Using L-PRF as an adjunct to bone regeneration

The techniques of bone grafting are constantly evolving in dentistry with the aim of achieving bone and tissue regeneration with reduced morbidity, cost, and treatment time.

The first generation of platelet-rich aggregates included platelet-rich plasma (PRP) and platelet-rich growth factor (PRGF). On the other hand, PRF stands for platelet-rich fibrin, which undergoes natural coagulation. The use and obtaining of PRF are simpler, require less time, do not require the use of anticoagulants, as well as artificial additives that influence the coagulation cascade such as bovine thrombin and calcium chloride. The use of leukocyte-platelet-rich fibrin (L-PRF) has become an alternative treatment in cases where there is a need for regeneration, both in soft and hard tissues. This second generation of platelet concentrates, extracted from the blood and obtained after processing through centrifugation, was introduced by Choukroun and colleagues in 2001.

The protocol for obtaining L-PRF involves collecting the patient’s own blood by venipuncture, in 9-10mL tubes coated with glass/plastic that must be immediately centrifuged at high speed at 400g RCF: 2700 rpm for 12 minutes or 3000 rpm for 10 minutes. After centrifugation, the constituents of the blood separate into three layers.

At the bottom of the tube, red blood cells accumulate, in the upper part, there is platelet-poor plasma, and the intermediate layer consists of the highest concentration of platelets and leukocytes (fibrin clot that we call L-PRF), as shown in Figure 1.

Figura 1 – esquema do tubete de vidro após a centrifugação. É possível observar que no fundo do tubete estarão as células vermelhas, acima, com mais consistência o coágulo de fibrina, que será removido com a pinça e utilizado para confecção das membranas e o plasma pobre em plaquetas, que será descartado.
Figure 1 – diagram of the glass tube after centrifugation. It is possible to observe that at the bottom of the tube will be the red blood cells, above, with a more consistent fibrin clot, which will be removed with tweezers and used for the preparation of membranes, and the platelet-poor plasma, which will be discarded.


In a matter of minutes, the activation of the majority of platelets in the blood sample occurs due to contact with the glass walls of the collection tube, triggering the coagulation cascade.

The L-PRF clot is rich in fibrin, platelets, leukocytes, monocytes, and growth factors. Studies suggest a positive effect on cell proliferation, migration, adhesion, differentiation, and the inflammatory process, which justifies its widespread use in dentistry.

How to use clinically?

For the clinical use of L-PRF, the clot is removed from the tube with forceps, and the portion of red blood cells adhered to the clot is then removed using a spatula, scissors, or a scalpel blade.

The fibrin clot can be transformed into plugs by compression, which can be used, for example, to seal extraction sockets (figure 2), or membranes with a thickness of 1mm. It can also serve as a framework for binding bone substitute particles, such as Nanosynt, for instance.

Figura 2 – imagem de um plug de L-PRF, preparado após a compressão dentro de um cilindro. Para a obtenção do mesmo, é necessário a centrifugação do sangue no tubete de vidro, por 12 minutos. Após a centrifugação, deve ser removida a parte intermediária – maior concentração de plaquetas e leucócitos com uma pinça e levada para dentro do cilindro disponível na caixa de L-PRF. Com o auxílio de uma pinça, levar o plug para o local desejado.
Figure 2 – Image of an L-PRF plug, prepared after compression inside a cylinder. To obtain it, blood must be centrifuged in a glass tube for 12 minutes. After centrifugation, the middle part – higher concentration of platelets and leukocytes – should be removed using forceps and placed into the cylinder provided in the L-PRF kit. With the help of forceps, place the plug in the desired location.


For membrane formation, the fibrin clot is placed on a perforated surface inside a metal box (PRF box) (figure 3), and it is compressed by the force of gravity with the assistance of the metal plate of the box for a period of 5 minutes.

Figura 3 – A figura 3 mostra a aparência do coágulo de fibrina (parte intermediária) assim que removido do tubete de vidro. Estes devem ser comprimidos com a tampa da caixa, para que então as membranas se formem e estejam prontas para o uso. O exsudato que se deriva desse processo pode ser utilizado como fonte de irrigação de biomateriais.
Figure 3 – The image depicts the appearance of the fibrin clot (intermediate layer) right after being removed from the glass tube. These should be compressed with the lid of the box, allowing the membranes to form and be ready for use. The exudate derived from this process can be utilized as a source of biomaterial irrigation.


The exudate released by the clot, due to its compression, will be stored in the lower compartment of the box. This exudate is rich in proteins (fibronectin and vitronectin) and can be used to hydrate grafts and biomaterials, as well as to irrigate surgical wounds. Figures 4 and 5 show the membranes after compression, ready for use, which can be employed to cover the palate that served as the donor area for gingival graft, as well as in the recipient area to aid in the formation of keratinized tissue.


Figures 4 and 5 – In figures 4 and 5, we observe the membranes after compression, ready for use. At this stage, they can be used in a diced form with the graft – sticky bone, or as membranes, covering grafts, donor areas, and recipient areas.

Regarding collagen membranes in bone grafting techniques; in the maxillary sinus for sinus lifting procedures, and in conjunction with the sticky bone technique, which will be described below. As for the preparation of the plug, it involves placing the fibrin clot into the small cylinder of the PRF box and gently pressing it with a cylindrical weight. Both the membrane and the plug can be used within a period of 2.5 to 3 hours after collection, and they should be irrigated with the exudate to prevent dehydration.

L-PRF can be used in combination with biomaterials or to agglutinate bone particles, forming a block called PRF block or sticky bone (figure 6).

Figura 6 – aparência do sticky bone ou PRF block quando pronto para utilização. Ele compreende a mistura do biomaterial, Nanosynt, da membrana de L-PRF picotada e do I-PRF que foi adicionado. Assim, além de melhor aglutinação do enxerto, conseguimos conduzi-lo melhor à área enxertada. Sendo assim, melhor indicado para enxertos de maior área de extensão, como por exemplo: técnica da tenda para aumento da espessura e enxerto de levantamento de seio maxilar. Após o preenchimento com o PRF block, é possível fazer o revestimento da área enxertada com membranas de PRF.
Figure 6 – Appearance of the sticky bone or PRF block when ready for use. It consists of a mixture of the biomaterial Nanosynt, diced L-PRF membrane, and added I-PRF. This combination not only enhances graft agglutination but also facilitates its placement in the grafted area. Therefore, it is particularly suitable for grafting larger areas, such as the tenting technique for thickness augmentation and maxillary sinus lift grafting. After filling with the PRF block, it’s possible to cover the grafted area with PRF membranes.


This technique increases the volume for reconstructing large defects, reducing the amount of required biomaterial and consequently the procedure’s cost. To prepare the PRF block, the patient’s blood is collected in 6 tubes coated with glass and 2 tubes coated with plastic. Plastic-coated tubes do not initiate the coagulation cascade, keeping fibrinogen in a liquid state. These tubes should be removed after 3 minutes of centrifugation, while the others should be kept until the cycle is complete. The fibrinogen (yellow liquid inside the plastic-coated tube) should be removed from the portion closest to the red blood cells, which are deposited at the bottom of the tube, using a plastic pipette, without aspirating the cells. The liquid should be kept inside the syringe. After the centrifugation of the other tubes is complete, the L-PRF clots are removed and gently compressed, as mentioned earlier, to form L-PRF membranes. In a glass or metal container, two membranes should be diced into small fragments using scissors and mixed with 0.5g of a bone substitute until a uniform mixture is obtained. 1cc of liquid fibrinogen (i-PRF) should be added, gently mixed for about 5 seconds, and the L-PRF block molded.

L-PRF has been indicated in periodontal plastic surgery, jaw osteonecrosis, buccal sinus communication, infra-bony defect regeneration, alveolar preservation, maxillary sinus lift, furcation lesions, gum recession, implant surgeries, and proves to be an excellent adjunct in the regeneration process.


Choukroun, J. (2001) Une opportunit_e en paroimplantologie: le PRF. Implantodontie, 42, 55– 62. French.

Dohan, D. M., Choukroun, J., Diss, A., Dohan, S. L., Dohan, A. J., Mouhyi, J. & Gigly, B. 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.

Pan J, Xu Q, Hou J, Wu Y, Liu Y, Li R, Pan Y, Zhang D. Effect of platelet-rich fibrin on alveolar ridge preservation: A systematic review. J Am Dent Assoc 2019; 150: 766-78. doi: 10.1016/j.adaj.2019.04.025.

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Quirynen M. Regenerative potential of leucocyte- and platelet-rich fibrin. Part B: sinus floor elevation, alveolar ridge preservation, and implant therapy. A systematic review. J Clin Periodontol 2017; 44: 225–234. doi: 10.1111/jcpe.12658

Temmerman A, Vandessel J, Castro A, Jacobs R, Teughels W, Pinto N, Quirynen M. The use of leucocyte and platelet-rich fibrin in socket management and ridge preservation: a split-mouth, randomized, controlled clinical trial. J Clin Periodontol 2016; 43: 990–999. doi: 10.1111/jcpe.12612.


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