Does Varying Platelet-Rich Fibrin Centri̇fugati̇on Protocols Enhance New Bone Formati̇on in Extracti̇on Site?

Background: Finding a protocol that could prevent bone resorption and be implemented in clinical practice would be crucial in providing sufficient bone to replace missing teeth with implants.

Purpose: The study aimed to determine the effectiveness of different centrifugation platelet-rich fibrin (PRF) protocols in new bone formation and bone regenerative markers.

Study design, setting and sample: This randomized clinical trial was conducted at Izmir Katip Çelebi Research Hospital, a population-based facility in Izmir, Turkey. Study subjects were composed of patients who required extraction of anterior teeth. Exclusion criteria included periodontal disease, resorption of alveolar bone, defects, smoking, alcoholism, and systemic diseases.

Independent variable: The independent variable was the PRF protocol. The subjects were randomly assigned to one of three groups: leukocyte platelet-rich fibrin (L-PRF), advanced platelet-rich fibrin (A-PRF) and control groups (healing naturally).

Main outcome variable: The primary outcome of interest was the percentage of new bone formation, determined by analyzing the staining intensity in histomorphometric assessments of bone samples collected 8 weeks after extraction. The secondary outcomes were regenerative effects measured by the immunohistochemical expression of markers such as osteocalcin, alkaline phosphatase, and proliferating cell nuclear antigen. Potential benefits were evaluated by clinical observations of pain, swelling, membrane visibility and healing.

Covariates: The covariates were age, sex and health conditions.

Analyses: Histologic comparative staining intensities and biomarkers expression between groups were evaluated by one way analysis of variance. A difference of P < .05 was considered statistically significant.

Results: The study included 57 subjects, with a mean age of 45 years (±5.6); 30 were male (53%) and 27 female (47%). The control group had a mean new bone formation of 32.68% (±2.5), the A-PRF group 61.37% (±3.0), and the L-PRF group 70.74% (±3.5) (P < .001). The A-PRF group showed significantly higher osteocalcin expression than the control group (P = .013). Alkaline phosphatase and proliferating cell nuclear antigen expression scores for PRF groups were significantly higher than the control group's (P = .001). Both groups demonstrated significantly lower pain scores, reduced gingival swelling, better membrane visibility, and healing compared to the control group.

Conclusion and relevance: PRF enhanced bone formation rates, with L-PRF showing the most significant effect.