This document discusses the use of Leukocyte & Platelet-Rich Fibrin (L-PRF) in various dental procedures over a 10-year period. It summarizes how L-PRF can be easily prepared from a patient's blood and provides a matrix that releases growth factors over 1-2 weeks to accelerate healing. The document outlines how L-PRF has been used successfully in extraction socket healing, ridge augmentation, sinus floor elevation, complex reconstruction procedures, and for membrane repair. Specific case examples with clinical photos are provided to demonstrate the benefits of incorporating L-PRF into these types of dental surgical procedures.

1. Leukocyte & Platelet-Rich Fibrin (L-PRF) in Ridge and Sinus Augmentation:
10-Year Clinical Experience
Extraction Sockets LateralWindow OsteotomyTranscrestal SFE
MichaelToffler DDS (info@michaeltoffler.com)
Peri-Implant DefectsRidge Augmentation

2. “PRF is easy to handle and modify, providing the defect with not only a matrix permitting cell
migration into the surgical site but also with crucial biological cues potentially accelerating the
wound healing process.” (Ghanaati et al 2014)

3. L-PRF: Simple Preparation
•
•
24 gauge
butterfly
needle
plastic tube coated internally with silica particles

4. 2700 RPM (400g) 12 minutes
RBCs
Fibrin Clot (PRF)
Acellular Plasma (PPP)
Intra-Lock.com

5. L-PRF:Preparation (cont)
•
•
• WBC
and PLT
Fibrin
clot
RBC
Li et al 2013

6. PRF ‘s naturally polymerized fibrin network sustains a slow release of growth factors and matrix glycoproteins for 7 - 14 days
(Ling 2009; Dohan-Ehrenfest et al 2009; He et al 2009; Wu et al 2012; Kawase et al 2015)
FRAGMENTSMEMBRANES PLUGS GF-ENRICHED BONE GRAFT MATRIX
(PRF-BLOCK®)
Standard 12 Minute Protocol Modified 3 Min Protocol
PRF BLOCK

7. We graft sockets to offset the post-extraction catabolic process and
minimize alveolar ridge degradation

8. •
•
•

9. The positive effect of growth factors in L-PRF could be particularly relevant when combined with osteoconductive
scaffolds with slow healing dynamics (Torres et al 2009; Anitua et al 2010), where bone metabolism is compromised
(eg. osteoporosis) as well as in early implantation scenarios (Chen et al 2004).

10. My “Socket Cocktail”
CaSO4, PRF, D/M/FDB

11. PRF has shown promising results in the early phases
of extraction socket healing
•
•
•
•

12. Flapless Extractions
• Socket grafted to a level 2 to 3 mm below free gingival margin

13. PRF provides an organized matrix at the start of healing, increasing the speed of vascular ingress and wound coverage (Dohan et al 2006)
Flapless Extractions
1 wk 4 wks
•1 or 2 PRF plugs placed in socket and secured with mattress and interrupted sutures

14. In SitesWith Severe Bone Loss, Ridge Augmentation Is Usually Performed
6-8Weeks AfterTooth Removal

15. This Delayed Approach Provides Additional Soft-tissue Coverage OverThe Augmented Site
1 WEEK
Maintenance of primary
closure is essential to
maximize bone gain
8 WEEKS after ext’s

16. L-PRF over Frenectomy and in Socket
8 wks
Ridge augmentation done simultaneously with ext #9 would require a larger flap with extensive
release, increasing postop pain and swelling as well as the risk of wound dehiscence.

19. Autogenous
bone goes
here

21. PRE-OP

22. Toffler M. Guided Bone Regeneration (GBR) Using Cortical Bone Pins in Combination with Leukocyte- and Platelet-Rich Fibrin (L-PRF).
Compend Cont Ed Dent 2014;35(3).
Salvin Dental

23. Cortical Bone Pins: ClinicalAdvantages
•No screws to retrieve
•Membrane support
•Graft retention

25. 2 mm twist adjustable stop (hhco-store.com)

28. 10-day post-op

29. Comparative healing at 6 months
• 6 months post-op • Pre-op

32. Stage-2 Final
Dr MichaelWoloch

34. PRF BLOCK®

36. PREOP6 MOS

39. Consistent Use of L-PRF in Sinus Elevation Surgery for the Last 10 Years
• Slow sustained release of key growth factors (Ling 2009; Dohan-Ehrenfest et al 2009; He et al 2009; Wu et al 2012; Lauritano et al 2013; Kawase et al 2015)
• Expedited sinus graft healing (Choukroun et al 2006; Inchingolo et al 2010; Tatullo et al 2012; Cruzat et al 2015)
• Maintenance of primary wound closure (Khiste & Tare 2013; Baiju et al 2013; Toffler et al 2014)
• Membrane protection (Diss et al 2008; Toffler et al 2010) and repair (Choi et al 2006; Shin & Sohn 2005; Baykul & Findik 2014; Toffler & Rosen 2015)

40. All My Approaches to Sinus Floor Elevation Incorporate L-PRF
Transcrestal/Simultaneous LWOTranscrestal/Staged

41. 10 mm long implants
“I use a transcrestal approach as often as I can, but prefer using a lateral (visual) approach not
only in severely atrophic sites but also in………….

42. …….patients with ≤ 4 mm of subantral bone and significant sinus pathology.”
Optical and Instrumental Access to Optimize Healing Response

43. ……and for extra added
safety, platelet-rich fibrin
(PRF) lines the sinus
membrane prior to grafting

44. Single Stage Placement 6 Months Later

47. 10 mm

49. 4.0 x 11 mm Implant PREOP

50. 5 mm core prepped to a depth 3 mm

51. Subantral
bone
height is
now
doubled
(7- 8 mm)

57. PRF inTSFE and Simultaneous Implant Placement

58. PRF will be added immediatedly after accessing sinus via direct infracture , drilling or piezosurgery
Direct Infracture Drilling/Controlled Erosion Piezosurgery

59. Sohn
2010

62. 2.8 mm tip to elevate
Widen osteotomy
to 4.1 mm
PRF

64. PREOP

65. Bone Densification and Placement 5 x 11 mmThommen Implant

66. PRF in Membrane Repair

67. Perforation Transcrestal Approach
PRF

68. Perforation Transcrestal Approach
4 mos
CBCT 3 years

71. At 4 months, full repair and 6.7 mm RSBH
6.73

72. 6.73
3-4 mm
of TSFE
4 years

73. 64 y/ F, heavy smoker
Implants placed 10 years ago, referred for tx peri-implant disease
Severe sinusitis, failure of implants 13 (floor intact), 14 (OAC)
14
13

74. Double Pedicle

75. porcine collagen membrane covers plugs
PRF

76. PRF covers collagen
CTG pedicle palate joins facial pedicles
CTG

77. 1 week 8 weeks
Asymptomatic, Successful Closure OAC

78. I hope I have demonstrated the potential benefits of incorporating PRF into:

79. Extraction Sites
• Serves as a matrix to accelerate the healing of wound edges much like a fibrin bandage
7 days

80. Ridge Augmentation
• Aids in hemostasis
• Provides a high quality of gingival maturation (Simonpieri et al 2009)
1 week

81. • The strength of PRF membranes enables a biomaterial to be maintained and protected
Ridge Augmentation

82. Composite Grafts
• PRF fragments serve as a biological connector between bone particles facilitating cellular migration, particularly for
endothelial cells necessary for neo-angiogenesis (Simonpieri et al 2009; Kobayashi 2011)

83. Complex Reconstructive Surgery
• Platelet cytokines are gradually released as the fibrin matrix is resorbed, thus creating a perpetual process of healing

84. PRF is a welcomed addition for all my SFE procedures, but it is especially
helpful in high risk membrane perf/sinus communication cases!
FAILED LWO SINGLETOOTH SITESOAF EXT/OAC SINUS SEPTA

85. info@michaeltoffler.com
ThankYou