PRF and PBM

A COACTION OF HEALING
 Platlet rich fibrin (PRF)
Platelet-rich fibrin (PRF), described by Choukran et a(2001)l, has become very popular in the field of
implant dentistry as well as regenerative dentistry and medicine

PRF is a matrix of autologous fibrin, in which are embedded a large quantity of platelet and
leukocyte cytokines

Fibrin platelet matrix contains numerous growth factors as a result of platelet activation including
platelet-derived growth factor (PDGF), transforming growth factor β (TGF-β, including β-1 and β-2-
isomers), vascular endothelial growth factor (VEGF), and epidermal growth factor (EGF).7 Insulin-
like growth factor-1 (IGF-1)[1]

Fibrin clot regulates release of cytokines over a 7 to 11 days as it disintegrates[2]

 
Photobiomodulation (PBM)
Low levels of red/near infrared light can interact with cells, leading to changes at the molecular,
cellular and tissue levels.
Photons of light energy, especially in the red or NIR, are predominantly absorbed in the
mitochondria
Increase in oxidative metabolisim in mitochondria
Cytochrome c oxidase (Cox) is the primary receptor
Secondary effect: Modulation of ATP, nitric oxide & reactive oxygen species
Tertiary effect: Downstream intracellular responses (gene transcription, and cellular
signaling) ,Extracellular, indirect, distant effects ,improvement in lymphatic flow
Patient medical and dental history
Forty year old female lawyer
Healthy with no reported medical conditions
Dental history
Patient is a regular dental attender with good hygiene
Long term history of bruxisim with an impressive collection of bite plates
Previous failed restorations and cerec crowns which were eventually replaced with zirconia
crowns
Upper right 5 was treated endodontically about 18 months ago
 Clinical exam
Patient complains of fractured tooth on upper right hand side
On examination 15 fractured subgingivally with canals occluded by
fractured posts, asymptomatic non tender
Radiographic examination confirms fractured post
Patient advised tooth has poor prognosis and replacement options given
to patient
Treatment plan
Patient opts for implant replacement but is unhappy with possible 6 month timeline for 2 stage
treatment plan
Laser assisted removal of root
PRF for healing and new bone growth
PBM for faster healing and improved outcomes
Laser assisted implant placement + PBM
Implant exposure with laser +PBM
Anticipated early loading
3d planning 3d planning confirms fractured posts in root

Fused roots

Thin buccal plate

Proximity of roots to sinus

Low possibility of primary stability for immediate placement of

implant
Laser assisted root removal
Performed with the use of a laser Er,Cr:YSGG
Laser parameters gold handpiece,MZ5 0.5mm tip diameter and 14mm tip length,pulsed,20Hz ,2
Watts to 4 Watts, Water100%, H mode
Laser tip angled towards root into periodontal ligament space (pdl)with progressive widening of
pdl space (full procedure discussed in separate presentation }
Luxatotors enlargen space and root piece manipulated out with minimal trauma
Laser assisted root removal
 PBM of peripheral blood
2 tubes(9ml each) of peripheral blood were collected
Photobiomodulation of collected blood as well as PBM of surgical site
flat-top handpiece for Nd:YAG (Genova™ handpiece-Fotona-Slovenia),
homogenous irradiation over a 1 cm² surface area
PBM of collected blood prior to centrifuge
pulsed mode, average power 0.5 W, total area 9 cm², application time 90 s (10 s per 1cm spot) , total
energy per tube 45 J, energy density 5 J/cm2
PBM of collected blood
PRF fabrication
2 tubes(9ml each) of peripheral blood were collected
and after undergoing 90s each of PBM they were
immdediately placed in a preprogrammed centrifuge
( DUO Quattro, PROCESS for PRF, Nice, France).
Centrifugation was performed according to the
following criteria for A-PRF sterile plain glass-based
vacuum tubes (A-PRF10 tube) (10 mL; 1300 rpm for
14 minutes).
PRF
Placement of PRF clots into surgical site
PBM of surgical site
Parameters
Flat-top handpiece for Nd:YAG (Genova™ handpiece-Fotona-Slovenia)
at 0.5 W, 10 Hz in MSP mode
Handpiece applied from buccal ,lingual and occlusal (3 spots)
pulsed mode, average power 0.5 W, total area 3 cm², application time 48 s (16 s per 1cm spot) ,
total energy to site 24 J, energy density
8 J/cm²
Post op evaluation 1 month later
 Implant fixture placement
After 4 weeks placement of implant fixture

Anyridge, Megan( Gyeongbuk, South

Korea), W4mm L10mm
PBM
Parameters
Flat-top handpiece for Nd:YAG (Genova™ handpiece-Fotona-Slovenia)
at 0.5 W, 10 Hz in MSP mode
Handpiece applied from buccal ,lingual and occlusal (3 spots)
pulsed mode, average power 0.5 W, total area 3 cm2, application time 48 s (16 s per 1cm spot) ,
total energy to site 24 J, energy density
8 J/cm²
PBM post implant placement
4 weeks post op
4 weeks post op –
good healing
shows an
acceptable
osseointegration
of the implant
Laser exposure of implant fixture

Parameters
A Fotona Lightwalker Er:YAG laser , with an H14N contact handpiece with an 8 mm long, 1.3 mm diameter
cylindrical sapphire tip. Level 4 water spray ,VLP pulse mode The spot size was 0.94 mm, frequency 20 Hz,
average power 4 W, and fluence 27.8 J/cm².
Exposure and placement of healing cap
completion
Discussion
The benefits of PBM as well as PRF are both well documented in numerous studies
The essential role of platelets in wound healing and cellular regeneration can possibly be bio
modulated via their mitochondria
Combination of reduced trauma via laser assisted surgical techniques as well as bio modulated
healing response improves surgical outcomes
Refrences
1.Fioravanti C, Frustaci I, Armellin E, Condò R, Arcuri C, Cerroni L. Autologous blood preparations
rich in platelets, fibrin and growth factors. Oral Implantol (Rome). 2016;8(4):96–113. Published
2016 Jul 23. doi:10.11138/orl/2015.8.4.096
2. Platelet-rich fibrin (PRF): A second-generation platelet concentrate. Part I: Technological
concepts and evolution.Dohan, David M. et al.Oral Surgery, Oral Medicine, Oral Pathology, Oral
Radiology and Endodontics , Volume 101 , Issue 3 , e37 - e44