Review Article

Page 1 of 10

Platelet rich fibrin: a literature review of applications in oral and

maxillofacial surgery
Timothy W. Neal^, Scott R. Sullivan, Scott Cannon, Wyatt Spresser, Thomas Schlieve

Department of Surgery, Division of Oral and Maxillofacial Surgery, UT Southwestern/Parkland Memorial Hospital, Dallas, TX, USA
Contributions: (I) Conception and design: All authors; (II) Administrative support: None; (III) Provision of study materials or patients: All authors; (IV)
Collection and assembly of data: All authors; (V) Data analysis and interpretation: None; (VI) Manuscript writing: All authors; (VII) Final approval of
manuscript: All authors.
Correspondence to: Timothy W. Neal, DDS, MD. Department of Surgery, Division of Oral and Maxillofacial Surgery, UT Southwestern/Parkland
Memorial Hospital, 5323 Harry Hines Boulevard MC 9109, Dallas, TX 75390, USA. Email: [Link]@[Link].

Background and Objective: Platelet-rich fibrin (PRF) is a second-generation autologous platelet

concentrate with reported regenerative, angiogenic, antibacterial, and wound-healing capabilities. The
purpose of this review was to examine the clinical applications of PRF in oral and maxillofacial surgery.
Methods: An online review of scientific articles was performed using the medical databases PubMed,
the Cochrane Library, and [Link]. Databases were searched for articles in the English language
from January 1st, 2001, to November 30th, 2023, using keywords dentoalveolar, orthognathic surgery, TMJ,
temporomandibular, dental extraction, dental, dentistry, dental implant, craniofacial surgery, AND platelet-
rich fibrin. MeSH terms were also used where available. Papers not written in the English language were
excluded.
Key Content and Findings: The majority of literature investigating PRF in oral and maxillofacial
surgery focuses on its utility in dentoalveolar procedures. Results are mixed in many areas of study; however,
there is high-quality evidence to support the use of PRF for alveolar ridge preservation, as a bone graft
adjunct, and for the treatment and prevention of alveolar osteitis.
Conclusions: PRF has potential utility in many different areas of oral and maxillofacial surgery. Future
studies are needed to clinically justify and fully elucidate the utility of PRF in temporomandibular,
craniofacial, orthognathic, osteonecrosis, and maxillofacial trauma surgery.

Keywords: Platelet-rich fibrin (PRF); autologous platelet concentrates; second-generation platelet concentrates

Received: 19 December 2023; Accepted: 11 March 2024; Published online: 26 March 2024.
doi: 10.21037/joma-23-35
View this article at: [Link]

Introduction has continued to grow, much of the current literature

investigating platelet concentrates focuses on regenerative
The use of autologous platelet concentrates has been
applications. The multitude of protocols and categories of
extensively studied in many specialties of surgery and
medicine. Hematology and transfusion medicine pioneered autologous platelet concentrates is a point of confusion for
the early development of platelet concentrates as a many clinicians and trainees. While this review focuses on
treatment for thrombocytopenia. Further advancements platelet-rich fibrin (PRF), it is important to briefly discuss
in technology and technique led to expanded uses as a first-generation platelet concentrates.
hemostatic and adhesive agent in surgery. As clinical interest In the long history of autologous platelet concentrates,

^ ORCID: 0000-0001-6168-9620.

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the field of oral and maxillofacial surgery took an early investigated the use of PRGF for ridge preservation with
interest. In 1982, Matras published a technique article positive soft and hard tissue healing outcomes (5). This
and case series discussing the use of fibrin sealant in protocol differed from PRP in that fractionation of the
oral and maxillofacial surgery. The article describes the collected blood separated leukocytes from the platelet clot.
two-component fibrin sealant system obtained from human Whether this exclusion is an advantage is debated in the
plasma. Component one is fibrinogen with associated factor literature. In addition, the PRGF protocol utilized a one-
XIII and fibronectin. Component two is made of thrombin step centrifugation process, sodium citrate anticoagulant
and calcium chloride. Aprotinin solution is added to one with calcium chloride activator, and no bovine thrombin.
of the two components as an antifibrinolytic. This fibrin The simplification of protocol materials made this product
sealant was used to anastomose the hypoglossal and facial easy to use in the ambulatory setting; however, the pipetting
nerves in a trauma patient, for hemostasis following the steps were tedious.
resection of a gingival tumor in a patient with anemia, and The first-generation platelet concentrates (fibrin glue,
to secure a bone flap following the excision of maxillary platelet gel, PRP, PRGF) shared common characteristics.
polyps (1). All required some sort of additive as a coagulant, activator,
A disadvantage of fibrin sealant is the use of donor or anticoagulant. Many of the first-generation protocols
plasma and possible viral transmission, which resulted in were tedious, time-consuming, required special equipment,
commercial fibrin sealant products not receiving Food or large volumes of blood collection. Regardless, many of
and Drug Administration (FDA) approval until 1998. these first-generation products are useful in many clinical
Tayapongsak et al. introduced autologous fibrin adhesive scenarios. The development of PRP led to a shift towards
to eliminate this disadvantage in 1994. The authors used protocol standardization, simplification, same-day blood
autologous fibrin sealant combined with particulate collection, and utility in the ambulatory setting. With the
cancellous bone grafts to reconstruct 33 mandibular introduction of second-generation platelet concentrates
continuity defects. Of the 33 included patients, 32 met the in 2000, many of the disadvantages of the first-generation
study success criteria, and the authors stated the addition were reduced (6). The purpose of this review is to examine
of autologous fibrin sealant resulted in earlier bone the clinical applications of PRF in oral and maxillofacial
remodeling and consolidation. The defect size was used to surgery. We present this article in accordance with the
determine the protocol for producing the autologous fibrin Narrative Review reporting checklist (available at https://
sealant. Blood collection occurred at a preoperative visit [Link]/article/view/10.21037/joma-23-35/rc).
when the defect was greater than 3 centimeters and at the
time of surgery if less. The process of producing autologous
Methods
fibrin sealant is lengthy and has a low yield compared to the
amount of blood collected (2). An online review of scientific articles was performed using
As an alternative, Whitman et al. proposed platelet gel in the medical databases PubMed, Cochrane Library, and
1997, also known as platelet-rich plasma (PRP). Compared [Link]. Databases were searched for articles in
to autologous fibrin sealant, the protocol was simplified, with the English language from January 1st, 2001, to November
immediate preoperative blood collection and two centrifuge 30 th, 2023, using keywords dentoalveolar, orthognathic
spin cycles. In their technique article, the authors reported surgery, TMJ, temporomandibular, dental extraction,
success in reconstructing mandibular defects using PRP in dental, dentistry, dental implant, craniofacial surgery, AND
combination with particulate bone graft (3). Marx et al. later platelet-rich fibrin. MeSH terms were also used where
performed histomorphometry studies utilizing PRP, which available. Papers not written in the English language were
showed greater bone density in mandibular continuity defects excluded. A total of 1,656 articles were available. Studies
grafted with PRP than those without (4). While the results that assessed the use of PRF in oral and maxillofacial
of PRP were promising, the original protocol required a surgery procedures were included. Titles and abstracts
cell separator, central venous access, a large quantity of were screened for relevancy by the first four listed authors
blood collection, two centrifugation cycles, and exogenous (T.W.N., S.R.S., S.C., W.S.), with disagreements reviewed
thrombin. These disadvantages led to the production of and decided upon by the senior author (T.S.). Table 1
plasma rich in growth factors (PRGF). In 1999, Anitua outlines the review specifications.

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Table 1 The search strategy summary

Items Specification

Date of search November 30th 2023

Databases and other sources searched PubMed, Cochrane Library, [Link]

Search terms used Dentoalveolar, orthognathic surgery, TMJ, temporomandibular, dental extraction, dental,
dentistry, dental implant, craniofacial surgery, AND platelet-rich fibrin

Timeframe January 1st, 2001–November 30th 2023

Inclusion and exclusion criteria Inclusion: studies that assessed the use of platelet-rich fibrin in oral and maxillofacial surgery
procedures

Exclusion: papers not written in the English language

Selection process Titles and abstracts were screened for relevancy by the first four authors (T.W.N., S.R.S., S.C.,
W.S.) with disagreements reviewed and decided upon by the senior author (T.S.)
TMJ, temporomandibular joint.

Table 2 First and second-generation platelet concentrates adenosine diphosphate (ADP), serotonin, and histamine,
First-generation platelet concentrates which increases platelet activation. This release induces
Fibrin glue
GIIb/IIIa receptor expression on the surface of platelets,
allowing fibrinogen to bind. This binding allows for the
Platelet gel/PRP
formation of a platelet plug. Platelets play a role in the
PRGF hemostasis, inflammatory, proliferative, and remodeling
Second-generation platelet concentrates phases of wound healing. Platelets release chemokines
and cytokines that enhance the inflammatory phase. The
L-PRF
release of fibroblast growth factor (FGF), platelet-derived
A-PRF
growth factor (PDGF), transforming growth factor beta
A-PRF+ (TGF-β), and vascular endothelial growth factor (VEGF)
i-PRF stimulates angiogenesis and connective tissue healing in the
proliferative and remodeling phases (7-9).
PRP, platelet-rich plasma; PRGF, plasma rich in growth factors;
L-PRF, leukocyte and platelet-rich fibrin; A-PRF, advanced
platelet-rich fibrin; A-PRF+, advanced platelet-rich fibrin+; i-PRF,
Types of PRF
injectable platelet-rich fibrin.
Since the introduction of PRF by Choukroun et al. in 2000,
many different protocols and subcategories have been
Narrative reported in the literature (6). Like the first-generation
platelet concentrates, the second generation has undergone
Platelet function
many iterations (Table 2). Second-generation concentrates
Platelets play a fundamental role in primary hemostasis. contain no added anticoagulants or activators; however,
They are small, anucleate, cytoplasmic fragments of they have the disadvantage of a short working time. In a
megakaryocytes with a life span of 7–10 days. When general sense, PRF is either solid form or liquid form. The
endothelial damage occurs, Von Willebrand factor binds form and distribution of cells and growth factors depend on
to exposed collagen. Platelets then bind to Von Willebrand the relative centrifugal force (RCF) and spin time (Eq. [1]).
factor by way of the receptor glycoprotein 1b (Gp1b). 2
This binding stimulates the release of platelet alpha and  N 
= 11.18 × r × 
RCF  [1]
dense granules. Alpha granules contain Von Willebrand  1000 
factor, fibrinogen, fibronectin, growth factors, cytokines, The value N is the revolutions per minute (RPM) and r
and chemokines. Dense granules contain calcium, is the radius in centimeters.

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Table 3 Original protocols for second-generation platelet concentrates centrifugation, compared to fixed angle, produces superior
Second-generation platelet separation and distribution of leukocytes and platelets
Original protocol
concentrate within the PRF matrix (15,16).
L-PRF 3,000 RPM for 10 minutes The ideal collection tube is dependent on the protocol
and PRF form desired. In general, additive-free glass
A-PRF 1,500 RPM for 14 minutes
tubes should be utilized when producing solid-form PRF.
A-PRF+ 1,300 RPM for 8 minutes When producing liquid PRF, additive-free plastic tubes
i-PRF 700 RPM for 3 minutes should be utilized. Glass stimulates the clotting cascade,
L-PRF, leukocyte and platelet-rich fibrin; A-PRF, advanced producing larger solid-form PRF matrices. Some studies
platelet-rich fibrin; A-PRF+, advanced platelet-rich fibrin+; i-PRF, have utilized silica-coated plastic tubes for the production
injectable platelet-rich fibrin; RPM, revolutions per minute. of PRF. However, Tsujino et al. found silica microparticles
incorporated into PRF matrices prepared with silica-
coated plastic tubes. These silica microparticles negatively
Since the original PRF protocol was introduced, termed impacted cell survival and proliferation (17,18).
leukocyte and PRF (L-PRF), protocols have decreased
in RCF and spin time, with new subcategories, termed
advanced PRF (A-PRF), advanced PRF+ (A-PRF+), and Dentoalveolar applications
injectable PRF (i-PRF) (10-12). At high centrifugation When focusing on PRF applications in oral and
forces, cells shift to the bottom of the tube, and because maxillofacial surgery, the topic is dominated by studies
of this, protocols have progressively decreased in force investigating applications for dentoalveolar procedures.
and speed to distribute cells and growth factors evenly Of the articles identified for this review, nearly 90% were
(Table 3). The end product is a PRF matrix concentrated related to dentoalveolar procedures. Historically, research
with leukocytes and growth factors that slowly release over investigating the use of PRF in dentoalveolar procedures
time. has produced mixed results, which is likely to blame
for the lack of widespread adoption of PRF by oral and
Centrifuge and collection tubes maxillofacial surgeons.
Several studies have reported promising results using
There is a significant commercial interest in the production PRF in extraction sockets following dental extraction for
of PRF. Several medical supply companies produce all-in- site preservation. In a split-mouth study by Temmerman
one kits with a centrifuge, collection tubes, and associated et al., the authors compared alveolar ridge width in 22
equipment to produce PRF clots, membranes, and i-PRF. patients who received PRF versus control (natural healing)
Typically, these centrifuges are pre-programmed with after dental extractions of bilateral and closely symmetrical
the appropriate spin time and RCF to create the desired teeth in the maxilla or mandible. At 3 months post-
PRF form. This commercial interest may be partially to procedure, there was a statistically significant difference in
blame for the continuous development of new protocols alveolar ridge width, with less bone loss in extraction sites
and the associated confusing terminology. For research treated with PRF (19). Hauser et al. evaluated the effect
purposes, standardization of the centrifuge and tubes may of PRF on extraction site healing in a randomized control
enable investigators to reproduce and build upon previous trial of 23 patients. Patients were randomly assigned to 3
works more efficiently. In clinical practice, most variable treatment groups: simple extraction and PRF, extraction
speed centrifuges may produce quality PRF products if the with mucosal flap and PRF, or simple extraction without
centrifuge radius is considered (13). In doing so, the speed may socket filling before implant placement. The group that
be adjusted to achieve the desired RCF for the chosen protocol received simple extraction and PRF in the socket showed
(Eq. [1]). In a study comparing PRF produced by three significantly better bone healing and microarchitecture
different commercially available centrifuges, Miron et al. when compared to the other treatment groups (20). Further
showed little variability in outcome when the appropriate studies investigated PRF as an adjunct to demineralized
protocol and collection tubes were utilized (14). Another free-dried bone allograft (DFDBA) for socket preservation.
important characteristic of the centrifuge is the angulation In a randomized controlled trial by Thakkar et al., the
of the tube. Several studies have shown that horizontal authors compared patients who received DFDBA combined

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with PRF for socket preservation to those who received is debated in the literature, with many topical dressings
DFDBA only. There was a significant difference in the advocated. While dressings like ZOE effectively relieve
alveolar ridge width, with better ridge preservation in the pain, several studies have reported a possible increase in
group that received DFDBA combined with PRF (21). infection risk, anaphylaxis, and delay in wound healing from
While many studies have reported promising results using these treatment modalities (42,43). With this in mind, PRF
PRF for ridge preservation, some have shown no significant is an attractive option for the treatment and prevention of
difference in treatment outcomes (22,23). In addition, alveolar osteitis.
several systematic reviews have evaluated the use of PRF Adequate soft and hard tissue healing is paramount for
for alveolar ridge preservation with inconclusive results dental implant success and stability. Compared to grafting
(24-29). With this in mind, the study by Hauser et al. may and site preservation, fewer studies have investigated the
be the simplest to draw conclusions from. PRF may improve effect of PRF on implant success and stability. Tabrizi
bone healing after dental extraction; however, other surgical et al. performed a split-mouth randomized clinical
factors may have a significant impact, such as a loss of blood trial of 20 patients receiving bilateral maxillary molar
supply to the alveolus during flap elevation. implants with and without PRF in the implant site prior
As an adjunct to bone grafts in sinus lift procedures, to placement. The study assessed implant stability with
multiple randomized clinical trials have shown no difference resonance frequency analysis at 2, 4, and 6 weeks post-
in bone formation with the addition of PRF (30-33). procedure. At all study intervals, implants placed in sites
However, when PRF was used as the sole grafting material treated with PRF had higher stability scores (44). Similar
for sinus augmentation, multiple studies showed substantial results were reported in studies by Pirpir et al. and Öncü
regeneration of bone for implant placement (34,35). It is and Alaaddinoğlu (45,46). Boora et al. evaluated the effect
worth noting that the latter two studies used radiographic of PRF on peri-implant healing in 20 patients who received
evaluations without a control group. When PRF was used dental extraction and immediate dental implant placement.
as a barrier membrane at the lateral osteotomy site in sinus One group received a PRF membrane around the implant
augmentation, there was no difference in bone regeneration before soft tissue closure, while the control group received
compared to collagen membranes (36). While the literature no membrane. At 3 months post-procedure, the PRF group
is mixed, there is clinical utility in using PRF to improve had less marginal bone loss (47). However, a randomized
the workability of bone graft materials. clinical trial that evaluated dental implants coated with
Another widely studied topic is the use of PRF following i-PRF before placement found no difference in implant
third molar extractions to promote wound healing, pain and stability over the 1-year study period compared to the
swelling reduction, and for prevention of alveolar osteitis. control (48). It is challenging to draw practical conclusions
Multiple systematic reviews have reported decreased rates from the available literature, and future studies investigating
of alveolar osteitis and postoperative pain scores in patients the effect of PRF on implant stability are needed.
who received PRF following third molar extractions
(37-39). Methodological heterogeneity among studies
Craniofacial surgery
included in these systematic reviews made it difficult to
evaluate outcomes related to swelling and wound healing, Few studies have evaluated the utility of PRF in craniofacial
although positive results were reported. PRF has also and orthognathic surgery procedures. Shawky and Seifeldin
shown promise as a treatment for established alveolar investigated PRF as an adjunct to autogenous anterior
osteitis. In a single-blinded prospective study by Reeshma iliac crest bone graft in a randomized clinical trial of
et al., the authors measured pain scores on days 1, 3, 5, 24 patients with unilateral alveolar clefts. New bone
and 7 following treatments with either PRF or zinc oxide formation was evaluated at 6 months postoperatively, and
eugenol (ZOE) for mandibular alveolar osteitis. There was patients who received PRF in combination with autogenous
a significant difference between the groups at all study time bone graft had a significant increase in the percentage of
points, with greater pain relief experienced by the group newly formed bone compared to the control group (49).
that received PRF (40). In a similar study by Hussain et al., In a similar study by Saruhan and Ertas, there was an
the authors concluded that PRF is as effective as ZOE in increase in the percentage of newly formed bone in alveolar
managing alveolar osteitis pain and is superior in socket cleft patients who received PRF with autogenous anterior
healing (41). The appropriate treatment of alveolar osteitis iliac crest bone graft compared to control; however, there

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was no statistically significant difference (50). Given the and Karadayi and Gursoytrak (57,58). The superiority of
results of PRF in combination with grafting materials for one injectable over another is a widely debated topic in
dentoalveolar procedures, more studies are needed in the the literature. It is important to note that arthrocentesis
cleft patient population. In addition, several applications alone is an effective treatment for patients whose primary
still need to be investigated, such as the impact of PRF on symptoms originate within the TMJ. While i-PRF has
hardware stability, bone healing, infection rate, and wound distinct regenerative advantages, further studies are needed
healing following orthognathic surgery. to justify its routine clinical use over established effective
products that are more simple-to-use such as hyaluronic
acid and corticosteroids.
Temporomandibular joint (TMJ)

Temporomandibular disorders are common conditions

Osteonecrosis
characterized by pain related to the TMJ, the muscles
of mastication, or both. For disorders of the joint, many Osteonecrosis of the jaws is a well-published side effect
studies have investigated various products for use following of certain medications and a complication of radiation
joint arthrocentesis and as intra-articular injections. therapy for head and neck cancer. The exact mechanism of
With the introduction of i-PRF, there has been a clinical medication-related osteonecrosis of the jaws (MRONJs)
interest in applications for conditions of the TMJ. PRF’s is unclear. Still, multiple factors have been shown to
biocompatibility, analgesic, and regenerative properties play a role in development, including inhibition of bone
make it an attractive option. A recent scoping review by remodeling, inflammation or infection, inhibition of
Sielski et al. analyzed the available literature investigating angiogenesis, and immune dysfunction (59). The likely
the use of i-PRF as a complement to arthrocentesis and mechanism for the development of osteoradionecrosis
found that i-PRF reduces articular pain and increases joint (ORN) is the dysregulation of fibroblastic activity that
mobility (51). Manafikhi et al. reported decreased joint noise results in radiation-induced fibrosis (60). In either case,
at 6 months in a cohort of 20 patients treated with two there is chronically exposed bone with impairment of
intra-articular i-PRF injections (52). In a retrospective study remodeling and healing.
of 54 patients, Torul et al. reported improvement in maximal Few studies have investigated the utility of PRF as an
incisal opening and pain scores following intra-articular adjunct treatment for MRONJ. Much of the available
injections of i-PRF (53). Yuce and Komerik retrospectively literature is limited to case series and retrospective
compared i-PRF to hyaluronic acid following arthrocentesis studies (61-63). Two prospective studies without control
in a cohort of 47 patients. The i-PRF group had a groups reported 93% and 77% disease resolution for
significant decrease in pain and improvement in maximum patients treated with surgery and PRF (64,65). Giudice
incisal opening at 12 months post-procedure compared to et al. performed one of the few randomized clinical trials
hyaluronic acid (54). In a prospective study by Vingender investigating PRF in MRONJ patients. The study groups
et al. comparing intra-articular injections of hyaluronic acid, included 24 stage II/III MRONJ patients who received
PRP, and i-PRF, the authors found similar post-procedure necrotic bone removal and PRF compared to 23 patients
effects on maximal opening and pain. The authors concluded who received necrotic bone removal only. Patients
that because the effects are similar, autologous products were evaluated at 1 month, 6 months, and 1-year post-
should be preferred to reduce the risk of possible adverse intervention, with a primary outcome of mucosal integrity
reactions. Of note, no adverse reactions were reported at the 6-month follow-up. At all time points, there was a
in the hyaluronic acid group in this study (55). Several greater percentage of patients with mucosal integrity in the
randomized clinical trials have compared i-PRF combined group that received PRF; however, the difference was only
with arthrocentesis versus arthrocentesis alone. In a study statistically significant at 1-month post-intervention. There
of 40 patients receiving arthrocentesis combined with were also lower pain scores and a greater percentage of
i-PRF versus arthrocentesis alone, Ghoneim et al. reported patients without infection in the PRF group, with statistical
a significant difference between the two groups at all differences seen at the 1-month follow-up only. Several
study time points, with greater improvement in maximum studies have investigated the utility of PRF in preventing
incisal opening, pain, and lateral movement in the i-PRF MRONJ (66-69). MRONJ, while well-documented in
group (56). Similar findings were reported by Işık et al. the literature, is a rare complication. Because of this, it

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is challenging to draw definitive conclusions from the Peer Review File: Available at [Link]
available literature and evaluate the preventative potential article/view/10.21037/joma-23-35/prf
of PRF.
Literature investigating the use of PRF in patients with Conflicts of Interest: All authors have completed the ICMJE
ORN is limited to case reports. Compared to PRF studies uniform disclosure form (available at [Link]
in MRONJ patients, the lack of literature is surprising, [Link]/article/view/10.21037/joma-23-35/coif).
considering ORN was described nearly 80 years before The authors have no conflicts of interest to declare.
MRONJ. The available case reports describe treatment
with PRF in combination with sequestrectomy with Ethical Statement: The authors are accountable for all
postoperative mucosal coverage and disease resolution aspects of the work in ensuring that questions related
(70-72). ORN is classically challenging to treat, and to the accuracy or integrity of any part of the work are
any modality that may benefit these patients should be appropriately investigated and resolved.
investigated. Given the angiogenic, antibacterial, and
regenerative properties, it is plausible that PRF may be Open Access Statement: This is an Open Access article
beneficial as an adjunct treatment for ORN. distributed in accordance with the Creative Commons
Attribution-NonCommercial-NoDerivs 4.0 International
License (CC BY-NC-ND 4.0), which permits the non-
Conclusions
commercial replication and distribution of the article with
The purpose of this review was to examine the clinical the strict proviso that no changes or edits are made and the
applications of PRF in oral and maxillofacial surgery. original work is properly cited (including links to both the
While not comprehensive, this article aimed to provide a formal publication through the relevant DOI and the license).
simple and concise review of a topic that may be a source of See: [Link]
confusion to trainees and surgeons alike. Autologous platelet
concentrates have a lengthy history intertwined with the
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doi: 10.21037/joma-23-35
Cite this article as: Neal TW, Sullivan SR, Cannon S, Spresser
W, Schlieve T. Platelet rich fibrin: a literature review of
applications in oral and maxillofacial surgery. J Oral Maxillofac
Anesth 2024;3:6.

© AME Publishing Company. J Oral Maxillofac Anesth 2024;3:6 | [Link]