On the mainstage at the 2023 AAID Annual Conference, Richard Miron, DMD, MMSc, PhD shared his journey from researching cell biology and working as a periodontist to promoting and providing facial esthetic treatment.
As a researcher, author and educator, Richard Miron, DMD, MMSc, PhD is known for his work on periodontal wound healing and helping develop platelet-rich fibrin (PRF) protocols and clinical applications, but as he took the podium on the mainstage at the 2023 American Academy of Implant Dentistry Annual Conference, he shared how began a growing facial esthetics business based on increasing patient demands for “Vampire Facials” a skincare procedure using either hyaluronic acid or PRF and microneedling.
Dr Miron shared his story about how his interest in implants and a scholarship opportunity led him to Bern, Switzerland for advanced studies in biology, dental implants, and periodontics. While he remains an active researcher and academic, Dr Miron says he feels its important to stay clinically active and treating patients so he can see the real-world applications of the concepts he researches.
When he saw the potential of providing facial esthetics alongside dental treatments using the technologies he researches, he jumped into it, and created a model for dental professional-delivered facial esthetic services that now spread to close to 200 practices around the country. Dr Miron encouraged the audience to look into providing facial esthetic services, but before he shared more details on the possibilities in facial esthetic services, Dr Miron backed up and provided a detailed rundown on the science behind PRF.
He first noted how at a cellular level the human body has an amazing ability to close wounds and heal itself. The process of blood clotting and concentrating growth factors and other beneficial natural chemicals at the wound site promotes this healing, but this requires blood flow, and the effectiveness of self healing changes throughout a person’s life.
“As we age, your ability to heal yourself goes down,” he says.
Dr Miron noted that clotting is a critical step in healing, but some wounds do not heal properly whether because of a lack of sufficient blood flow to the wounded area, or other factors. The PRF precursor platelet rich plasma (PRP) was developed to bring these blood-based healing factors directly to wound sites. In dentistry both PRP and PRF have been mixed with graft materials to promote healing, but Dr Miron explained why they are not interchangeable.
“PRF allows clinicians to take concentrated blood growth factors and put them in places where there’s not enough blood flow to promote healing,” he says.
With PRP a patient’s blood is spun in a centrifuge to separate the while blood cells, the red blood cells and the platelets. However, traditional blood draw tubes contain anti-clotting factors to keep the blood from clotting and becoming unusable. However, with PRP some of those anti-clotting factors remain in the PRP material, meaning some negatives are mixed into the positive benefits from the platelets. For PRF special tube were designed with hydrophobic properties to keep blood in a liquid form for 4 hours without the use of any additives.
This allows PRF to provide all the benefits from the concentrated platelets while also promoting clotting, and thus promoting enhanced wound healing. Dr Miron says that with this knowledge he would not consider using PRP in clinical care any longer.
Before he moved on to discussing dental and esthetic uses of PRF, Dr Miron first shared a series of examples of the results medical doctors are having when using PRF with patients who are at risk of having a digit or a limb amputated due to a wound not healing. In many cases use of a custom PRF membrane can help patient wounds heal and eliminate the need for an amputation. Dr Miron explained that PRF in a normal clot will keep working for approximately 2 weeks.
Still, Dr Miron explained that PRF wasn’t the answer for situations requiring longer healing times, but that changed in 2019, with the development of Alb-PRF, a mixture of heated PRF and unheated PRF to create a more robust form of the healing agent that provides benefits for 4-6 months. In his practice, Dr Miron now uses Alb-PRF in his practice to make custom membranes for his periodontal patients which are both less expensive and more effective than collagen membranes.
“In my perio practice we have not used a collagen membrane in years,” he says.
In other fields this new, longer-lasting form of PRF is allowing medical doctors to create new minimally invasive treatments. One example Dr Miron shared is that spinal surgeons are using Alb-PRF injections rather than invasive surgery for patients with serious and painful back ailments.
When sharing best practices for producing PRF chairside, Dr Miron explained how there isn’t a specific RPM and time for blood to be in a centrifuge to create PRF because the power of the G-forces on the blood in the centrifuge is more important than the speed at which it spins. While a centrifuge manufacturer might provide a protocol with an RPM setting, that would only be accurate for using that exact system.
Dr Miron also explained the physics of the centrifuge process and why using a system that spins blood in a horizontal position is better than one that spins at a fixed angle. He says that spinning the blood in this way will produce 4 times the beneficial factors than spinning an angled tube of blood.
While he does use PRF in a range of esthetic procedures, Dr Miron also uses it with implant and periodontal cases. One technique he is using involves placing a PRF matrix around implant healing caps both help promote wound healing, and to help prevent the colonization of bacteria at the implant site.
“Bacteria love the roughened portion of dental implants,” Dr Miron says. “[With PRF it’s] not just platelets to help the implant heal faster, but it’s also leukocytes that are antibacterial.”
Other clinical uses include using an incubator for the production of PRF clots that can be tucked into periodontal pockets, and application at bone graft sites to prevent infection and promote healing. He uses 3D design software and a 3D printer to create custom PRF clot grafts shaped to match the patient’s specific needs. He noted that not only is the treatment effective, but also affordable and profitable for a dental practice.
“Everybody should do this. It literally costs a dollar.”
Using PRF to create custom grafts helps speed healing, and depending on the case standard PRF can be used and resorbed in several weeks instead of several months for traditional graft materials. For cases that require longer term healing, Alb-PRF lasts 4 to 6 months before resorption, making it a great replacement for collagen.
With the science explained, and the dental applications demonstrated, Dr Miron finally returned to the topic of facial esthetics, explaining the market for these services is far larger than that for dental services, and adding these services to a practice is generally easy, as many of the services can be provided by hygienists or assistants with just a little education.
While facial esthetic treatments are offered in a range of settings both clinical and retail, Dr Miron argues that dentists are better educated about facial anatomy than most esthetic providers, and thus are better prepared to offer esthetic services. He says microneedling is a service dentists can easily add to their practice. It’s safe for patients, can be used to break up scar tissue, and when combined with PRF or hyaluronic acid, provides a very effective skin care treatment. Other esthetic uses of this technology include using Alb-PRF as an all-natural alternative to the dermal fillers used in eye lifts, and even in procedures like the Brazilian Butt Lift.