L-PRF membranes for wound bandage
Introduction
Wound healing after an injury is a complex process that follows a consistent pattern across various tissues. It involves numerous cellular and humoral components, including the local influx and activation of macrophages and platelets.
L-PRF membranes, with a 20-fold higher concentration of platelets and leukocytes entrapped in a robust 3-D fibrin network, possess several essential characteristics for wound healing. These include a barrier function, an antibacterial and analgesic activity, and the release of growth factors that enhance tissue regeneration and neovascularization. As a result, L-PRF membranes can act like a bandage for wounds inside the mouth and help heal long-lasting wounds outside the mouth (like diabetic foot or venous leg ulcers); see Pinto et al. 2025.
Cases
(d = day, w = week, m = month, y = year)
1: L-PRF membranes for the increase of the gingival width around implants
Prepare a partial thickness flap with a small zone of gingiva and displace apically to achieve a recipient site free of muscle fiber attachment. Suture the flap to fix its margins and base in the new apical position by simple interrupted periosteal sutures. The exposed connective tissue is sealed with L-PRF membranes, which are sutured to the underlying tissue.
Split-mouth case (Temmerman et al. 2018).
Clinical benefits
Two RCTs investigated the outcomes of using L-PRF membranes compared to the gold standard free gingival graft (FGG) for augmenting deficient (in width) keratinized mucosa (Temmerman et al. 2018, Al-Diasty et al. 2022). The following observations were made:
-
successful augmentation was achieved with both treatment options, although L-PRF resulted in less gain in gingival width due to more initial graft shrinkage,
-
significantly better patient-reported outcome measures (PROMs) were observed with L-PRF membranes, including reduced pain, less swelling, ... ,
-
fewer per- and postoperative complications were associated with the use of L-PRF membranes.
2: L-PRF membranes for the increase of the gingival width around implants
d 0: an incision is made (more palatally), and a partial thickness flap is elevated; the flap is apically displaced, and abutments are connected.
d 0: L-PRF membranes are applied; one can make small incisions in the membrane and push the membrane over the abutment (as a poncho thanks to the membrane's elasticity); fix the flap margins with interrupted periosteal sutures.
w 1: the gingiva slowly grows over the L-PRF membranes.
w 2: nearly complete wound closure.
w 3: complete wound closure.
w 5: optimal soft-tissue healing with significant increase in gingival width, final abutments can be placed.
Courtesy T. Testori
3: L-PRF membranes for the increase of the gingival width around implants
d 0: an insufficient gingival width might jeopardize implant longevity.
d 0: an incision is made in the middle of the gingival width, and a full-thickness flap is reflected; small perforations in the exposed bone will improve the blood supply to the future graft.
d 0: the application of L-PRF membranes, just make small incisions and push the membrane over the abutment (poncho).
d 0: use 2 layers of membranes.
d 0: suture the flap but keep the L-PRF membranes partially exposed.
d 7: the gingiva slowly grows over the L-PRF membranes which also get vascularized (pink arrows).
w 3: significant increase in gingival width.
d 0: the initial gingival width.
w 3: the gingival width after augmentation.
Courtesy P. Ferrer
4: 2 cases using L-PRF membranes as wound dressing for donor sites
L-PRF membranes as wound dressing following free gingival graft harvesting, with healing after 1 and 2 weeks.
L-PRF membranes as wound dressing following free gingival graft surgery (the graft was taken very deep, and the borders are too sharp) with the healing after 1 and 2 weeks.
Clinical benefits
Several randomized controlled trials (RCTs) have compared the healing outcomes following a free gingival graft surgery between the application of L-PRF in the wound and other wound dressings. Systematic reviews of these studies (Gusman et al. 2021, Meza-Mauricio et al. 2021, Silva et al. 2023) found that using L-PRF membranes for wound dressing led to quicker healing and better experiences reported by patients (like less pain, discomfort, and bleeding).
However, some trials did not observe significant differences, likely due to variations in the control group treatments (stent, hemostatic agent).
5: L-PRF membranes in wound after harvesting subepithelial connective tissue graft
L-PRF membranes can also be used to fill wounds following connective tissue graft harvesting and primary wound closure.
Clinical benefits
Several RCTs explored the benefits of using L-PRF membranes in the management of soft tissue donor sites after harvesting a connective tissue graft (CTG) from the palate, and reported a faster healing and improved patient-reported outcome measures (e.g., less pain, less discomfort, less bleeding) when L-PRF membranes were inserted in the wound before closure (Lektemur Alpan et al. 2020, Silva et al. 2023).
Important notice
Clinical experience (widening the zone of gingiva):
-
Because there is no need for a graft, the surgery becomes easier and shorter.
Additional Benefits (widening the zone of gingiva):
-
The regenerated gingiva has a similar color as the patient's own gingiva.
-
The PROMs are significantly better with the suggested treatment strategies, especially because there is no need for a donor site.
-
Complications when harvesting a free gingival graft (e.g., paresthesia, herpetic lesions, mucocele, arteriovenous shunts, and excessive bleeding) can be avoided.
Interesting references
Several videos and/or cases on this webpage are discussed more in detail in the following book: Quirynen M & Pinto N 2022. Leukocyte- and Platelet-Rich Fibrin in Oral Regenerative Procedures. Quintessence Publishing;
ISBN: 978-1-78698-105-9