implants to “tent up” the sinus membrane through elevation without L-PRF can be successful in stimulating bone to fill the area, the authors concluded L-PRF was an optimal addition to this procedure to improve natural bone regeneration around implants.1 CONCLUSION Although not all studies have reported predictably favorable outcomes, clinical results have demonstrated the efficacy of L-PRF in a variety of common dental procedures. The use of L-PRF as a biological modifier stimulates tissue and leads to the improvement of tooth support and maintenance. It is an added treatment modality to make the surgical and healing process easier on the patient. Using the patient’s own tis- sue greatly aids in a quicker healing and reduces the risk of infection. As a biologic modifier, L-PRF seems to have limitless possibilities when it comes to bone and soft tissue regeneration and overall healing. Studies with control and test groups show that implant placement, as well as various other dental treatments, can still be consistently suc- cessful without the use of L-PRF, but the improved results when L-PRF is used are statistically significant. Areas for future research should inves- tigate its use in various other bone grafting procedures, such as cleft palate repair, distraction osteogenesis, and treatment of osteonecrosis of the jaw. Additionally, further research may find that this technique REFERENCES 1. Mazor Z, Horowitz R, Del Corso M, Prasad H, Rohrer M, Ehrenfest D. Sinus floor augmentation with simultaneous implant placement using Choukroun’s platelet-rich fibrin as the sole grafting material: A radiologic and histologic study at 6 months. J Periodontol. 2009;80:2056–2064. 2. Castro AB, Meschi N, Temmerman A, et al. Regenerative potential of leucocyte- and platelet-rich fibrin. Part B: sinus floor elevation, alveolar ridge preservation, and implant therapy. A systematic review. J Clin Periodontol. 2017;44:225–234. 3. Weinberg, M, Westphal, C, Froum, S, et al. Comprehensive Periodontics For the Dental Hygienist. 3rd ed. New York: Julie Levin Alexander; 2010:74,398. 4. McRedmond JP, Park SD, Reilly DF, et al. Integration of proteomics and genomics in platelets: A profile of platelet proteins and platelet-specific genes. Mol Cell Proteomics. 2004;3:133–144. 5. Anilkumar K, Geetha A, Umasudhakar, Ramakrishnan T, Vijayalakshmi R, Pameela E. Platelet- rich-fibrin: A novel root coverage approach. J Indian Soc Periodontol. 2009;13:50–54. 6. Temmerman A, Vandessel J, Castro A, et al. The use of leucocyte and platelet- rich fibrin in socket management and ridge preservation: a split-mouth, randomized, controlled clinical trial. J Clin Periodontol. 2016;43:990–999. 7. Retna Kumar K, Genmorgan K, Abdul Rahman SM, Alaguvel Rajan M, Arul Kumar T, Srinivas Prasad V. Role of plasma-rich fibrin in oral surgery. J Pharm Bioallied Sci. 2016;8:S36–S38. 8. Al-Khawlani E, Adly O, Ahmed A, El- din El-Desouky G, Abass A, Abdelmabood A. Evaluation of platelet- DecisionsInDentistry.com rich fibrin versus platelet-rich plasma on the outcome of mandibular fracture: a comparative study. Egypt J Oral Maxillofac Surg. 2014;5:96–102. 9. Li Q, Reed D, Min L, et al. Lyophilized platelet-rich fibrin promotes craniofacial bone regeneration through runx2. Int J Mol Sci. 2014;15:8509–8525. 10. Sharma A, Pradeep AR. Treatment of 3- wall intrabony defects in patients with chronic periodontitis with autologous platelet-rich fibrin: a randomized controlled clinical trial. J Periodontol. 2011;82:1705–1712. 11. Kawase T, Okuda K, Wolff L, Yoshie H. Platelet-rich plasma-derived fibrin clot formation stimulates collagen synthesis in periodontal ligament and osteoblastic cells in vitro. J Periodontol. 2003;74:858–864. 12. Sharma A, Pradeep AR. Autologous platelet-rich fibrin in the treatment of mandibular degree II furcation defects: A randomized clinical trial. J Periodontol. 2011;82:1396–1403. 13. Reddy S, Prasad MGS, Bhowmik N, Singh S, Pandit H, Vimal SK. Vestibular incision subperiosteal tunnel access (VISTA) with platelet rich fibrin (PRF) and connective tissue graft (CTG) in the management of multiple gingival recession-a case series. Int J Appl Dent Sci. 2016;2:34–37. 14. Gupta V, Bains V, Singh GP, Mathur A, Bains R. Regenerative potential of platelet rich fibrin in dentistry: literature review. Asian J Oral Health Allied Sci. 2011;1:22–28. 15. Peck M, Marnewick J, Stephen L. Alveolar ridge preservation using leukocyte and platelet-rich fibrin: a report of a case. Case Reports in Dentistry. 2011;2011:345048. 16. EL Kenawy M, EL Shinnawi U, Salem A, et al. Efficacy of platelet rich fibrin (PRF) membrane in immediate dental implant. Mansoura J Dent. 2014;1:78–84. could be used to stimulate gingival growth and aid in the repair and/or regeneration of attachment loss caused by periodontal disease. One of oral health professionals’ primary objectives is to educate patients and discuss all treatment options. As such, clinicians should remain aware of viable treatment alternatives that could contribute to improved outcomes. In this light, L-PRF is an advantageous technique that provides optimal results when utilized in conjunction with many dental procedures. D The answer sheet and further instructions are located on the tear-out card that appears on page 37, or take the test online at DecisionsInDentistry.com. CE QUESTIONS 1. In what year was the leukocyte platelet rich fibrin (L-PRF) technique first described? A. 2000 B. 2001 C. 2010 D. 2017 2. The use of L-PRF can provide which of the following? A. Enhanced healing B. Possibly fewer appointments C. Faster end result D. All of the above 3. Grafts can use which substitute to stimulate growth? A. Human B. Animal C. Synthetic D. All of the above 4. Which type of graft comes from nonvital materials? A. Alloplast B. Autograft C. Allograft D. Xenograft 5. Which type of graft comes from a different species? A. Autograft B. Allograft C. Xenograft D. Alloplast 6. How much blood is drawn in the initial step of the L-PRF procedure? A. 7 to 9 ml B. 9 to 10 ml C. 10 to 13 ml D. 20 ml 7. Correct handling of the blood is a significant factor in L-PRF treatment success. True False 8. Which of the following is a clinical application of the L-PRF technique? A. Soft tissue and bone regeneration B. Extraction socket and alveolar ridge preservation C. Improvement of furcation defects D. All of the above 9. The use of L-PRF is helpful during sinus lift procedures, especially when bone is needed for implant placement. True False 10. In which L-PRF study were the 6-month postprocedural results deemed 100% successful? A. Sharma and Pradeep B. Al-Khawlani et al C. Mazor et al D. El Kenawy et al December 2017 • Decisions IN DENTISTRY 43
