Using PRF as a scaffold for bone regeneration: thoughts?

In an onlay situation you definately need bone with a stiff membrane to hold the space. I think the PRF alone is fine in an extraction defect with walls.

Understand that the sole reason for using graft material is to maintain space while there is a transition to host bone. However, if you have a space maintainer in the way of an absolutely rigid barrier (reinforced PTFE, titaniun mesh, sonic weld or equivalent), L-PRF alone is sufficient. If you rely on PRF alone or in combination with a resorbable collagen membrane as an onlay graft, you will not get the desired result. In this case, mixing L-PRF with a graft material is indicated. I will often use this protocol with tenting screws to generate moderate bone volumes with outstanding results. RJM

Prf alone is resorbed quickly and is not able to maintain space for bone regeneration. I completely agree with the comments above.

thank you for the posts . as PRF alone do well in an extraction defect with walls , I suggest to split the ridge and expand it beyond it's module of elasticity , then fill the space ( the created socket ) with PRF alone , without achieving primary closure of the wound ( healing by secondary intention like a socket so I will gain attached gingiva instead of loosing it by the releasing incision and the flap advancement ) , could it work . any recomendations .

I do not agree with R. Miller: "if you have a space maintainer in the way of an absolutely rigid barrier (reinforced PTFE, titaniun mesh, sonic weld or equivalent), L-PRF alone is sufficient)" . From where did you get this indication ?? have you a literature review ? I don't believe that you made already several cases.. PRF is first an inducer of vascularization in vivo.. it's the evidence based. it's not an indication for bone regeneration without walls (as GBR) Miller has to stop to induce confusion between PRF and L-PRF.. it's the same product: same protocol, ,same machine. I would like from the companies to respect the name given by the inventors.. L-PRF is a pure marketing invention from Intra-Lock.. the right name is PRF as Platelet Rich Fibrin. BTW, PRF or L-PRF are completely outdated and replaced by the new concept of "Blood concentrates" as "Advanced PRF" including all the blood cells and releasing BMPs.

Dr Choukroun, You have no legitimacy to speak about your clinical experience; you are anesthesiologist, not a dental surgeon or anything related to the profession. All the cases that you show online or in your lectures were done by clinicians that you almost never cite. You are also the owner of the company that sells a PRF kit (and bone substitutes) in France, and therefore a direct competitor of Intra-lock. Your conflict of interest explains your animus towards them and to me personally. Therefore, your comments should be considered purely as a marketing strategy. Concerning the use of L-PRF as sole grafting material in a protected cavity using a space maintainer, it is actually the old concept of GBR itself (If you were a dental professional, you probably would know that). It is even a concept that you advocated a long time ago, before you started selling bone substitutes. And here are the 2 references, one from my friend Dr Mazor, and one from... yourself: - Mazor Z, Horowitz RA, Del Corso M, Prasad HS, Rohrer MD, Dohan Ehrenfest DM. Sinus floor Augmentation With Simultaneous Implant Placement Using PRF (Platelet-Rich Fibrin) as sole grafting material: a radiological and histological study at 6 months. J Periodontol. 2009;80(12):2056-64. - Simonpieri A, Choukroun J, Del Corso M, Sammartino G, Dohan Ehrenfest DM. Simultaneous sinus-lift and implantation using microthreaded implants and leukocyte- and platelet-rich fibrin as sole grafting material: a 6-year experience. Implant Dent. 2011;20(1):2-12. In these 2 articles, the implants are the space maintainers, and it allows a good bone regeneration with L-PRF only. Please note that in the article you participated in, the PRF is actually termed L-PRF (leukocyte- and platelet-rich fibrin) in the title and the whole article. Concerning the term L-PRF, you should read these articles. The classification article is now one of the most cited in the field. - Dohan Ehrenfest DM, Rasmusson L, Albrektsson T. General classification of platelet concentrates: from pure platelet-rich plasma (PRP) to leucocyte- and platelet-rich fibrin (L-PRF). Trends Biotechnol. 2009;27(3):158-67. - Del Corso M, Mazor Z, Rutkowski JL, Dohan Ehrenfest DM. The use of L-PRF (Leukocyte- and Platelet-rich Fibrin) during immediate post-extractive implantation and loading for the esthetic replacement of a fractured maxillary central incisor. J Oral Implantol. 2012;38(2):181-7. - Dohan Ehrenfest DM, Bielecki T, Mishra A, Borzini P, Inchingolo F, Sammartino G, Rasmusson L, Everts PA. In search of a consensus terminology in the field of platelet concentrates for surgical use: Platelet-Rich Plasma (PRP), Platelet-Rich Fibrin (PRF), fibrin gel polymerization and leukocytes. Current Pharmaceutical Biotechnology. 2012;13(7):1131- 7. - Dohan Ehrenfest DM, Bielecki T, Jimbo R, Barbe G, Del Corso M, Inchingolo F, Sammartino G. Do the fibrin architecture and leukocyte content influence the growth factor release of platelet concentrates? An evidence-based answer comparing a Pure Platelet-Rich Plasma (P-PRP) Gel and a Leukocyte- and Platelet-Rich Fibrin (L-PRF). Current Pharmaceutical Biotechnology. 2012;13(7):1145-52. L-PRF is the general name of the sub-family of products, like P-PRP, L-PRP, P-PRF. This is actually the real scientific non-commercial term used to qualify this product, and an acronym used by most academic groups. Intra-lock has chosen this name to stick to the current scientific classification and avoid confusion. No invention, just respect of scientific terminology. Concerning A-PRF, you have no scientific articles from independent teams, no evidence. The funny thing is that this technique does not even exist yet. You are selling new tubes for the past 2 months and you also announced the launch of a specific centrifuge at the ANTHEC meeting in October 2013. That is a rather short time period to claim efficacy with your new protocol. I also examined your new A-PRF tubes. They are just glass tubes "Made in China", to save a few dollars. And your new protocol is simply to reduce the speed of centrifugation to 1500 rpm, and extend the spin time to 14 minutes. No CE markings for the system, no FDA approvals. All this sounds very commercial, and not very professional. Actually, if US colleagues want to try A-PRF, I advise them to buy a CE-marked FDA-approved system from Intra-lock, and simply change the parameters to try this “improved” protocol. If colleagues want to know more about PRF applications by the original team that developed the L-PRF technique, I understand that there will be a significant release of articles very soon. I will post the link as soon as we receive it. RJM

Please keep the comments focused on facts and science and take the personal feuds offline. Ad hominem attacks, both against a person or company, are in violation of our comment guidelines. Thank you for your understanding.

Robert, You try to put confusion to the lectors: we talk on GBR and not on sinus elevation. it's completely different. biologically and mecanichally. You do not answer to my question ? Is the L-PRF different from PRF or not ? I Described the A-PRF since 1 year. As with the PRF, we need long time to get scientific evidence. Do you have a any scientifc evidence ? I'm waiting since a while any evidence from you. impossible as the L-PRF is a simple copy..

Use the Fibrin Block matrix from a proven PRF device or - C.G.F. protocol / Medifuge

Medifuge c.g.f Fibrin block matrix is presently used for GBR without additives view literature by Dr Sohn ( Korea ) on the web

I have been reading these posts for the past couple of years and find it almost comical that certain people suggest that the "Intra-Spin" Centrifuge is essential to producing PRF. I worked in a lab in college for a while spinning down blood, urine, Cerebrospinal Fluid, etc. It is ture that "Not all centrifuges are the same", however for the most part they are. To suggest you need to spend 4 Grand to purchase a centrifuge, a bunch of empty vacutainers ($1.00 each), some butterfly needles and a "Steel Box" is silly. I've used PRF, PRGF and PRP many times over the years and I definitely like PRF due to it's ease of use. No need for anticoagulants, thrombin or other additives. No heat baking like with PRGF although I liked a lot and had excellent clinical results. You can purchase a centrifuge from a company like ACE Surgical for instance for under $1000 or many other companies for $300-400. Almost ALL lab centrifuges have variable speeds and timers and are almost all set at an angle of 33 degrees for optimal "Rouleaux Formation" to separate out the blood components. You can set it for 12 minutes as recommended or if the patient is on blood thinners, I would suggest spinning for 15-18 minutes. There is no appreciable difference if you spin at 2700 rpm, 2900 rpm, or 3000rpm. This is not that complicated! There are some centrifuges that are adjustable but you would not want much deviation. Anything over 45 degrees could cause an explosion of the unit with shrapnel flying around. Intra-Lock has done a nice job of marketing their product but the financial cost is completely unreasonable and can be easily replicated for a fraction of the cost. Dentists like Dr. Miller might have you believe that the Intra-Lock Centrifuge is the only way to harvest optimal PRF, but this is completely inaccurate. Also, so much seems to have been made out of the "PRF Box" that comes with the product. Its a little steel case with holes in it that allows the serum to extravagate so you can use this miracle liquid and "dip your implants in to it" or mix graft particulate in to it. It also has slots so you can fabricate your own PRF plugs. It just seems like an awful lot of money for this product in my opinion. Ronald L. Katz, DMD Diplomate, American Board of Oral and Maxillofacial Surgeons Adjunct Associate Professor, Dept. OMFS at Nova Southeastern University

Ron; I am perturbed by the fact that you find evidence based research and over 100 peer reviewed papers to be "comical". Or maybe you feel that your credentials and academic appointment give you the authority to trash the published science on this topic. So let's go back to basics here to try to get you to understand this modality. First, no one has suggested that IntraSpin is the "only way" to get PRF. It's just that, after 100 papers using the parameters that we teach, for you to make the statement that the quality and viability of cells using different spin rates or different centrifuges gives you an identical product is wholly incorrect. Dr. Nelson Pinton from Chile did a study comparing some of the most commonly used centrifuges and performing SEM's of the PRF clots. There is an astounding difference in the quality of fibrin and vitality of cells, with the EBA 20 centrifuge having the best results. This is why this centrifuge was chosen by Intra-Lock. With regard to the centrifuge you recommend, do you know the rcf value of this machine? If you cannot answer this question, how can you make a qualified decision to tell clinicians to use it. While all centrifuges will produce a separation of blood components, just because you have a fibrin zone does not mean you have undamaged cells. The efficacy of PRF is directly related to the number of undamaged cells in the preparation, as it is with PRP. With regard to spin angle, you can get a 45 degree or articulated arm centrifuge, but will give you less than optimal separation of blood components. And no, these other centrifuges do not self destruct and throw "shrapnel" throughout the room. Next, the "box" you belittle is patented and will give you consistent thickness of membranes, unlike other perforated plates. You can buy a box of 100 vacutainers for about $30, or about 30 cents per tube, not $1.00 that you quote. Additionally, for the purchase price you also recieve a full instrument package to prepare the PRF, so add that to your pricing comparisons. Finally, were you aware that the Intra-Lock IntraSpin System is the only FDA cleared PRF system in the world. This company had to prove efficacy of the recommended use and preparation of PRF, and invested a considerable amount of research dollars doing so. Most clinicians that I have met are happy to invest in a thoroughly researched and tested instrument package, even if the cost is higher than a collection of odd instruments from different sources. So, while I don't mind clinicians debating an issue or technique, or even taking issues with my comments, let's keep the debate based on science and efficacy rather than empiracally based statements. RJM

Robert, as usual, you want to create confusion. The only one investment that did Intra-Lock was to pay a call to the german company for doing a 100% copy of Process PC02... Copy is not science !. I agree with Ronald katz, you price is totally unreasonable.!!! I'm happy to see that you start to talk on rcf, cells, may be you are looking to move to A-PRF ? you're welcome ! Just to inform you that the new A-PRF12 machine is sold at 1200$.(Equipment excluded)

Tu a raison Joseph, Brigandage n'est pas une science! (Brigandry is not science) Robert; the crux of my statement had to do with the costs of the Intra-Lock system which was essentially copied from the invention of Dr. Choukroun's PRF technique. Utilizing knowledge and experience, I am quite confident that I could easily purchase a similar or same centrifuge as well as all the instruments and disposables for a fraction of the cost that Intra-Lock is selling it for. After brief research, it is amazing how the Intra-Spin Centrifuge looks like the Hettich Mikro Series. However I am not that cheap and therefore it is the reason that I am planning on purchasing the A-PRF system this week. I never bashed the science in any way and if I did I apologize as I would not disrespect Dr. Choukroun's invention. Again, I've used PRF in practice and love it. I was using PRP over 10 years ago during OMFS Residency training. I have clinical experience with PRGF and PRF. I look forward to attending the SYFAC meeting in Paris this summer where I might learn more about Relative Centrifugal Forces.

I don't see your rationale here. First of all, buying large membranes and cutting them into smaller pieces is unsterile and repulsive. It's the same as buying bone graft in bulk and dividing it to save some money. With respect to FDA approval, doctors, surgeons, dermatologists and ophthalmologists have been using Botox off-label for years to smooth forehead wrinkles and 'crow's feet’. It was recently FDA approved recently. Some general dentists have patented dental implants and promoted their use to other dentists in some of the local courses they give without FDA approval. Sound familiar?

After doing extensive reading, research, cost comparisons, etcetera I have concluded that the A-PRF Technique and centrifuge is the right choice. Dr. Choukroun's live webinar made the decision easy. In addition, I felt most comfortable with the inventor of this technique rather than paying nearly double for a copied version which provided less equipment. Choukroun provides you with 2 PRF Boxes and 10 instruments compared to only half that provided by interlock. I've used both and can honestly say that A-PRF is the clear choice. Hope this helps. Be well

Nice to see that someone actually peruses the literature when making clinical decisions. Well, the proof of the pudding has finally been disclosed, and it looks like A-PRF is a resounding dud. Why do I say this? We need only to examine the paper that Process for PRF relies on in defending their new protocol. Journal of Oral Implantology: Advanced Platelet-Rich Fibrin (A-PRF) - A new concept for cell-based tissue engineering by means of inflammatory cells by Shahram Ghanaati, MD DMD, Goethe University Frankfurt. In the discussion, and I quote, "In the present work we have shown that T- lymphocytes, B-lymphocytes, stem cells, and monocytes are found in both groups within the first 25-30% proximal part of the clot. There are no statistically significant differences between both groups in terms of distribution of those cells". Now, they claim there are more cells in the A-PRF fraction. If you read the paper, you will find that they tested standard L-PRF in a 9ml tube while measuring the cell numbers for A-PRF in a new 10ml tube. Not exactly equivalency in volumes, don't you think? When you test the new L-PRF 10ml tubes, you find IDENTICAL cell numbers. So you may ask, is there a qualitative difference between L-PRF and A-PRF? For that answer, I refer you back to the same paper. The A-PRF clots are significantly less dense because of the lower centrifugal force. This makes the A-PRF clot less robust. As a result, the A-PRF clot resorbs MORE QUICKLY. Not a great strategy if you need PRF membranes to stay in situ longer. So, once again, the standard L-PRF protocol is still favored. Also, how many of you are aware that the FDA is now involved in investigating the sales of A-PRF in the US? If a cease and desist order is issued, A-PRF will be barred from this country. For clinicians that have purchased this system here, you may have to return it for refund. RJM

Having used L-PRF for several years ,A-PRF for over a year and now A-PRF+ for a couple months I can personally attest to benefits of the improved protocol invented by Dr. Choukroun. The membranes are robust and DO NOT disintegrate as RJM claims, I have noticed little difference except it is much quicker and the tissue response seems better, but that is hard to quantify in my hands, never mind the benefits of i-PRF which now enjoys worldwide support and a phenomenal invention with numerous applications in our field. L-PRF 454g force CGF 200-300 g force A-PRF+ below 200 g force Seems the world is lowering the force to save the cells, lots of great literature demonstrating this phenomena. Anyone trying blocking the use of A-PRF would therefore have to be a heretic. Perhaps we should be BOYCOTTING Intralock if it continues to TRY and stop the use of a superior product for which they receive no $$$$$? Can it be this simple or are we to believe RJM's interest is entirely fiduciary? Try it, very easy to order in Canada and the prices are excellent, especially compared to the American company selling the imitator.

Also forgot to include the link showing the FDA is involved because Intra-Lock filed a suit, not to protect the public ,but to protect their profits! If you want to pay nearly double for an antiquated system locked in the past or use the open architecture and future improvements offered by the originator Dr. Choukroun, your choice, but beware of IMITATORS! Intra-Lock Files Suit to Protect Consumers from Unapproved Dental Device ://www.pharmiweb.com/PressReleases/pressrel.asp?ROW_ID=97492

Joseph; I have been using autologous biologics for almost 20 years, originally trained by Dr. Robert Marx. I also have a graduate degree in Biology and wrote my thesis in Endocrinology. So please, stop the nonsense about my lack of understanding of biology. It's interesting that I go to the literature to defend my thesis, and you react emotionally with broad based statements without any references. As I recall, May 4, 2013 at 12:47 AM, you posted on Osseonews that "We have the CE and we do not need FDA approval. I’ll publish soon the FDA letter." Then you posted on this blog that "You’ll have soon good news about the FDA!! The submission is already in the pipe and we’ll be able to show our 510K in few weeks…". Found out that you really do need FDA clearance for marketing a blood-borne product, didn't you. I have been involved in getting 510K's from FDA for several products and I will tell you it is a very difficult thing to achieve. One thing that FDA NEVER does is to telegraph to the individual when your 510K is arriving. So your comment about getting it in a few weeks is absurd. It could take a few months or even a few years as we found out when we did the heavy lifting for PRF. A 510K for PRF is not a formality nor is it simply granted out of the kindness of their hearts (which does not exist at the FDA level). It is a very serious undertaking that is meant to protect patients from products that do not perform as claimed. You know that there are monocytes in the L-PRF modality. Yet, you give clinicians the impression that they only exist in your new "A-PRF" version. I quote from the very papers that you are relying on to push A-PRF that unequivocally state that the cell populations are the same, and you accuse me of making a commercial statement. The next surprise in the evolution of PRF is ours, Joseph, and will be released shortly. RJM

Joseph - I have a question for you. If the new A-PRF and I-PRF are so much better than L-PRF, why have you refused to train myself and Ziv Mazor on this technology? We have been very big proponents of the L-PRF that YOU PERSONALLY trained us on. We have lectured, researched and published on this technique and the biomaterials that are produced with the specific method. If you are truly a teacher, not someone trying to make money off a commercial process, you would teach YOUR disciples and not keep it to yourself. Bob Horowitz

To answer the original question, no I would not use PRF alone to maintain space. I would mix it with allograft or combination with a membrane for space maintenance similar to how rBMP is used. As far as L-PRF, I have been using it for 5 years and am very happy with the results. I would not complain about the price as Intralock did bring the process to the mainstream US dental population, with Dr. Choukroun, and am sure incurred significant costs to do so. This would be akin to the drug companies charging higher fees for medications before their patent runs out to make up for the research costs, advertising etc. As far as the legal question as to whether Dr. C can change up the times for the spin cycle and directly compete with Intralock after their split is a legal question and will not be resolved here as am sure the lawyers will not allow either party to speak about the specifics of their contract. As for me I am coming out with AAA+PRF in the future with a Korean company with new spin times for $999. I hope no one minds.

after reading all the comments above it is so obvious that companies use the lack of information of basic science that most of the dentist has no interest.Plz for all doctor to make a decision it is important to update your knowledge .the field of tissue engineering is so dynamic and the more we know we realize we are so ignorant that the moto( biomimic) nature is impossible, if you really want to know whether PRF is sufficient or not,and all Q about different type..again go back to basic science. , talking about leukocytes number in in this piece of scaffold is nonsense because the cells in the wound regarding immune is more higher than what you trap in the your PRF. please doctors review the dynamics of wound molecular healing ,then you well be able to chose what to use.

Dr. Barghash is correct in his assessment that recruited cells far outweigh the number of cells contained in a PRF membrane over time. But what he does not state is that the RATE at which cells are recruited is directly proportional to the concentration and time of release of growth factors from the wound site. If you have read any of the current literature, especially the Dohan, et al paper from Current Pharmaceutical Biotechnology, 2012,13,pp1145-1152 "Do the fibrin architecture and leukocyte content influence growth factor release of platelet concentrates? An evidence-based answer comparing a pure PRP gel and a Leukocyte and Platelet Rich Fibrin (L-PRF), you will find the answer. TGFb1, PDGFab, VEGF, thrombospondin, vitronectin, and fibronectin are all released in significantly increasing amounts over time. As PDGF is chemotactic for monocytes (release of BMP's), it stands to reason that recruitment of these, and other, early healing cells is substantivley ramped up over 7-14 days. There is no contest when it comes to either PRP, or PRGF when accounting for early vasculogenesis and rate of healing. The preponderance of evidence for L-PRF is there for all to see. Unfortunately, there are no such studies comparing the other permutations of PRF. However, we are currently engaged in that research and will soon publish it. Be prepared for our next biologically-based evolution in PRF technology. RJM

Dr.Miller, working in the field of tissue engineering we all know that our problem is working ex vivo is totally different than In vivo, the paper you referring is done in test tube, let me say the piece of bread in side our stomach is totally different than the one on the table, again the paper rationale is wrong based on the scaffold alone ignoring the main field of in vivo, do not tell me that a soloist can play the whole orchestra

Rather strange analogies, but as a researcher myself we know that we can never extrapolate the findings of an in vitro study directly to clinical results. So we rely on other measurements. The best way to compare efficacy in situ is through histologic analysis after healing. Meaurements of vascularity, cellularity, rate of epithelialization over a defect, soft tissue biotype, percentage of vital bone, number of osteocytes are certainly valid markers. If we use the meaurements of growth factor release of each autologous modality, and then compare the RELATIVE clinical results from the literature using each of these measurements, there is a clear consensus that L-PRF is the best delivery vehicle for these growth factors. There are two papers from our colleagues in South America that will show incredible bone regeneration of ridge width with L-PRF alone, in the total absence of both the facial and palatal plates. While I am certainly a student of the literature, clinical results are still the most important arbiter of success. So I stand by my defense of some of the pioneering papers by the Dohan group in France. RJM

so what you call a title of paper , evidence base, and the conclusion is we suggest , or hypothesized. and how come you compare degradation rate ignoring the degradation enzymatic factors, ph changes , the dynamic field & the real players of degradation ,.I would like also Dr. Miller to tell me How long does the leukocytes in the L-PRF well stay a life after application of L -PRF in the grafted area?

According to the research paper, "Advanced Platelet-Rich Fibrin (A-PRF) - A new concept for cell-based tissue engineering by means of inflammatory cells. J Oral Implantol. 2014 Jun 19" (http://www.ncbi.nlm.nih.gov/pubmed/24945603), the definitions for the various protocols are: "Standard platelet-rich fibrin (S-PRF) (rpm 2700, 12 minutes), and A (advanced)-PRF (rpm 1500, 14 minutes)" I didn't see L-PRF mentioned in this article. What is the precise spin protocol for L-PRF? Interestingly, the conclusion of the current research is : "The relevance and feasibility of this tissue-engineering concept have to be proven through in vivo studies." This means, of course, that at the present time there is no proof that any of the spin protocols are necessarily better than the others because of a lack of in vivo data.

A-PRF+ 10 ml tubes A-PRF 12 rpm 13 time: 8 min PC O2 rpm 15 time: 8 min i-PRF 9 9 ml tubes A-PRF 12 rpm 700 time: 3 min PC O2 rpm 800 time 3 min Now you can spin away........

Dr. Barghash; it would be exceedingly difficult to measure the life span of each cell subtype without doing daily punch biopsies into the surgical site. Not sure I can get patients to buy into that one nor do I want to have potential infections in my surgical site. So, again, I correlate this to clinical outcome. But I think your questions are misdirected. They should actually be asked of your friend Dr. Choukroun. After all, it is his group that has essentially trashed the entire body of a decade long peer-reviewed literature base on L-PRF (>250 papers). And what does he seek to replace it with? Another in vitro study on the same fractionated blood at a slower spin rate. Cell viability at early healing times will become the benchmark for efficacy in PRF technology. Dr. Nelson Pinto of Concepcion, Chile has just completed a landmark study where he compared not the spin rate, but rather the vibration frequency of six of the most widely used centrifuges. What he found was that the higher the vibration rate, the worse the quality of fibrin and astronomically higher cell damage. Sorry to inform our readers that the A-PRF centrifuge from China had the highest vibration rate and worst outcome in quality of fibrin. This paper has been submitted for publication. So you ask, what is the centrifuge with the least vibration and highest quality fibrin/cell count? It is the Eba 20 centrifuge from the IntraSpin System. So, as Dr. Leachman suggested, spin away. RJM

Robert, I would like to remain you that I'm the inventor of the PRF technique. Why do you want to change the name ? L-PRF is only PRF or standart PRF.. Intra-lock is trying only to put confusion in the field.. Did you invent a new protocol? No !! I started (and Intra-lock was only during several years ourdistrinbutor in USA with the PC02. You have in your office the PC02 model. You cannot say that intraspin is different. t's simply a 100% copy of our last PC02. And you promote the same settings that I advised. Then, we introduced a better machine. Yes, a better machine who is sold 50% less than PC02. Why to pay double for a copy? The scientific community knows what I did and trust me. They follow me. Because I improve all the time the protocol. Then, with the A-PRF+ and the i-PRF I can demonstrate that the reflexion and improvements are coming from myside and not from Intra-Lock. Sorry for you and your company.

Dr.miller let me first make it clear that I have no personal interest to defence x or z , and I think this a forum for scientific discussion and that is my real interest. also you referred to a specific paper and i have replied scientifically on paper rational, you mention in your last comment vibration rate is what count regarding centrifugation and not spin rate, although they are related, so reducing the feed speed reduce the vibration rate . another point regarding best fibrin quality , I would like to know the parameter of fibrin quality , are you talking 3D architecture wise, protein conformation, chemical make up,conducting quality, growth factors rate of release,the surface topography induction ability.,,again it is for me very interesting scientific discussion.

Dr Miller, In protocol for preparation of L-PRF clots, centrifugation force RCF should be 400g - which corresponds to 2700 RPM using Intra-Spin centrifuge, is that true? What is the length of rotor's radius in Intra-Spin centrifuge then? I would be grateful if you could answer this question.

The IntraSpin centrifuge, which is the Hettich EBA 20 with proprietary software, spins at exactly 408 rcf. When it is set at 2700, if you press the rcf button, it gives you the corresponding g force. There is a new paper, claiming that the IntraSpin system spins at over 700 g's. This is completely wrong if you are using this system. There are other major errors as well in this paper. It's not just the length of the radius, but also the angulation of the tube and the g force per unit of time. The current IntraSpin centrifuge has a low initial rpm, then slowly ramps up to 2700 rpm. This protocol gives you the best cell distribution, followed by best compaction of the fibrin clot and activation of monocytes. RJM

Dear Dr Miller, thank you for your reply. Things look a little bit different from my point of view. I’ve read the Hettich EBA 20 manual, which clearly explains the relation between RCF and RPM in that particular centrifuge. It is presented by equation: RCF = (RPM / 1000)^2 x r x 1,118 r – rotor’s radius in mm. http://www.hettweb.com/docs/eba-20/eba-20-manual.pdf 2700 RPM can result in 408 RCF only if rotor’s radius length would be 50mm. We can exchange our experiences, present different points of view and argue about them, but in my opinion the figures just speak for themselves.

I appreciate your opinion, but you made one critical error in your analysis. The tubes in the EBA 20 centrifuge are at a 33 degree angle. The volume of blood where fractionation occurs is, in fact, 50 mm from the rotor. Therefore, you do not measure the distance from the top of the tube. As I commented in my previous post, g force will vary at different locations of an angled tube. We therefore take an average reading at the point of separation of the fibrin zone and RBC zone. This is how Hettich arrives at their rcf settings. RJM

Dr Miller, I agree with Lukasz. All the labs in the world calculate the RCF with only one formula. Why do you want to change the rule ? Just to put confusion ? In the Hettich Lab website, the calculator of RCF shows 701 RCF when the speed 2700 is applied. Since 2001, we know that L-PRF is made with 700 RCF. When the angulation changes, the radius changes and therefore the RCF result is modified..

For those who want to see the actual Hettich rcf calculator, go the the PRF/Platelet Rich Fibrin Facebook page. The following is my response: "There seems to be a group of clinicians who claim that the IntraSpin EBA 20 centrifuge has a g force (rcf) of over 700 when spinning at the classic 2700 rpm. This is the calculator from the Hettich website for their centrifuge, showing that at 2700 rpm, the rcf is actually 408 g's, exactly what I have been posting for years."

Hello, I am interesting to buy the Intraspin system in Argentina, but Intralock can´t send it here, so i am trying to buy it in Intralock Brazil, as they suggested me. From Brazil they send me pictures of the product and I realized that the centrifuge is a german Hetttich EBA 200 (not 20, but it seem to be better) with a sticker of the intraspin logo...so, my cuestion are: first, if the intralock intraspin centrifuge is fact an Hettich EBA 200; and second, why intraspin costs about US$ 3700 and Hettich EBA 2000 just about 1100... Thank you!!!!!!

The IntraSpin L-PRF System uses the Hettich centrifuge. However, Intra -Lock owns the proprietary software for the system. The key to maximizing your success in cell distribution and not damage cells is the spin cycle built into the machine. If you buy it off label you are simply buying a centrifuge that immediately goes to the speed set on the dial. The Intra-Lock software is the evolution of cell studies completed by the top PRF researchers in the field. Buy it from the source. RJM

Thank you very much for your response. So, where can I get a complete data sheet of the intraspin system, insted this very beautiful but brief technical specification data sheet? https://www.intra-lock.com/assets/l-prf-for-web.pdf I also have read the papers comparing differents centrifuges, but I don´t undestand why in the first part of the work they compared 4 centrifuges for vibration rates, and then in the third part they just compared for biological secretions the best one (intraspin) against the worst one (a-prf), but they didn´t also compared against the other 2 "intermediates" centrifuges, particularly the "second better" (Salvin PRF-like) showed very similar resultant product as informed in the second part (macroscopic and SEM comparison). I am very greatful with you because i spent more than a year with this questiones!

I had a very interesting situation trying to buy Intraspin "from the source", Intralock, by its oficial reseller in Brazil. They offered me literally a Hettich Eba 200 with an Intraspin logo sticker...3 times more expensive than the regular hettich Eba 200...so I ask to the main Intraspin office if both centrifuges were equivalent, so they answered NO. Intraspin has a software that permit slow acceleration .... so it is unchekeable because this information is not provided in any Intraspin cataloge or data sheet...do someone knows how really does it works? Has been prove that progresive acceleration is strictly necesary to achieve LPRF? On the other hand, many Hettich centrifuges allows to regulate the acceleration ratio also....I dont understand WHY Intraspin is SO especial...but I am begining to understand why is so expensive...