Regenerative potential of platelet concentrates in periodontal surgery

Regeneration is an emerging field in medicine. Current regenerative methods in periodontics include the use of autografts, allografts, alloplasts, or xenografts and naturally derived synthetic membranes that are either bioresorbable or nonresorbable. In the last twenty years, platelet concentrates (PCs) have emerged as a potential regenerative method in Oral and Maxillofacial Surgery, used as a sole filling material or as scaffold. Its purpose is to accelerate neoangiogenesis in order to stimulate the grafted cells and consequently to enhance bone regeneration, avoiding necrosis and limiting infection development.

Leucocyte- Platelet-Rich Fibrin (L-PRF) is a kind of platelet concentrate developed for specific use in Oral and Maxillofacial Surgery. It is produced from a small peripheral blood sample, which is immediately centrifuged without any anticoagulant. Coagulation starts during the centrifugation, and three layers are obtained: red blood corpuscles (RBCs) at the bottom of the tube, platelet-poor plasma (PPP) on the top and an intermediate layer called “buffy coat” where most platelets and leucocytes are concentrated. L-PRF has potential advantages, namely: it creates a bioactive construct that stimulates the local environment for differentiation and proliferation of stem and progenitor cells and it acts as an immune regulation node with inflammation control abilities, such as slow continuous release of growth factors over a period of 7-14 days.

Rich in fibrin, platelets (± 95% of initial blood), leucocytes (± 50% of initial blood), monocytes and stem cells, L-PRF is further transformed into a membrane, circa 1 mm in thickness, by careful compression. Its stronger fibrin architecture and mechanical properties favour its use as protection of the Schneiderian membrane in the sinus lift or as GTR membrane. L-PRF introduces the concepts of Natural Tissue Regeneration (NTR) and Natural Bone Regeneration (NBR) which are based on promoting regeneration of various periodontal tissues required for a normal tooth function (bone, periodontal ligament, gingival attachment) and bone regeneration, respectively. Both techniques use L-PRF: autologous, without foreign body reactions and allowing the own body to regenerate itself.