L-PRF in dental surgery
Introduction
L-PRF is a special material derived from your own blood that helps with healing. It's rich in things like fibrin, platelets, white blood cells, and growth factors. These components play a crucial role in tissue repair and regeneration, also within the oral cavity.
The platelets and white blood cells in L-PRF have amazing properties that help stop bleeding, promote the growth of new blood vessels, reduce pain, and speed up wound healing. These qualities make L-PRF particularly useful in dental surgeries, where it aids in the repair and regeneration of both soft and hard tissues.
information for your dentist, periodontologist, maxillofacial surgeon
open access
1. Natural regeneration of bone after tooth loss
After a tooth is extracted, the jawbone in the area where the tooth was will start to shrink, particularly on the side near your cheek. The bone width can shrink a lot, up to 60%, and the height by more than 2 mm. Most of this shrinking occurs within the first 3 months after the tooth is removed. The bone will continue to shrink afterwards, especially if there are issues like gum disease or infections around the tooth root. Using L-PRF right after the tooth extraction can help reduce this shrinkage by supporting bone repair/regeneration.
a. L-PRF application immediately after tooth extraction
When the bone left after a tooth is removed is intact (A) or only slightly damaged (B), L-PRF (in yellow) is placed into the wound (C,D). The opening of the socket/wound is then covered with L-PRF membranes (yellow with an orange line), and it is not necessary to close the wound completely (C & D). This process can reduce bone shrinkage by 50-70%.
b. L-PRF application after initial wound healing
When there is significant bone loss after a tooth is removed (A), it is best to wait for the soft tissue to heal first. The bone defect can then be treated in two ways: (B) using L-PRF alone, or (C) using a mixture of L-PRF and a bone substitute (blue stars for the bone substitute and yellow & orange pieces for chopped L-PRF membranes). The bone substitute can come from your own body (autologous), another person (allograft), an animal (xenograft), or be made in a lab (alloplast). For larger defects, a slow-resorbing barrier membrane (white structure) might be needed to stabilize the graft, and the wound must always be closed completely. In very large defects (D), a bone-block from your jaw or another source (allograft/alloplast/xenograft) is often used because it is more stable.
2. Natural regeneration of bone in sinus after pneumatization
The maxillary sinus is an air-filled space above your upper jaw. As you grow, this sinus enlarges and fills with air, which helps make your skull lighter and improves the sound of your voice. However, when a tooth (from the back part of the upper jaw) is removed, the open space where the tooth roots were can cause the sinus to expand even more. This is called sinus pneumatization. It can sometimes complicate dental procedures, like implant surgery, because there's not enough bone to work with. L-PRF helps to regenerate the lost bone in the sinus.
L-PRF application for bone formation in the sinus maxillaris
When a tooth is removed, the sinus floor can drop down. To push it back up to its original position, there are different treatments:
A: Transcrestal technique: If there's enough bone left, a small cylindrical hole (implant osteotomy) is made where the tooth root was. L-PRF is placed into the sinus through this hole, carefully pushing the sinus membrane up. Then, an implant is placed in the osteotomy. The area filled with L-PRF will partially turn into bone.
B & C: Window technique: If there's not much bone left, a small opening (window) is made in the bony wall of the sinus facing the cheek. The sinus membrane is lifted up, and the newly created space is filled. If the bone is strong enough, an implant is placed at the same time, and the sinus can be filled with just L-PRF; the L-PRF will partially turn into bone. The implant helps keep the sinus membrane up and prevents pneumatization (B).
If an implant can't be placed right away, the space needs to be filled with a bone substitute (helping to resist pneumatization), often a xenograft or alloplast. L-PRF can be added to the substitute to help the bone grow faster and improve its quality (C).
3. Natural regeneration of bone lost due to periodontitis
Periodontitis is a serious gum infection that damages the soft tissue and bone supporting your teeth. It is caused by plaque, a sticky film of bacteria that forms on your teeth. If plaque isn't removed by brushing your teeth and cleaning between your teeth (using a toothpick, interdental brush, or dental floss), it can lead to gum inflammation, called gingivitis. If gingivitis isn't treated, it can turn into periodontitis (see radiographs). Your immune system fights the bacteria, but the infection also breaks down the bone and tissue that hold teeth in place. Over time, this can and often will lead to tooth loss.
L-PRF application for bone regeneration after periodontitis
To regenerate the lost bone (initially filled with granulation tissue, shown in red in A) more predictably, pieces of chopped L-PRF membranes are applied in the bony crater (yellow & orange pieces), and the defect is covered with L-PRF membranes (B). In large defects (C), a mixture of chopped L-PRF pieces and a bone substitute is used as filler to improve bone healing.
4. Natural regeneration of gingival recessions
Gum recession occurs when your gums pull back or wear away, exposing more of your teeth or their roots. This can cause cosmetic issues, tooth sensitivity, and damage to the exposed areas. To fix this, a small surgery can be performed where the gums are lifted to cover the exposed roots. Often, a piece of soft tissue from the roof of your mouth (the palate), called a connective tissue graft, is placed under the gums to help them heal better and make them stronger to to resist recession.
However, the wound from taking a graft can be painful, especially for the first days. Alternatively, L-PRF membranes can be used instead of the connective tissue graft, which reduces the pain of the procedure.
L-PRF application for the regeneration of gingiva
Final situation after covering the exposed root by lifting the gums. Several L-PRF membranes (yellow and orange, 4 layers in this case) are placed under the flap and over the recession. The gums are sutured to create a stable condition for optimal healing.