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Table of Contents
Year : 2022  |  Volume : 9  |  Issue : 4  |  Page : 103-105

A neoteric platelet concentrate – Titanium-prepared platelet-rich fibrin

1 Post Graduate Student, Department of Periodontics, Government Dental College, Raipur, Chhattisgarh, India
2 Associate Professor, Department of Periodontics, Government Dental College, Raipur, Chhattisgarh, India
3 Professor and HOD, Department of Periodontics, Government Dental College, Raipur, Chhattisgarh, India

Date of Submission18-Dec-2022
Date of Acceptance19-Dec-2022
Date of Web Publication29-Dec-2022

Correspondence Address:
Dr. Bhumika Jhawar
Department of Periodontics, Government Dental College, Raipur, Chhattisgarh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijpcdr.ijpcdr_26_22

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Titanium-prepared platelet-rich fibrin (TPRF) is the future of modern regenerative dentistry that has a wider application not only in the periodontic field and implant dentistry but also in oral surgery, endodontics, tissue engineering, and other medical fields including orthopedic and plastic surgery. It accelerates wound-healing properties along with its antibacterial and antihemorrhagic are beneficial for patients which attract more clinicians to adopt this technology. To discover the biological properties of TPRF and its broader applications in the area of periodontic and implant dentistry, TPRF is increasingly being investigated. Positive growth and improved healing results and less patient pain have been seen in current studies.

Keywords: Modern regenerative dentistry, neoteric platelet concentrate, periodontitis, titanium-prepared platelet-rich fibrin

How to cite this article:
Jhawar B, Kujur S, Gupta V, Chanreiphy H, Kumari P. A neoteric platelet concentrate – Titanium-prepared platelet-rich fibrin. Int J Prev Clin Dent Res 2022;9:103-5

How to cite this URL:
Jhawar B, Kujur S, Gupta V, Chanreiphy H, Kumari P. A neoteric platelet concentrate – Titanium-prepared platelet-rich fibrin. Int J Prev Clin Dent Res [serial online] 2022 [cited 2023 Feb 6];9:103-5. Available from: https://www.ijpcdr.org/text.asp?2022/9/4/103/366149

  Introduction Top

Periodontitis is a chronic infectious disease of the supporting tissues of the teeth affecting approximately 10% of the population which may lead to the loss of teeth.[1] The pocket formation and ulceration of the epithelial lining which are formed during inflammation of periodontal tissues form ports of entry which may lead to transient bacteremia.[2],[3] Periodontal disease is a low-grade systemic inflammation leading to increase in the number of platelet activation[4] and platelet numbers decrease after periodontal therapy.[5] Interestingly Porphyromonas gingivalis and Streptococcus sanguis induce platelet activation and aggregation in vitro and animal studies.[6] The ultimate goal of periodontal treatment is halting periodontal disease progression and regeneration of tissues which was destroyed as a result of periodontal disease. Attaining a complete periodontal regeneration with this current regenerative procedure offer limited success.[4] Various biomaterials based on endogenous regenerative technology have been used for periodontal tissue regeneration in addition to autogenous[5],[6],[7],[8],[9],[10] and allogenic bone grafts. Platelets have an important role in hemostasis and wound healing along with various growth factors, hence leading to the evolution of platelet concentrates into existence for periodontal regeneration. Initially, fibrin glue was originally described in 1970[7] and these platelet-rich plasmas by Sunitha Raja V, Munirathnam Naidu E in 1998 contains fibrin, fibronectin, and vitronectin which leads a cell to osteoconduction and epithelial migration, but it is least favorable to cytokine and cellular migration. Thus, second-generation platelet concentrates platelet-rich fibrin was developed by Dohan et al. in 2006. It is a polymerized fibrin matrix in a tetramolecular structure with >97% of the platelets, cytokines, leukocytes, and circulating stem cells.[8],[9],[10],[11],[12],[13] Various factors that influence the fibrin network pattern of PRF and titanium-prepared PRF (TPRF) are genetic factors, acquired factors such as variations in XIII and thrombin in plasma hyperhomocysteinemia, blood flow, platelet activation, hypertension, strain hyperglycemia, medication, oxidation, and cigarette smoking. Thus, the fibrin network pattern of this platelet concentrate can be changed due to periodontal disease. The aim of this present study is to evaluate the various fibrin network patterns of PRF and TPRF in patients with and without periodontitis.

  History Top
[Figure 1][14]
Figure 1: Historical background: How era changes from PRP to TPRF

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  Rationale Top

The tubes for the PRF preparation are treated with dense silica particles which sediment along with the erythrocytes, a tiny part of it gets laid off in buffy coat, fibrin, and platelet-poor plasma sheets and thereby extends to the patient. A histomorphometry examination represented that the TPRF fibrin system encloses a greater extent than the white blood cell and PRF network, and the fibrin appears copious in the TPRF models. Consequently, platelet activation by titanium assumes to exhibit some higher distinctive features. Even so, the interval between the release of growth factors with TPRF is quite long as compared to PRF.

  Preparation Of Titanium-Prepared Platelet-Rich Fibrin Top

TPRF is a new platelet concentrate, the method of preparation of which is based on the hypothesis that titanium tubes may be more effective at activating platelets than the glass tubes used in Choukroun's method. This material is used to avoid any adverse effects in the short or long term, or both, of dry glass or glass-coated plastic tubes, and to eliminate any speculations about silica. In our initial trials, we found titanium-induced platelet aggregation similar to that in glass tubes, and the clot produced in titanium tubes was clinically identical to that produced in glass tubes. Activation of platelets with titanium compared with activation with silica particles provides the distinctive characteristics of TPRF, including its increased biocompatibility. The TPRF collection protocol in human subjects is similar to the conventional PRF protocol as follows. A blood sample is collected without anticoagulant in 10 ml titanium tubes, which are immediately centrifuged at 2800 rpm for 12 min. The absence of anticoagulant implies that most platelets in the blood sample will be activated within a few minutes after contact with the wall of the titanium tube, which initiates the coagulation cascade. Fibrinogen is initially concentrated in the upper part of the tube before the circulating thrombin transforms it into fibrin. A fibrin clot is then formed in the middle of the tube between the red corpuscles at the bottom and the acellular plasma at the top.[15]

  Mechanism of Titanium-Prepared, Platelet-Rich Fibrin Top

PRF has to be considered a fibrin biomaterial and a favorable loose and dense fibrin matrix for migration of endothelial cells and fibroblasts which helps in rapid angiogenesis and remodeling of tissues. The strong thrombin concentrations in the bilateral junctions allow thickening of fibrin polymers leading to rigid network, unfavorable to cytokines enmeshment, and migration of cells. Weak thrombin in equilateral junctions leads to a fine and flexible fibrin network favorable to cell migration and cytokines.[16]

  Conclusion Top

Although the reviewed studies differ in their application of PRF and the manipulation protocols used in periodontal surgery, all contain a common factor. The ability of PRF to promote periodontal wound healing, as measured by clinical criteria (e.g., probing depth reduction and clinical attachment level gain) as well as increased levels of defect bone fill, which was investigated either radiographically or by surgical reentry. We recommend that future clinical studies compare various PRF preparations and application protocols to gauge their simplicity of use and determine any significant differences these preparations and protocols may have on clinical outcomes.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Pihlstrom BL, Michalowicz BS, Johnson NW. Periodontal diseases. Lancet 2005;366:1809-20.  Back to cited text no. 1
Geerts SO, Nys M, De MP, Charpentier J, Albert A, Legrand V, et al. Systemic release of endotoxins induced by gentle mastication: Association with periodontitis severity. J Periodontol 2002;73:73-8.  Back to cited text no. 2
Forner L, Larsen T, Kilian M, Holmstrup P. Incidence of bacteremia after chewing, tooth brushing and scaling in individuals with periodontal inflammation. J Clin Periodontol 2006;33:401-7.  Back to cited text no. 3
Wakai K, Kawamura T, Umemura O, Hara Y, Machida J, Anno T, et al. Associations of medical status and physical fitness with periodontal disease. J Clin Periodontol 1999;26:664-72.  Back to cited text no. 4
Christan C, Dietrich T, Hägewald S, Kage A, Bernimoulin JP. White blood cell count in generalized aggressive periodontitis after non-surgical therapy. J Clin Periodontol 2002;29:201-6.  Back to cited text no. 5
Lourbakos A, Yuan YP, Jenkins AL, Travis J, Andrade-Gordon P, Santulli R, et al. Activation of protease-activated receptors by gingipains from Porphyromonas gingivalis leads to platelet aggregation: A new trait in microbial pathogenicity. Blood 2001;97:3790-7.  Back to cited text no. 6
Sunitha Raja V, Munirathnam Naidu E. Platelet-rich fibrin: Evolution of a second-generation platelet concentrate. Indian J Dent Res 2008;19:42-6.  Back to cited text no. 7
Yajamanya SR, Chatterjee A, Babu CN, Karunanithi D. Fibrin network pattern changes of platelet-rich fibrin in young versus old age group of individuals: A cell block cytology study. J Indian Soc Periodontol 2016;20:151-6.  Back to cited text no. 8
[PUBMED]  [Full text]  
Nunes CR, Roedersheimer MT, Simske SJ, Luttges MW. Effect of microgravity, temperature, and concentration on fibrin and collagen assembly. Microgravity Sci Technol 1995;8:125-30.  Back to cited text no. 9
Kawase T, Okuda K, Wolff LF, Yoshie H. Platelet-rich plasma-derived fibrin clot formation stimulates collagen synthesis in periodontal ligament and osteoblastic cells in vitro. J Periodontol 2003;74:858-64.  Back to cited text no. 10
Dohan DM, Choukroun J, Diss A, Dohan SL, Dohan AJ, Mouhyi J, et al. Platelet-rich fibrin (PRF): A second-generation platelet concentrate. Part I: Technological concepts and evolution. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;101:e37-44.  Back to cited text no. 11
Dohan DM, Choukroun J, Diss A, Dohan SL, Dohan AJ, Mouhyi J, et al. Platelet-rich fibrin (PRF): A second-generation platelet concentrate. Part II: Platelet-related biologic features. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;101:e45-50.  Back to cited text no. 12
Dohan DM, Choukroun J, Diss A, Dohan SL, Dohan AJ, Mouhyi J, et al. Platelet-rich fibrin (PRF): A second-generation platelet concentrate. Part III: Leucocyte activation: A new feature for platelet concentrates? Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;101:e51-5.  Back to cited text no. 13
Chatterjee A, Debnath K, Ali MM, Babu C, Gowda PL. Comparative histologic evaluation of titanium platelet-rich fibrin and platelet-rich fibrin in hypertensive and smoker participants: A cell cytology study. J Indian Soc Periodontol 2017;21:195-200.  Back to cited text no. 14
[PUBMED]  [Full text]  
Reddy S, Bhowmik N, Cutinha VV, Yadav N, Pandit HR, Kumari A. Treatment of Intrabony defects using titanium prepared platelet rich fibrin (T-PRF): A case report. Int J Appl Dent Sci 2018;4:77-83.  Back to cited text no. 15
Arabaci T, Albayrak M. Titanium-prepared platelet-rich fibrin provides advantages on periodontal healing: A randomized split-mouth clinical study. J Periodontol 2018;89:255-64.  Back to cited text no. 16


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