PRF brings new challenges to dental clinics-American Dental Forum

2021-12-15 01:10:09 By : Mr. Jacky chen

Wednesday. December 15, 2021, 9:00 AM Eastern Standard Time (New York)

Professor Ingrid Różyło-Kalinowska

Wednesday. December 15, 2021, 8:00 PM Eastern Standard Time (New York)

Friday, December 17, 2021, 7:00 AM Eastern Standard Time (New York)

Monday, December 20, 2021, 1:00 PM Eastern Standard Time (New York)

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Recent research has focused on the development of natural treatment alternatives that are easy to prepare, non-toxic, or biocompatible with living tissues, and are affordable. The goal is to release growth factors locally, thereby accelerating the healing of hard and soft tissues.

PRF is a natural fibrin-based biological material without anticoagulants or artificial additives (biomedical modifiers), allowing us to obtain autologous fibrin membranes and embolisms with high concentrations of platelets and leukocytes to release growth at the surgical site Factor 7 to 14 days and accelerate the natural healing process.

Literature evidence shows that the potential role of PRF in most oral surgery is the key to regeneration and tissue engineering. The slow polymerization during centrifugation and the fibrin-based structure can make PRF a better healing biomaterial than PRP and other fibrin adhesives, but the literature is also controversial, and many publications have proved the excellent effects of PRP and PRF.

Figure 1: Boca Dental Supply blood collection tube steri-pack is a single-use medical-grade packaging for blood collection and PRF manufacturing. Discard any unused tubes. Figure 2: Doctors usually take less than two minutes to draw blood from a patient. Figure 3: PRF clot in the PRF box. Figure 4: PRF plug. Figure 5: PRF sticky bone. Figure 6: PRF short ribs. Figure 7: Ordinary natural glass tube and silica-coated tube. Figure 8: Ordinary natural glass tube and silica-coated tube. Figure 9: Ordinary natural glass tube and silica-coated tube. Fig. 10a-e: PRF is used for invasive surgery.

There is evidence that the presence of growth factors and cytokines in platelets plays a key role in inflammation and wound healing. Platelets also secrete fibrin, fibronectin, and vitronectin, which act as a matrix of connective tissue and adhesion molecules for more efficient cell migration. This led to the idea of ​​using platelets as a therapeutic tool to improve tissue repair during wound healing.

Due to its benefits to soft tissues, PRP is now widely used for facial rejuvenation, joint regeneration, hair growth stimulation and ED treatments. Moreover, due to easier and cheaper alternatives, PRF fluids are beginning to be used in place of PRP (PRP $450 per patient vs. PRF $8).

Compared with PRP, the advantages of PRF are as follows:

The production of all blood concentrates at the patient's treatment site poses new challenges for dentists and staff: infection control protocols, staff training, education and research on the products used in the PRF production process.

Handling patients’ blood and manufacturing blood products Transforming dental clinics into blood bank facilities should follow stricter cross-contamination control protocols to avoid doctors’ liability risks and comply with US Centers for Disease Control (CDC) and OSHA federal regulations and follow surgical care protocols Standard for operation.

PRF is used for invasive bone surgery that is close to the eyes, ears, brain and in direct contact with bones, maxillary sinuses, veins, arteries, and nerves. If proper pollution control protocols are not followed, these procedures may be adversely affected.

All instruments used to manufacture PRF should be aseptically sealed and placed in a sterile area separate from instruments used to remove contaminated tissue, debride bones, and extract teeth. The two-site agreement will eliminate the risk of PRF membrane contamination, PRF sticky bone and PRF short ribs will be used for bone reinforcement, and PRF exudate that can be used as a sealant for the surgical site.

Tourniquets, bandages, gauze, needles and blood collection tubes can only be used as packaging for a single patient. I use the blood collection tube steri-pack (BCTSP) from Boca Dental Supply, LLC.

BCTSP tube is the only disposable medical grade packaging used for blood collection and manufacturing PRF in the global market. After opening the tube pack, discard any unused tubes.

The manufacture of PRF membranes and stoppers is a simple four-step protocol:

Doctors usually take less than two minutes to draw blood, and the rest of the procedures for making PRF can be performed by appropriately trained staff.

The blood is collected in a glass tube and centrifuged for eight minutes. The contact of the clotting factor with the natural hydrophilic glass surface activates the coagulation cascade, resulting in the conversion of fibrinogen to fibrin, forming a natural PRF clot.

If plastic tubes are used for PRF clots, PRF membranes and PRF plugs, these tubes may contain additives such as silica and other hazardous chemicals to simulate the clothing characteristics of natural glass. The final product will be chemically induced and will produce artificial PRF membranes and Artificial PRF clot of the stopper.

Using plastic tubes with silica coatings and other chemicals to mimic the natural properties of glass poses the challenge of not knowing what damage dentists can cause to the health of patients. Literature and research evidence indicate that silica and other coatings with chemicals or additives used in laboratory blood collection tubes increase the risk of cancer and damage DNA. When PRF goes from cardiovascular and general surgery to dentistry, the use of plastic tube silica and other hidden additives can be harmful and contradict the basic philosophy of PRF: "No anticoagulants and additives."

More research is needed to determine the ultimate damage of silicon dioxide and other additives in plastic blood collection tubes to grafted bones, maxillary sinuses, periodontal defects, and all other bone enhancement procedures in the graft area and post-extraction sites. There are currently no publications or studies available to evaluate the possible cancer and systemic effects of silica and all other chemicals that mimic natural glass in plastic laboratory tubes when used in the manufacture of PRF.

When using plastic blood collection tubes without any additives for blood collection and centrifugation, we get liquid PRF, which is used to apply to the sticky bone and convert it into PRF steak ribs. This improves the handling characteristics of the bone and helps to keep the bone graft material in a solid form and prevents small particles of bone from migrating between the patient's bone and periosteum. The migration of small bone particles may be a cause of increased inflammation and swelling after surgery.

Because the time to process the blood in the plastic tube to make the PRF liquid in the centrifuge is reduced, less heat will be generated, allowing a greater number of live white blood cells without degradation. This will speed up the healing process; it is also possible that when the blood is processed at 700 RPM or lower, some stem cells may also be concentrated in the PRF fluid.

PRF is the latest and most popular technology to accelerate dental healing. In most large-scale dental implant conferences and conferences in the fields of oral and maxillofacial surgery, periodontology, OMS, endodontics, implantology and bone regeneration, the number of speakers showing successful cases has increased year by year.

As clinicians involved in the regeneration process and PRF manufacturing, we are obliged to use only materials and supplies that ensure patient safety, and at the same time eliminate the clinician’s liability risks.

Note: Dr. Alvaro Betancur is the inventor of the blood collection tube Steri-Pack (BCTSP).

Do dentists usually test for HIV or other blood-borne infections as part of the PRF process, or does disposable equipment, gloves, etc. mean that such testing is not performed as part of the PRF program?

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