A comprehensive clinical review of Platelet Rich Fibrin (PRF) and its role in promoting tissue healing and regeneration in dentistry. Part III: Clinical indications of PRF in implant dentistry, periodontology, oral surgery and regenerative endodontics

The purpose of Part III of this review is to analyse the available literature and clinicalbased evidence on PRF relating to its clinical indications in implant dentistry, periodontics, oral surgery and regenerative endodontics. An improved understanding of the clinical indications of PRF will facilitate the clinicians’ ability to enhance the therapeutic applications of PRF in these fields. PRF is increasingly being investigated and used world-wide by clinicians as an adjunctive autologous biomaterial to promote bone and soft tissue healing and regeneration. PRF has also grabbed the attention of clinicians world-wide because this biomaterial is derived from the patients’ own blood; is easy to make at chair-side, easy to use within the daily clinical routine; widely applicable in dentistry with virtually no risk of rejection; whilst being financially realistic for the patient and the practice. The 3D architecture of the fibrin matrix provides the PRF membrane with great density, elasticity, flexibility and strength that are excellently suited for handling, manipulation and suturing. The gold standard for in vivo tissue healing and regeneration requires the mutual interaction between a scaffold (fibrin matrix), platelets, growth factors, leukocytes, and stem cells. These key elements are all active components of PRF, and when combined and prepared properly, in whichever form, are involved in the key processes of tissue healing and regeneration. PRF is widely being used with promising results in various clinical applications with the primary aim of promoting wound healing, accelerating graft maturation, decreasing the healing period, protecting and promoting improved outcomes in soft tissue and bone healing, and tissue regeneration. PRF combined with GBR procedures offers several added and synergistic advantages including promoting wound healing in compromised wound healing situations, bone growth and maturation, graft stabilization, wound sealing and hemostasis, and improving the handling properties of graft materials. PRF added to, or combined with bone substitutes, offer an effective and easy way for managing and/or augmenting peri-implant osseous defects, sinus floor elevations, intrabony defects, fresh extraction sockets and alveolar ridges with deficient or atrophied alveolar bone. PRF membranes used as a protective or wound bandage on connective tissue harvesting sites (palate) or donor sites (vestibule), significantly accelerates wound healing and reduces post-operative pain and discomfort. The use of PRF in revitalization, revascularization, and regenerative pulp therapies are currently attracting a lot of attention and several case studies in the field of regenerative endodontics are being reported. One of the clinical limitations to note is the heterogeneity in the quality of platelets and blood components due to use of different PRF preparation protocols. Irrespective C L I N I C A L