Modern day alchemy has been used to describe the bone and tissue banks of the world today. You remember alchemy, trying to turn something like lead into gold? The bone/tissue banks don't pay for their raw products, they instead get them from donors like you and me after we are dead, for free! Then they turn it into products that they sell to dentists for the price equivalent of gold. What a racket! No wonder organized crime wants a piece of the action. Bone morphogenetic proteins (BMP2) will not be widely available to dentistry any time soon as long as corporate greed exists in the world today. One of my oral surgeons and I did one of those "Teeth in a Day" procedures to replace all of a patient's maxillary teeth with a hybrid FPD, and just the costof the BMP2 alone was $5000 (bilateral sinus lift with facial onlay grafts and he was swollen like a toad, unable to wear his dentures for two weeks after). After all, if they can sell BMP to an orthopedic surgeon for a big bucket of dollars, why should they sell a small dab to dentistry for a reasonable price ($800+ is the smallest amount they will sell to dentists). I guess the thinking on this is that if they open up the market to the dental profession at a reasonable price, the orthopedic guys will just buy that instead of the high dollar product they currently are forced to buy. Platelet Rich Plasma (PRP) isn't as expensive (or versatile) as BMP2, tissue, or bone, but the disposables used in the process of PRP amount to nearly the cost of bone products. Some of the PRP kits are fairly reasonable in price, but some border on being cost prohibitive. Then there are always relatively cheap techniques like the one I was introduced to during an implant workshop out in L.A. by a periodontist named Jin Kim. There has to be something out there that satisfies the many criteria for grafting/wound healing that modern dentistry can use without breaking the bank. The patient populations around the world cannot routinely pay for processed bone, tissue, or even PRP at these prices. Stacking the cost of these products on top of the cost of the extraction/implant/graft puts it out of reach for most people. Wouldn't it be great if we had a material that was cheap, relatively easy to get, and completely compatible with every patient's particular biological immunity? Also, a product that lasts up to 2 weeks in the body, super-charges the healing response, is a suturable membrane, can be placed in extraction site socket grafts, used with connective tissue grafts, and in sinus lift grafts? Well, I think there is such a product out there that comes close, and it is going to change how dentists treat their every day patients around the world. The product is called Leukocytic-Platelet Rich Fibrin (L-PRF) or just PRF for short. At first appearance, PRF sounds like PRP. You still have to draw blood like PRP, and you still have to use a centrifuge like PRP, but that is were the similarities end. Joseph Choukroun, MD, invented and pioneered the research and development of PRF membranes. Fibrinogen is the active form of fibrin and is found in blood plasma. It plays a role in platelet ?-granule aggregation during hemostasis. Fibrinogen transforms into the insoluble sticky fibrin in the presence of the patient's naturally occurring thrombin and consolidates the initial platelets into a clot at the site of an injury. Not using foreign thrombin as in PRP it helps alleviate many fears over immune reactions and antigenicity problems that some fear may happen when using either bovine or human thrombin. Trapping the platelets and leukocytes inside the fibrin clot helps in many ways:
- Transforming Growth Factor beta or TGF? is a protein that assists in cellular differentiation and proliferation.
- Platelet Derived Growth factor or PDGF helps bring in mesenchymal stem cells into the area as well as differentiate and proliferate endothelial cells.
- Insulin-like Growth factor or IGF helps healing cells from dying so fast and continue healing longer.
- Growth factors will work on type 1 collagen to form fibroblasts and osteoblasts
- Releases cytokines to attract the healing response of the body.
- Leukocytes will enhance the bodies own inflammatory process to heal quicker.
- Fibrin network increase the blood flow into the area with Vascular Endothelial Growth Factor or VEGF.
- Neutrophile degrades the site for wound remodeling and bring in the macrophages to clean up the site.