Dental Surgery

Why would you travel from Kansas City, say, to St. Louis “just for an extraction”?

In our office, we make every effort to save our patients’ teeth, but sometimes, tooth removal is unavoidable.

There are several reasons why extraction may be recommended, including

• Extensive decay that makes a tooth non-restorable.
• Advanced gum disease, where tooth mobility creates a hopeless prognosis.
• An abscessed tooth with infection that the patient prefers not to have treated with a root canal.
• An infected root canal tooth.

Whatever the situation, it’s imperative that any extraction be performed painlessly and that the bone at the extraction site is cleaned thoroughly, removing the periodontal ligament to prevent any bacterial growth or infection during postoperative healing.

Along with extracting the tooth as atraumatically as possible, it’s also important to promote the best healing possible. This healing process can be greatly improved by utilizing Platelet Rich Fibrin (PRF).

About Platelet Rich Fibrin (PRF)

Immediately after a tooth extraction or the debridement of a cavitation site, a healing process begins that affects the eventual bone volume and architecture of the surgical site.  Satisfactory and timely healing are essential to obtain ideal functional reconstruction.

Critical elements of PRF are known to be growth factors contained within the concentrated platelets. These growth factors have shown to accelerate and enhance the healing process for both hard and soft tissue.

Scientific studies have documented numerous positive effects with the use of PRF during extractions and other surgical procedures. These include less postoperative pain, reduced swelling, improved soft tissue healing, increased bone formation, and reduced resorption of alveolar bone width.^{1, 2, 3}

Our PRF protocol supports good healing, decreasing inflammation and pain, and reducing the risk of dry sockets or cavitations developing.

Spin Technique for Collecting PRF

1. Draw blood from the patient using a vacutainer holder with an attached sterile blood collection needle.
2. Collect blood using a red top 10ml vacutainer collection tube for PRF and an orange top 10ml vacutainer blood collection tube for PRP.
3. Spin blood for 12 minutes in a centrifuge unit at 1150 rpms for PRF; 3 minutes at 700 rpm’s for PRP.

PRF: Draw off the top layer of liquid plasma from the collection tube and discard. Using sterile college pliers, remove the middle fibrin clot from tube and place onto a sterile 2×2 gauze.  Use sterile box to produce fibrin plug or flat fibrin membrane. The PRF sample is now ready for placement into the surgical site.

PRP: Using a sterile 3ml syringe with a 21-gauge needle, draw off the top clear, yellow liquid which contains the concentrated platelets or the liquid growth factors that will be used in the surgical site or mixed with autogenous bone grafting material.

REFERENCES

1. Shahram Ghanaati, Carlos Herrera-Vizcaino, Sarah Al-Maawi, Jonas Lorenz, Richard J Miron, Katja Nelson, Frank Schwarz, Joseph Choukroun, Robert Sader; Fifteen Years of Platelet Rich Fibrin in Dentistry and Oromaxillofacial Surgery: How High is the Level of Scientific Evidence?. J Oral Implantol 1 December 2018; 44 (6): 471–492. doi: https://doi.org/10.1563/aaid-joi-D-17-00179
2. Gupta N, Agarwal S. Advanced-PRF: Clinical evaluation in impacted mandibular third molar sockets. J Stomatol Oral Maxillofac Surg. 2021 Feb;122(1):43-49. doi: 10.1016/j.jormas.2020.04.008. Epub 2020 Apr 29. PMID: 32360489.
3. Alzahrani AA, Murriky A, Shafik S. Influence of platelet rich fibrin on post-extraction socket healing: A clinical and radiographic study. Saudi Dent J. 2017 Oct;29(4):149-155. doi: 10.1016/j.sdentj.2017.07.003. Epub 2017 Aug 2. PMID: 29033524; PMCID: PMC5634795.