Richard J. Miron - Understanding Platelet-Rich Fibrin

In appreciation of her contributions to my career, 100% of the royalties from this textbook will be donated to create a scholarship named after her for new dental graduates at the University of Laval. Milles fois merci pour tout tes efforts!

Foreword

Many important medical/dental discoveries were stumbled upon by pure chance. An example of this is osseointegration, which launched the modern era of dental implants and orthopedic-embedded prostheses. It occurred when orthopedic researcher Per-Ingvar Brånemark found that his titanium research cages in sheep were so completely ingrown with bone that he couldn’t remove them. Similarly, platelet-rich plasma (PRP)/platelet-rich fibrin (PRF) was discovered by the serendipity of observing accelerated and more complete healing in patients who developed hematomas. From that simple observation in the 1980s, the components of the blood clot responsible for the advanced healing have since been determined to be the complete and active growth factors in the alpha granules of viable platelets and several cell adhesion molecules and homing signals in the fibrin clot.

From the early pioneering work in the 1990s to the present, the benchmark of platelet numbers and the functional characteristics of the growth factors, cell adhesion molecules, and homing signals of PRP/PRF have progressed to a mature science and easy-to-use point-of-care devices.

Today, PRP/PRF devices are able to predictably concentrate platelets to known therapeutic levels by a variety of technologic means and to include or exclude leukocytes as per the needs of the wound. PRP/PRF has become a mainstay in bone regeneration in dental implantology and jaw reconstruction, for tendon and joint repair in orthopedics, for soft tissue healing in wound care centers, and in plastic surgery; it has thus benefited hundreds of thousands of patients worldwide.

As one of several individuals who were there at the beginning of the PRP/PRF discovery and who helped to move it along the way somewhat, I am delighted to see that the next generation of clinical researchers as published in Understanding Platelet-Rich Fibrin have brought it to the next level.

This text is written for the clinician to understand how and why PRF promotes healing of both bone and soft tissue as well as how to apply it to improve their own results. Written with a balanced blend of science and clinical applications by the most experienced and accomplished PRP/PRF scientists and clinicians of the day, and beautifully illustrated, Understanding Platelet-Rich Fibrin is a book for this decade that transcends all specialties of dentistry and many of medicine.

Robert E. Marx, DDS

Professor of Surgery and Chief of OMFS

University of Miami

Miller School of Medicine

Miami, Florida

Preface

Over 20 years ago, platelet concentrates entered into the medical field as a means to deliver autologous growth factors responsible for favoring wound healing. During this time span, it has gained widespread acceptance in many fields of medicine due to its more natural delivery system.

Most notably, the past 5 years have seen a tremendous increase in publications on PRF, with over 200 scientific peer-reviewed papers being published each and every year. During this span, a marked increase in our understanding of PRF therapy has been made with respect to selection of appropriate centrifugation devices, impact of tube chemistry on clotting, the optimization of protocols to better concentrate PRF, and even the ability to extend the working properties of PRF from 2–3 weeks toward 4–6 months using a simple heating process. Collectively, we continue to gather new knowledge, and as a result, PRF therapy has become one of the fastest-growing therapeutic options in dentistry. Thousands of users have now benefited from this technology, and this number is only expected to continue to increase.

This book is very different from others in its concept design. More than a dozen expert researchers and clinicians alike were gathered as editors across their different fields of expertise. As section editors, these true experts of their respective disciplines were able to produce a much higher overall quality of this textbook. I am grateful for their encouraging team spirit, their effort in bringing this book to an entirely new level, and their level of professionalism and mindset that ultimately led to this comprehensive textbook. I am also grateful to the numerous clinicians who have provided videos to better educate/demonstrate surgical techniques and concepts with PRF, which will greatly enhance the learning experience of the reader.

The book is divided into four primary sections, including (1) biology of PRF, (2) periodontology, (3) implant dentistry, and (4) additional dental and medical applications. The book aims to take the reader from a basic biologic understanding of PRF through explanations of the various protocols utilized followed by application of these concepts in numerous clinical scenarios.

I therefore am thrilled to introduce our textbook titled Understanding Platelet-Rich Fibrin . I hope you enjoy learning the many aspects centered around the use of PRF in regenerative dentistry.

Acknowledgments

To my parents, family, and friends who have all sacrificed far too often in my pursuit of a career in academic dentistry.

To my classmates, colleagues, and mentors who constantly raised the bar and strived for better.

To Quintessence Publishing for your thorough input in the editing, illustrations, and design of this textbook.

To my family at Lakewood Ranch Dental in Florida who have made clinical practice as enjoyable an experience as can be on a daily basis.

To all leaders and researchers alike who have contributed enormously to the field of PRP/PRF and laid the foundation for this textbook to be written.

To the faculty in the Department of Biomedical Sciences and Cell Biology at the University of Western Ontario (London, Canada; BMSc, MSc), the Dental School at the University of Laval (Quebec; DDS), the Department of Music at Berklee College (Boston; MMus), the Department of Periodontology at the University of Bern (PhD, Dr med dent), the Department of Oral Implantology at Wuhan University (China; postdoctoral research fellow), the Plastic Surgery Department at Queen Mary University (London; clinical masters in facial esthetics), and the Department of Periodontology at the University of Illinois at Chicago (clinical masters in periodontology). Your education and mentorship has provided endless opportunities.

And lastly, to the team at Advanced PRF Education ( www.prfedu.com) for making excellence in teaching a top priority.

Contributors

Fabrice Baudot, dds, msc

Private Practice

Saint-Gély-du-Fesc, France

Luis Bessa, dds

Director, North Clinic

Porto, Portugal

Mark Bishara, dds

Private Practice

Bowmanville, Ontario, Canada

Thomas Boas, msc (econ)

CEO, Puremed

Roskilde, Denmark

Luigi Canullo, dds, phd

Independent Researcher

Rome, Italy

Marco Antonio Castro Pinto, dds, msc

Professor, Department of Reconstructive Dentistry

Montemorelos University School of Dentistry

Nuevo Léon, Mexico

Raluca Cosgarea, dds, msc, phd

Professor, Department of Prosthetic Dentistry

Iuliu Hat¸ieganu University

Cluj-Napoca, Romania

Catherine Davies, mbbch, mba

Private Practice Specializing in Facial Esthetics

Johannesburg, South Africa

Massimo Del Fabbro, md, phd

Professor, Department of Biomedical, Surgical, and Dental Sciences

University of Milan

Milan, Italy

Scott Delboccio, dmd

Private Practice

Naples, Florida