WHICH IS BETTER; PRGF OR PRF?

 I have written on this in the past, and was reintroduced to the subject in a recent article in our journal (J Oral Maxillofac Surg 76:1823.e1-1823.e12, 2018).

PRGF (platelets rich in growth factors) and PRF (platelet rich fibrin – also called L-PRF) are terms used to describe products of blood fractionation used in surgical procedures. Unfortunately they do not have a specific definition from a procedure standpoint medically/surgically. The original descriptor for PRGF was “plasma rich in growth factors” which is also an appropriate term, but I feel falls short of showing that we are using a platelet concentrate, not just plasma. There is an importance in that some techniques that other practitioners use to separate the component parts include additional cells which may adversely affect the desired result. Some include the white blood cells (leukocytes) and others include some red cells (erythrocytes) and/or additional plasma and components. I feel strongly that there is a difference in results and in our practice we stick to using primarily the platelet–growth factor portion where we can, which is the vast majority of cases.

Historically we used the patient’s own bone harvested locally, from the jaw, or from a distant area such as the hip or rib as examples. This works well especially for large defects and especially with vascularized grafts (bone grafts including the grafting of associated blood vessels and tissue such as muscle). The problem with your own bone is the necessity of a donor surgical site and also that our bodies absorb our own bone easily – so a graft such as an onlay graft using your own bone, which might be performed for implant reconstruction, will absorb easily during the healing process resulting in the loss of the graft.

In comes materials such as ceramics, animal bone products, and human bone products. Of these the human bone product (deproteinated and irradiated for sterilization) has shown to be the best received and very stable for grafting of smaller defects as might be used in typical oral surgical procedures. The ceramics and animal bone products have their uses and we find them to be excellent for certain applications, however they may show a more difficult “take” or acceptance and they tend to stay on forever in their present state (which is technically not usually a problem – but can be). The human bone product is essentially completely reabsorbed and replaced by your own native bone during the healing process. This result is more desirable to me.

When you mix PRGF and the human bone product (and in some cases the other bone substitutes) I call it a “super-charged” graft with not only a bony scaffold (the bone graft material), but also a very cellular accelerant which “induces” bone growth (the PRGF). This has been a quantum leap for our grafting procedures and gives great results. The cited article backs up the idea that the PRGF works better than just PRF to induce tissue regeneration and growth.

We have been using these techniques for about 10 years. Again, we have been performing implants and grafting procedures for over 30 years and we have trained in and tried all of the reasonable techniques. We stick with what works best and keep looking for new and better materials and methods.

In our hands, PRGF works better than PRF for grafting techniques.