Evolution, current status and advances in application of platelet concentrate in periodontics and implantology

Table 1 Compilation of different platelet concentrates, their discovery and different protocols available

Platelet concentrate type	Method (automated/manual)	Highlights
P-PRP	Cell separator PRP (Automated) Weibrich et al[50]	PRP collected by discontinuous method where patient is connected to machine continuously, around 300 mL PRP can be collected. When PRP is obtained from a blood bag of 450 mL, 40 mL of PRP can be obtained per bag. Differential ultracentrifugation employed (3000 g)
	Vivostat PRF (Automated) Leitner et al[42]	Type of advanced cell separator designed to produce fibrin sealant It is cumbersome, expensive, have low and damaged platelet yielding capacity
	Anitua’s PRGF# (Manual) Anitua[43]	Citrated blood is collected in 5 mL tubes and softly centrifuged for 8 min at 460 g Platelet poor layer (1 mL) is discarded and the PRGF layer above buffy coat layer is pipetted out from all tubes and collected in one tube. Calcium chloride is added for clotting. However there are problem in ergonomy and reproducibility of the procedure
	Nahita PRP (Manual) Tamimi et al[44]	Protocol similar to Anitua’s PRGF
L-PRP	PCCS PRP (Automated) Weibrich et al[45]	Consists of two compartments, citrated blood is transferred into first compartment and centrifuged for a short time. Using air pressure, upper layer PPP and buffy coat are transferred into second compartment and centrifuged for a longer time. PPP is transferred back to first compartment and final product - leukocyte and PRP is left behind. It is no longer available
	SmartPReP PRP (Automated) Weibrich et al[46]	It also has two compartments, but requires less manipulation It is a multifunctional system which can also be used to concentrate stem cells from bone marrow transplant
	Megalian APS PRP (Automated) Christensen et al[47]	This advanced cell separator had optical reader. It has compact size, designed for small blood samples (upto 50 mL). Although, platelet collection efficacy is high but cell preservation is yet to be known
	GPS PRP (Automated) Martovits et al[48]	Another variation of 2 chambers, 2 stage centrifuge protocol PPP is discarded and second centrifuge is with RBC layer. Final PRP is aspirated from the surface of RBC layer
	Friadent PRP (Manual) Weibrich et al[46]	Both these techniques employ classical method of 2 stage centrifuge. First soft spin that gives three layers. PPP and buffy coat transferred to another tube and after hard spin the PPP is discarded leaving behind PRP Depending on technique of collecting buffy coat, one can randomly get either P-PRP or L-PRP
	Curasan PRP (Manual) Weibrich et al[50]
	AutoloGel (Automatic) Driver et al[49]	The final product was called as “autologous platelet-rich plasma gel”
	Regen PRP (Manual) Plateltex PRP (Manual) Mazzucco et al[41]	Both these techniques uses specific jellifying agents such as calcium gluconate and lyophilized purified batroxobin, an enzyme that cleaves fibrino-peptide to induce fibrin polymerization without bovine thrombin and gelling in about 10 min[47] The Regen method also employs a separator gel within the centrifugation tubes to improve collection of platelets and leucocytes
	Ace PRP (Manual) Tamimi et al[44]	Similar protocol but with variation in centrifugation force and time and types of anticoagulant
P-PRF	Fibrinet PRFM (Manual) (PRFM Kit, Cascade Medical, New Jersy, United States) Leitner et al[42]	Consists of two tubes, one for blood collection and another for PRFM clotting. Around 9 mL blood is collected in a tube containing tri-sodium citrate anticoagulant and a separator gel and centrifuged for 6 min at high speed. Buffy coat and PPP are transferred in second tube containing calcium chloride and centrifuged for 15 min and then stable PRFM clot can be collected. Very low amount of leucocytes are obtained due to the specific separator gel used, however the fibrin matrix is more denser and stable than PRP’s
L-PRF	Choukroun’s PRF (Manual) Choukroun et al[22]	Considered second generation platelet concentrate obtained by natural process without any anticoagulants or jellifying agents Venous blood collected and centrifuged at low speed yielding and RBC layer, PRF clot in middle and acellular plasma top layer The PRF clot can be pressed between guage to make a strong membrane
	Intra-Spin[9] (Manual) (Intra-lock, United States)	The only FDA approved kit for PRF. It employs 9 mL glass coated plastic tube, centrifuged at room temperature at 2700 rpm (around 400 g) for 12 min. Contains and Xpression kit to compress the clot to make membranes
	Titanium-prepared PRF (experimental) (Manual) Tunalı et al[33]	The platelet activation by using titanium tubes instead of glass tubes seems to offer some high characteristics to T-PRF The PRF obtained was highly organized and with continuous integrity. The fibrin meshwork is thicker and covers larger area
	Other non FDA cleared centrifuge to produce L-PRF: Salvin 1310 (Salvin Dental) and LW-UPD8 (LW Scientific)	Studies have shown that as compared to Intra-spin, these 2 machines produces more vibration and resonance
CGF	Medifuge, Silfradent srl, Italy Sacco[26]	Permits the isolation of a much larger, denser fibrin matrix which is richer in growth factors Demonstrates presence of TGF-b, VEGF and CD34+
Sticky Bone	Sohn[29]	Autologous fibrin glue mixed with bone graft
T-PRF	Tunalı et al[33]	Titanium tubes were used for collection and centrifugation instead of glass tubes
A-PRF	(Advanced PRF Process, France) Choukroun[32]	Earlier vascularization, faster soft tissue growth, more cytokines and release of BMPs
i-PRF	Mourao et al[34]	Blood collected in 9 mL tube without any additive, centrifuged for 2 min at 3300 rpm, the resultant orange color fluid in the tube is the i-PRF

PCCS: Platelet concentrate collection system; APS: Autologous platelet separator; PRP: Platelet-rich plasma; PRGF: Plasma rich in growth factors; PRF: Platelet-rich fibrin; TGF: Transforming growth factor; VEGF: Vascular endothelial growth factor; GPS: Gravitational platelet separation system.