Search Results (49)

Background/Objectives: Platelet-rich fibrin (PRF) is widely used in regenerative medicine and dentistry because of its ability to deliver growth factors and cellular components that support tissue healing. However, accurate quantification of platelets and leukocytes within PRF matrices remains challenging, as indirect subtraction-based methods may not reliably reflect the true cellular composition. This study aimed to apply a direct fibrinolytic digestion–flow cytometry approach for precise cellular quantification and to systematically evaluate the effects of different centrifugation protocols on PRF cellular composition and fibrin architecture. Methods: PRF clots were generated using high-speed protocols (leukocyte- and platelet-rich fibrin [L-PRF] and concentrated growth factors [CGF]) and low-speed protocols (advanced PRF [A-PRF] and A-PRF+). Cellular content was quantified using a fibrinolytic digestion-based approach with tissue plasminogen activator, followed by flow cytometry analysis. Histological evaluation was performed to assess fibrin architecture and cellular distribution. Results: L-PRF and CGF exhibited significantly greater platelet enrichment than A-PRF. T-lymphocyte counts were elevated across all PRF groups, with significantly higher levels observed in L-PRF and CGF than in A-PRF. Monocyte and neutrophil levels were reduced following PRF preparation; however, A-PRF retained significantly higher neutrophil levels than CGF, whereas B-lymphocyte levels showed a moderate increase without significant intergroup differences. Histologically, high-speed protocols produced pronounced cellular stratification and denser fibrin networks, whereas low-speed protocols demonstrated a more homogeneous leukocyte distribution within a porous fibrin matrix. Conclusions: Centrifugation protocols significantly influence PRF cellular composition and fibrin architecture. The direct fibrinolytic digestion–flow cytometry approach provides a reliable method for accurate cellular quantification and may facilitate the standardization and optimization of PRF preparation protocols for regenerative applications. Full article

Although internal fixation and surgical approaches promote fracture healing, some outcomes remain unsatisfactory. Advanced platelet-rich fibrin (A-PRF) has been shown to provide more growth factors, and in vitro cell proliferation has not been evaluated for treating bone fractures in veterinary medicine. The purpose of this study was to evaluate the bone-healing activity of A-PRF in traumatic canine fractures. Twelve dogs with single radius–ulna or tibia–fibula fractures were randomly assigned to two groups: a control group and an A-PRF group. Both groups were treated with a locking compression plate and screws and received pain control. Post-operatively, dogs were evaluated for serum C-reactive protein (CRP) levels and post-operative pain scores on days 1, 3, and 7. Lameness and weight-bearing scores were evaluated on days 1, 3, 7, 14, 30, and 60. Bone healing was assessed at 2 weeks, 1 month, and 2 months using calculated relative bone density (%). Compared with the control, the A-PRF group showed higher bone density at 2 months and lower lameness at 14 days post-operatively. Although the CRP level, an inflammation response marker, was higher in the A-PRF group within one day. No significant difference in pain score was observed. In conclusion, A-PRF serves as an effective adjunctive therapy for promoting bone healing when treating canine appendicular fractures with surgical internal fixation. Full article

Background/Objectives: This study evaluated autologous platelet concentrates (APCs), including advanced platelet-rich fibrin (A-PRF+) and concentrated growth factors (CGFs), as biologically active matrices, and photobiomodulation (PBM) as a biophysical stimulus affecting soft and hard tissue regeneration following mandibular third molar extraction. Methods: A six-arm parallel randomised controlled trial was conducted including 135 patients. A total of 122 participants completed follow-up and were analysed: control (n = 22), photobiomodulation (n = 20), A-PRF+ (n = 19), CGF (n = 20), A-PRF+ plus photobiomodulation (n = 22), and CGF plus photobiomodulation (n = 19). The primary endpoint was postoperative pain intensity assessed on postoperative day 3 using an 11-point visual analogue scale (VAS). Secondary outcomes included swelling, trismus, wound healing assessed by the early healing index, and bone regeneration assessed by CBCT-based fractal dimension analysis at 4 months. Results: On postoperative day 3, mean VAS pain was 2.95 ± 2.65 in the control group and 1.00 ± 1.65 in the photobiomodulation group, corresponding to a mean difference of 1.95 VAS points. The overall between-group difference for day 3 pain was statistically significant. In swelling outcomes, no statistically significant between-group differences were observed at days 1, 3, or 7 across facial measurement lines. In CBCT fractal analysis, a significant group effect was detected for the mid socket region, with higher fractal dimension at 4 months in the CGF plus photobiomodulation group compared with the control. Conclusions: Both APCs and PBM positively influenced postoperative healing. Their combined application, particularly CGF with PBM, showed the most consistent regenerative effects, although not all outcomes differed significantly between groups. These minimally invasive strategies may support soft and hard tissue regeneration. Full article

Background: Autologous platelet concentrates, including platelet-rich fibrin (PRF) matrices, have been proposed as biologically active scaffolds for vital pulp therapy. Evidence on the clinical use of different solid PRF matrices for direct pulp capping remains limited. Objective: The aim of this study is to describe and monitor two clinical cases of reversible pulpitis treated with direct pulp capping using two PRF membranes prepared by different centrifugation approaches, namely advanced platelet-rich fibrin plus (A-PRF+) and horizontal platelet-rich fibrin plus (H-PRF). Methods: In Case 1, A-PRF+ was prepared using a fixed-angle centrifugation protocol; in Case 2, H-PRF was prepared using a horizontal centrifugation protocol. In both cases, deep carious lesions with small carious pulp exposures (<1.5 mm) were managed by caries removal, ozone-assisted dentin disinfection, and direct pulp capping with the respective PRF membrane, followed by temporary calcium-silicate cement definitive coronal restoration. Clinical and radiographic follow-up, including cone-beam computed tomography, was performed for up to 12 months. Results: In Case 1 (A-PRF+), reparative dentin bridge formation was confirmed at 90 days, with a thickness of 0.2 mm. In Case 2 (H-PRF), reparative dentin was observed within 46 days, with a thickness of 0.28 mm. In both cases, pulp vitality was maintained, and no clinical symptoms or periapical changes were detected during the 12-month follow-up. Conclusions: These two cases suggest that direct pulp capping using PRF membranes (A-PRF+ or H-PRF), combined with ozone-assisted dentin disinfection and adequate coronal sealing, may be associated with maintained pulp vitality and hard-tissue repair after carious pulp exposure diagnosed as reversible pulpitis. Due to the descriptive two-case design and major confounding factors (including age and lesion characteristics), no comparative conclusions can be drawn. Prospective controlled clinical studies with standardized protocols are warranted. Full article

Background and Clinical Significance: This case presents immediate implant placement combined with PRF (A-PRF+) and a photogrammetry-based workflow, illustrating predictable full-arch implant-supported rehabilitation. Case Presentation: Main clinical findings included compromised abutment teeth and patient dissatisfaction with aesthetics. Interventions included extractions, immediate implants, PRF socket management, and digital provisional and definitive restorations. Outcomes demonstrated stable occlusion, satisfactory aesthetics, and high patient satisfaction. Conclusions: Immediate placement with PRF and photogrammetry provides reliable outcomes in complex full-arch cases. Full article

Background and Clinical Significance: Medication-related osteonecrosis of the jaw (MRONJ) is a severe complication of antiresorptive therapies such as Zolendronic acid, used for bone metastases. Its management remains challenging, with outcomes often unpredictable. Platelet-rich fibrin (PRF), rich in growth factors, has been proposed as a potential adjunct to surgical treatment, aiming to promote tissue regeneration and improve patient outcomes. Case Presentation: We reported three clinical cases of MRONJ in patients previously treated with Zolendronic acid. All patients underwent surgical sequestrectomy combined with A-PRF application. Disease stages ranged from early to advanced (stages I–III). The success of treatment was evaluated based on how well the tissue healed, the extent of bone recovery, the amount of pain relief, and improvements in the patient’s quality of life. The patient with early-stage MRONJ achieved complete healing. On the other hand, the patients with stage II and III disease showed only partial clinical improvement. Nevertheless, all cases demonstrated significant subjective reduction in pain and enhanced overall quality of life following PRF therapy. Conclusions: Early-stage intervention offers the best prognosis for MRONJ. While A-PRF may improve postoperative comfort and quality of life, its curative effect appears limited in advanced disease. This highlights the need for further randomized clinical trials to demonstrate the role of A-PRF in the treatment of MRONJ. Full article

Background: This study aims to evaluate the effect of different types of platelet concentrates (autologous blood biomaterials) on the migration potential of human dental pulp stem (hDPSCs). Materials and Methods: Our team created a model of human dental pulp stem cells (hDPSCs). Various types of AB biomaterials were produced from blood samples from volunteers using the protocols presented: A-PRF+, Gel A-PRF+, and Solid PRF. The scratch wound healing assay was used to examine the closure of the experimental wounds on day 1 and day 14. The wound areas were quantified using Image J software. Statistical analysis was performed with the Kruskal–Wallis and Mann–Whitney U tests, as the data did not follow a normal distribution, which was confirmed by the Shapiro–Wilk test (p < 0.05). Results: The results demonstrate significantly faster closure of the experimental wounds on day 14 of the studied biomaterials AB: A-PRF+, Gel A-PRF+, and Solid PRF compared to the control group of cells. Gel A-PRF+ exhibited the most pronounced stimulatory effect on cell migration (p = 0.0036 vs. control), followed by Solid PRF and A-PRF+. Conclusions: The results indicate that autologous blood platelet concentrates stimulate the migration of hDPSCs in vitro. Gel A-PRF+ demonstrated the strongest effect, underscoring its potential clinical relevance for applications in tissue engineering. Full article

Background: Platelet-rich fibrin (PRF) is an autologous platelet concentrate (APC) produced through blood centrifugation. Despite the development of various centrifugation systems, protocol variability continues to pose challenges in selecting the optimal method. This study investigated the effects of three different centrifuges and collection tubes on the fibrin characteristics and growth factor release in leukocyte- and platelet-rich fibrin (L-PRF) and advanced platelet-rich fibrin plus (A-PRF+). Methods: Blood samples from six healthy female volunteers were processed using three centrifuges (Duo, IntraSpin, and LMC-3000) and three collection tubes (Pyrex, A-P, and silica-coated plastic) under high- (~700× g for 12 min) and low-speed (~200× g for 8 min) protocols. Fibrin clot weight and length were assessed. Growth factor release of platelet-derived growth factor-BB (PDGF-BB) and vascular endothelial growth factor (VEGF) was quantified using ELISA. Fibrin architecture was examined via scanning electron microscopy (SEM). Results: High-speed protocols tended to produce larger clots, whereas low-speed protocols generated smaller but more biologically active matrices. The IntraSpin and Duo centrifuges yielded greater clot dimensions and higher growth factor release than the LMC-3000. While tube type had no significant effect on growth factor levels, silica-coated tubes tended to produce the largest clots. The Pyrex tubes demonstrated comparable or superior growth factor release. Conclusions: PRF quality is influenced by centrifuge design, g-force, and tube material. Low-speed protocols with certified centrifuges are recommended, and FDA-approved glass tubes may provide a reliable alternative to reduce silica-related risks. Standardization and appropriate material selection are essential for consistent, safe, and effective regenerative outcomes. Full article

Background: The growing interest in the field of platelet-rich fibrins has led to the development of novel generations of these concentrates, with one of the newest additions being advanced platelet-rich fibrin plus (A-PRF+). The updated centrifuge protocol utilized for the preparation of A-PRF+ has been shown to provide blood clots with more white blood cells and growth factors trapped in the fibrin matrix, presenting a more homogenous distribution. The objective of this study was to assess the available randomized clinical trials (RCTs), in order to evaluate the effects that the addition of A-PRF+ can have on postoperative quality of life and soft tissue healing after dental surgery. Materials and Methods: To perform a systematic review based on high-quality results, only RCTs were taken into consideration. The search included articles published between 1 January 2014 and 31 December 2024, indexed in the PubMed, Cochrane, Library, Embase, Scopus, and Google Scholar databases. Nine full texts were finally acquired after the screening of articles, from which relevant data were extracted. Results: A-PRF+ positively influenced the postoperative quality of life in patients. The subjective analysis of pain and its management via painkiller intake indicated that, in general, the addition of A-PRF+ into protocols results in less pain, pain that lasts for a shorter time, and pain that is more easily managed through medication, as a lower number of pills was needed to restore comfort. Furthermore, the occurrence of facial swelling and trismus was also reported to be lower in the A-PRF+ groups. As for soft tissue healing, A-PRF+ significantly enhanced the epithelialization process, total wound area reduction, and inflammation in the surrounding tissues. This positive effect was most noticeable at 7- and 14-day follow-ups. The addition of A-PRF+ also had a positive effect on postoperative bleeding by significantly reducing the bleeding time, providing benefits for patients undergoing antiplatelet drug therapy in particular. Conclusions: The addition of A-PRF+ into the surgical protocol can positively enhance the patient’s quality of life, reduce the need for postoperative medication, and improve the patient’s confidence by reducing potential swelling and trismus. A-PRF+ also positively influences soft tissue wound healing, further enhancing the postoperative well-being of patients, and provides an excellent hemostatic effect even in patients that are on antiplatelet drug therapy. Full article

Regenerative endodontic approaches for immature necrotic permanent teeth must balance biological efficacy, clinical practicality and long-term aesthetic outcomes. This study evaluates a novel regenerative protocol using autologous advanced platelet-rich fibrin plus (A-PRF+) scaffold sealed exclusively with glass ionomer cement (GIC) and compares it to conventional calcium hydroxide apexification used as the control. Twenty-eight patients were prospectively enrolled and followed for 12 months alongside a retrospectively selected historical control group. Outcomes were evaluated through standardised blinded clinical, radiographic and vitality assessments. The A-PRF+ protocol demonstrated significantly faster periapical healing, superior root lengthening, increased dentinal wall thickness and apical closure (p < 0.0001), with excellent aesthetic outcomes and no reported tooth discolouration. Pulpal blood flow measured by laser Doppler flowmetry indicated vitality restoration in 93% of cases. Preliminary linear regression identified treatment duration as a significant predictor of apical closure (p < 0.0001), with possible enhancement by additional patient-specific variables. These findings validate the A-PRF+ protocol as a highly effective, aesthetically favourable and predictable regenerative strategy, establishing a new benchmark for the management of immature necrotic teeth and laying the foundation for personalised predictive endodontic care. Future studies should include multicentre randomised controlled trials to confirm long-term clinical sustainability and generalisability. Full article

Background: Medication-related osteonecrosis of the jaw (MRONJ) is drug-induced bone destruction that is exposed for a minimum of 6 to 8 weeks in patients who have not received head and neck radiotherapy and who have not been diagnosed with facial bone metastases. MRONJ treatment outcomes are unpredictable. Therefore, alternative treatment methods are being explored, such as blood-derived platelet-rich preparations enriched with growth factors, including advanced platelet-rich fibrin (A-PRF). The presence of growth factors may enhance healing and reduce post-procedure complications. There are no studies examining the effect of A-PRF on the healing of patients with MRONJ. The aim of this study was to retrospectively evaluate treatment outcomes of patients with MRONJ surgically treated without and with the use of A-PRF. Materials and methods: This retrospective study included 28 patients who suffered from osteomyelitis due to MRONJ and underwent surgical treatment between 2019 and 2024. The patients were divided into two groups: the first group received surgical treatment without A-PRF, and the second group received surgical treatment with the application of A-PRF. This study analyzed demographic and clinical data, as well as treatment outcomes. Results: The patients were aged from 43 to 82 years. The most common cause of MRONJ was the administration of zoledronic acid for oncological reasons (22 patients, 78.6%), given intravenously. In 20 patients (71.4%), the antiresorptive treatment lasted longer than three years. The obtained healing distribution was binomial (presence or absence of healing). Estimation of the probability of healing using the maximum likelihood method provided a result of approximately 64%. The probability of ten or more healed patients in the A-PRF group was 41%. A-PRF helps with a probability of 59%, and without A-PRF, it was lower. Concomitantly, the differences between the group with A-PRF and without A-PRF were not statistically significant. Conclusions: The patients with MRONJ should have regular check-ups with radiological examinations at least every six months to detect possible recurrence. Treatment for MRONJ is long and difficult. Treatment of non-advanced lesions, without additional risk factors (such as treatment with zoledronate intravenously for oncological purposes for 3 years), showed a better prognosis. Sometimes, in addition to surgery, it is necessary to consider alternative methods. A-PRF may enhance MRONJ healing. However, there is no evidence of a significant effect of A-PRF on the healing of MRONJ. Full article

Background: Advanced platelet-rich fibrin + (A-PRF+) represents a third generation of autologous platelet derivatives. Appropriate centrifugation conditions cause the formation of a clot containing platelets, which slowly release growth factors that influence healing. The objective of this article was to undertake a review of the available literature on the effectiveness of A-PRF+ use in hard tissue procedures. Materials and methods: In order to ensure the most accurate and relevant results, only randomized clinical trials regarding bone regeneration techniques/bone healing that compared the effect of the A-PRF+ addition in dentistry were included in this study. Articles taken into consideration for the review were published between the beginning of 2014 and 31 December 2024. The search of manuscripts for the review was conducted using the PubMed, Scopus, Google Scholar, and Cochrane databases. For this study, 10 articles focusing on A-PRF+ were qualified. Results: A-PRF+ was found to increase the post-surgical vertical and horizontal alveolar ridge dimensions. The bone formed in the surgical site presented a higher volume of vital and non-vital bone and a more optimal bone composition, at the same time providing a lower percentage of connective tissue inclusions. When combined with other grafting biomaterials, A-PRF+ enhanced their performance and integration. A-PRF+ did not have any significant effect on the mineral bone density compared with other grafting materials. Compared with PRF and other blood derived plasmas rich in growth factors, the performance of A-PRF+ was generally better, but often with no statistical significance. The treatment of periodontal defects measured by the reduction in pocket depth and clinical attachment level also fared better with the A-PRF+ addition, although there was no differences noted between A-PRF+ and biphasic calcium phosphate and xenograft. Finally, the A-PRF+ addition improved the primary implant stability in the evaluated studies. Conclusions: The A-PRF+ addition to the surgical protocols significantly enhanced the healing of the bone and when combined with biomaterials improved their integration and increased the implant insertion torque, improving the primary and secondary stability. It may be a viable alternative for patients that express their concern towards human- and animal-derived biomaterials. Full article

Background: Apical surgery can address periapical pathologies when conventional endodontic treatments fail. Advanced platelet-rich fibrin (A-PRF) has emerged as a regenerative material with the potential to enhance healing in periapical surgery. In this study, we evaluated the effect of A-PRF on periapical lesion healing using cone beam computed tomography (CBCT). Methods: A randomized controlled trial at Rīga Stradiņš University Institute of Stomatology included 43 participants (15 males, 28 females; mean age: 44 years) with periradicular lesions. Participants were divided into experimental and control groups. Baseline and follow-up CBCT imaging assessed lesion volumes at 6 and 12 months post-surgery. Results: Mean lesion volumes significantly decreased from 431.4 mm³ at baseline to 102.8 mm³ at 6 months and 49.2 mm³ at 12 months (p < 0.001). A-PRF did not significantly reduce the lesion sizes compared to the controls (p = 0.043), but was associated with reduced inflammation and enhanced soft tissue healing. Key confounders included gender and baseline lesion volume, with males exhibiting smaller lesion sizes postoperatively. Conclusions: The results suggest that A-PRF may not offer a significant advantage in terms of reducing defect size or improving radiographic resolution. Full article

Autologous blood centrifugation produces various forms of platelet concentrates widely used in tissue regenerative therapies due to their high concentrations of growth factors and abundance of autologous cells. Advanced Platelet-Rich Fibrin (A-PRF), introduced as a low-speed centrifugation product, contains an even higher concentration of growth factors, a greater number of cells, and a looser fibrin clot structure compared to previous Leukocyte and Platelet-Rich Fibrin (L-PRF). This study aims to assess the potential of A-PRF as a local delivery system for antibiotics. Different concentrations (0.5 mg/mL, 0.25 mg/mL, and 0.125 mg/mL) of injectable amoxicillin (AMX) and metronidazole (MTZ) were preliminarily tested for their impact on A-PRF clot formation, with 0.5 mg/mL selected for subsequent experiments. Blood samples from healthy volunteers were supplemented with antibiotics and centrifuged to form clots. Antibiotic-enriched A-PRF clots were immersed in phosphate-buffered saline (1x PBS) and analyzed at 24 h, 72 h, 7 days, and 14 days. AMX showed a consistent release (mean: 19.9 ± 4.8 ng/mL at 24 h) over 14 days, while MTZ demonstrated greater variability (mean: 12.8 ± 4.5 ng/mL at 24 h). AMX release remained constant over the 14-day period, with no significant variations among patients. In contrast, MTZ displayed a progressively lower release over time. Microbiological analysis revealed bacterial growth inhibition zones for Fusobacterium nucleatum (AMX: 23 mm, MTZ: 28 mm) and Prevotella intermedia (AMX: 34 mm, MTZ: 30 mm) at 24 h. These findings suggest that A-PRF can act as an effective local antibiotic delivery system, maintaining sustained antimicrobial activity and potentially reducing the need for systemic antibiotics. Full article

Background and Objectives: This study aimed to evaluate the role of A-PRF (advanced platelet-rich fibrin) in the enhancement of wound healing and protecting the periodontal health of mandibular second molars after the extraction of mandibular third molars. Additionally, the study assessed the levels of pro-inflammatory cytokines in the gingival crevicular fluid (GCF) of mandibular second molars as markers of inflammation. Materials and Methods: Twenty-five systemically healthy adult patients with bilateral removal of impacted mandibular third molars were included. Each patient received A-PRF in one extraction site, while the contralateral site served as a control. Periodontal parameters of the adjacent second molar, including probing depth (PD) and clinical attachment level (CAL), were measured in distal–vestibular (DV) and distal–lingual (DL) sites. Pain, swelling, and overall healing were subjectively evaluated. Levels of tumor necrosis factor-alpha (TNF-α), interleukin 1 beta (IL-1β), and interleukin 6 (IL-6) in the GCF were analyzed. Evaluations occurred at baseline and three months post-surgery. Results: A-PRF significantly improved PD (from 4.69 ± 0.61 mm to 3.85 ± 0.34 mm in DV, and from 4.71 ± 0.65 mm to 3.79 ± 0.27 mm in DL, respectively) and CAL (from 2.41 ± 0.25 mm to 1.82 ± 0.21 mm in DV, and from 2.40 ± 0.36 mm to 1.75 ± 0.19 mm in DL, respectively) of the adjacent second molar, compared to control sites, three months post-surgery. Pain and swelling scores were notably lower on the 7th postoperative day in the A-PRF group. A-PRF also reduced pro-inflammatory cytokines in GCF, significantly more than in control sites, at three months post-surgery. Conclusions: A-PRF enhances the periodontal and inflammatory status of adjacent teeth and wound healing after the extraction of mandibular third molars. Full article