Clinicians have been using PRF and other platelet concentration products with the regenerative procedure in order to enhance the healing and to reduce the postoperative complications (24), however, studies have shown that PRF have only mild antibacterial activity against some bacterial agents like S. aureus, and it is not affective against resistance bacteria like F. Nucleatum (25, 26). Moreover, the most frequent postoperative complication in minor surgery is infection due to the exposure of the flap (or membrane) and the bacterial colonization of the wound (21, 27).
Therefore, this research aimed to improve the antibacterial activity of PRF by adding different forms of antibiotics and developing a reproducibly protocol which produce PRF with best antibacterial activity and best physical properties.
PRF that has a high antibacterial activity would be very effective where infection is predictable, and can reduce the need of antibiotic especially in the field of dental surgeries (28), and can help to reduce the use and side effect of systematic antibiotic (cell toxicity, and antibiotic resistance) (29).
Several studies tried to improve the antibacterial activity of PRF, one study added silver nanoparticles (SNP) which created SNP modified PRF, and this study concluded that SNP modified PRF had an improved mechanical properties and higher antimicrobial activity (20), other study evaluated release kinetics of different antibiotic from PRF, the results showed that PRF could release antibiotics for a week (30).
Three forms of antibiotic were tested, ampoule (0.5, 1 ml) solution (0,5, 1 ml) had the best results and did not change the physical properties of the PRF, while PRF failed to form when adding powder form of antibiotic. The reason to test different forms of antibiotic agent is to give the clinician variety of options during the practical practice.
Results showed that adding ampoule or solution form can significantly increase the antibiotic activity of PRF, compared with normal PRF (control), and could release antibiotic for 10 days. No significant difference between ampoule and solution form was noticed, however, ampoule had higher results, this can be explained because ampoule is already prepared for IV, IM injection while the solution concentration may have been diluted in the serum. No previous study had studied the effect of pharmaceutical form on the antibiotic release of PRF. Also, 0.5 ml and 1ml volume had similar results, however, 0.5 ml had a slightly higher antibacterial activity, which agrees with the results of previous study (19).
The protocol used in this study succeed to improve the antibacterial activity of PRF preserved the physical properties of the PRF. The antibiotic release in our study lasted for 10 days, other study recorded that the bacterial growth inhabitation lasted between 4-7 days (19, 30).
This results can be helpful in oral surgery were infection is the main complication and the main source of failure (21), oral surgeries and treating of periodontal diseases can improve by the gradual local release of antibiotic (37).
Further research and improvement should be done to the protocol proposed in this study using different antibiotic agents and bacteria in order to prepare this concept for the clinical application.
Finally, and Within the limits of this study, it can conclude that the proposed protocol in this study has succeeded to improve the antibacterial properties of PRF, creating a local antibiotic delivery biomaterial that can be used widely after minor surgery, and can significantly reduce the use of systematic antibiotics.