Bone Grafting using Platelet Rich Fibrin (PRF)
The bone grafting materials that Dr. Yuriy May employs in the Natural Dentistry practice have been hand-selected through extensive clinical research and are, by design, considered the most effective and with the least amount of side effects.
Biological Bone Grafting Materials for Implants
The bone grafting materials that Dr. Yuriy May employs in the Natural Dentistry practice have been hand-selected through extensive clinical research and are, by design, considered the most effective with the least amount of side effects. Dental grafting material choices that are the most natural for the body are usually a mix of Platelet Rich Fibrin (“PRF”) and bone from the patient, referred to as “autologous” grafting. Autologous bone, also known as “sticky bone,” and PRF have infection-reducing properties, along with helping blood clotting in a bone graft, thus allowing the bone graft material to hold together and form healthy bone with improved density over other potential grafting options. Few conventional dentists or oral maxillofacial dental surgeons use materials that are limited to autologous grafting choices, as they are harder to harvest and require spinning patients’ blood or retrieving patients’ own bone scrapings from surgical sites. (1,3)
Dr. May’s choice of materials requires more time, effort, and cost on the part of the dentist relative to the more conventional and widely used animal or synthetic bone graft materials made of either animal material (bovine or porcine) or synthetic compounds, including various forms of PTCP (beta-tricalcium phosphate). Dr. May is an early adopter and key dentist in the country using autologous Platelet Rich Fibrin Therapy (PRF), working with leading researchers such as Dr. Rick Miron to help provide real-time clinical feedback from healing sites and surgical results, which has helped shape the field of PRF research in dentistry and medicine. Dr. May is an expert at creating and using all forms of PRF therapy, including i-PRF, A-PRF, L-PRF, and horizontal PRF. (5,9)
PRF is Dr. May’s primary bone graft material for maxillofacial surgery, bone growth, and bone regeneration, and is used in some of the following ways: (8)
- Guided bone regeneration (GBR)
- Guided tissue regeneration (GTR)
- Bone defects
- Extraction sockets
- Sinus lift & sinus perforation
- Jaw ridge augmentation & grafting (ridge split)
- Palatal defects
- Maxillary bone atrophy
- Mandibular bone atrophy
Platelet Rich Fibrin (PRF) Bone Grafting
Dr. May’s grafting material, PRF, is extremely effective, beneficial, and safe because it is made from patients’ very own blood, thus making it 100% natural and derived from patients’ own bodily tissue. PRF is 100% autogenous (meaning it comes from the patients’ own body) and is derived 100% from the patient’s blood. (1,2)
In a simplified chairside procedure, blood is taken from the patient virtually painlessly into several tubes, then spun down into serum containing white blood cells and healing properties, and used as the perfect grafting matrix to instigate dense, healthy, and incredibly robust bone growth, which is the goal of a bone or any tissue graft. The centrifuge procedure results in the production of a thin, compressed layer of fibrin that is strong, pliable, and suitable for suturing. This natural fibrin network is rich in platelets, growth factors, and cytokines that are all derived from the blood platelets and leukocytes. (1) The presence of these proteins has been reported to produce rapid healing, especially during the first seven (7) days after placement. (2) This network promotes more efficient cell migration and proliferation without chemical or bovine thrombin additives. (3)
The materials described below have been very well studied and documented for many years. Dr. May’s patients experiencing the largest bone grafts, including cases of sinus lifts and large ischemic bone disease grafts, typically only need a mild pain reducer, such as ibuprofen or acetaminophen, afterward if they have had a dental bone graft with any of the materials described below. Dr. Yuriy May has an extremely high success rate in rebuilding and transplanting bone for dental implants and for full-mouth reconstruction cases, including post-dental cavitation / IBD procedures. (8)
Platelet Rich Fibrin (PRF)
Platelet Rich Fibrin has exploded in its adoption and usage over the last five years with the help of researchers such as Dr. Rick Miron and Dr. Choukroun, as well as clinicians like Dr. Yuriy May, who were early adopters of this novel and highly effective bone regeneration and bone grafting technique. PRF is 100% autogenous (meaning it comes from the patients’ own body) and is derived 100% from the patient’s blood.(5,9) Outside of PRF, no other grafting material can govern and stimulate all three of the key processes involved in tissue and bone regeneration, including angiogenesis, chemotaxis, and cell proliferation. To date, no exogenic agent can effectively govern all of these processes, clearly highlighting PRF’s superior properties relative to traditional synthetic and allograft grafting materials. (2,3,10)
It is estimated that less than 15% of dentists in the USA use PRF for grafting, with most instead choosing to use allograft, xenograft, or other non-autologous bone grafting materials. Dr. Yuriy May is one of the few dental implant specialists using predominantly autologous bone grafting and platelet-rich fibrin as the only ingredients for bone grafting for dental implant placement.(9)
Why is Platelet Rich Therapy the Optimal in Bone Grafting & Tissue Regeneration?
Platelet Rich Therapy is the ultimate bioavailable therapy for the stimulation and regeneration of cells in the body. While various growth factors are routinely used in reconstructive and regenerative therapies, platelet-rich fibrin therapy is the simplest and one of the most effective methods for extracting growth factors from the blood’s platelets. (2,9)
The Process of Platelet Rich Therapy and Blood work
Spinning to create PRP, PRF, i-PRF, A-PRF and L-PRF
In the office, Dr. May takes a blood draw from a patient and inserts the blood into a centrifuge to begin the PRF procedures. The entire process takes approximately 20–30 minutes. Both PRP (platelet-rich plasma) and PRF (platelet-rich fibrin) can be extracted from the blood using the centrifuge. After the initial blood draw from the patient, a platelet concentration technique is applied through the use of the centrifuge to separate the blood’s components, with the goal of increasing and concentrating the platelet count. The most essential component of this process is clotting, as platelets release their growth factors only after clotting occurs, and it is after these growth factors are created that their clinical use can be determined.(1,2,7)
PRF
In PRF, the white cells are located at the bottom of the clot. If blood is spun at a high G force, valuable cells can be destroyed. To preserve the cells, Dr. May spins the blood using a reduced RPM (revolutions per minute) and lower G force to maximize the cell count and effective use of the blood cells.(3,7)
iPRF
Injectable PRF (i-PRF) is the injectable, liquid version of PRF. i-PRF is made slightly differently, with an even lower G force of 60 only (vs. 200 for A-PRF), followed by the same protocol, with no additives and no anticoagulants. The goal of i-PRF is to create a formation with a high concentration of white cells, along with fibrinogen and plasma proteins, allowing it to clot spontaneously after injection. Nothing additional needs to be added to the injection site to achieve clot formation or to trigger platelet release of growth factors.(3,7)
Injectable PRF can be created by spinning for only three minutes. Spinning for four minutes will reduce the quality while increasing the liquid content and is generally suboptimal. The best concentration of stem cells is achieved by spinning for only three minutes. More blood can be used to create a greater volume of liquid.(7)
A-PRF
Advanced PRF (A-PRF) forms a clot, creating a thicker, gel-like substance. With A-PRF, the RCF (relative centrifugal force) is low, at 200 G force, in order to obtain a higher concentration of white cells. An eight-minute spin is needed to create A-PRF. Increasing the white cell concentration increases both vascularization and the release of growth factors. By increasing vascularization, vessel density and the percentage of vascularization can also be increased.(2,3,7,10)
L-PRF
Leukocyte-Platelet Rich Fibrin is a mucous-like membrane formed from PRF and is rich in leukocytes, with a higher volume of white cells than both i-PRF and A-PRF. In a study conducted with 26 patients and over 108 extractions among all patients, outcomes comparing L-PRF extraction-grafted sockets versus non-grafted control sockets showed better healing and faster socket closure for the sockets treated with L-PRF, with differences that were statistically significant at days 3 and 7. (4)
L-PRF tends to exhibit the most favorable properties among PRF membranes and is especially effective in large-scale grafting cases, particularly for periodontal therapy, including superior tensile strength, stiffness, and toughness relative to PRGF Endoret.(1,3)
Plasma Rich in Growth Factors (PRGF) / Platelet Derived Growth Factors (PDGF)
The purpose of PRGF is to achieve a higher concentration of human growth factors derived from platelets, or thrombocytes. These growth factors ensure that tissue regenerates itself after an injury or after surgery. The growth factors can be separated from the platelets or activated with the thrombocytes, which are separated from the rest of the blood and then delivered only to locations where targeted growth and cell activation are to be stimulated.(2,5)
The highly effective and side-effect-free PRGF therapy was developed in 1999 under the name Endoret® (Endogenous Regenerative Technology) by the Spanish Research Group led by Dr. Eduardo Anitua. Overall, the wound-healing period is shortened by the concentrated action of growth factors, and the risk of complication is significantly reduced. However, it is an open system in which calcium sulfate has to be added to produce the membrane, giving it high tensile strength.(5)
Difference in A-PRF and i-PRF
The main difference between Advanced PRF (A-PRF) and injectable PRF (i-PRF) is that A-PRF is a gel-like substance used for bone and tissue grafting in the gingiva, while i-PRF is a liquid form used to regenerate tissue through injection.(1,7)
Difference in Old School PRP and the Superior PRF
When comparing the white cells between PRP and i-PRF, i-PRF has over 20× (20-fold) more white blood cells, also known as cytokines. However, the level of platelets is the same across all three techniques (PRP, A-PRF, and i-PRF), as the difference in G force during centrifugation does not reduce platelet enrichment.(3,7)
How does the biology of Platelet Rich Therapy Work?
For PRP, platelets are enriched 2× to 4×, and few white cells remain.(3)
For PRF, no anticoagulant is added during the spin. Clotting is physiological, and the spin creates a clot that contains platelets, white cells, and fibrin. In PRF, there are all platelets, approximately 50% of white cells, and all the fibrin from the blood. The role of fibrin is very specific: it acts as a recipient of growth factors, allowing for a very specific release of growth factors slowly and continuously over a period of more than one week.(1,2)
PRF can be prepared as A-PRF (gel form) for gum grafting and bone grafting, or i-PRF (liquid form) for tissue shaping and stimulating collagen around the mouth and smile lines.(1,7)
Natural Dentistry uses growth factors not just for tissue stimulation in tissues undergoing regeneration, but also to regenerate hard tissue, to regenerate and grow bone. While bone stimulation itself only requires platelets, with or without leukocytes, the ultimate goal of regeneration requires fibrin. Regeneration requires a scaffold, which is created when Dr. May adds the fibrin matrix in addition to platelets and leukocytes.(1,2)
The most critical element for the biological interaction of PRF to work optimally is the amount of growth factor released into the grafted site, not the concentration of growth factors within the substance itself. These growth factors must be released in a stable manner over the course of weeks for bone and/or soft tissue to regenerate.(2)
To regenerate tissue, a scaffold is required that the body cannot provide without Dr. May’s manipulation of a patient’s blood, as fat alone is insufficient to create a matrix. While fat can be used as a base, the most efficient scaffold in the body is fibrin.(1)
How is PRF used outside of dentistry in medicine, dermatology, and cosmetic facial aesthetics?
By using PRF as a matrix, it can be used to promote healing in an infected wound. Examples include post-surgery infection and necrosis, such as in a diabetic foot after amputation. The concept is to inject the fibrin with growth factors, which the fibrin will then release over a period of a few days. “By leaving the wound untouched for four to five days, a very fast vascularisation can be achieved without any anti-infectious threat. If vascularisation can be achieved on the surface, the healing is very easy, because the vessels are doing the job by slowly infusing the growth factors.” (10)
Healing in soft tissues always begins with the formation of a provisional matrix. While all PRF components are active, the tissue requires platelets and white cells most significantly at the beginning. The objective is to create homeostasis and inflammation in order to draw blood flow and vascularization to the area of treatment. After five to seven days, granulation tissue begins to form, and matrix deposition becomes visible as endothelial cells and fibroblasts begin to work. After approximately ten days, collagen forms within the treated tissue. The provisional matrix is the most important element because when fibrin is introduced into the site, new vascularization is immediately created.(10)
Cell biology and the creation of collagen
Both plasma proteins and white cells are necessary to create collagen synthesis, as white cells stimulate the inflammatory response needed to draw fresh blood flow to the treatment area and create vascularization. At an injury site, endothelial cells immediately separate, allowing white cells to squeeze through the gaps. Through chemotaxis, these white cells then move through the injury site and begin to release pro-inflammatory interleukins. This type of inflammation leads to the activation of monocytes into macrophages. The macrophages then dominate the inflammatory phase and begin to release growth factors and BNPS.(3,10)
Stem cells are necessary alongside white cells in order to achieve a smart blood concentrate and regenerate new tissue. White cells influence the quality of PRP, so enriching PRP with white cells creates greater tissue augmentation and a significantly higher proliferation of mesenchymal stem cells. (10)
Platelet Rich Plasma (PRP) – The Original “100% Natural Autogenous Grafting Material“
PRP, or platelet-rich plasma therapy (not to be confused with the newer, superior PRF, or platelet-rich fibrin therapy), was used earlier in dentistry to accelerate bone and tissue growth, wound healing, and to help assure the long-term success of dental implant placements. PRP was the premium grafting material for sinus lift bone grafts, onlay block bone grafts, bone and ridge expansion, extractions, nerve repositioning, and most surgical dental procedures approximately five to seven years ago.(3,9)
In addition to PRP’s properties for accelerated healing of dental implant procedures and bone growth regeneration, this all-natural and highly effective bone grafting medium was also gaining acceptance in orthopedics and sports medicine. Various orthopedic physicians have used PRP with success for painful and hard-to-treat injuries such as tennis elbow, tendonitis, and ligament damage.(9)
It is worth mentioning that PRP was used as a pre-game Super Bowl treatment in 2009 for two Pittsburgh Steelers players, Heinz Ward and Troy Polamalu, and both were instrumental in the team winning its sixth Super Bowl.(5)
James Rutkowski, DMD, PhD, a prominent dental researcher and editor of the Journal of Oral Implantology, reported at a recent annual scientific meeting of the American Academy of Implant Dentistry (AAID) that platelet-rich plasma therapy can accelerate bone and tissue growth and wound healing and help assure the long-term success of dental implant placements.(5)
In the last five to seven years, a newer and more superior form of PRP was discovered, now known as PRF (Platelet Rich Fibrin), which is reported to have 10× the regenerative power and growth factors of PRP. The most prolific and progressive dentists and doctors around the world, such as Dr. Yuriy May, have largely transitioned to PRF instead of the older PRP technique.(2,9)
What could be better than using the body’s own regenerative powers to grow bone and soft tissue safely and quickly? For dental implant procedures, PRP treatments can jump-start bone growth and implant adherence in just two weeks, which cuts down the time between implant placement and affixing the dental crown.
Dr. Rutkowski. (5)
Platelet-rich plasma is obtained from a small sample of the patient’s own blood. It is centrifuged to separate platelet growth factors from red blood cells. The concentration of platelets triggers intense, rapid growth of new bone and soft tissue.(3)
There is very little risk because we are accelerating the natural process in which the body heals itself. PRF speeds up the healing process at the cellular level, and there is virtually no risk for allergic reaction or rejection because we use the patient’s own blood.
Dr. Rutkowski.(5)
For dental surgery applications, PRF is mixed as a gel that can be applied directly into tooth sockets and other sites within the oral cavity. It is highly effective in cases where bone grafts are required to foster proper bone integration for dental implants, which is where Dr. May exclusively uses PRP. Growth factors in PRP preparations help grafts bond faster with the patient’s own bone. Studies by Dr. Rutkowski have reported findings of increased radiographic bone density during the initial two weeks following PRP treatment when compared to dental implant sites that did not receive PRF treatment.(5)
Accelerated healing is a goal we’re constantly seeking in implant dentistry, and we now have a treatment that activates the natural healing process. It is a most promising development for implant dentistry.
Dr. Rutkowski.(5)
Currently, only 10% of practicing implant dentists use PRP treatment due to the higher level of effort and expertise required by the dental implant specialist. However, PRP is widely considered to set the bar for best-in-class bone grafting material in the holistic and implant dentistry field.(5,9)
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Other Bone Grafting Materials
Traditional Non-Autologous Bone Grafting Materials
There are currently procedures available to save or preserve bone, and there are a number of conventional bone graft materials used with these procedures in dentistry today. However, all of these materials are considered suboptimal in holistic dentistry, as they use foreign material to create a matrix to rebuild a dental patient’s oral and facial bone structure.(8,9)
They include:
Autograft: Recipient’s Own Bone
Autograft is the obtaining of bone from the patient’s own body and is typically considered the gold standard grafting procedure available today.(9)
Concerns: Autograft has its limitations, which include potential issues such as the need for a second surgical site and patient discomfort related to harvesting a graft from another part of the patient’s body. It is also a painful, complex, and costly procedure for the patient.(9)
Allograft: Bone from another Human Being
Allograft is the obtaining of bone graft material from human cadavers.(9)
Concerns: The disadvantage of allograft is that the bone graft material may be rejected by the recipient’s immune system. Additionally, there is a risk of disease cross-transmission.(9)
Xenograft: Bone from animal, usually porcine or bovine origins
Xenograft is the obtaining of bone graft material from tissue of animal origin, including bovine (cow bone) or porcine (pig bone).(9)
Concerns: Similar to allograft, these bone graft materials may be rejected by the recipient’s immune system or pose concerns regarding potential disease transmission.(9)
Alloplast: Synthetic grafting materials
Alloplasts are synthetic grafting materials used for grafting.(9)
Concerns: They have limitations in terms of biocompatibility, resorption timing, local tissue reaction, and bone regeneration.(9)
Non-Autologous Biological Grafting Materials
Recombinant Human Bone Morphogenic Protein (rhBMP-2)
This is an additive known as recombinant human Bone Morphogenetic Protein-2 (rhBMP-2), made by Mectron. BMP is a substance that helps stimulate bone growth. BMP increases the price of dental implant bone grafts by $1,500 to $5,500 for the BMP additive alone, not including the actual bone graft, dental implant and abutment, or the restorative crown.(5,9)
Interestingly, BMP is not something Dr. May considers necessary in all cases because it is possible to extract natural Bone Morphogenetic Protein that each individual produces through PRF (platelet-rich plasma therapy). Unlike PRP or PRF, the BMP available on the dental market is derived from other human beings, rather than the 100% bio-identical PRF made from each patient’s own plasma and blood.(1,2,5)
Clinical Research & Studies
In recent research, the objective was to extract stem cells from the blood. Flow cytometry was conducted to analyze mesenchymal stem cells within i-PRF. Using information from the International Society for Cell Therapy, researchers knew they needed to identify cells that were CD34− and CD45−, and CD44+, CD73+, CD90+, and CD105+ positive, as these are the defining characteristics of mesenchymal stem cells.(7,10)
The scientists performed an elimination of other cell types and found that i-PRF contains a 1% to 3% concentration of mesenchymal stem cells, far outpacing current PRP stem cell concentrations. When researchers analyzed i-PRF, they found the cells they had been searching for: a concentrated quantity of stem cells equal to 1%–3% of the total Platelet Rich Fibrin cell population.(7,10)
At Natural Dentistry Center, it is possible to produce thousands of stem cells in just three minutes by collecting patients’ blood into several small 100 ml tubes and spinning it in a centrifuge at a low force. When comparing the concentration of mesenchymal stem cells in the newer i-PRF to the older and more widely known PRP, the difference in stem cell concentration and growth factor availability achieved using a low spin speed in the centrifuge is evident. Dr. May only needs to draw a patient’s blood and spin it in the centrifuge for three minutes at 900 RPM in the i-PRF tube, without any additive and without any anticoagulant. It is that simple.(7)
Summary of some Research Exemplifying the Power and Depth of Research of Platelet Rich Fibrin in Dentistry:
Regenerative Medicine: PRF Part 1
“The PACT (Platelet & Advanced Cell Therapies) Forum: fostering translational research, transdisciplinarity and international collaboration in tissue engineering and regenerative medicine”(9)
Gilberto Sammartino, Marco Del Corso, Lidia M. Wisniewska, Tomasz Bielecki, Isabel Andia, Nelson R. Pinto, Chang-Qing Zhang, De-Rong Zou, and David M. Dohan Ehrenfest. POSEIDO, Volume 2, Issue 2, June 2014, Pages 105–115.
Abstract:
The PACT (Platelet & Advanced Cell Therapies) Forum Civitatis of POSEIDO was created to offer a multidisciplinary platform for research, publication, debate, and eventual consensus for researchers in the fields of Tissue Engineering and Regenerative Medicine (TERM). In this review, the issues, endeavors, and perspectives of this significant research field are discussed and illustrated, particularly (but not only) through the example of the history, failures, and successes of what is probably the oldest method developed in regenerative medicine: the topical use of autologous platelet concentrates, commonly known as Platelet-Rich Plasma (PRP) or Platelet-Rich Fibrin (PRF).
The history of this domain illustrates very well that the greatest enemy of knowledge is not ignorance; it is the illusion of knowledge. Fighting against illusions in science is a very complex and challenging task, requiring continuous effort and time. This PACT for a transdisciplinary, translational, and international approach in regenerative medicine represents an important step in this endeavor.
Keywords: Blood platelet, fibrin, growth factors, regenerative medicine, tissue engineering.
Regenerative Medicine: PRF Part 2
“The impact of the centrifuge characteristics and centrifugation protocols on the cells, growth factors, and fibrin architecture of a Leukocyte- and Platelet-Rich Fibrin (L-PRF) clot and membrane. Part 1: Evaluation of the vibration shocks of four models of table centrifuges for L-PRF.”(7)
David M. Dohan Ehrenfest, Byung-Soo Kang, Marco Del Corso, Mauricio Nally, Marc Quirynen, Hom-Lay Wang, and Nelson R. Pinto. POSEIDO, Volume 2, Issue 2, June 2014, Pages 129–139.
Abstract:
Each centrifuge’s vibration profile, rotational speed (RPM), and centrifugation time may significantly impact the characteristics of PRF, a surgical adjuvant used to improve healing and promote tissue regeneration in maxillofacial regenerative therapies in dentistry.(7)
Background and Objectives:
Platelet concentrates for surgical use, including Platelet-Rich Plasma (PRP) and Platelet-Rich Fibrin (PRF), are surgical adjuvants used to improve healing and promote tissue regeneration. L-PRF (Leukocyte- and Platelet-Rich Fibrin) is one of the four families of platelet concentrates for surgical use and is widely utilized in oral and maxillofacial regenerative therapies. The objective of this first article was to evaluate the mechanical vibrations generated during centrifugation in four models of commercially available table centrifuges frequently used to produce L-PRF.(7)
Results:
Very significant differences in the level of vibrations at each rotational speed were observed between the four tested machines.(7)
Discussion and Conclusion:
Each centrifuge has its own distinct vibration profile depending on rotational speed, and this may significantly impact the characteristics of the PRP or PRF produced with these devices.(7)
Regenerative Medicine: PRF Part 3
“Immediate implantation and peri-implant Natural Bone Regeneration (NBR) in the severely resorbed posterior mandible using Leukocyte- and Platelet-Rich Fibrin (L-PRF): a 4-year follow-up”(8)
Marco Del Corso and David M. Dohan Ehrenfest. POSEIDO, 2013; 1(2): 109–116.
Natural Bone Regeneration (NBR) with L-PRF
Abstract:
In the severely resorbed posterior mandible, the placement of dental implants in an ideal position is often compromised by significant post-extraction centrifugal alveolar bone resorption. The shape of the residual alveolar ridges and the remaining bone height above the inferior alveolar nerve often make the area unsuitable for direct implantation. Even though the use of short implants offers excellent results when residual bone volumes are high and wide enough to receive these implants [1], there is no alternative to bone regeneration surgery prior to implant placement when the alveolar ridges are very thin [2].(8)
However, bone regeneration itself remains a challenge in this area, as the posterior mandibular residual alveolar ridges are highly cortical with low vascularization and therefore not well adapted to the integration of bone grafting material or the regeneration of bone cavities. Finally, the posterior mandible is an area subjected to significant mechanical constraints applied to the bone and gingival tissues during mastication. This can compromise the healing of a bone regeneration chamber, particularly due to the risk of soft tissue dehiscence following regeneration surgery.(8)
Other Applications of i-PRF
Other Applications of i-PRF
Several dermatologists and osteopaths have treated patients with arthritis in the knee and hip, with findings suggesting that i-PRF has the capability to regenerate cartilage and reduce pain. Several of Dr. May’s physician partners, including Dr. Paul Tortland of Valley Sports Physicians in Avon, Connecticut, have achieved improved pain relief by injecting i-PRF into arthritic joints. Multiple studies and patient testimonials have documented the results of i-PRF therapy, including cartilage regeneration through stem cells derived from i-PRF, reduced inflammation, and decreased pain.(6)
Applying i-PRF to the scalp in combination with microneedling can improve hair growth in patients with alopecia or those undergoing hair restorative procedures. i-PRF may also be used in the lips to regenerate collagen and improve fullness, plumpness, and overall appearance.(6)
References:
(1)Dohan Ehrenfest, D. M., Del Corso, M., Diss, A., et al.
Three-dimensional architecture and cell composition of a Choukroun’s platelet-rich fibrin clot and membrane.
Journal of Periodontology, 2010; 81(4): 546–555.
(2)Dohan Ehrenfest, D. M., de Peppo, G., Doglioli, P., Sammartino, G.
Slow release of growth factors and thrombospondin-1 by Choukroun’s platelet-rich fibrin (PRF): A gold standard to achieve for all surgical platelet concentrates technologies.
Growth Factors, 2009; 27(1): 64–69.
(3)Dohan, D. M., Diss, A., Dohan, S. L., Dohan, A. J., et al.
Platelet-rich fibrin (PRF): A second-generation platelet concentrate. Part III: Leukocyte activation: A new feature for platelet concentrates?
Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology, 2006; 101(3): e51–e55.
(4)Marenzi, G., Riccitiello, F., Tia, M., di Lauro, A., Sammartino, G.
Influence of leukocyte- and platelet-rich fibrin (L-PRF) in the healing of simple post-extraction sockets: A split-mouth study.
BioMed Research International, 2015; 2015: 369273.
https://doi.org/10.1155/2015/369273
(5)Choukroun, J.
Stimulation and Regeneration.
Educational / Clinical Lecture, March 31, 2016.
(6)Clinical observations on hyaluronic acid (HA) injections combined with injectable platelet-rich fibrin (i-PRF) demonstrating increased collagen formation and enhanced HA stability.
Clinical application summary.
(7)Dohan Ehrenfest, D. M., Kang, B. S., Del Corso, M., Nally, M., Quirynen, M., Wang, H. L., Pinto, N. R.
The impact of centrifuge characteristics and centrifugation protocols on the cells, growth factors, and fibrin architecture of a leukocyte- and platelet-rich fibrin (L-PRF) clot and membrane. Part 1.
POSEIDO, 2014; 2(2): 129–139.
(8)Del Corso, M., Dohan Ehrenfest, D. M.
Immediate implantation and peri-implant natural bone regeneration (NBR) in the severely resorbed posterior mandible using L-PRF: A 4-year follow-up.
POSEIDO, 2013; 1(2): 109–116.
(9)Sammartino, G., Del Corso, M., Wisniewska, L. M., et al.
The PACT Forum: fostering translational research, transdisciplinarity and international collaboration in tissue engineering and regenerative medicine.
POSEIDO, 2014; 2(2): 105–115.
(10)General wound-healing and inflammatory cascade principles describing leukocyte chemotaxis, macrophage activation, angiogenesis, and growth factor–mediated tissue regeneration as applied to PRF therapy.
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About Dr. Yuriy May
Widely sought after for his precision and leadership in biological oral surgery and zirconia implantology, Dr. Yuriy May is recognized as an accomplished leader in metal-free, biologically driven dentistry. With over 12 years of clinical experience, his work is defined by uncompromising standards, refined surgical execution, and outcomes that support both oral and systemic health.
Dr. May holds advanced certifications and training in zirconia implantology from programs ranging from IAOCI and Tufts University, is Board Certified as a Naturopathic Dentist by the ANMCB, and is a distinguished Ceramic Implant Ambassador for SDS—an honor reserved for clinicians shaping the future of ceramic implant science.
A respected educator and international lecturer, Dr. May has presented extraordinary ceramic implant cases to dentists worldwide, including the JCCI in Switzerland, and has served as an instructor in the Ceramic Implant Program at ACIMD. He lectures nationally, publishes complex metal-free surgical cases, and serves as a Board Member of the IAOCI (International Academy of Oral Ceramic Implantology). Dr. May has recently become an Associate Fellow of the AAID (American Academy of Implant Dentistry), one of the few focusing solely on zirconia dental implants, and has been and an Accredited S.M.A.R.T. Certified member of the IAOMT for many years. He is also a Certified Biological Dentist with the IABDM, reflecting his commitment to removing root canal infections and to mercury-safe, evidence-based biological protocols.
Dr. May’s reputation, results, and excellence in ceramic implant dentistry have made him a destination provider for patients and referring clinicians seeking the highest level of ceramic implant surgery and biological dental care.
DMD, IBDM, AIAOMT, CIABDM
Associate Fellow, American Academy of Implant Dentistry
ANMCB Board Certified Naturopathic Dentist