can be helpful in preserving the bony ridge that holds the tooth sockets, a structure known as the alveolar ridge. A review in JADA found “that PRF may play a positive role in reducing postoperative pain and ridge dimension changes after tooth extraction.” That is, in addition to less pain, there also was less bone loss after tooth extraction.
This is one reason why PRF can be helpful in implant surgeries, too, since there needs to be good bone for the implants to integrate with. But that’s only part of it, as a review in Clinical Oral Implants Research showed.
In this case, the research team focused on human studies that used PRF for bone regeneration and implant therapy. After they sifted through almost 6000 studies, 12 randomized clinical trials remained for their analysis.
Because the studies were each designed so differently, a meta-analysis was impossible. Still, the researchers could evaluate their results and found that only three showed no benefit to using PRF. All of the others
showed superior outcomes for PRF for any of the evaluated variables, such as ridge dimension, bone regeneration, osseointegration process, soft tissue healing.
PRF, they concluded, “might reduce alveolar width resorption, and might enhance implant stability during the early phase of osseointegration.”
Best of all, PRF makes for a more comfortable experience for you as a patient. A 2017 study of PRF after third molar extractions, for instance, showed that, compared to control group patients, those who received PRF
- Had significantly less pain in the 5th, 6th, and 7th days after surgery.
- Used significantly fewer painkillers for the 2nd, 3rd, 6th, and 7th days after surgery.
- Had significantly lower rates of dry socket.
“PRF,” they concluded, “could reduce alveolar osteitis, pain, and analgesic consumption following removal of impacted mandibular third molars.”
Indeed, it could – and it routinely does, as we see up close and personal every week in our office.