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regenerative dentistry

APPLICATIONS IN REGENERATIVE DENTISTRY
DU PLatelet-RICH FIBRIN (PRF)

All oral surgery techniques can be combined with FRP: bone grafts
GINGVES and dental implants

APPLICATIONS IN REGENERATIVE DENTISTRY
DU PLatelet-RICH FIBRIN - PRF

Most of the existing surgical therapies in oral surgery have been modified in the light of the PRF technique. But not only that, new therapeutic protocols in dentistry and medicine have been invented thanks to the formidable regenerative capacity of FRPs.

Every scientist and clinician is trying to explore the immense potential of this new therapy and to make mentalities evolve as quickly as the protocols.

For example, the surgical techniques of gum and bone grafts have been reformatted and reinvented according to the principles of regenerative dentistry, thanks to Dr. Joseph Choukroun, its designer. Like his predecessors, he was able to create a whole universe and a medical community that revolves around his principles, which he has and continues to enact.

1. PRF FOR SOCKET MANAGEMENT FOLLOWING DENTAL EXTRACTIONS

Note: The protocols for filling dental sockets are described more specifically in the chapter: “Pre-implant bone grafts“.

The healing properties and advantages of using platelet-rich fibrin (PRF) are used to optimize bone healing in empty sockets after tooth extraction and reduce bone loss.

Recent research has shown that the main cause of accelerated three-dimensional resorption of alveolar bone after tooth extraction is mainly due to the reduction in blood flow resulting from the loss of this tooth.

In the alveolar bone, the periodontal ligament, called desmodont, contains most of the blood supply. Once the tooth has been extracted and the surrounding dental ligament removed, rapid and drastic bone loss occurs in the missing teeth, especially in the thin oral bone walls.

FRP can be used as a single graft biomaterial by filling the tooth socket with a-PRF membranes.

FRP can be used in combination with all types of bone graft fillers to limit post-extraction three-dimensional changes.

The protocol that is becoming the standard is described by Dr. Joseph Choukroun as a mixture of bone bank and i-PRF. A cover of a-PRF membranes completes the ensemble.

But all reconstructions can be done with any type of bone graft and with most biomaterials: from synthetic bone substitutes to autografts.

However, samples from the chin, the skull in its parietal part or from the iliac region are too complex. Filling materials of synthetic or animal origin or bone bank are preferable.

comblement-osseus-alveole-cas1
prf-cas1

2. THE USE OF PRF IN SINUS LIFT

IN THE CASE OF POSTERIOR ATROPHY OF THE MAXILLA

We have more than thirty years of experience with the first maxillary sinus floor elevation procedure, also called sinus lift or sinus filling.

However, the risks of hazards remain numerous. However, innovative protocols associating PRF are a guarantee of optimization and acceleration of healing. In particular, for elderly patients or those weakened by pathologies that reduce their vascularization and therefore their ability to heal. Even balanced diabetes decreases vascular concentration and reduces blood flow by thickening the blood. High cholesterol levels will decrease the ability of osteoblast cells to make bone. The elderly are naturally our core patient group, since edentulism and bone resorption increase with age. However, these patients have a diminishing capacity for tissue regeneration. The use of FRP in these situations is a guarantee of improved healing, even if the ideal does not exist.

Although many improvements have been made in surgical techniques and biomaterial selection, this procedure remains associated with many potential risks of complications. The most common is the tearing of the Schneider’s membrane that lines the sinus walls. This thin membrane, which has the consistency of a “wet toilet paper sheet”, must be gently lifted in order to insert a bone graft between it and the bony floor of the sinus and thus perform the sinus lift.

The dental surgeon, although familiar with the anatomical characteristics and anomalies of the maxillary sinus cavity, can perforate this fragile membrane. The high rate of perforation of Schneider’s membrane during a sinus lift has as a possible consequence a risk of acute or chronic infection, such as chronic sinusitis or an infectious or inflammatory superinfection like rhinitis. The application of a-PRF membranes to repair small breaches of this Schneider membrane has been shown to be particularly effective.

The intrasinus cavity bounded by the floor of the maxillary sinus and Schneider’s membrane is filled by the bone graft saturated with FRP in all its forms. The contribution of blood platelets and scar cells is considerable.

In surgical techniques of bone grafting, such as sinus lift, associating PRF, Dr. Joseph Choukroun suggests the use of S-PRF as a binding agent for allograft-type bone granules used as intra-sinus bone grafts. S-PRF (liquid PRF whose aggregation has been slowed down without anticoagulant), possibly associated with A-PRF (PRF in the form of a fibrin membrane) will finally architect a fibrin matrix lattice around the biomaterial granules. An addition of I-PRF to provide more macrophages, leukocytes and stem cells can be done.

A wide range of bone biomaterials is used to perform a unilateral or bilateral maxillary sinus lift. This type of bone grafting is used to manage the atrophy of the posterior maxillary alveolar ridges. Bone grafts are the same as for bone reconstruction or bone grafting following dental extractions. For example: filling biomaterials from the family of synthetic bone substitutes, biomaterials of animal origin such as xenografts, biomaterials of human origin from living donors such as allografts, biomaterials from the patient-donor such as autografts, with harvesting from the chin or the gonia or cranial angle or from the hip at the level of the iliac bone.

It is remarkable that collagen membranes are most often used as a gingival cell barrier and bone graft packing.

The development of second generation platelet concentrates PRF generates new protocols. Initial studies were done to determine if FRP could be used alone?

After ten years of clinical trials, studies show that FRP can be used alone as a grafting material but that it should most often be combined with bone graft particles to improve space maintenance as well as angiogenic potential in the surgical pocket formed in the sinus between Schneider’s membrane and the sinus floor.

Two levels of examination can be performed:

  • Either a classic 2D radiological examination at the dentist’s office such as a dental panoramic.
  • Or radiological examinations performed by a practitioner specialized in CT and dental scanning. Like the Cone Beam which is the best 3D examination with a lower irradiation than the CT scanner.

This exploration of the facial and maxillary bone mass by means of a three-dimensional scanner allows for a very detailed study of the upper and lower jaws as well as the entire oral cavity in order to identify any form of anomaly or anatomical peculiarity.

In the case of the sinus lift, only certain anatomical structures are of interest: the maxilla in its posterior part, the nasal cavities that contain the middle turbinates and the facial sinuses. The sinus cavities are all interconnected and consist of the maxillary sinuses, the ethmoid sinus, the sphenoid sinus and the frontal bone sinus.

A very large middle horn can block the nostril. But even if it can interfere with breathing as long as there is no obstruction to the sinus airway it is not important to do a sinus lift, as well as common polyps.

On the other hand, a pathological image such as a radiological opacity, sign of an infectious lesion such as maxillary sinusitis which can be unilateral or bilateral, is a hindrance to sinus elevation. Acute infectious sinusitis is a contraindication to sinus lift, unless the procedure resolves both the etiology of the acute sinusitis and the sinus elevation. Chronic inflammatory sinusitis is not necessarily a contraindication to sinus lift but should be considered jointly by the ENT specialist and the dental surgeon.

The role of the radiologist is crucial since he will diagnose a possible tumor lesion, ostial obstruction, sinusitis or polyposis.

Periodontal disease affects the gums and the alveolar bone. In the final stage of periodontitis, the bone resorption is such that the molars and adjacent teeth are completely loosened and dental extractions are inevitable. This topic is discussed in the chapter on periodontology.

Once the alveolar bone has been deprived of the teeth it is supposed to hold, the jawbone continues to resorb to the stage of a thin bone lamella of one or two millimeters. In this case, the bone loss is such that the bone volume is insufficient for the placement of dental implants.

The solution is an increase in bone volume through a special bone grafting procedure called maxillary floor elevation. It must be performed inside the maxillary sinus with a living, vascularized biomaterial that can receive and osseointegrate a dental implant.

Otherwise, there is the alternative of zygomatic implants.

There are different surgical techniques:

  • Summers’ technique or the crestal approach : This is the least invasive technique, but it is performed blindly and is the least effective.
  • The Caldwell-Luc technique or the lateral approach: This is the most invasive but most convenient technique that consists of crossing the lateral wall of the maxilla to reach the sinus.

The surgical procedure has different stages : under general anesthesia or local anesthesia, an incision, the removal of a flap, the placement of a graft necessary for bone reconstruction and the increase in volume of the sinus walls, and finally stitches.

A mixture of bank bone, I-PRF and some S-PRF and A_PRF membranes results in a bioactive biomaterial loaded with growth factors, called “sticky bone” because of its plasticity.

The fibrin membranes of A-PRF are also evoked for the closure of the so-called calwell-Luc lateral approach window, after an elevation of the floor of the maxillary sinus.

A-PRF fibrin membranes are frequently used for the repair of Schneider’s membrane perforations that line the sinus walls.

Drilling for the placement of a dental implant or several titanium implants can be done simultaneously with the elevation of the sinus floor.

A dental prosthesis such as an implant-supported bridge will then be placed immediately after the installation.

In the postoperative period, painkillers, antibiotic prophylaxis, anti-inflammatory drugs, mouthwash and brushing that avoids the operated area will be prescribed.

The postoperative aftermath may be a hematoma and/or bleeding.

The most important risk in sinus lift is accidental perforation of Schneider’s membrane. In this case a simple inflammation of the area can be observed, possibly accompanied by rhinitis.

Alternatively, superinfection can set in and interfere with bone healing. In some acute cases, the graft must be removed and the sinus cleaned.

Sometimes a piece of the graft may detach from the graft body and remain free in the sinus. In this case, there are several cases to consider:

  • Either it is totally neutral and remains in the sine;
  • Either it evacuates itself through the airways;
  • Either it remains stuck in the unfudibular ostium and must be removed by endoscopy;
  • If the piece is too big to come out and causes chronic sinusitis, it will be removed endoscopically through a middle meatotomy.

The use of FRP mixed with the biomaterial graft reduces the operative time and prevents complications to some extent:

  • FRP gives the graft more healing capacity than a simple neutral biomaterial. The postoperative period is simplified and shortened.
  • The PRF gives the intra-sinus bone graft this gelatinous consistency that avoids the “ball bag” phenomenon with the biomaterial granules that spill into the sinus. The risk of a piece coming off is reduced.

3. THE USE OF PRF FOR THE TREATMENT OF MUCOGINGIVAL RECESSIONS

The new surgical technique of soft tissue regeneration (attached gingiva and mucosa) called FASTP (Fibrin Assisted Soft Tissue Promotion) brings significant improvements in aesthetic and plastic surgery of the gum contour (muco-gingival surgery)

The results of numerous randomized clinical trials have demonstrated its marked ability to promote the healing of soft tissue wounds. This property is used to accelerate the regeneration of mucogingival recessions. 

A new surgical concept is introduced after years of clinical experience with PRF, called the FASTP technique or “Fibrin Assisted Soft Tissue Promotion” which can be translated as “Fibrin Induced Soft Tissue Regeneration Optimization”.

The surgical principle is an introduction of A-PRF fibrin membranes through a tunneling in the mucosa (with or without contribution of attached gingiva taken from the palate) associated with a traction of the soft tissues.

This traction, achieved with complex sutures (Apical Mattress), combined with the induction of tissue regeneration, thanks to PRF, leads to an optimal recovery of muco-gingival recessions.

greffe-gencive-cas1-1

4. THE USE OF PRF FOR PERIODONTAL REGENERATION

Over the last 20 years, an increase in the prevalence of periodontal disease has been observed, due in particular to the increase in longevity of life.

Regeneration of subosseous defects and tooth root furcations was achieved using biological agents and growth factors contained in FRPs.

These follow a series of pioneering studies using collagen barrier membranes, which first established the concept of guided tissue regeneration (GTR) with or without various bone graft biomaterials.

Growth factors and biological agents were then introduced as potential regenerative agents for peri-root and furcation sub-bone defects.

Approximately 20 years after the introduction of growth factors derived from first generation platelet concentrates such as PRPPDGF or enamel matrix derivatives (EMD), it is now second generation platelet concentrates such as Fibrin Rich Plasma (FRP) that are being studied for tissue regeneration of periodontal resorptions.

FRP has recently been used in the treatment of periodontitis. The fibrin membranes of A-PRF contain autologous growth factors in supra-physiological concentrations. The membranous shape is convenient to insert in angular bone lesions.

The fibrin network has also been shown to serve as a temporary matrix for space creation, supporting angiogenesis and blood clot formation in periodontal pockets.

Randomized clinical trials involving the use of FRP for the regeneration and repair of subosseous defects and furcations are compelling.

Comparative studies show that this regeneration modality reduces periodontal pocket depths and increases the level of clinical gingival attachment when used alone or in combination with other periodontal biomaterials.

5. THE USE OF PRF IN DENTAL IMPLANT PLACEMENT


The use of FRP promotes angiogenesis and tissue healing around the implants
.

The action of FRPs is beneficial to bone healing during osseointegration of implants and also to the improvement of the soft tissue around them.

Treatment protocols are accelerated. Long-term maintenance is optimized due to the increased quality of the hard and soft tissues.

Dental implants have gradually become the standard for replacing missing teeth. Today, notwithstanding the possible hazards, implant osseointegration is no longer considered a probability but a virtual certainty.

Practitioners’ attention is now focused on the speed and quality of osseointegration. Surgical techniques are aimed at improving bone quality to optimize primary stability at the time of implant placement.

The consequence is a shortening of the implant loading time: early loading at 6 weeks or immediate loading.

Surgical therapies have been optimized, such as long-term esthetic stability, which depends on the periodontal biotype, i.e. the quality of the gingiva and the quantity and quality of the bone supporting the dental implant.

The management of the gingival tissue surrounding the dental implant and its restoration is a major issue. It is now recognized that vascularization of the bone and gingival tissues surrounding the dental implant is essential for long-term stability. Past and current trends have focused on bone and bone augmentation as keys to implant success.

For this reason, it is essential to ensure that implant sites are managed appropriately to optimize bone and gingival tissue.

The contribution of PRF and PRP is fundamental in this approach since platelet blood concentrates significantly promote angiogenesis, i.e. the proliferation of blood vessels in the tissues in which they are placed. Therefore, the addition of PRP or PRF to gingival and bone tissues induces a new vascularization and increases the quality and vitality of these so-called “soft” and “hard” tissues.

Remplacement d'une dent du sourire comme un incisive centrale par un implant dentaire et une couronne cosmétique
prf-rog-cas

6. THE USE OF PRF IN GUIDED BONE REGENERATION (GBR)

Guided Bone Regeneration has played a leading role in regenerative dentistry since the mid-1980s.

The principle of Guided Bone Regeneration ROG (i.e. GBR) is underpinned by the use of collagen barrier membranes that prevent infiltration of the bone tissue by fast-growing gingival tissue competing with slower-growing mineralized bone tissue.

These concepts are widely used in bone reconstruction in pre-implant oral surgery.

Bone morphogenetic proteins (BMPs) are considered the gold standard for facilitating new bone formation. In particular the BMP 2. However, a wave of research using autologous platelet concentrates (PRP and PRF) has demonstrated the optimization of post-surgical angiogenesis with

The use of liquid PRP, due to the incorporation of anticoagulants, is questionable in the case of ROG since the presence of the fibrin clot is preponderant.

The second generation of autologous platelet concentrate (PRF) has been used in dentistry, due to its preparation protocols in the form of fibrin membrane. PRF was developed as a new generation membrane for ROG procedures.

The osteo-conduction and biocompatibility of bone grafts and resorbable (or non-absorbable) barrier membranes have been widely discussed in the literature. Now, biomaterials as bone grafts are no longer used as passive materials: mixed with PRFs, they have acquired the additional advantage of being activated by the patient’s own scar blood cells and growth factors. By exploiting the blood elements that induce bone formation, biomaterials have become bioactive.

7. IMMEDIATE LOADING OF A COMPLETE PROSTHESIS WITH THE PRF

The dental rehabilitation of patients with complete edentulism remains a major challenge for the practitioner.

It is now estimated that more than 20% of the population aged 65 years and over, suffers from complete tooth loss. As the population ages, this number will only continue to grow.

In Dr. Alain Simonpieri’s protocol, the primary stability of dental implants in native bone is optimized by the placement of an immediate prosthesis (full arch screw-retained). It reduces micro-movements to less than 200 microns. This is the basis of the technique.

Implant surgical techniques for immediate loading after dental implant placement increase the survival rate and gingival esthetics through very early immobilization of the implants.

The goal is to maintain long-term stability of the implants and the aesthetics of the prosthesis. The use of autologous platelet-rich fibrin (PRF) in its membrane (A-PRF) and injectable (I-PRF) form as biological agents capable of inducing early vascularization of bone and soft tissue optimizes this goal. This means that the contribution of a-PRF and i-PRF in this surgical technique optimizes the main objective, which is to achieve optimal osseointegration and long-term stability of the hard and soft tissues around the implants in order to preserve esthetics.

rajeunissement du visage
PRP esthétique
acide hyaluronique esthétique

8 . THE USE OF PRF IN AESTHETICS AND FACIAL REJUVENATION

The development of centrifugation protocols at lower speeds than for PRP, has allowed the development of a liquid Rich Fibrin Plasma that can be injected into soft tissue, I-PRF.

It can be used as an autologous substitute for conventional PRP therapies. Unlike the latter, it has the advantage of not containing any additives or known anti-coagulants-inhibitors of tissue regeneration.

I-PRF injections into the dermis or connective tissue of the face is undeniably a major protocol in skin rejuvenation therapies.

In addition, these injections around or in scars are particularly effective for the reduction of keloid scars or acne scars.

We note the growing number of dentists who are training in facial aesthetics. As the population continues to age, they are also increasingly concerned about their aesthetic appearance. An increasing use of products including Botox, hyaluronic acids, PDO threads, and platelet-rich plasma (PRP), among others, has been used for facial rejuvenation procedures.

It is now estimated that more than 16 million cosmetic procedures are performed each year in the United States and this trend is expected to continue to increase as the population ages. The techniques are more practical, more economical and safer.

9. USE OF FIBRIN-RICH PLASMA IN THE FIELDS OF MEDICINE

Plasma Rich Fibrin (PRF) is widely used in dental surgery, but it is applied much more often in general medicine for various indications.

FRP was first used for the treatment of painful leg ulcers. They have also been shown to improve a variety of leg and hand ulcers;

PRF is used in plastic surgery and aesthetic medicine to treat facial soft tissue defects, superficial rhytides (wrinkles), acne scars, lipostructure surgical procedures;

FRP is used in ENT to heal acute traumatic perforations of the ear drum;

PRF is used in orthopedics and rheumatology to treat tendon injuries, knee osteoarthritis, chronic rotator cuff tears in rheumatology;

– The PRF is used in general surgery for the management of laparoscopic cholecystectomy, vaginal prolapse repair, urethra-cutaneous fistula repair;

These indications are just a few of the many indications for FRP for extensive regeneration across various fields of medicine outside of dentistry.

Every day, new applications are discovered. The story of regenerative medicine and dentistry is just beginning.

jérôme Weinman - chirurgien - dentiste – contact
THE ANTHOLOGY OF OUR CLINICAL CASES

YOU ARE UNIQUE!

CLINICAL APPLICATIONS OF REGENERATIVE DENTISTRY TISSUE REGENERATION AND PRF

INITIAL SITUATION VS. CLINICAL OUTCOME

WHAT ARE THE BIOLOGICAL COMPONENTS OF PRF (PLATELET RICH FIBRIN)

The biological components of PRF (Platelet Rich Fibrin): Growth factors and their action on cellular activity.

During the natural healing process, blood plays a central role in tissue regeneration by providing various types of blood cells, growth factors, cytokines and clotting factors.

The concept of PRP, like that of PRF, is the acceleration and potentiation by autologous natural blood agents of the body’s natural healing or regenerative processes.

All of this is possible thanks to the injection of supra-physiological doses of platelets containing the molecular factors that induce tissue regeneration.

PRP (Platelet Rich Plasma) was originally developed to increase the number of platelets in scar sites. However, the use of animal anticoagulants does not make this protocol optimal, even if the recovery is considered almost optimal.

The second generation concentrate called PRF (Fibrin Rich in Platelet) was therefore developed as seen previously.

Les cellules souches et la régénération tissulaire aux facteurs de croissance tissulaire, les PRP et les PRF

THE BENEFITS OF PRF

Les utilisations du PRF (Plasma Rich Platelet) dans les domaines de la médecine régénérative et de la dentisterie régénérative

First advantage: it is 100% natural with no exogenous anticoagulant

Over the years, many discoveries have led to the understanding that fibrin acts on the anchoring of different types of cells and thus allows a slow and progressive release of growth factors by these cells.

This release has been shown to improve angiogenesis, the behavior of healing cells and thus tissue regeneration.

Second advantage, it optimizes tissue engineering

It provides the three fundamental keys to optimizing tissue engineering, namely:

Like PRP, FRP contains a lot of blood platelets. Preparation of PRF with a modification of the centrifugation speed and centrifugation time allows an enrichment in elements of the healing plasma cell group. Decreasing the speed and time of centrifugation has been shown to increase the number of macrophages and leukocytes. These cells are important for host defense and wound healing.

These blood cells play a major role in wound healing because they secrete many growth factors capable of inducing cell migration, proliferation and differentiation. These platelets and cells of the scarring group, such as leukocytes, secrete a large number of molecular factors that induce regeneration and tissue growth.

In particular:

  • Transforming Growth Factor-B1 (TGF-B1);
  • Platelet-Derived Growth Factor (PDGF);
  • Vascular Endothelial Growth Factor (VEGF);
  • Insulin-like Growth Factor-1 (IGF-1), capable of further promoting cell migration, proliferation and differentiation.

PRF contains 100% of the leukocytes in the sample, compared with 10 to 50% of the leukocytes in PRP, depending on the material used.

Since anticoagulants are not used for the preparation of PRF, a three-dimensional fibrin scaffold is formed, in a completely biological and natural way. Over the years, many discoveries have led to the understanding that the and

Scientific research has led to the understanding that this fibrin clot has two simultaneous actions:

  • To hold captive the different types of blood cells necessary for healing: fibrin acts on the anchoring of different types of cells.
  • Growth factors are released gradually over time, both in quantity and in nature: the anchoring of cells in the fibrin matrix allows a slow and progressive release of growth factors by these cells.

This release of growth factors, with a different quantity and nature over time, has been shown to induce cellular behavior, allowing angiogenesis and ultimately tissue regeneration.

Thus, it is easy to see that FRPs allow the body to heal faster and more efficiently.

WHAT ARE THE PRF MANUFACTURING PROTOCOLS AND THEIR EVOLUTION?

THE EVOLUTION OF PRF MANUFACTURING TECHNIQUES TOWARDS THE CONCEPT OF LOW SPEED CENTRIFUGATION

Over the past five years, further modifications of centrifugation speed and time have improved FRP manufacturing protocols. A new concept has emerged, now called the “low speed centrifugation concept”.

Decreasing the centrifugation speed of freshly collected blood from the patient in specially adapted tubes allowed the collection of a new set of cells, mainly leukocytes.

The concept of low speed centrifugation (LSCC) introduces the idea that with the reduction of the applied centrifugation force or RCF (Relevant Centrifugation Forces) the fibrin matrix traps an increased number of healing inflammatory cells and platelets, which in turn contain growth factors.

Advanced PRF (A-PRP) and Advanced PRF plus (A-PRF +) take the form of solid matrices, which is the basis of PRF.

A-PRF + prepared according to the LSCC concept, compared with PRF, has an increased number of platelets and leukocytes. It shows significantly higher concentrations of growth factor release over 10 days.

In addition, further reduction of RCF based on the LSCC concept allowed the development of an injectable PRF (i-PRF) without the use of anticoagulants. Special blood collection tubes naturally delay the organization of the fibrin matrix without the use of anticoagulants, allowing clinical use in a short but reasonable time.

The i-PRF, prepared with the lowest FCR, includes the highest number of leukocytes and platelets, illustrating the effect of LSCC on this blood concentrate system.

Leukocytes are the main protagonists of the healing and regeneration process. Their presence in the Advanced PRF and Injectable-PRF matrices highlights their improved regenerative capacity. The new protocols for manufacturing A-PRF matrices and I-PRF injections have a wide range of clinical applications in dentistry, maxillofacial surgery and other medical fields.

Due to their simplified, minimally invasive preparation protocol, the effectiveness of this system is obvious.

THE PROTOCOL FOR OBTAINING PRF (J.CHOUKROUN, SCHLEICHER 2000)

How are FRPs prepared?

Blood is composed of 99% red blood cells, 0.2% white blood cells and 0.6-1% platelets (thrombocytes), which are used for blood clotting.

A blood sample is taken from the patient in up to 4 vials of 10 ml (a small amount compared to the total volume of blood and equivalent to a conventional blood test).

Centrifugation of the blood vials separates its components and recovers a platelet-rich concentrate.

One part is used to prepare a thin membrane about 1mm thick which are used to cover the surgical sites.

Another part may be mixed with autogenous, allogenous, xenogenic or alloplastic (synthetic) bone which is used to fill the bone defect.

Clinical uses: Sinus fillings with, depending on the case, the possibility of immediate implant placement, filling of bone deficits after extraction, soft tissue healing after implant placement.

Conclusion: Thanks to the work of genetic engineering over the past 10 years, bone regeneration is occurring faster, in greater quantity and quality, and with a safer margin than other methods.

The surgical techniques used are optimized by the contribution of autologous platelet concentrate.

The PRP or Plasma Rich Platelet is a system distributed by the company REGENLAB validated by Professor Meningaud (Henry Mondor Hospital)

The PRF or Platelet Rich Fibrin is a protocol of recovery developed by Dr. J. Choukroun.

Some other blood centrifugation techniques:   Plasma Rich in Growth Factors or P.R.G.F (Anitua 1999)

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