Modifications to platelet-rich fibrin (PRF): From resorption of 2 weeks to 4-6 months utilizing the novel Bio-Heat technology

Extended platelet-rich fibrin (e-PRF) is reshaping regenerative dentistry by extending membrane longevity from weeks to months. See how Bio-Heat technology enhances PRF’s clinical applications in bone regeneration, soft tissue healing, implant dentistry, and esthetic medicine.
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June 10, 2026
12 min read

Key Highlights

  • Bio-Heat technology transforms traditional PRF into extended PRF (e-PRF), increasing membrane resorption time from two to three weeks to as long as four to six months.
  • e-PRF combines heated albumin gel with concentrated PRF to create a longer-lasting, biologically active membrane for guided bone regeneration, extraction sites, sinus grafting, and recession coverage.
  • Beyond dentistry, injectable e-PRF shows promise as a natural alternative to synthetic dermal fillers and as a regenerative treatment for joint, cartilage, and sports-related injuries.
Reprinted with permission from Fujioka-Kobayashi et al. (2020).(36)
6a2886ea3064c0a76c0e97c7 Figure 4h Image00008

Abstract

Platelet-rich fibrin (PRF) has been demonstrated to be an excellent biomaterial addition to most surgeries performed in dentistry owing to its excellent biocompatibility, supraphysiological concentration of autogenous cells and regenerative growth factors over time. Nevertheless, one of the main reported drawbacks of PRF is its rather fast resorption properties characterized within a two-to-three-week time frame, thus limiting its use as a “barrier: membrane in GBR/GTR procedures.

Interestingly, recent studies have demonstrated that by heating a liquid platelet-poor plasma (PPP) layer, the resorption properties of heated albumin (albumin gel) could be significantly extended from a standard two-week resorption period to greater than four months (extended-PRF; e-PRF) using the Bio-Heat technology.

This brief overview highlights the scientific development over the past five years utilizing this novel regenerative modality demonstrating its marked improvement in membrane stability. These e-PRF membranes have since been utilized as a biological barrier membrane for GBR, extraction site management, root coverage, and closure of the lateral window during sinus grafting procedures with a longer-lasting half-life. This article also briefly discusses its use in regenerative medicine as a biological filler material that can be utilized as a replacement for synthetic fillers such as Juvéderm and Restylane in esthetic medicine applications and as a regenerative agent in sports medicine for damaged cartilage such as knees and shoulders.

Introduction

Platelet concentrates have been utilized in many fields of regenerative medicine for over three decades1 owing to their ability to deliver supraphysiological concentrations of autologous platelets, leukocytes, and growth factors.2,3 While platelet-rich plasma (PRP) has been extensively employed as a first-generation platelet concentrate, platelet-rich fibrin (PRF) has since been utilized with a better ability to release more growth factors over an extended period of time with superior clinical outcomes in various fields of medicine and dentistry.4,5 PRF has proven to be an excellent biomaterial composed of autogenous cells and growth factors entrapped within a fibrin network that have been shown to break down more slowly over time when compared to traditional PRP.5

Nevertheless, one of the main reported drawbacks of PRF (and especially PRP) is its faster-than-ideal resorption rate characterized within a two-to-three-week time frame.6 Because of its fast resorption rate, PRF membranes cannot be utilized as a barrier membrane similar to collagen due to their inability to exclude soft tissues over an extended period of time. Interestingly, a number of recent studies have demonstrated that PRF could be significantly extended from two-to-three-week resorption properties to greater than four months (extended-PRF; e-PRF) by heating a liquid platelet-poor plasma (PPP) layer (denaturing albumin) using Bio-Heat technology.7

This heated version of platelet poor plasma (PPP), which has now been utilized in many areas of medicine and dentistry, has recently been the basis of intensive research endeavors across many regenerative labs owing to its extended working properties. Since one of the main limitations of PRP/PRF has historically been its short in vivo turnover rate, these extended PRF membranes can be used as substitutes for collagen membranes in various bone regeneration applications requiring a typical “barrier” function that protects bone regeneration from faster growing soft tissues.8

To overcome the quick degradation properties of platelet concentrates and better maintain volume stability, the Alb-PRF protocol was developed. This protocol involves the use of the PPP layer (containing ~60% albumin) and heating it to 75 °C for 10 minutes to allow for albumin denaturation as well as breaking of many weak linkages or bonds (e.g., hydrogen bonds) within its protein molecule. Following denaturation, the proteins are then restructured in a more densely organized assembly that extends the resorption properties of PRF to up to four to six months (QR code 1).9-12 However, the heating process also destroys cells/growth factors, and thereby, the platelet concentrates lose much of their regeneration potential. For these reasons and following heating, a concentrated PRF layer (C-PRF)13,14 taken from the buffy coat is then mixed back into the heated PPP (albumin gel) once cooling has occurred (termed Alb-PRF or e-PRF for extended PRF).15

QR code 1

QR code 1

In view of previous research to date on this topic, the aim of this short review article is to present the biological properties of this novel regenerative modality. Furthermore, the step-by-step processing of e-PRF as well as clinical studies to date on the topic is presented in Figure 1. As an injectable filler, a 25G needle or 22G canula is recommended (QR code 2). Alternatively, a similar process can be utilized to create a custom shape membrane with extended properties (e-PRF) lasting up to four months and utilized clinically as a substitute for collagen membranes (figure 2, QR code 3).

Reprinted with permission from Fujioka-Kobayashi et al. (2020).(36)
Figure 1: e-PRF preparation protocol. 1) Whole blood was centrifuged at 2000 × g for eight minutes. The upper layer (yellow layer) shows the liquid plasma layer. 2) The uppermost layer of platelet-poor plasma (PPP) was collected in a syringe. 3) The collected PPP was heated in a heat block device at 75°C for 10 minutes and thereafter 4) cooled to room temperature for approximately 10 minutes. An injectable albumin gel was then prepared. 5) The liquid platelet-rich layer (liquid-PRF), including the buffy coat layer with accumulated platelets and leukocytes, was collected in a separate syringe. 6) The albumin gel and native liquid PRF were then thoroughly mixed by utilizing a female‒female luer lock connector. 7) Injectable e-PRF in final ready form.

Figure 1: e-PRF preparation protocol. 1) Whole blood was centrifuged at 2000 × g for eight minutes. The upper layer (yellow layer) shows the liquid plasma layer. 2) The uppermost layer of platelet-poor plasma (PPP) was collected in a syringe. 3) The collected PPP was heated in a heat block device at 75°C for 10 minutes and thereafter 4) cooled to room temperature for approximately 10 minutes. An injectable albumin gel was then prepared. 5) The liquid platelet-rich layer (liquid-PRF), including the buffy coat layer with accumulated platelets and leukocytes, was collected in a separate syringe. 6) The albumin gel and native liquid PRF were then thoroughly mixed by utilizing a female‒female luer lock connector. 7) Injectable e-PRF in final ready form.

QR code 2

QR code 2

Reprinted with permission from Miron 2021.(37)
Figure 2: An e-PRF membrane prepared for use. Case performed by Dr Ezio Gheno.

Figure 2: An e-PRF membrane prepared for use. Case performed by Dr Ezio Gheno.

QR code 3

QR code 3

Clinical use of Alb-PRF/e-PRF membranes for periodontology and implant dentistry

One of the main areas where the e-PRF membranes were first clinically utilized and tested was as a substitute for collagen membranes (QR code 1). Therefore, several clinical case series were started whereby the e-PRF membranes were created and utilized for extraction site management to cover bone allografts following tooth removal similar to either a collagen membrane/plug or a PTFE membrane (figure 3). This opportunity offers clinicians a 100% all-natural biomaterial with extended resorption properties that can also be left exposed in the oral cavity following placement. Notably, the e-PRF membranes may also be left exposed in the oral cavity, and their inclusion of supraphysiological concentrations of leukocytes allows for greater defense against incoming pathogens16 as well as lead to less pain postoperatively.17 QR code 4 highlights a clinical example of an e-PRF membrane used, and Figure 3F highlights the much faster soft tissue closure ability of epithelial tissue over the e-PRF membrane when compared to alternative strategies.

Figure 3A: Clinical case using an e-PRF membrane as a substitute for a collagen barrier membrane following extraction site management. (A) Sectioning of teeth. (B) Following tooth extraction. (C) Allograft bone grafting with PRF fragments. (D) Fabrication of the e-PRF membrane following heat treatment at 75 °C for 10 minutes in the Bio-Heat device. (E) e-PRF membrane in place with suturing (Video is found in QR code 4). (F) One week postoperative. Note the excellent healing. (G) Eight weeks post-op. (H) Four months post-op. Case performed by Dr Nathan Estrin.

Figure 3A: Clinical case using an e-PRF membrane as a substitute for a collagen barrier membrane following extraction site management. (A) Sectioning of teeth. (B) Following tooth extraction. (C) Allograft bone grafting with PRF fragments. (D) Fabrication of the e-PRF membrane following heat treatment at 75 °C for 10 minutes in the Bio-Heat device. (E) e-PRF membrane in place with suturing (Video is found in QR code 4). (F) One week postoperative. Note the excellent healing. (G) Eight weeks post-op. (H) Four months post-op. Case performed by Dr Nathan Estrin.

Figure 3B

Figure 3B

Figure 3C

Figure 3C

Figure 3D

Figure 3D

Figure 3E

Figure 3E

Figure 3F

Figure 3F

Figure 3G

Figure 3G

Figure 3H

Figure 3H

E-PRF membranes have been utilized extensively during GBR procedures (figure 4, QR code 5). Here, such membranes may be much less foreign to soft tissues, with reports of improved biocompatibility. Finally, e-PRF membranes have also been utilized as a substitute for various collagen membranes during recession coverage procedures utilizing a vestibular tunneling approach (figure 5, QR code 6).

Figure 4A: Use of the e-PRF membrane for GBR. (A, B) Lower first molar demonstrating deficiency of the buccal surface of the implant. (C) Flap elevation demonstrating complete loss of the buccal bone of this malpositioned implant. (D) Implant removal. (E) Grafting of the defect site with bone particles mixed with PRF fragments. (F) Fabrication of an e-PRF membrane. (G, H) Placement of the e-PRF membrane covering the grafted defect (Video is found in QR code 5). (I) Final soft tissue closure. Case performed by Dr. Alan Rene Espinoza.

Figure 4A: Use of the e-PRF membrane for GBR. (A, B) Lower first molar demonstrating deficiency of the buccal surface of the implant. (C) Flap elevation demonstrating complete loss of the buccal bone of this malpositioned implant. (D) Implant removal. (E) Grafting of the defect site with bone particles mixed with PRF fragments. (F) Fabrication of an e-PRF membrane. (G, H) Placement of the e-PRF membrane covering the grafted defect (Video is found in QR code 5). (I) Final soft tissue closure. Case performed by Dr. Alan Rene Espinoza.

Figure 4B

Figure 4B

Figure 4C

Figure 4C

Figure 4D

Figure 4D

Figure 4E

Figure 4E

Figure 4F

Figure 4F

Figure 4G

Figure 4G

Figure 4H

Figure 4H

Figure 4I

Figure 4I

QR code 5

QR code 5

Figure 5A: Use of e-PRF for the management of multiple gingival recessions. (A) Preoperative images demonstrating multiple anterior gingival recessions. (B, C) Postsurgical result following tunneling with e-PRF via a vestibular incision (Video is found in QR code 6). (D) Two weeks post-op; note the excellent soft tissue healing. (E) Eight weeks post-op. Case performed by Dr Nathan Estrin.

Figure 5A: Use of e-PRF for the management of multiple gingival recessions. (A) Preoperative images demonstrating multiple anterior gingival recessions. (B, C) Postsurgical result following tunneling with e-PRF via a vestibular incision (Video is found in QR code 6). (D) Two weeks post-op; note the excellent soft tissue healing. (E) Eight weeks post-op. Case performed by Dr Nathan Estrin.

Figure 5B

Figure 5B

Figure 5C

Figure 5C

Figure 5D

Figure 5D

figure_5e_8_week_post_op
QR code 6

QR code 6

In summary, clinical studies have now utilized the e-PRF membranes in various applications similar to collagen barrier membranes (as their replacement) for procedures including ridge preservation,18-21 intrabony defect regeneration,22, 23 bone regeneration,24 papilla reconstruction,25 immediate dental implant placement,26 sinus grafting,27,28 third molar extraction,29 and recession coverage.30

Clinical studies using e-PRF as an injectable bio-filler in esthetic and sports medicine

To date, thousands of cases have utilized the technology of extending the working properties of platelet concentrates as a biological filler (Bio-Filler). One of the first approaches was to restore the facial volume (figure 6, QR code 7).31 Interestingly, Alb-PRF has also been utilized for injections into deficient papilla with quite promising results, yielding up to four years of data (figure 7, QR code 8). Last, Alb-PRF has also been utilized as a biological growth factor for joint and spinal injections such as diseased osteoarthritic joints and spinal injections (QR code 9).32-35

Reprinted with permission from Miron 2021.37
Figure 6A: (A) Mid-40-year-old female patient with pronounced Mariotte lines, deep nasolabial folds and an overall aged facial appearance. (B) Final outcome following three treatments with 100% natural approaches, including laser therapy, microneedling with PRF, and e-PRF injections. Case performed by Dr. Scott Delboccio.

Figure 6A: (A) Mid-40-year-old female patient with pronounced Mariotte lines, deep nasolabial folds and an overall aged facial appearance. (B) Final outcome following three treatments with 100% natural approaches, including laser therapy, microneedling with PRF, and e-PRF injections. Case performed by Dr. Scott Delboccio. 

Reprinted with permission from Miron 2021.(37)
Figure 6B

Figure 6B

QR code 7

QR code 7

Reprinted with permission from Miron 2021.(37)
Figure 7A: (A) Clinical photograph demonstrating maxillary anterior teeth with multiple black triangles. (B-C) Injection techniques of the Alb-PRF mixture into various papillas. (D) Final clinical photographs after injections (Video found in QR code 8). Case performed by Dr Ezio Gheno.

Figure 7A: (A) Clinical photograph demonstrating maxillary anterior teeth with multiple black triangles. (B-C) Injection techniques of the Alb-PRF mixture into various papillas. (D) Final clinical photographs after injections (Video found in QR code 8). Case performed by Dr Ezio Gheno.

Reprinted with permission from Miron 2021.(37)
Figure 7B

Figure 7B

Reprinted with permission from Miron 2021.(37)
Figure 7C

Figure 7C

Reprinted with permission from Miron 2021.(37)
Figure 7D

Figure 7D

QR code 8

QR code 8

QR code 9

QR code 9

Also by the authors:

Editor’s note: This article originally appeared in Perio-Implant Advisory, a chairside resource for dentists and hygienists that focuses on periodontal- and implant-related issues. Read more articles and subscribe to the newsletter.

References

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  27. Barakat M, Khalil A, Albash Z. Efficacy of platelet-rich albumin and fibrin gel in two-stage lateral sinus lift: a prospective study. Ann Med Surg (Lond). 2025;87(9):5409-5416. doi:10.1097/MS9.0000000000003589
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  29. Javid K, Mourão CF, Mello-Machado RC, et al. Clinical and biochemical evaluation of the use of Alb-PRF versus L-PRF in mandibular third molar extractions: a split-mouth randomized clinical trial. J Funct Biomater. 2023;14(1):505. doi:10.3390/jfb14100505
  30. Abdulhak S, Kassem T, Alsayed Tolibah Y. Comparison between autologous albumin gel and liquid platelet-rich fibrin mixture versus connective tissue graft to modify the gingival phenotype: a randomized controlled trial. Cureus. 2024;16(6):e61958. doi:10.7759/cureus.61958
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  37. Miron RJ. Understanding Platelet Rich Fibrin: Quintessence; 2021.

About the Author

Richard Miron, DDS

Richard Miron, DDS

Richard Miron, DDS, is currently lead educator and researcher at Advanced PRF Education and an adjunct visiting faculty in the department of periodontology at the University of Bern, Switzerland, where he completed his PhD studies since 2009. Dr. Miron is a prolific author and international lecturer on topics relating to growth factors, bone biomaterials, and guided bone regeneration. He is widely considered one of the top contributors to implant dentistry. He has written 10 textbooks on regenerative dentistry including Next Generation Biomaterials for Bone and Periodontal Regeneration, Understanding Platelet Rich Fibrin, and Modern Implant Dentistry.

Nathan Estrin, DMD

Nathan Estrin, DMD

Nathan Estrin, DMD, received his bachelor’s degree in kinesiology from Indiana University and went on to earn his DMD from LECOM School of Dental Medicine. He received his training in periodontics at Stony Brook University in New York. During his dental studies, he developed a passion for regenerative, implant, and laser surgery and has more than 15 publications and three book chapters in these areas. Dr. Estrin is a board-certified periodontist in full-time private practice in Sarasota, Florida. He is also adjunctive faculty at LECOM School of Dental Medicine and a lead educator for PRFedu, where he trains dental offices on platelet-rich fibrin, lasers, and modern periodontal therapy.

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