Systematic review of platelet-rich fibrin (PRF) centrifugation protocols in oral and maxillofacial surgery and the introduction of AR2T3: an easy to remember acronym to correctly report vertical and horizontal PRF centrifugation
Carlos Herrera-Vizcaíno
Abstract
Background: Platelet-rich fibrin (PRF) is a blood concentrate widely used in dentistry and in oral and maxillofacial surgery obtained through centrifugation. Recent studies have shown that the centrifugation protocols (CP) and the centrifuge machine affect the final characteristic of PRF. It is therefore essential to review the various CP outlined in the literature with the aim of increasing their reproducibility. The aim of this systematic review is to revise the existence of standardization of the latest CP. Methods: A systematic approach was used to perform the electronic literature search. Included studies were those performed in humans. The research question was formulated as follow: ‘‘Is the reporting of PRF’s centrifugation protocols standardized?’’. The last electronic search was conducted in October 2020 in biomedical search engines. The results were gathered in table format, analyzed and discussed. Results: A total of 121 articles were found in the literature to be eligible for qualitative evaluation. The search gave as a result vertical and horizontal centrifugation protocols. Twenty-nine different CP and 16 different centrifuge machines were used to produce PRF. Fixed-angle rotors ranged from 33° to 45° and the radius-max from 85 to 130 mm. The protocols reported in RPM ranged from 700 to 3,500 rpm and the protocols reported in RCF (×g) ranged from 44 to 1,000 g. The treatment with the highest diversity of CPs [RPM/RCF (×g)/time] was the enhancement of soft tissue healing. Conclusions: It was found an absence of standardization in the reporting of the centrifugation protocols of PRF. In this regard, the present review involves a general discussion of all the principles that influence the final content of PRF and introduces the AR2T3 acronym. The purpose of AR2T3 is to increase the reproducibility of future PRF studies. The use of the acronym will allow the elaboration of meta-analyses and guidelines that are not yet available due to the heterogeneity of the data.