PRF CGF Sticky bone and AFG….oh my

Frios system by Dentsply Friadent

Great article by Sohn describing different types

PRP – platelet rich plasma (precursor PRF)  Marx 1998 1st generation

PRGF – similar PRP – plasma rich in growth factors Anitua 2001

Second generation

PRF – 2nd generation – platelet rich fibrin has many growth factors (PDGF, VEGF, TGF-β1, EGF, TSP-1, TGF-B [BMP]) (silica-coated vacutainer tubes w/o anticoagulant) spun at 2700prm for 12 minutes  formation Kim 2013 Choukroun 2000. Can chop these membranes and add to bone grafts or make sticky bone with i-PRF as below.

CGF – concentrated growth factors – membrane or graft – little better than PRF, very similar just centrifuged differently  Sacco 2006

CGF = Vacuette blood collection (20-60ml total) tubes x4 (silica-coated vacutainer tubes w/o anticoagulant) 9ml filled via vacuette butterfly blood collection set spun in Intraspin at variable 2400-2700rpm for 12 minutes (Medifuge another) and PRF transferred to Xpression Fabrication Kit.  All Intra-Lock International products.

CGF is produced by processing blood samples with a special centrifuge device; three layers are formed: top acellular plasma (PPP), middle CGF and bottom red blood cells (RBC) layers.

Sticky Bone

Can be used to make “sticky bone” – CGF membrane and autologous fibrin glue (AFG) made same time  Sticky bone article JIACD Sohn Dec 2015

1. 20-60CC of patient’s venous blood
2. Divided in one to two non-coated vacutainers (yellow cap) to obtain autologous fibrin glue (AFG) also known as autologous plasma, which will make sticky bone
3. Two to seven glass coated test tubes (red cap) without anticoagulants to obtain CGF layer
4. Centrifuged at 2400-2700 rpm (Medifuge, Silfradent srl, Sofia, Italy) with a rotor turning at alternated and controlled speed for 12 minutes
5. AFG tube removed after 2 minute-centrifugation.  The non-coated tube shows 2 different layers. The upper layer is AFG layer and red blood cell is collected in bottom layer which will be is discarded.
6. AFG layer removed with syringe and mixed with bone or bone strips
7. 5-10 minutes forms yellow sticky bone
8. Vacant slot is filled with water filled test tube for weight balance
9. Silica coated tube shows three different layers. Platelet poor plasma, fibrin buffy coat layer, and red blood cell layer
10. Exudate from CGF membrane mixed with sticky bone and turns red

Our data show the presence of TGF-β1 and VEGF in CGF and RBC layers. In addition, we show CD34 positive cells in CGF.  Rodella 2011

Which system should you get?

Choukroun has been around a long time and his system can be bought cheaper than most. Hitec sells the system for around $2,000. Miron has a nice book on the PRF topic.