The challenge of filling cylindrical defects with A-PRF

In oral and maxillofacial surgery, the adaptation of Advanced Platelet-Rich Fibrin (A-PRF) to specific geometries such as osteosynthesis screw holes, fistulous tracts or extraction sockets remains problematic. Its gelatinous texture makes manual shaping imprecise, while conventional compression methods — using metal boxes or gauze — present a major biological drawback: they expel the growth factor-rich exudate and alter the architecture of the fibrin matrix.

This study presents a standardised technique using biopsy punch instruments to precisely calibrate A-PRF. The objective is to create custom-made fibrin cylinders, adapted to the exact diameter of the defect, without resorting to deleterious compression. The authors evaluate the efficacy of this approach through two clinical cases: the filling of screw sites after bimaxillary osteotomy and the treatment of a post-radiotherapy cutaneous fistula. The tested hypothesis is that punch shaping preserves the structural and biochemical integrity of the clot, thereby optimising its regenerative properties and intraoperative handling.

A clinical approach based on precision shaping

This study is based on a presentation of clinical cases (two patients) aimed at validating a handling technique for A-PRF (Advanced Platelet-Rich Fibrin) for filling uniform cylindrical defects. The objective was to maintain the integrity of the fibrin architecture without resorting to compression.

The experimental protocol was conducted according to the following steps:

• Preparation of A-PRF: Autologous blood collection in pre-cooled glass tubes, followed by centrifugation at 1,300 rpm for 14 minutes.
• Sampling and shaping: The fibrin clot was separated from the erythrocyte phase. A sterile skin biopsy instrument (punch), the diameter of which was chosen to precisely match that of the defect, was inserted directly into the clot to create cylindrical plugs.
• Clinical applications: In the first case (female, 25 years old), a 2 mm punch was used to fill the screw holes following the removal of mandibular osteosynthesis plates. In the second case (male, 45 years old), a 6 mm punch was used to fill a cervical fistulous tract post-radiotherapy.

Unlike traditional compression methods (metal boxes or gauze), this technique does not use a control group but relies on clinical observation of handling and immediate and short-term post-operative healing.

Results of the clinical and technical application

The study demonstrates that the use of a biopsy punch to shape the A-PRF (Advanced Platelet-Rich Fibrin) allows for precise adaptation to cylindrical defects while preserving the biological integrity of the platelet concentrate. Unlike standard compression methods, this technique maintains the growth factor-rich exudate within the fibrin matrix.

Summary of clinical cases

The efficacy of the technique has been validated on two distinct types of defects, summarised in the following table:

Parameter	Case No. 1: Fixation screw holes	Case No. 2: Fistulous tract (Sinus tract)
Patient	Female, 25 years old	Male, 45 years old
Background	Removal of mandibular plates (post-osteotomy)	Post-radiotherapy wound dehiscence
Punch diameter	2 mm	6 mm
Clinical outcome	Perfect adaptation without compression of the plugs	Complete filling; resolution of infection

Qualitative observations and handling

From a technical standpoint, the authors report several significant advantages related to the handling of the A-PRF clot (obtained after centrifugation at 1300 rpm for 14 minutes):

• Geometric precision: The punch enables the creation of regular cylinders corresponding exactly to the diameter of the defect, thus avoiding the formation of voids (dead spaces) often observed during manual cutting with scissors or forceps.
• Biological preservation: Direct insertion of the punch into the clot prevents the expulsion of the exudate. This preservation of the liquid phase is crucial for maintaining the maximum concentration of cytokines and growth factors.
• Ease of transfer: Despite the gelatinous and slippery consistency of A-PRF, punch shaping simplifies immediate transfer to the surgical site, thus reducing exposure and handling time.

Important note: As this is a technical case presentation, the study does not provide p-values or comparative statistical analysis. The results focus on technical feasibility and immediate clinical response, which proved favourable in both situations presented, with satisfactory clinical healing observed during post-operative follow-ups.

Analysis of clinical implications

The results of this study, although based on a case series (n=2), demonstrate that a change of tool — switching from scissors or compression to a biopsy punch — radically alters the biological integrity of the A-PRF. In case no. 1 (2 mm screw holes) as well as in case no. 2 (6 mm fistulous tract), the punch technique achieved a perfect marginal fit. Clinically, this means an elimination of the dead spaces (voids) often encountered during the manual insertion of slippery and shapeless fibrin clots.

Limitations and scope of application

The study honestly acknowledges its own limitations: this approach is exclusively reserved for uniform cylindrical defects. It does not replace membranes for large areas, nor PRF fragments for irregular volumetric fillings. Furthermore, as this is a case report, long-term clinical efficacy compared to conventional methods remains to be validated by larger-scale comparative studies.

Comparison and benefits for clinical practice

Unlike conventional protocols involving compression (metallic boxes, gauze) which expel the growth factor-rich exudate, this method preserves the fibrin architecture and its biological content. For the surgeon, the use of a standard instrument (biopsy punch) makes handling predictable and reduces operating time. It is a low-cost solution that optimises the regenerative properties of A-PRF — prepared here at 1300 rpm for 14 min — by avoiding any mechanical distortion of the biomaterial prior to its implantation.

Summary of results

This study validates the use of biopsy punches (2 and 6 mm) to shape A-PRF cylinders (centrifuged at 1300 rpm for 14 min) perfectly adapted to uniform defects. Clinical results show that this technique preserves the exudate and the natural fibrin architecture by avoiding compression, thus optimising the regenerative potential and the handling of the clot.

In practical terms, for the practitioner:

• Millimetric fit: Use standard diameter punches to precisely seal narrow sockets or osteosynthesis holes, thus preventing the formation of dead spaces prone to infection.
• Biological preservation: Stop compressing your clots with gauze or in a metal box; punch cutting preserves the exudate rich in growth factors directly within the matrix.
• Simplified handling: Transform the A-PRF, often slippery and unstable, into a cohesive and easy-to-insert cylindrical plug, which reduces operating time in difficult-to-access sites.

Handling Advanced Platelet-Rich Fibrin (A-PRF) in the operating theatre is often an ergonomic challenge. Its gelatinous and slippery consistency makes manual shaping imprecise, while conventional compression methods (metal boxes or gauze) expel the growth factor-rich exudate, thereby denaturing the fibrin architecture. A recent study presents a simple and reproducible technical alternative: the use of biopsy punches to create perfectly calibrated A-PRF "plugs".

---

Information intended for healthcare professionals. This content may contain errors or truncated summaries. We recommend always checking against the original source article. Delynov disclaims all liability regarding the use of this information. This document is not intended for patients or the general public.