PRF vs. PRP: Which is preferable?

I used PRP for 8 yrs but the past 2 yrs have switched over to PRF. The PRF is easier to work with. I can make membranes with it. I use it for osseus grafts, perio grafts, sinus lift procedures, extraction sockets. I have not used PRFG. The PRF has a slower release of the platelets compared to PRP and a higher concentration of leucocytes. No problem using with an alloplast grafting material.

A well known PRP device is very cheap but sundries its black gold prices I can only say Medifuge c.g.f , vacuette tubes are about $2 each Readily available from the Medifuge supplier or from most medical suppliers brand Bio_one made in Austria You should use only 23 gauge needle which is the best size to allow free plasma flow in USA unit is available..... ???, contact Silfradent Italy

Dr. Joseph Choukroun and Dr. Richard Miron have written a book on this topic called "Platelet Rich Fibrin in Regenerative Dentistry: Biological Background and Clinical Indications". As far as PRF or PRP creating better bone, I am doubtful. PRP and PRF have only been shown to improve soft tissue healing

PRF activates the NF-kB Pathway which counteracts bone formation. P-PRP promoted 1. HBMSCs (Human Bone Marrow Osteoblastic Stromal Cells) proliferation, viability and migration 2. EaHy926 Proliferation (transformed human umbilical vein endothelial cells) a stable source of endothelin converting enzyme (ECE) 3. EaHy926 m tube formation 4. HBMSCs osteogenic differentiation promotion (in vitro) compared with L-PRP. So P-PRP wins on bone regeneration on the evidence to date. Evidence suggests that PRF promotes soft tissue healing probably through NF-kB Pathway. This debate is fueld by commercial interests which will act as a barrier to evidence based scientific investigation. Wenjing Yin et al 2016 https://translational-medicine.biomedcentral.com/articles/10.1186/s12967-016-0825-9

The article is about l-PRP and P-PRP not PRF? Am I confused?

Dear Suhas If you say it is not necessary , do you mean to day all the study done on PRF is not correct ? Just for sake of discussion - will you say its not necessary to do implants when removabel partial dentures / bridges work . With what ever clinical experience we have PRF gives much better results as written in previous blog .

Daniel what is the RCF you are using on your centrifuge? Could everybody reveal their RCF, not the RPM because that differs Depending on the centrifuge parameters. Also temperature. Being a chef, before becoming a dentist I'm inclined to try others recipes to See if I can improve the result. it is cooking!

I agree 99% with Dr Camm. The 1% difference is on the procedure: let's use the already published and approved procedures before trying to "enhance the recipe".

Robert: Look at my post from April 4, where I explain the technique. There are TWO separate tubes. One has sodium citrate, from which I get PRP liquid. These tubes are 5cc tubes, although 10cc ones can be used. The other tube has nothing in it. These are 10cc tubes. When spun down (in the same spin), I get PRP liquid in the sodium citrate tubes, and I get a separated clot in the other tubes which I can use as a clot mass or I can flatten into a PRF membrane. So with a quick draw of 2,4,6, etc tubes, I get to use PRP and/or PRF. The tube with no additives coagulates during the 10-minute spin process. I NEVER use bovine thrombin. The use of that opens the platelets way too fast and makes the growth factors dissipate too quickly. There is no need to use bovine thrombin. In isolating the concentrated platelets into a syringe (the "buffy coat"), it is unavoidable that some immature RBC's are also drawn up. They do not hurt the technique, and there is no need to use expensive systems to avoid them. There is no need to use huge tubes and do a double-spin technique. Dr. Rutkowski has shown that the single spin technique with a CliniSeal centrifuge produces more that adequate concentration of platelets. I reference the following article: J Oral Implantol. 2008;34(1):25-33. doi: 10.1563/1548-1336(2008)34[25:AAOARS]2.0.CO;2. Analysis of a rapid, simple, and inexpensive technique used to obtain platelet-rich plasma for use in clinical practice. Rutkowski JL, Thomas JM, Bering CL, Speicher JL, Radio NM, Smith DM, Johnson DA. Source Duquesne University, Pittsburgh, Pa., USA. Abstract The use of platelet-rich plasma (PRP) has become more generally accepted, and implant dentists are using PRP more frequently to promote the healing of oral surgical and/or periodontal wounds. Critical elements of PRP are thought to be growth factors contained within the concentrated platelets. These growth factors are known to promote soft-tissue healing, angiogenesis and osteogenesis. We present a rapid, simple, and inexpensive methodology for preparing PRP using the Cliniseal centrifuge method. This study demonstrates that platelets are concentrated approximately 6-fold without altering platelet morphology. Further we demonstrate that key growth factors, platelet-derived growth factor BB (PDGF-BB), transforming growth factor B (TGF-B1), vasculature endothelial growth factor (VEGF), and epidermal growth factor (EGF) are present in comparable or higher concentrations than those reported with the use of other techniques. Prolonged bench set time (>3 hours) after centrifugation resulted in decreased concentration of TGF-B1 but not decreased concentration of PDGF-BB, VEGF, or EGF. This study confirms the molecular aspects of PRP obtained using this inexpensive and efficient methodology. The research has been done. The technique is easy and effective and inexpensive and SAFE. You would service your patients well to learn this. To make a statement that a clinician should only use an FDA-approved system is ludicrous. Act like a doctor. Do the research and study the technique. The manufacturers are not the teachers. Daniel P. Camm

Thanks Dr. Cam for the informative article by . Dr. Rutkowski. I think research like that continues to increase the awareness and use of growth factors and tissue engineering in the daily practice of implantology.

Thanx! So very close to the 1150 X g in the Rutlowski paper, 10 minutes?

I gotta say putting the PRP mixture onto the L-RPF membrane would help keep it in place, instead of washing out and would make it a "super band-aid" . I am gonna try it on Monday, regardless of the literature, after all I live in Canada and we worry less about litigious patients, but you always have to be on the lookout.

GMK, strange, you forgot all my articles and the principal who was the first. Xpressing is a vulgar copy of the PRF Box. May be you are a guy from the intra-lock team? It should explain the nature of your posts.

The slow release of growth factors up to 7 days was published in 4 different articles, but I have just participated in an in vitro study using IntraSpin showing release up to 14 days. This is going to publication as we speak. Intra-Lock is the only company with FDA and CE marking for PRF, this is a fact and the reality of the PRF protocol. It is also a fact that Dr. Choukroun is the owner of the Process for PRF company, selling a machine without fulfilling any of the legal requirements; No CE marking and no FDA 510k clearance,. That is a major conflict of interest. Maybe in France the authorities will tolerate this or simply are not aware that there is no clearance for his machine. We have heard of the scandal of the French company PIP that sold hundreds of thousands of breast implants, only to break open after a few months/years causing untold injuries. Perhaps that is why we have stringent guidelines in this country before we can market a medical device. If you use a medical device in the US without certification, the authorities simply close your business. Are you suggesting that US dentists ignore this and open themselves up to potential legal issues? How can there be any debate on this issue? We should be thankful to Intra-Lock for doing the heavy lifting and absorbing the expense of certification while keeping the cost of the system at a reasonable price point. Compare that to the high costs of PRP and PRGF systems. I would suggest that Dr. Choukroun do the same with regard to CE and FDA clearance. After all, Process is his company and I would suggest he not engage in ad hominum attacks with his "inventive" statements. Last, your statement that "people do not understand biology" is incredible coming from you, as these studies were done by some of the best PhD's in our profession.The last time I heard this expression, it was about...you. From the mouth of the academic people and clinicians that collaborated with you in the past, particularly on PRF, and now consider you to be completely commercial. I believe that this forum is not the place for this kind of agressive messaging, Dr. Choukroun. RJM

Comparing this issue to French breast implant failure is sad and irrelevant. Medical/legal issue is poorly argued as well. I use a 400lb hospital grade Heraeus Megafuge1.0R, which is often the reference centrifuge for many membrane experiments in the literature, instead of a mini-proprietary centrifuge that becomes obsolete the moment new parameters become the standard. I would also argue that if this isn't the place for controversial discussion what plac would be? I own NO stock in any dental company, I just want to improve my surgical results by using the best platelet products possible and as they improve I want to change as well and not end up with a storage room full of antiquated centrifuges. Why don't try to produce one that you can alter the settings for future iimprovements, not a good business decision, but an excellent decision for someone looking for long term success!

400lbs? Wow? How much cost your centrifuge? I'd rather spend a couple of grand only, and have a "legal" stuff. Plus, you can change the settings if you wish...

Actually I think its 460lbs, but it was refurbished for a grand total of $1200, bought for $350 at an auction. Many are out there, just try a lab equipment sales, online or otherwise. I have a second Heraeus Megafuge 1.0R in for 2nd hand parts and servicing for a dentist friend.

Drs Choukroun and Miller, would you please be so kind as to provide us with a list of manuscripts on this topic. I am sure there are many that would like to have a deeper understanding on this topic. I have always enjoyed the comments from both of you. I thank you

Richard; You can find a long list of PRF papers in the PRF module of the Intra-Lock website (intra-lock.com). I personally have a list of over 85 peer reviewed papers on the subject with several more as yet unpublished manuscripts waiting to be accepted. RJM

Dr Miller, I never cite my own company in the forums. In all of your post you cite I-L. We have the CE and we do not need FDA approval. I'll publish soon the FDA letter. I confirm here that you are not able to do PRF education. Intra-spin is the 100% copy of the PC02. You got the machines by chance. and you'll stop to get them soon. be sure.

Medifuge c.g.f. made Silfradent has all approvals and is a phase separator which is superior than a one speed centrifugation protocol.....

Is there actual research showing its superiority? Salesman or scientist?

View the web for Medifge c.g.f ... There is much research already available including GBR without additions..... unfortunately the net have been hijacked by others also that claim their powder is concentrated growth factors Medifuge C.G.F protocol is a plasma phase separator by gravitation, phase separation occurs with a series variation of rpm with controlled acceleration...... / the g forces Creates a Liquefied ( a protocol PRP ) and/or Fibrin block matrix without additives Liquefied you can view the various layers PPP - PRP - CGF - RBC Fibrin block matrix is of high tensile elastic strength, ...... ideal for a quality autologous membrane ...... A PRP device has dental application Medifuge C.G.F & PRF devices creates Fibrin block matrix

Must have FDA approval, I agree not relevant if Dr Choukroun is owner Dr Choukroun is promoting better medicine than cow manure, I support 100% His PRF device vs Medifuge C.G.F.... you to decide

I have looked for it for years now. Lately I've spent an inordinate amount of time on the web searching and reading articles on the subject. Im spending evenings trying to dig up articles to see what is the superior centrifuge speed, temp, etc.

Cliff, thanks for your comments. I cannot reveal nothing before the next week as I officially launch the A-PRF at the Osteology meeting in Monte-Carlo. Be sure that I'll do that soon. Take care about the courses without the PRF label education (my own label). They use PRF only for implants commercial advertizing. follow my eyes...

I will carefully follow your eyes...

Here is an Excellent paper for PRP preparation. Optimized Preparation Method of Platelet-Concentrated Plasma and Noncoagulating Platelet-Derived Factor Concentrates: Maximization of Platelet Concentration and Removal of Fibrinogen Jun Araki, M.D.,1 Masahiro Jona, M.T.,2 Hitomi Eto, M.D.,1 Noriyuki Aoi, M.D.,1 Harunosuke Kato, M.D.,1 Hirotaka Suga, M.D.,1 Kentaro Doi, M.D.,1 Yutaka Yatomi, M.D.,2 and Kotaro Yoshimura, M.D. TISSUE ENGINEERING: Part C Volume 00, Number 00, 2011 ª Mary Ann Liebert, Inc. DOI: 10.1089/ten.tec.2011.0308

Simply purchase a Medifuge c.g.f. from Silfradent...... is cheaper It is possible to modify the rev/g protocol... but require high tech clever IT engineer