Effect of Platelet-Rich Fibrin on Orthodontic Tooth Movement

Complex malocclusions—such as extreme overjet, posterior crossbite, severe tooth rotation, occlusal abrasion, and combined extraction cases—present significant challenges in orthodontics. Fixed orthodontic appliances (brackets and archwires) remain the mainstay in managing complex cases due to superior force control compared to removable appliances.

In recent decades, adjunctive innovations in fixed appliance therapy have emerged to accelerate tooth movement, modulate alveolar bone response, and reduce treatment duration. One such intervention is the local injection of Platelet-Rich Fibrin (PRF) and its variant, advanced PRF (a-PRF), into the gingival or sulcular area to enhance bone remodeling during tooth movement.

Basic Principles: Force Application and Bone Remodeling in Fixed Appliances

Effective tooth movement in complex cases requires consideration of the following principles:

1. Force Control and Measured Force
   Fixed appliances allow precise force application through archwire adjustments, torque control, loops, bends, and secondary modifications.
2. Alveolar Biological Response
   Tooth movement involves bone resorption on the pressure side and bone formation on the tension side. The speed and efficiency of this process represent natural limiting factors.
3. Anchorage and Side Effect Control
   Complex cases often require additional anchorage (e.g., mini-implants or TADs) to prevent unwanted tooth movement.
4. Biological Intervention
   Local injections of materials such as PRF or a-PRF are used as adjunctive strategies to facilitate tissue remodeling.

PRF / a-PRF Research as an Adjunctive Intervention

A study conducted by FKG UGM student Marshanti Emmadita, under the supervision of Dr. drg. Cendrawasih Andusyana Farmasyanti, M.Kes. Sp.Ort(K), and drg. Yanuarti Retnaningrum, Sp.Ort(K), titled “Pengaruh Injeksi Intrasulkular Platelet Rich Fibrin dan Advanced-Platelet Rich Fibrin terhadap pergerakan gigi ortodonti pada kelinci”, found that PRF and a-PRF injections into the gingival sulcus enhanced bone remodeling during orthodontic treatment.

Key finding: a-PRF demonstrated a greater accelerating effect on remodeling and potential improvement in tooth movement speed compared to conventional PRF, indicating that local biological therapy may complement fixed appliance management in complex cases.

Management Strategy for Complex Cases: Fixed Appliances + Biological Approach

Here are some strategic steps to consider:

1. Comprehensive Initial Evaluation
   • Cephalometric analysis, study models/digital scans
   • Force planning, anchorage selection, and treatment sequencing
   • Assessment of periodontal condition and suitability for biological modification
2. Fixed Orthodontic Force Design
   • Use of large-slot brackets (e.g., 0.022″), specialized archwires, and torque control
   • Precise bends and sequencing for controlled complex movements
   • Combination with TADs or mini-implants when necessary
3. Local Biological Intervention (PRF / a-PRF)
   • Intrasulcular injection at target tooth roots
   • Objective: accelerate alveolar bone remodeling and shorten treatment duration
   • 3. Biomarker monitoring (e.g., ALP, RANKL/OPG) may support effectiveness evaluation
4. Monitoring and Dynamic Adjustment
   • Regular follow-ups to adapt to tissue response
   • Consider reinjection or force modification if response is slow
   • Maintain optimal oral hygiene to prevent inflammation
5. Retention and Stability Maintenance
   • Use of retainers post-treatment
   • Monitor relapse, especially in cases involving extreme tooth movement

Challenges and Practical Considerations

• Cost and Technique: PRF/a-PRF requires additional materials and expertise
• Individual Variability: Biological responses vary among patients: Respon jaringan biologis berbeda antar individu; efek PRF mungkin lebih besar pada tulang dengan kapasitas remodeling baik.
• Injection Frequency: Single injections may be insufficient; repeat injections may be needed
• Safety and Side Effects: Monitor for inflammation and potential complication
• Human Clinical Evidence: Animal studies provide biological rationale, but human clinical trials are still needed

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Management of complex malocclusions using fixed orthodontic appliances requires advanced biomechanical expertise and careful force planning. However, combining local biological interventions such as PRF or a-PRF injections shows promise in accelerating bone remodeling and improving treatment efficiency. While animal studies provide important foundational evidence, clinical confirmation in humans is required before widespread adoption in complex orthodontic cases.

References
Marshanti Emmadita, Dr. drg. Cendrawasih Andusyana Farmasyanti, M.Kes.Sp.Ort(K), drg. Yanuarti Retnaningrum, Sp.Ort (K), PENGARUH INJEKSI INTRASULKULAR PLATELET RICH FIBRIN DAN ADVANCED-PLATELET RICH FIBRIN TERHADAP KADAR RECEPTOR ACTIVATOR OF NUCLEAR FACTOR-Kappa Beta LIGAND (Kajian pergerakan gigi ortodonti pada kelinci Oryctolagus cunniculus), https://etd.repository.ugm.ac.id/home/detail_pencarian_downloadfiles/1424218

Author: Rizky B. Hendrawan | Photo: Freepik