Leukocyte- and platelet-rich fibrin in Implant Dentistry

An interview with Dr Simon Nocton and his team to talk about how the use of Leukocyte- and platelet-rich fibrin (L-PRF) in their practice is helping patients to recover quickly from oral surgery.

In a nutshell, what is PRF?

Platelet rich fibrin (PRF) is a by-product of blood that is rich in platelets offering patients a natural and satisfactory method of accelerating the healing process in oral surgery such as extractions, the placement of dental implants and bone grafting. It is a technique that provides a concentrated source of growth factors from platelets and whole cells to promote healing.
In my practice patients also seem to experience significantly less pain post-operatively, and as it carries a low risk of infection this is a combination that works for both me and my patients.

Blood is drawn from a patient and centrifuged through a device to separate the plasma from the red blood cells. The PRF is then extracted from the rest of the plasma and, in some instances, mixed with bio-materials to create a substance to be used in certain procedures. From start to finish it takes about 18 minutes in total to prepare the PRF membranes. Providing you start the procedure at the beginning of the appointment, it can be done when patients come in for treatment. We don’t need to change the set-up of what we do to accommodate PRF, which is good for continuity. I can focus on the patient while the team does their job. It’s something not out of the ordinary for what we do.

What benefits have you found from using the procedure?

Without a doubt the greatest impact for patients is noticed in their short-term recovery. If I offer patients the option to have a procedure that looks and feels like a simple blood test and can make their procedure less painful, make the recovery time quicker and more effective, I would be surprised to hear patients decline the chance. Any bone augmentation using L-PRF, providing it is successful, will benefit the longevity of the implant or restoration.

What has it meant for your post-treatment care? Do you monitor patients less or more as a result?

I monitor patients closely out of intrigue to see for myself to what extent the procedure speeds up the healing process. The literature supports the benefits, but it’s great for patients to hear first-hand from their surgeon having seen it happen in practice in their own treatment rather than in theory. Our patients seem to experience reduced pain and due to this I could actually be more hands off, given how well it appears to be working.

But are there any patients who this is inappropriate for?

Naturally we have to be slightly more careful with patients who take anti-coagulants. As you might imagine, we have to change our protocol significantly to protect them.

What is the implication of introducing this as a new procedure in a practice?

Sometimes having blood taken by the dentist is a mental block – for both patient and dentist. Some dentists haven’t utilised their blood-taking skills acquired at dental school for some time. That is why in our practice the dental support team are specifically trained to venepuncture. Here, one of the team’s nurses, Miriam, will take the blood, create the L-PRF, mix the membrane to form the graft for the patient and assist the surgeons with the procedure. Because it’s not a skill everyone has utilised beyond dental school, that’s where being progressive and including different members of the dental team and their skills make sense. Skill mix is something we firmly believe in here. It keeps our staff motivated.

How have patients responded?

With fascination. It’s right and responsible to give patients information on any procedure, and this is no different. We discuss in detail what L-PRF is about, that it is their blood product being used and the risks involved. There isn’t any data that suggests this is an unhelpful procedure. Most people are pleased if we can help how their body will heal. Unlocking the hidden potential in their body to help them heal is something many respond positively to.

Are there any other applications for PRF in dentistry?

It’s interesting you say that. Although I do not think it is right for us to experiment on people, there may be some use in facial aesthetics. That is not one of my areas of expertise, but I do know that treatments such as vampire facelifts that use platelet concentrates has a huge effect on skin tone and acne scarring. These are non-dental uses, albeit procedures that are now carried out by dental professionals. I am sure dentists are good people to do facial aesthetics, there are few people short of plastic surgeons with such a wide knowledge of facial anatomy. Dentists may have an increased role using PRF in facial aesthetics for healing and aiding patients to transform how the appearance of their skin looks.

I have read that some people are using PRF as a total bone substitute, and I’m absolutely sure that is not where the strength of this technique lies. I think it needs to be used in combination with a bone substitute to create a robust scaffold for bone to grow in to. To me that’s a more responsible approach to take to something that is relatively new.

Does the surgery’s use of innovative techniques such as this aid team development?

In Miriam’s words, “it’s inspiring”. She doesn’t feel like she’s a “spare part”, simply handing people things. Acquiring the skills to be part of the team delivering L-PRF to patients means so much to her. Both her and I would recommend any dentist should include their nurse as much as possible on a practical level. It frees up the dentist to do more and makes the wider team feel valued. Encouragement from the dentist breeds a culture of positivity. A lot of nurses don’t say anything because they perhaps lack the confidence. They may think “I’m sure this guy is taking out the wrong tooth here” but won’t say anything because, well, the dentist knows better. It definitely does wonders for their confidence being included in the way the practice develops and this can be seen in the overall care the patient receives.

It is really important for us as a team to make every team member count. It’s a culture – PRF has undoubtedly galvanised that. It’s an exciting time to be in dentistry. The hardware and technological progression is beyond belief, and on the softer, biological side we’re seeing advances we didn’t think would really be possible. There is potential where we didn’t have potential before. We can now influence how cells behave – tissue engineering coming into dentistry is fascinating.

Patients have access to technology before and after a visit – are they becoming more demanding?

The City of London is a great place to work because largely speaking those who work in the City are heavily influenced by technology. Their jobs often dictate that they are inquisitive for knowledge, so it doesn’t particularly surprise me that many of the patients we have who have not heard about PRF treatment very quickly will look it up.

For me that’s great. It’s music to my ears. It gives great validity to informed consent because it gives me a platform for discussion and I will happily spend as much time as a patient requires to explain how the procedure works and the science behind it. Ultimately it gives them more information to base their decision on.

Would you say you’re ahead of the curve with this one?

Globally, there are pockets where it has been adopted heavily – hotspots in Belgium, Paris and Seoul to name but a few. If you live in an area that increases your exposure to it and therefore direct vision of results, it blossoms from there. It’s the UK’s turn. There are variants in the technique, but there will come a time when it no longer sits on the periphery. It’s not quite now, but it’s certainly at the start of that journey.

For me, to still have the desire to indulge in learning and studying after so many years in practice is great. The buzz comes in adopting something innovative and challenging. It’s not just me – it’s the whole team. It has stimulated everyone in the practice. Implant dentistry in itself – other than the surface technology – hasn’t changed for a number of years. The biological approach has changed, and embracing that to aid patients is fascinating and a challenge we all gratefully accept.

For more information on the use of L-PRF in implant dentistry, email us or call us on 020 7680 8914.