Table 1 Evolution of Autologous Platelet Concentrates (APCs).
First generation | |
|---|---|
PRP | • Introduced in the 1980s (Sun et al., 2022) • Involves collecting a patient’s blood in a vial containing an anticoagulant, followed by two centrifugation stages. • Depending on the conditions of the second centrifugation stage, the resulting PRP can be classified as either leukocyte-rich platelet plasma (L-PRP) or pure platelet-rich plasma (P-PRP), with the primary distinction being the leukocyte content. • There is currently no standardized protocol for either centrifugation stage; there are approximately 40 different protocols for obtaining PRP (Pavlovic et al., 2016). |
PRGF | • Introduced in 1999 by Eduardo Anitua. • Uses sodium citrate as the anticoagulant and calcium chloride as an activator (similar to PRP). • Employs a one-stage process involving only a single centrifugation. |
Second generation | |
PRF | • Developed by Joseph Choukroun in 2001. • Characterized by the absence of anticoagulants or additives. • Utilizes only one centrifugation stage. • Upon blood collection, the sample must be quickly placed in the centrifuge and spun to prevent premature coagulation. In this process, fibrinogen concentrates at the top of the tube, and when mixed with circulating thrombin, it transforms into fibrin, trapping platelets in the process. A fibrin clot forms in the middle of the tube, with red blood cells settled at the bottom and plasma above (Dohan et al., 2006). |
A-PRF | • Subsequent development introduced by Ghanaati et al. in 2014. • Involves spinning larger tubes (10 ml compared to the 9 ml used for PRF) at a lower rotational speed (1500 rpm) for an extended duration (14 minutes). • The adjustment in centrifugation parameters facilitates the release of more leukocytes and greater quantities of growth factors such as TGF-β1, PDGF, and VEGF (Fujioka-Kobayashi et al., 2017). |
A-PRF+ | • Iteration of A-PRF that further reduces the centrifugal speed and processing time, resulting in increased growth factor release (Miron & Choukroun, 2017). |
Third generation | |
CGF | • Introduced by Sacco in 2005. • Also uses a single centrifuge (Chen and Jiang, 2020). • Produces a denser fibrin matrix by employing a variable centrifugation speed, alternating between acceleration and deceleration (unlike PRF, which maintains a constant speed throughout the process). This variation enhances the conversion rate of fibrinogen to fibrin. • The properties of the resulting CGF can differ based on the materials used for the tubes; rough inner walls yield a dense gel, while smooth walls produce a looser gel. • If anticoagulants are added prior to centrifugation, a liquid CGF is obtained (Sun et al., 2022). • A comprehensive review by Chen and Jiang (2020) found no evidence that CGF is superior to previous generations of platelet-rich aggregates, indicating a need for further studies to assess any potential benefits of using CGF. |
