Often one has to deal with the absolute uncertainty of fellow dentists in the choice of tubes used to obtain fibrin clots and platelet-rich plasma. This is understandable, dentists did not delve into physiology as deeply as therapists. Hence the problem - an insufficient level of proficiency in the subject. I will be only glad if you, dear colleague, have studied hematology well, but statistics cannot be fooled, this article will be of benefit to many doctors who want to start using the PRF technique in their practice.
So the goals.
1) Obtaining platelet-rich plasma that thickens before use
PRF clumps. It is a thickened part of blood plasma containing many growth factors for osteo- and angiogenesis. Membranes and plugs can be prepared from them using a special PRF-BOX. The essence of the PRF box is in squeezing out fibrin in order to release it from excess plasma. Bone materials are covered with membranes, palate defects after gingival grafts, Schneider's membrane with its perforations and simply sinus lifts, is used for periodontal surgery. Plugs - for filling post-extraction sockets of teeth and periodontal defects. Outside of dentistry, clots are used to regenerate mucous membranes and skin.Likewise, the clots can be cut into small pieces with scissors and mixed with bone substitutes.
Key words:
PRF (platelet-rich fibrin);A-PRF (advanced - increased type);
CGF (concentrated growth factor);
SUPERFIBRIN (ideal (best) method for making fibrin clots).
2) Obtaining platelet-rich plasma, which thickens after application
This plasma is used for mixing with the bone substitute in order to stabilize it and give it a certain shape. For injections into periodontal tissues in order to improve their blood supply, change the biotype of the gums. Sometimes for gluing the edges of the mucous membrane, for example, Schneider's membrane.
Keywords:
i-PRF (injectable)AFG (autologic fibrin glue)
Sticky Bone
3) Obtaining platelet-rich plasma, which will NOT thicken in the future
PRP plasma. For this goal, we need prp tubes which you can buy at the our website. It is used for PRP therapy of skin and joints, for example. In cosmetology it is now fashionable to say: "Plasmolifting". The PRP technique assumes that the plasma does not clot either before or after it is introduced into the patient's body. The mechanism of action is all the same growth factors.
Keywords:
the PRP (Platelet Rich Plasma)Plazmoterapiya
Plasmolifting
Please note that these are just recommendations. For example, the table does not have a label for sodium citrate - blue. Therefore, it is necessary to delve into the composition of the additive in more detail, depending on the manufacturer, because there may be differences in color coding.
Important! The manufacturer is usually irrelevant to the outcome. For example, the so-called "branded" or "original" Chukrun tubes are made in China. And "Plasmolifting" is also made in China. But it is worth noting that tubes of the same type from different manufacturers can still have different quality. For example, our English test tubes are better than Italian ones in terms of the quality of the plasma activator spraying.
Now about the process of obtaining each type of plasma
1) Tubes for plasma that will thicken before use (PRF clots, A-PRF, SUPERFIBRIN)
First, let's understand the mechanisms. Blood clotting is a complex biological process of the formation of fibrin protein filaments in the blood, which polymerizes and forms blood clots, as a result of which the blood loses its fluidity, acquiring a curdled consistency. The coagulation activator can be silica / kaolin / glass surface. The last three activate factor 12 , then thrombin is formed from prothrombin, which activates the transition of fibrinogen to fibrin. Well, fibrin is already doing its job - it binds and forms a clot.
The clotting time is 15-30 minutes (data from the manufacturer of the tubes, centrifugation is not expected) . Centrifugation and heating accelerate this process. And yet, the rate of clotting depends on the individual patient.
As a rule, thrombin tubes are not used for PRF preparation, because centrifugation is not always enough for five minutes. Let me remind you that the purpose of centrifugation is erythrocyte sedimentation before fibrin binding begins. In the case of using a thrombin supplement, there is a high risk of thickening before the erythrocytes are separated, as a result, the clot will be red.
There remains the option with silica, kaolin or empty glass. They usually have a red cap.
NB Carefully invert the tube 5-8 times in order to achieve complete mixing with the reagents. Do not shake: violent mixing may cause foaming and hemolysis!
So, for PRF and A-PRF you need tubes with a plasma activator (with silica or empty glass). If you still do not have a box for PRF, take a look here: PRF-BOX
2) Tubes for plasma that will thicken after application (i-PRF, Sticky Bone, AFG)
The principle of obtaining i-PRF is as follows. The content of the vein is taken into a container without a plasma activator. Some of the fluid is separated from the red cells before fibrin begins to bind. The obtained, not yet coagulated, turbid-red liquid is quickly withdrawn with a syringe and applied just as quickly. After a few minutes, the liquid will thicken.
NB The use of thrombin or a clotting activator is risky in that the resulting i-PRF will thicken before use. The collection from the vein and the beginning of centrifugation should be lightning fast!
So, i-PRF requires tubes without activator. IPRF tubes can be purchased HERE
The principle of obtaining AFG (Sticky Bone) is very similar, but has its own characteristics. Autologous fibrin glue for the so-called "sticky bone" is prepared in specialtubes for sticky bone. Red cells settle as a result of centrifugation, the lower part of the plasma (up to 1/2) at the junction with erythrocytes is withdrawn with a syringe and used as intended.
NB Please note! The material was obtained without the use of a coagulation activator, so it takes some time for the thickening process. All steps can be completed without haste. Centrifugation speed and time can vary over a wide range; this is not a critical issue for AFG.
3) Tubes for plasma that will not thicken (PRP, Plasmolifting)
PRP therapy has been used for over 15 years. The task of obtaining centrifugate is erythrocyte sedimentation and prevention of coagulation. Usually, centrifugation is carried out at a sufficiently high speed for 8-12 minutes, this time is enough for the sedimentation of the red cells. If you haven’t purchased a centrifuge yet, take a look at this option: Centrifuge for PRF and Plasma Therapy
For additives, it should be an anticoagulant that will prevent the centrifugate from clotting. Sodium citrate or sodium heparin can be used as an additive. Each of them has its own nuances. Sodium citrate blocks blood calcium and thus blocks coagulation. But if you then add calcium chloride to the centrifugate, it will still curdle.
Heparin participates in the formation of the thrombin-antithrombin III complex, as a result of which thrombin, being bound, becomes unable to convert fibrinogen into fibrin, as a result of which the blood does not clot. After heparin, blood clotting is almost impossible, except perhaps adding a large portion of thrombin. Both of these anticoagulants do not prevent platelet aggregation.
It is worth noting that after injections of PRP obtained with a heparin supplement, the formation of hematomas is often observed in patients. I hope the reasons are clear.
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