PRF vs. PRP: Which is preferable?

I have heard about the benefits of using PRP [platelet rich plasma] and PRF [platelet rich fibrin] but I am not clear on exactly how these can improve the healing process of bone grafts and what the differences are between the two protocols.  I understand there is some controversy of which stimulates osteogenesis and soft tissue growth.  Which method is preferable?  Can these be used with an alloplast?

53 thoughts on “PRF vs. PRP: Which is preferable?

  1. I stopped using PRP due to the expense of the kits, I works fine for sinus lifts but I have seen literature that it is better for soft tissue, it can also be combined with BMP-Rh2 but there are studies that large doses of BMP have been linked to cancer. I use prgf which is the BTI product. It works very well and is cost effective. I don’t know about PRF, I just know that simply spinning down a blood clot without paying attention to how the platelets and growth factors are released doesn’t really help healing. I think one has to do their own research when selecting a product there are so many products and claims out there in the dental market. I usually get my information from the better contuing Ed implant courses as to what products are recommended. Good luck.

    • I used PRP for 8 yrs but the past 2 yrs have switched over to PRF. The PRF is easier to work with. I can make membranes with it. I use it for osseus grafts, perio grafts, sinus lift procedures, extraction sockets. I have not used PRFG. The PRF has a slower release of the platelets compared to PRP and a higher concentration of leucocytes. No problem using with an alloplast grafting material.

    • A well known PRP device is very cheap but sundries its black gold prices
      I can only say Medifuge c.g.f , vacuette tubes are about $2 each
      Readily available from the Medifuge supplier or from most medical suppliers
      brand Bio_one made in Austria
      You should use only 23 gauge needle which is the best size to allow free plasma flow
      in USA unit is available….. ???, contact Silfradent Italy

  2. Not evidence-based. No evidence to support use of either. I have not seen any good literature on PRF and some animal models have shown no difference. The same holds true for PRP.

  3. The science is pretty clear: for internal medicine, the choice is PRP. For dermatology and orofacial, the best choice is PRF.
    Look up this paper: Current Parmaceutical Biotechnology, 2012, 13, Dohan and Al:
    Current Knowledge and Perspectives for the use of PRP and PRF in oral and Maxillofacial Surgery.
    Not even talking about cost here….

  4. For last two years , we use PRF for almost every implant case. Sure for every case of sinus agumentation/ sinus lift/ graft procedure/ immediate transitory prosthesis cases. PRF works great. Its easy to prepare in your own clinic , prepared from patient’s blood without adding any chemical & is almost free.
    I use centrifugal machine which is very economic.( around 100 + $ ) .
    Sorry , I do not know how to put photographs in blog. It may help to explain better.

  5. There is an old axiom, “You don’t know what you don’t know”, that was never more applicable than it is for this debate. For those of you who have made the statement that there is no literature to support the use of PRF in Oral surgery/Implantology, what journals have you been reading? There are over 85 recent peer-reviewed papers for PRF that run the gamut from biology to clinical applications and I would be happy to give anyone the link to this bibleography. Dr. Dohan, et al, from France, clearly has been the best researcher in the field and has made the statement that PRF concentrates more platelets in a single pass than PRP, and that the viability and survival of platelets is clearly superior in the PRF process. So let’s get off that horse with regard to research. With regard to process time, ease of protocol, handling, timing of release of growth factors, and cost, PRF clearly is the winner in every category.
    RJM

  6. Thanks Dr Robert. Giving just one article for reference. As Dr Robert said there are many,As a clinician our experience is PRF is big help in most surgeries.
    Volume 22 , Issue 3
    May/June 2007
    Pages 417–422

    Platelet-Enriched Fibrin Glue and Platelet-rich Plasma in the Repair of Bone Defects Adjacent to Titanium Dental Implants

    Tae-Min You, DDS / Byung-Ho Choi, DDS, PhD / Shi-Jiang Zhu, MD / Jae-Hyung Jung, DDS / Seoung-Ho Lee, DDS, PhD / Jin-Young Huh, DDS / Hyun-Jung Lee, DDS / Jingxu Li, DDS

    PMID: 17622008

    Purpose: The aim of this study was to compare the effects of platelet-enriched fibrin glue and platelet-rich plasma (PRP) on the repair of bone defects adjacent to titanium dental implants. Materials and Methods: In 6 mongrel dogs, 3 screw-shaped titanium dental implants per dog were placed into the osteotomy sites in the tibia. Before implantation, a standardized gap (2.0 mm) was created between the implant surface and the surrounding bone walls. Six gaps were left empty (control group), 6 gaps were filled with autogenous particulate bone mixed with PRP (PRP group), and 6 gaps were filled with autogenous particulate bone mixed with platelet-enriched fibrin glue (fibrin glue group). Results: After 6 weeks, the bone-implant contact was 59.7% in the fibrin glue group, 29.2% in the PRP group, and 10.2% in the control defects; this difference was statistically significant (P < .05). Discussion and Conclusion: Greater bone-implant contact was achieved with platelet-enriched fibrin glue than with PRP. The results indicate that platelet-enriched fibrin glue can induce a stronger peri-implant bone reaction than PRP in the treatment of bone defects adjacent to titanium dental implants. Int J Oral Maxillofac Implants 2007;22:417–422

    Key words: bone grafting, bone regeneration, dental implants, fibrin glue, platelet-rich plasma

  7. Be careful about liability when using it in the USA. There is only ONE system commercially available for L-PRF that has been FDA approved.
    Using just a lab centrifuge, won’t do the job, and you will have a hard time defending in case of any problem linked or not to your surgery….

  8. PRP and PRF both are not necessary. Operative site gets covered with blood clot and that is good enough for healing. Good surgical aseptic technique is all that is required for normal healing.

    • Dear Suhas
      If you say it is not necessary , do you mean to day all the study done on PRF is not correct ?
      Just for sake of discussion – will you say its not necessary to do implants when removabel partial dentures / bridges work .
      With what ever clinical experience we have PRF gives much better results as written in previous blog .

  9. With all due respect, you are correct in your statement about “normal” healing. But what we are doing here is getting “accelerated” healing. Why should I wait for the normal healing cascade to take place when I can get, in one one week, the healing response I normally see at 3-4 weeks? We live in the era of biologics. We understand the entire wound cascade and the growth factors associated with all of the phases. Our strategy today is to give mother nature a helping hand to compress both healing and treatment time. Isn’t that what prudent clinicians do? Additionally, Intra-Lock International has the only FDA cleared L-PRF system in the US. For medico-legal reasons, this system should be what you use for your procedures.
    RJM

  10. Robert Miller is 100% correct.
    If we reason as Suhas, then “Air conditioned automobile” or “cellphone” or “internet” are not needed.
    But who would give them up today?

  11. This discussion is on-going. There is a wealth of literature that supports the use of PRP-PRF. Much of it has been done by Jim Rutkowski, the editor of the Journal of Oral Implantology. It is definitely effective for bone and soft tissue formation.
    I use it for every bone grafting case I do and for most of the implant cases. With Dr. Rutkowski’s technique, the cost is about $7 per case, and the time of acquiring both the PRP and the PRF is about 10 minutes. Everything necessary to do it is available from Salvin Dental Supplies. There is no reason NOT to use it.
    If you would like to talk to me about the technique, call me at 440-655-6512. I would be glad to send you a slide series showing the technique.
    Dr. Rutkowski and Dr. Jim Fennell are giving a two-day course in April on the use and technique of using PRP-PRF. I suggest you Google Dr. Rutkowski to read his research or to find out about the course.

    Dan Camm

  12. With all respect, could not find a single publication from Dr Rutkowski on PRF. Could you pls advise where to search?
    FOund about 100 from other authors in US and other International journals….

  13. Thanks DMF. Got the paper. It is about PRP.
    Also found on Google some papers featuring co-author Dr Rutkowski…
    The main difference between PRF and PRP are:
    Fibrin and Leucocytes present in PRF but not in PRP.
    That explains the difference in indications and clinical behaviors.

    ONLY PRF makes a difference on soft tissue closure. All authors agree on that.
    If soft tissue heal faster and better, guess what happens to the underlying bone?

  14. With the single-spin technique, which is very effective at concentrating platelets, I draw up two tubes of blood: One tube has sodium citrate to keep the blood from coagulating. When I spin that down, I can draw out the PRP (liquid “Buffy Coat”) laver into a syringe. I mix that with bone graft, place it onto CollaPlugs, place it on sutures. How effective is it? It is free and easy, so even if it is just a little effective, it is worth it. I think it gives a real jump start to the healing process. I see a noticeable difference.
    The other tube I draw up has nothing in it. I spin it down immediately with the other tubes for 10 minutes. I get a separated clot of blood: plasma on the top of the clot, RBC’s on the bottom of the clot, and in between the concentrated platelets “trapped” in this clot. I lay it on a slab and cut off 2/3 of the plasma and 2/3 of the RBC’s. I place this clot in a socket, or I squeeze it with a Rutkowski “squished” from Tatum Instruments into a membrane and place that over a surgery site under the flap.
    With the PRP, it is liquid, so it probably stays in the area a short time. With the PRF, it is a clot, so the platelets open up over a period of time. The preparations are exactly the same in content. They just are a different form of concentrated platelets.

    Daniel Camm

    • Daniel what is the RCF you are using on your centrifuge?
      Could everybody reveal their RCF, not the RPM because that differs
      Depending on the centrifuge parameters. Also temperature.
      Being a chef, before becoming a dentist I’m inclined to try others recipes to
      See if I can improve the result. it is cooking!

  15. There are some “cooking recipes” with no scientific evidence to back them up, and there are controlled studies published in peer reviewed journals….
    Characterization and valid protocols have been published years ago, about PRF.
    The best start consists in reading them, and trying them before trying to “enhance”…
    The most prolific author in the literature to write about PRF over the last 5 years has been Prof. Dohan.
    I recommend reading this classification to understand difference between various platelets concentrates:
    Trends Biotechnol. 2009 Mar;27(3):158-67. doi: 10.1016/j.tibtech.2008.11.009. Epub 2009 Jan 31.
    Classification of platelet concentrates: from pure platelet-rich plasma (P-PRP) to leucocyte- and platelet-rich fibrin (L-PRF).
    Dohan Ehrenfest DM, Rasmusson L, Albrektsson T.

  16. Thanks for the references. I love reading the intricacies of this procedure and why it works. From a clinical perspective, I love this procedure for the following reasons:
    1. At the very least, the literature suggests that it is effective. It may not be 100% proven, but it is well supported.
    2. There is a start up cost for the centrifuge and materials of about $1700, but after that, the cost per procedure is almost nothing.
    3. The time to do the procedure is 10 minutes. With a 2-3 hour surgery, this is inconsequential.
    4. Anecdotally, I notice a distinct difference in healing time with this procedure.
    5. There is absolutely no harm to the patient.

    Why not do this procedure? There are very few things we do in dentistry that fit all these qualities.

    Daniel Camm

    • I agree 99% with Dr Camm.
      The 1% difference is on the procedure: let’s use the already published and approved procedures before trying to “enhance the recipe”.

  17. I am throughly confused by Dr. Camm’s protocol, as it is neither PRP or PRF. Platelet Rich Plasma requires a dual spin centrifuge where a large tube of blood has been treated with anticoagulant (sodium citrate) and then treated with calcium chloride to make a gel and bovine thrombin to release growth factors from the platelets. Platelet Rich Fibrin uses none of these chemical additives and, as a result, releases growth factors over a sustained period of time (7-14 days). It should never come in contact with anticoagulant. Why would you even entertain the idea of adding your “version” of PRP when all of the growth factors from both the platelets AND leucocytes are present in ideal amounts? RBC’s have never been a part of the PRF protocol and are essentially useless; they should be removed completely. Finally, to get an ideal result using PRF, you should have the instrumentation to fabricate socket plugs and membranes. All of the histology and research has been done in these forms. Using an FDA cleared PRF System (Intra-Lock International) will protect you medico-legally should your case develop problems post-surgery. Caveat Emptor.
    RJM

    • Robert:
      Look at my post from April 4, where I explain the technique. There are TWO separate tubes. One has sodium citrate, from which I get PRP liquid. These tubes are 5cc tubes, although 10cc ones can be used. The other tube has nothing in it. These are 10cc tubes. When spun down (in the same spin), I get PRP liquid in the sodium citrate tubes, and I get a separated clot in the other tubes which I can use as a clot mass or I can flatten into a PRF membrane. So with a quick draw of 2,4,6, etc tubes, I get to use PRP and/or PRF.
      The tube with no additives coagulates during the 10-minute spin process. I NEVER use bovine thrombin. The use of that opens the platelets way too fast and makes the growth factors dissipate too quickly. There is no need to use bovine thrombin.
      In isolating the concentrated platelets into a syringe (the “buffy coat”), it is unavoidable that some immature RBC’s are also drawn up. They do not hurt the technique, and there is no need to use expensive systems to avoid them.
      There is no need to use huge tubes and do a double-spin technique. Dr. Rutkowski has shown that the single spin technique with a CliniSeal centrifuge produces more that adequate concentration of platelets. I reference the following article:

      J Oral Implantol. 2008;34(1):25-33. doi: 10.1563/1548-1336(2008)34[25:AAOARS]2.0.CO;2.
      Analysis of a rapid, simple, and inexpensive technique used to obtain platelet-rich plasma for use in clinical practice.
      Rutkowski JL, Thomas JM, Bering CL, Speicher JL, Radio NM, Smith DM, Johnson DA.
      Source
      Duquesne University, Pittsburgh, Pa., USA.
      Abstract
      The use of platelet-rich plasma (PRP) has become more generally accepted, and implant dentists are using PRP more frequently to promote the healing of oral surgical and/or periodontal wounds. Critical elements of PRP are thought to be growth factors contained within the concentrated platelets. These growth factors are known to promote soft-tissue healing, angiogenesis and osteogenesis. We present a rapid, simple, and inexpensive methodology for preparing PRP using the Cliniseal centrifuge method. This study demonstrates that platelets are concentrated approximately 6-fold without altering platelet morphology. Further we demonstrate that key growth factors, platelet-derived growth factor BB (PDGF-BB), transforming growth factor B (TGF-B1), vasculature endothelial growth factor (VEGF), and epidermal growth factor (EGF) are present in comparable or higher concentrations than those reported with the use of other techniques. Prolonged bench set time (>3 hours) after centrifugation resulted in decreased concentration of TGF-B1 but not decreased concentration of PDGF-BB, VEGF, or EGF. This study confirms the molecular aspects of PRP obtained using this inexpensive and efficient methodology.

      The research has been done. The technique is easy and effective and inexpensive and SAFE. You would service your patients well to learn this. To make a statement that a clinician should only use an FDA-approved system is ludicrous. Act like a doctor. Do the research and study the technique. The manufacturers are not the teachers.

      Daniel P. Camm

      • Thanks Dr. Cam for the informative article by . Dr. Rutkowski.
        I think research like that continues to increase the awareness and use of growth factors and tissue engineering in the daily practice of implantology.

      • I gotta say putting the PRP mixture onto the L-RPF membrane would help keep it in place, instead of washing out and would make it a “super band-aid” . I am gonna try it on Monday, regardless of the literature, after all I live in Canada and we worry less about litigious patients, but you always have to be on the lookout.

  18. I always like the concept of “Keep It Simple”:
    1- L-PRF is a single spin technique.
    2- No Additive in the tubes
    3- Making membranes express the “juice” inside the Xpression kit.
    4- This serum is used to boost biomaterial soaking in there while you perform surgery.
    5- There are tons of literature about the technique.
    6- FDA approved and inexpensive.
    Why bother about re-inventing the wheel?

    + Adding PRP onto the PRF membrane is a strange idea. Its relevance has to me measured in a controlled study. That has not been done as far as I know….

    • GMK, strange, you forgot all my articles and the principal who was the first.
      Xpressing is a vulgar copy of the PRF Box.
      May be you are a guy from the intra-lock team?
      It should explain the nature of your posts.

  19. Dan; I understand that you use two tubes. But I take exception to the statement about “acting like a doctor”. A part of doctoring is reading the literature and understanding it. And I have read Jim’s paper as well. But here is your disconnect. The concentration of growth factors is directly proportional to the number of platelets and leucocytes present in the blood draw. There is a series of pioneering papers authored by Dohan, et al, entitled “Platelet Rich Fibrin (PRF): A second-generation platelet concentrate Parts I-IV” in Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006; where they make the statement (based on histomorphometric analysis) that close to 100% of the platelets are harvested in the PRF clot. So if I desire additional platelets, I simply use an additional membrane. But the one thing that the “PRP” of your protocol does not contain is leucocytes (since you are using only the buffy coat), one of the main reservoirs of VEGF.So it would seem that PRF is the desired protocol if your arbiter of efficacy is concentration of growth factors. One last point is that your PRP platelet mass is now contaminated with sodium citrate, which may delay local coagulation and subsequent early angiogenesis. So before you start suggesting that clinicians use a new empirical protocol, let’s wait for a controlled study that directly compares both so that we can judge the effectiveness of each protocol. Now that’s doctoring!
    RJM

  20. Sorry Dr Miller, I do not agree with your comments for many reasons (I already posted opinions about your wrong comments related to the PRF protocol):
    1. PRF does not release growth factors during 14 days. You must read carefully the articles.
    2. You write that Intra-Lock is the only one company who has the FDA approval. You must be more informed about the medico-legal. Putting these comments place yourself in a very big conflict of interest as you are shareholder of Intra-Lock !!!
    3. The king is dead, long live the King!! The PRF will be replaced the next week by the Advanced PRF: A-PRF. I developped this new protocol to get BMP-2 and BMP-7 with long term release. For free. It took two years of research.
    I changed all the settings, the tubes etc. and the A-PRF outcome in the bone grafts is more powerful. Definitely.Publications soon.
    Sorry for the copiers who are only able to propose material and never understand what is the biology: they are not able to give the right information and to teach as well the doctors. Joseph CHOUKROUN

    • The slow release of growth factors up to 7 days was published in 4 different articles, but I have just participated in an in vitro study using IntraSpin showing release up to 14 days. This is going to publication as we speak.
      Intra-Lock is the only company with FDA and CE marking for PRF, this is a fact and the reality of the PRF protocol. It is also a fact that Dr. Choukroun is the owner of the Process for PRF company, selling a machine without fulfilling any of the legal requirements; No CE marking and no FDA 510k clearance,. That is a major conflict of interest.
      Maybe in France the authorities will tolerate this or simply are not aware that there is no clearance for his machine. We have heard of the scandal of the French company PIP that sold hundreds of thousands of breast implants, only to break open after a few months/years causing untold injuries. Perhaps that is why we have stringent guidelines in this country before we can market a medical device. If you use a medical device in the US without certification, the authorities simply close your business.
      Are you suggesting that US dentists ignore this and open themselves up to potential legal issues? How can there be any debate on this issue? We should be thankful to Intra-Lock for doing the heavy lifting and absorbing the expense of certification while keeping the cost of the system at a reasonable price point. Compare that to the high costs of PRP and PRGF systems. I would suggest that Dr. Choukroun do the same with regard to CE and FDA clearance. After all, Process is his company and I would suggest he not engage in ad hominum attacks with his “inventive” statements.
      Last, your statement that “people do not understand biology” is incredible coming from you, as these studies were done by some of the best PhD’s in our profession.The last time I heard this expression, it was about…you. From the mouth of the academic people and clinicians that collaborated with you in the past, particularly on PRF, and now consider you to be completely commercial.
      I believe that this forum is not the place for this kind of agressive messaging, Dr. Choukroun.
      RJM

      • Comparing this issue to French breast implant failure is sad and irrelevant.
        Medical/legal issue is poorly argued as well. I use a 400lb hospital grade Heraeus Megafuge1.0R, which is often the reference centrifuge for many membrane experiments in the literature, instead of a mini-proprietary centrifuge that becomes obsolete the moment new parameters become the standard.
        I would also argue that if this isn’t the place for controversial discussion what plac would be?
        I own NO stock in any dental company, I just want to improve my surgical results by using the best platelet products possible and as they improve I want to change as well and not end up with a storage room full of antiquated centrifuges.
        Why don’t try to produce one that you can alter the settings for future iimprovements, not a good business decision, but an excellent decision for someone looking for long term success!

        • 400lbs? Wow? How much cost your centrifuge?
          I’d rather spend a couple of grand only, and have a “legal” stuff. Plus, you can change the settings if you wish…

          • Actually I think its 460lbs, but it was refurbished for a grand total of $1200, bought for $350 at an auction.
            Many are out there, just try a lab equipment sales, online or otherwise. I have a second Heraeus Megafuge 1.0R in for 2nd hand parts and servicing for a dentist friend.

      • Drs Choukroun and Miller, would you please be so kind as to provide us with a list of manuscripts on this topic. I am sure there are many that would like to have a deeper understanding on this topic. I have always enjoyed the comments from both of you.
        I thank you

        • Richard; You can find a long list of PRF papers in the PRF module of the Intra-Lock website (intra-lock.com). I personally have a list of over 85 peer reviewed papers on the subject with several more as yet unpublished manuscripts waiting to be accepted.
          RJM

      • Dr Miller,
        I never cite my own company in the forums. In all of your post you cite I-L.
        We have the CE and we do not need FDA approval. I’ll publish soon the FDA letter.
        I confirm here that you are not able to do PRF education.
        Intra-spin is the 100% copy of the PC02. You got the machines by chance. and you’ll stop to get them soon. be sure.

      • Medifuge c.g.f. made Silfradent has all approvals and is a phase separator which is superior than a one speed centrifugation protocol…..

      • View the web for Medifge c.g.f …
        There is much research already available including GBR without additions….. unfortunately the net have been hijacked by others
        also that claim their powder is concentrated growth factors
        Medifuge C.G.F protocol is a plasma phase separator by gravitation,
        phase separation occurs with a series variation of rpm with controlled acceleration…… / the g forces
        Creates a Liquefied ( a protocol PRP ) and/or Fibrin block matrix without additives
        Liquefied you can view the various layers PPP – PRP – CGF – RBC
        Fibrin block matrix is of high tensile elastic strength, ……
        ideal for a quality autologous membrane ……
        A PRP device has dental application
        Medifuge C.G.F & PRF devices creates Fibrin block matrix

      • Must have FDA approval, I agree
        not relevant if Dr Choukroun is owner
        Dr Choukroun is promoting better medicine than cow manure, I support 100%
        His PRF device vs Medifuge C.G.F…. you to decide

        • I have looked for it for years now. Lately I’ve spent an inordinate amount of time on the web searching and reading articles on the subject. Im spending evenings trying to dig up articles to see what is the superior centrifuge speed, temp, etc.

  21. Would you be so kind asto reveal the g force, times and temperature?
    Thanx for the excellent work and for FREE!
    Please keep up the work!

    • Cliff,
      thanks for your comments.
      I cannot reveal nothing before the next week as I officially launch the A-PRF at the Osteology meeting in Monte-Carlo.
      Be sure that I’ll do that soon. Take care about the courses without the PRF label education (my own label). They use PRF only for implants commercial advertizing. follow my eyes…

        • Here is an Excellent paper for PRP preparation.

          Optimized Preparation Method of Platelet-Concentrated
          Plasma and Noncoagulating Platelet-Derived
          Factor Concentrates: Maximization of Platelet
          Concentration and Removal of Fibrinogen
          Jun Araki, M.D.,1 Masahiro Jona, M.T.,2 Hitomi Eto, M.D.,1 Noriyuki Aoi, M.D.,1 Harunosuke Kato, M.D.,1
          Hirotaka Suga, M.D.,1 Kentaro Doi, M.D.,1 Yutaka Yatomi, M.D.,2 and Kotaro Yoshimura, M.D.

          TISSUE ENGINEERING: Part C
          Volume 00, Number 00, 2011
          ª Mary Ann Liebert, Inc.
          DOI: 10.1089/ten.tec.2011.0308

    • Simply purchase a Medifuge c.g.f. from Silfradent…… is cheaper
      It is possible to modify the rev/g protocol… but require high tech clever IT engineer

  22. Medifuge c.g.f. is a phase separator
    Creates an injectable and/or a fibrin block matrix for placement
    with a layer of concentrated growth factor + CD34 positive stem cells
    with low cost sundries
    ie a PRP & PRF protocol…

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