Leukocyte-rich Fibrin Research Articles

Scientific evidence available after 18 years of application of fibrin rich in platelets and leukocytes in the repair of surgical wounds: An integrative review

Introduction: In the last 18 years, Platelet and Leukocyte Rich Fibrin (L-PRF) has emerged as an innovative biomaterial in regenerative medicine and dentistry, standing out for its ability to continuously release growth factors and promote more efficient healing. However, the variability in the preparation and application of L-PRF, together with the lack of standardization, represent major challenges, increasing the need for further research to improve and standardize its clinical use. Materials and Methods: This study is an integrative review, with no need to submit it to the Research Ethics Committee. The guiding question was: “What is the main evidence in the literature on the applications of platelet- and leukocyte-rich fibrin in dentistry?”. Results and Discussion: L-PRF has proved effective in various areas of dentistry. In implantology, it accelerates bone healing and improves implant integration. In periodontics, it promotes regeneration of bone damage and improves the quality of periodontal tissue. In gingival recessions and soft tissue lesions, it accelerates regeneration and reduces post-operative discomfort. In periodontal and maxillofacial surgery, it contributes to a faster and more comfortable recovery from swelling and pain. Variability in the preparation and application of L-PRF is still a challenge, and standardization of protocols is essential to ensure more consistent and predictable results. Conclusion: After 18 years, L-PRF has shown beneficial effects in dentistry, especially in terms of bone regeneration and improved post-operative healing. However, the standardization of protocols seems to be crucial in order to improve its clinical results.

Bibliometric survey from 1964 to 2023 on the applications of platelet and leukocyte rich fibrin (L-PRF) in oral and maxillofacial surgery

Bibliometric survey from 1964 to 2023 on the applications of platelet and leukocyte rich fibrin (L-PRF) in oral and maxillofacial surgery

The efficacy of Platelet and Leukocyte Rich Fibrin (L-PRF) in the healing process and bone repair in oral and maxillofacial surgeries: a systematic review.

The search to optimize the healing and bone repair processes in oral and maxillofacial surgeries reflects the constant evolution in clinical practice, driven by the demand for increasingly satisfactory results and the need to minimize postoperative complications. To evaluate the efficacy of Platelet and Leukocyte Rich Fibrin (L-PRF) in the healing and bone repair process in oral and maxillofacial surgeries. The systematic review protocol for this study included the definition of the research question, the domain of the study, the databases searched, the search strategy, the inclusion and exclusion criteria, the types of studies to be included, the measures of effect, the methods for screening, data extraction and analysis, and the approach to data synthesis. Systematic literature searches were carried out on Cochrane databases, Web of Science, PubMed, ScienceDirect, Embase and Google Scholar. The strategic search in the databases identified 1,159 studies. After removing the duplicates with the Rayyan© software, 946 articles remained. Of these, 30 met the inclusion criteria. After careful evaluation based on the inclusion and exclusion criteria, 8 studies were considered highly relevant and included in the systematic review. Platelet and Leukocyte Rich Fibrin (L-PRF) has a positive effect on the healing process and bone repair in oral and maxillofacial surgeries.

Use of platelet- and leukocyte-rich fibrin (L-PRF) as a healing agent in the postoperative period of third molar removal surgeries: a systematic review.

The aim of this study was to analyze the effectiveness of L-PRF as a healing agent in the postoperative period of third molar extraction surgeries, as well as to investigate secondary effects, such as the reduction of pain, edema and other discomforts after the surgical intervention. The methodology adopted consisted of carrying out a systematic review of the literature, following the model outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The inclusion criteria were previously established according to a systematic review protocol approved by the Prospective Register of Systematic Reviews (PROSPERO) under number CRD42023484679. In order to carry out a comprehensive search, a search in five databases was carried out, PubMed, Web of Science, Scopus, Cochrane Library and Embase. The search resulted in the selection of randomized controlled trials that conformed to the established criteria. Two authors independently screened the records and extracted the data. The assessment of bias was conducted according to the guidelines recommended by the Cochrane Collaboration, using version 2 of the Cochrane tool for assessing the risk of bias in randomized trials (RoB 2). This study demonstrated that L-PRF stands out by providing direct benefits to healing, vascularization and tissue regeneration. L-PRF plays an important role in reducing postoperative pain, edema, the incidence of alveolar osteitis and infections after third molar removal surgery, compared to patients who did not undergo the use of L-PRF.

Major clinical outcomes of the use of biostimulators (L-PRF and coenzyme Q10) in the optimization of buccomaxillofacial surgery: a systematic review

Introduction: Tissue engineering combines three key elements matrix (three-dimensional structures that support growth, collagen cell, bone mineral), signaling molecules (growth factors (GF) and leukocyte cytokines), and cells (osteoblasts, fibroblasts or other adequate populations for tissue regeneration. Many studies suggest that antioxidants act as inhibitors of osteoclastogenesis and the inhibitory effect of CoQ10 on osteoclast differentiation. These findings highlight the potential therapeutic applications of CoQ10 for the treatment of bone diseases. Objective: The present study highlighted the main approaches to the use of fibrin-rich plasma (L-PRF) and coenzyme Q10 in buccomaxillofacial surgery through a systematic review. Methods: The systematic review rules of the PRISMA Platform were followed. The search was carried out from October 2023 to January 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases, using articles from 2006 to 2022. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed accordingly, according to the Cochrane instrument. Results and Conclusion: A total of 104 articles were found, 38 articles were evaluated and 23 were included and developed in this systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 36 studies with a high risk of bias and 20 studies that did not meet GRADE. The use of platelet and leukocyte-rich fibrin can reduce bone absorption, infection, pain, local edema, and wound healing. L-PRF presents itself as an autogenous biomaterial with great versatility, low cost, easy acquisition and wide use, and infinite possibilities. It can be combined with other materials in the most diverse areas of dentistry. Also, CoQ10 concentrations can suppress ROS, which is needed as a signaling intermediate. CoQ10 acts as an enhancer of all stages of osteoblastic differentiation. Thus, CoQ10 suppresses osteoclast differentiation by eliminating generated intracellular ROS. Furthermore, CoQ10 enhances bone regeneration in all differentiation processes through transcription factor activity.

Applications of platelet- and leukocyte-rich fibrin (L-PRF) in Oral and Maxillofacial Surgery

Introduction: Oral and maxillofacial surgery plays a crucial role in the reconstruction and restoration of facial structures, seeking to improve both aesthetics and function. The use of platelet-rich fibrin (L-PRF) represents a notable advance, accelerating healing and improving surgical outcomes. Materials and Methods: This review covers 710 studies from various electronic databases (PubMed, Scopus, Web of Science, Science Direct and Google Scholar). The aim is to thoroughly investigate the applications of platelet- and leukocyte-rich fibrin (L-PRF) in Oral and Maxillofacial Surgery and Traumatology. Results: The analysis reveals that L-PRF stands out as an effective autologous therapy in oral and maxillofacial surgery. Its application shows remarkable potential for accelerating the healing process, contributing significantly to the effectiveness of procedures. Discussion: L-PRF has emerged as an excellent choice in oral and maxillofacial surgery and traumatology, improving both the aesthetic and functional aspects of facial reconstructions. This highlights the relevance of this autologous therapy and its benefits in surgical practice. Conclusion: The applications of platelet and leukocyte-rich fibrin (L-PRF) in Oral and Maxillofacial Surgery and Traumatology are fundamental and promising. This advance represents not only a means of accelerating healing, but also a significant contribution to better aesthetic and functional results in surgical procedures in this area.

Platelet and leukocyte rich fibrin (L-PRF) applied in necrotizing Fasciitis treatment: case report

The reconstruction of extensive defects on the face caused by infections is a challenge for the oral and maxillofacial surgeon. Platelet and leukocyte-rich fibrin (L-PRF) is an excellent option for rehabilitative treatment, as it contains molecular and cellular elements that induce repair, being a therapeutic biomaterial with high potential for soft tissue regeneration. This article presents the clinical case of the patient C.T.A.S., female, 21 years old, who reported multiple tooth extractions, with an evolution of 30 days of volume increase and intense algesia in the left bucal space. Diagnosing necrotizing fasciitis, the patient underwent IV antibiotic therapy and surgery to drain and debride the lesion. Postoperatively, therapy with platelet- and leukocyte-rich fibrin was initiated for tissue regeneration in the area affected by fasciitis. As an adjuvant to L-PRF membranes, low-level laser therapy and hyperbaric oxygenation sessions were performed. When using L-PRF to resolve this case, a satisfactory result was observed regarding the aesthetic-functional repair. In addition to having the advantage of being cost-effective, and having a simple protocol to be performed, L-PRF proved to be effective in promoting tissue regeneration.

Use of platelet- and leukocyte-rich fibrin (l-prf) in bisphosphonate-related osteonecrosis of the jaw (bronj) in rats - split-mouth study

This study aimed to clinically evaluate the effect of platelet- and leukocyte-rich fibrin (L-PRF) membranes in preventing bisphosphonate-related osteonecrosis of the jaw (BRONJ) in rats. In this study, twelve Wistar rats (six males and six females) were used. A split-mouth study was performed; the right-side was used as treatment, with treatment of platelet- and leukocyte-rich fibrin membranes (L-PRF group, LPRFG), and the left-side received no intervention as control (control group, CG). The rats received intravenous Zolendronate (Zol) (80 ug/kg/week) injections during nine weeks to induce the BRONJ. The surgical extractions were divided into two stages: in the eighth week of Zol injections, the first lower molars on both sides were removed followed by bone decorticalization. In the ninth week of Zol injections, extractions of the second lower molars were performed on both sides, followed by bone decorticalization. L-PRF membranes were made of 1 ml of blood by cardiac puncture. The following clinical variables were analyzed: presence of bone exposure, inflammation (edema, erythema), suppuration, bony sequestrum and epithelialization of the alveoli. In addition, the mesiodistal (MD) and buccolingual (BL) dimensions of bone exposure were obtained using a millimeter probe. Statistical analysis was performed using Fisher's exact test, with a significance level of 0.05. There were no significant differences between the sides regarding the presence of bone exposure, inflammation, suppuration, bony sequestrum and epithelialization of the alveoli (p > 0.05). However, lower bone exposure was observed in the MD (p = 0.002) and BL (p = 0.03) dimensions in the LPRFG. Thus, the use of L-PRF membrane decreased bone exposure contributing to the alveoli healing of BRONJ in rats.

Use of platelet- and leukocyte-rich fibrin (L-PRF) as an alternative for tissue regeneration in sinus lift surgery

This study aimed to understand how fibrin rich in platelets and leukocytes acts as an alternative for tissue regeneration in surgeries for maxillary sinus elevation. This integrative review was developed in six steps, where the guiding question was formulated according to the PICo strategy. Thus, a total of 142 publications were searched and a total of 23 articles were selected for this review after applying the inclusion and exclusion criteria. Platelet- and leukocyte-rich fibrin (L-PRF) has been increasingly investigated as a potential bioactive substance for more effective bone regeneration, not only because it is considered an easily obtained autogenous material, but also due to its high concentration of fibrin, platelets and leukocytes, assisting in the process of angiogenesis, thanks to its growth factors, which contributes to bone formation when associated with grafts, as it multiplies fibroblasts and osteoblasts. Furthermore, for the surgical method, the use of L-PRF decreases the dispersion of the graft particles used, helping to condense more mineral and consequently resulting in a smaller volume introduced into the maxillary sinus, thus minimizing the time to obtain vertical bone height. However, since the preparation is properly autologous, the amount of L-PRF acquired is insufficient, causing a disadvantage in its use. In this sense, we realize the importance of L-PRF in maxillary sinus elevation surgery, as it is a simple, cheap and the most accessible technique for the production of autologous fibrin membrane or platelet concentrate.

SECEC Research Grant 2008 II: Use of platelet- and leucocyte-rich fibrin (L-PRF) does not affect late rotator cuff tendon healing: a prospective randomized controlled study

Because the retear rate after rotator cuff repairs remains high, methods to improve healing are very much needed. Platelet-rich concentrates have been shown to enhance tenocyte proliferation and promote extracellular matrix synthesis in vitro; however, their clinical benefit remains unclear. We hypothesized that arthroscopic rotator cuff repair with leucocyte- and platelet-rich fibrin (L-PRF) results in better clinical and radiographic outcome at 12 months of follow-up than without L-PRF. Thirty-five patients were randomized to receive arthroscopic rotator cuff repair with L-PRF locally applied to the repair site (L-PRF+ group, n = 17) or without L-PRF (L-PRF- group, n = 18). Preoperative and postoperative clinical evaluation included the Subjective Shoulder Value, visual analog score for pain, Simple Shoulder Test, and Constant-Murley score. The anatomic watertight healing, tendon thickness, and tendon quality was evaluated using magnetic resonance arthrography at 12 months of follow-up. No complications were reported in either group. The mean Subjective Shoulder Value, Simple Shoulder Test, and Constant-Murley scores increased from preoperatively to postoperatively, showing no significant differences between the groups. Complete anatomic watertight healing was found in 11 of 17 in the L-PRF+ group and in 11 of 18 in the L-PRP- group (P = .73). The mean postoperative defect size (214 ± 130 mm(2) in the L-PRF+ group vs 161 ± 149 mm(2) in the L-PRF- group; P = .391) and the mean postoperative tendon quality according to Sugaya (L-PRF+ group: 3.0 ± 1.4, L-PRF- group: 3.0 ± 0.9) were similar in both groups at 12 months of follow-up. Arthroscopic rotator cuff repair with application of L-PRF yields no beneficial effect in clinical outcome, anatomic healing rate, mean postoperative defect size, and tendon quality at 12 months of follow-up.