Novel and enhanced approaches of leukocyte- and platelet-rich fibrin in periodontal and implant surgery

Biomaterials have been introduced in oral surgery many years ago. The most accepted definition is from 1982 and is as follows: “any substance (other than a drug) or combination of substances, synthetic or natural in origin, which can be used for any period of time, as a whole or as a part of a system which treats, augments, or replaces any tissue, organ, or function of the body”. As also described in the definition, biomaterials can be of natural or synthetic origin. Natural biomaterials are derived from organism of the same or different species. If a natural biomaterial is made of tissue harvested from the patient itself, then it can be defined as autogenous. Platelet concentrates (PC) are autogenous products derived from patients own blood. In the early seventies PC were introduced as a fibrin glue. Later in 1997, Whitman presented a double centrifugation protocol of autogenous blood to produce platelet rich plasma (PRP). The biggest drawback of PRP was the demanding preparation protocol. For this reason, leukocyte- and platelet-rich fibrin (L-PRF) was introduced by Choukroun in 2001 as a second-generation PC. Beside the simplified preparation protocol, L-PRF contains a higher value of platelets and leukocytes compared to PRP. In the past 20 years a lot of research has been performed on L-PRF to understand his mode of action. L-PRF can be widely used in periodontal and implant surgery for both, hard and soft tissue management. The most favourable biological features of L-PRF are the regenerative potential and the antibacterial capacity. The regenerative potential can be attributed to the angiogenic capacity of L-PRF and the release of growth factors such as, vascular endothelial growth factor (VEGF), platelet-derived growth factor (PDGF), transforming growth factor (TGF), bone morphogenetic protein (BMP), and fibroblast growth factor (FGF). The antibacterial activity seems mainly to be against the strict anaerobic gram-negative periodontal pathogens like Porphyromonas gingivalis, Prevotella intermedia, and Fusobacterium nucleatum. Moreover, an analgesic activity of L-PRF is also mentioned in the literature. The main advantage of an autogenous biomaterial like L-PRF is the absence of adverse effects due to poor biocompatibility. L-PRF shows a faster and predictable wound healing. Moreover, patients financial, ethical and/or religious considerations can make the use of L-PRF more favourable. Through innovations in bioengineering, there is now a greater focus on extending the application possibilities of L-PRF. To accomplish that, more high-quality research is needed regarding L-PRF characteristics and preparation protocols.