Chairside Autologous VEGF Enrichment of Dental Implant Surfaces: A Closed-Field Workflow for Accelerating Early Osseointegration

 

Dr. Mina Bassanty^*

Citation: Bassanty M. Chairside Autologous VEGF Enrichment of Dental Implant Surfaces: A Closed-Field Workflow for Accelerating Early Osseointegration. J Oral Med and Dent Res. 7(2):1-14.

Received: June 9, 2026 | Published: June 20, 2026                                                 

Copyright^©️ 2026 Genesis Pub by Bassanty M. This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0). This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author(s) and source are properly credited.

DOI: https://doi.org/10.52793/JOMDR.2026.7(2)-118

Abstract

Dental implant therapy has achieved high clinical success; however, the early healing phase remains vulnerable. Successful osseointegration depends not only on implant macro- and micro-design, but also on the rapid establishment of blood clot stability, network of vascular establishment, and osteogenic cell activity at the implant-bone interface [1,2]. Although titanium implants, particularly sandblasted and acid-etched surfaces, have improved mechanical bone interlocking, they remain biologically passive and do not actively provide sustained angiogenic signaling [3].

Autologous platelet concentrates offer a life-changing strategy for transforming implant surfaces into biologically responsive interfaces because they provide fibrin matrices and growth factor reservoirs that may support peri-implant healing [1,4].  Among of these growth factors released from these preparations, vascular endothelial growth factor (VEGF) is especially relevant because it supports endothelial cell migration, capillary formation, oxygen delivery, nutrient exchange, and osteoprogenitor capacity [4,5].

Despite this biological potential, conventional growth factor-based coating approaches could be limited by workflow inefficiency when implant immersion requires prolonged chairside time. Rapid mechanical permeation using closed-field centrifugation systems may overcome this limitation by allowing autologous fibrin and VEGF-rich preparations to penetrate the implant itself within seconds [5], at a micro surface level.

Keywords

Chairside Autologous VEGF; Dental Implant Surfaces; Osseointegration.

Introduction

This article therefore evaluates the biological rationale and clinical workflow potential of chairside autologous VEGF enrichment of dental implants, with particular emphasis on centrifugation protocol design, platelet concentrate characteristics, implant surface, and sustained VEGF release.

Figure 1: Biological challenge at the early implant-bone interface. Conventional rough titanium surfaces improve mechanical interlocking, whereas VEGF/fibrin enrichment may support early vascularization and osteogenic recruitment. Author-created schematic based on the biological rationale described by [1,4,5].

The success of dental implants has traditionally been associated with primary stability, surface roughness, and long-term bone-implant contact. However, the earliest biological events after implant placement are equally decisive. Osseointegration is not simply a radiographic observation; it is a histological process defined by direct structural and functional contact between living bone and the implant surface [2]. This process begins immediately after placement, when blood contacts the implant surface and forms a provisional fibrin matrix that guides cellular migration, vascular ingrowth, and new bone formation [1].

Modern titanium implants were developed to improve this biological response. In particular, sandblasted and acid-etched titanium surfaces enhanced bone-implant contact by increasing surface roughness and improving mechanical interlocking with newly forming bone [2,3]. Nevertheless, surface roughness alone does not fully address the biological demands of early healing. A rough surface may improve physical anchorage, but it does not necessarily provide the angiogenic and osteogenic signals required for rapid vascularization and predictable bone maturation [4,5].

This limitation is clinically important because early vascularization is one of the key requirements for successful osseointegration. Blood vessels deliver oxygen, nutrients, immune cells, and osteoprogenitor cells to the healing interface. When vascular ingrowth is delayed, bone formation may become slower and less predictable, particularly in compromised clinical situations such as poor bone quality, fresh extraction sockets, systemic disease, or immediate loading protocols [4,2]. Therefore, the challenge in contemporary implantology is no longer limited to producing a mechanically rough surface; it is to create an implant surface that can actively participate in early wound healing.

Figure 2: Chairside clinical workflow components (Round up machine by Silfradent). Autologous blood collection and a closed-field mechanical permeation device provide a practical route for implant surface enrichment without substantially prolonging surgery. Author-created workflow image based on the closed-field implant permeation concept described by [5].

Despite the advantages of SLA titanium surfaces, several biological limitations remain. First, their surface energy and wettability may not always provide ideal conditions for rapid blood spreading, clot adhesion, and fibrin stabilization [2]. These early events are essential because the fibrin matrix acts as the first biological scaffold for endothelial cell migration and capillary formation [1]. Second, peri-implant vascularization depends largely on vessel ingrowth from the surrounding bone, a process that may be delayed in clinically compromised sites [4]. Third, conventional titanium surfaces do not retain or release angiogenic mediators in a controlled manner. As a result, the biological stimulus created by initial blood contact may be short-lived and insufficient to support rapid vascular organization during the critical early phase of healing.

This is why growth factor enrichment has become an attractive direction in regenerative implant dentistry. VEGF is particularly relevant because it directly supports endothelial cell proliferation, migration, and survival through VEGF receptor-mediated signalling [4,5]. By promoting new capillary formation, VEGF contributes to the establishment of a vascular network capable of supporting bone regeneration. In addition to its angiogenic role, VEGF may also influence osteoblast survival, mesenchymal stem cell differentiation, alkaline phosphatase activity, and collagen type I expression [4]. Therefore, VEGF should not be viewed only as a vascular mediator, but also as a biological link between angiogenesis and osteogenesis.

The clinical translation of growth factor-based implant biofunctionalization depends not only on biological efficacy, but also on workflow efficiency. A technique that improves implant healing but significantly prolongs surgical time may be difficult to adopt in routine practice. For this reason, closed-field chairside coating systems are of particular interest. By combining autologous platelet concentrates with rapid mechanical centrifugation, it may be possible to impregnate implant microtopography with fibrin and VEGF-rich preparations within seconds rather than minutes [5]. This creates the possibility of converting a conventional titanium implant surface into a biologically active interface immediately before placement.

Figure 3: Proposed chairside workflow for autologous VEGF enrichment: blood draw, centrifugation, CGF/LPCGF preparation, closed-field implant coating, placement, and early angiogenic healing. Author-created schematic informed by platelet concentrate preparation principles and implant coating protocols [1,6,5].

The present article focuses on the integration of optimized centrifugation protocols with a closed-field implant coating workflow. Unlike studies that examine platelet concentrates in isolation, this approach considers the full clinical sequence: blood collection, centrifugation, fibrin or liquid CGF preparation, implant surface permeation, and potential VEGF release [6,5]. The central innovation is the possibility of improving early angiogenic signalling while maintaining a practical and time-efficient chairside procedure.

Methodology (Comparative Protocols)

Platelet concentrates in implant dentistry

Platelet concentrates have gained considerable attention in implant dentistry because of their ability to act as autologous reservoirs of growth factors, including vascular endothelial growth factor (VEGF) [1,6].

The four main families of platelet concentrates—pure platelet-rich plasma (P-PRP), leukocyte- and platelet-rich plasma (L-PRP), pure platelet-rich fibrin (P-PRF), and leukocyte- and platelet-rich fibrin (L-PRF)—differ in their cellular composition, fibrin architecture, and growth factor release profiles, thereby influencing their biological effects on peri-implant healing [6].

Table 1: Classification of platelet concentrates used in implant dentistry.

This table summarizes the four principal families of platelet concentrates according to leukocyte content, fibrin architecture, growth factor release pattern, and expected clinical behaviour. PRP-based preparations generally provide rapid but short-term growth factor release, whereas PRF-based preparations form a denser fibrin scaffold that supports gradual release and scaffold-based healing. Adapted from [1,6].

PRP-based formulations (P-PRP and L-PRP) are characterized by a liquid or gel consistency with a low-density fibrin network, resulting in rapid but short-term release of growth factors following activation [1]. Although these systems can provide an early surge of VEGF that may enhance initial angiogenic signalling, their limited retention at the implant surface and lack of sustained release restrict their ability to support prolonged vascular maturation and stable bone formation.

In contrast, PRF-based concentrates (P-PRF and L-PRF) form a high-density fibrin matrix that serves as a three-dimensional scaffold for cell migration and vascular ingrowth [4]. This fibrin architecture enables the gradual and long-term release of VEGF and other osteogenic growth factors over several days.

Centrifugation principles

Upon centrifugation, erythrocytes settle faster at the bottom of a recipient, whereas leukocytes and platelets deposit on the top of the erythrocytes, followed by plasma over the cells [1,6]. The acceleration exerted on the blood through centrifugation is known as the relative centrifugation force (RCF) and is expressed in multiples of the Earth’s gravitational force (9.81 m/s2) and abbreviated as ‘‘g’’ [1].

Thus, a higher cell mass and RCF applied result in faster cell settling at the bottom of a tube [6]. The centrifugation process and the surface of the tubes initiate the coagulation cascade of blood and activate platelets, causing the release of bioactive molecules (hemostatic factors, angiogenic factors, growth factors, proteases, and serotonin [1].

Fixed-angle high-speed centrifugation (CGF)

According to the centrifugation method, standard concentrated growth factor (CGF) is prepared using a fixed-angle centrifugation protocol with relatively high rotational speeds (RPM) and a variable-speed program [2].

In contrast to PRP and conventional PRF, CGF centrifugation involves alternating acceleration and deceleration phases, which promote enhanced separation of blood components and the formation of a dense, highly polymerized fibrin matrix [1,2]. The use of fixed-angle centrifuges results in stronger radial centrifugal forces, thereby affording more compact stratification of erythrocytes, buffy coat, and plasma fractions [6].

High-speed settings increase the g-force, facilitating platelet entrapment within the fibrin network and concentrating growth factors, such as vascular endothelial growth factor (VEGF), platelet-derived growth factor (PDGF), transforming growth factor-β (TGF-β), and insulin-like growth factor (IGF) [4]. Consequently, CGF exhibits a thicker fibrin scaffold with greater tensile strength than conventional L-PRF [1,2].

Low-speed centrifugation concept (LSCC)

The low-speed centrifugation concept (LSCC) represents a modification of conventional platelet-rich fibrin (L-PRF) preparation protocols, aimed at optimizing the biological quality of the fibrin matrix rather than maximizing mechanical density [4,6].

LSCC employs a reduced centrifugation speed (lower RPM and g-force) and shorter or controlled centrifugation times, typically using fixed-angle centrifuges, to preserve a higher proportion of viable platelets, leukocytes, and circulating progenitor cells within the fibrin clot [4]. Decreasing the centrifugal force, LSCC limits excessive cellular displacement toward the red blood cell fraction, thereby allowing platelets and leukocytes to remain more uniformly distributed throughout the fibrin network [6].

This results in a less compact but biologically richer fibrin scaffold, characterized by increased cellular content and enhanced growth factor [4]. LSCC has been shown to significantly increase the concentration and release of angiogenic mediators, particularly vascular endothelial growth factor (VEGF), as well as platelet-derived growth factor (PDGF) and transforming growth factor-β (TGF-β) [4,2].

Centrifugation protocols based on RPM

Table 2: Reported centrifugation protocols according to rotational speed and processing time.

This table compares commonly reported high-, medium-, and low-speed centrifugation protocols used for platelet concentrate preparation. Differences in RPM, time, and relative centrifugation force influence cellular distribution, fibrin density, and growth factor availability. Adapted from [6].

According to Frontiers of Oral and Maxillofacial Medicine (2023), centrifugation processes can be classified into high-, medium-, and low-speed protocols [6].

According to more than 70 articles, the most successful and effective protocols are high- and low-speed protocols [6].

Sixty studies described the protocol ‘‘3,000 rpm for 10 min,” which made it the most-cited protocol in the high range of RPM [6]. The second most-cited protocol in this range was “3,000 rpm ×12 min” [6].

Figure 4: Comparative centrifugation protocols used for platelet concentrates preparation.

The figure illustrates how variation in centrifugation speed and duration affects platelet concentrate characteristics. High-speed protocols tend to produce denser fibrin matrices, whereas lower-speed approaches may preserve greater cellular and growth factor content. Adapted from [6,4].

Influence of centrifuge rotor angulation

Centrifuge rotor design is an important but often under-reported variable in platelet concentrate preparation. In fixed-angle centrifugation, tubes are held in an inclined position during rotation. This creates an oblique force vector that pushes cells toward the outer wall of the tube, potentially producing uneven cellular distribution and non-uniform fibrin organization [1,6]. Although fixed-angle systems are widely used in PRF and CGF preparation, the angulated position may influence the final concentration of platelets, leukocytes, and growth factors within the fibrin matrix [1,3].

Horizontal centrifugation has been proposed as an alternative method because tubes move into a horizontal position during centrifugation, allowing blood components to separate more directly according to density. This may produce more uniform layering of erythrocytes, leukocytes, platelets, and plasma fractions [6,3]. As a result, horizontal centrifugation may improve cellular distribution within the fibrin scaffold and enhance growth factor availability, particularly for angiogenic mediators such as VEGF [4,3].

From a biological perspective, rotor angulation is clinically relevant because the quality of the platelet concentrate depends not only on speed and time, but also on how centrifugal force is distributed through the blood sample [1,6]. More uniform separation may improve fibrin architecture, cellular preservation, and sustained growth factor release [4,3]. Therefore, when comparing centrifugation protocols for implant surface biofunctionalization, rotor orientation should be considered alongside RPM, relative centrifugation force, centrifugation time, tube characteristics, and preparation system [1,6,3].

Table 3: Comparison between fixed-angle and horizontal centrifugation systems.

This table summarizes the major mechanical and biological differences between fixed-angle and horizontal centrifugation. Rotor angulation influences force distribution, cellular layering, fibrin architecture, and the availability of growth factors within the final platelet concentrate. Adapted from [1,6,3].

These mechanical differences are directly relevant to implant surface biofunctionalization. A platelet concentrate with improved fibrin organization, cellular distribution, and growth factor availability may interact more effectively with implant microtopography. Therefore, centrifugation angle is not merely a technical parameter; it may influence the biological quality of the coating applied to the implant surface.

Table 4: Comparative summary of centrifugation protocols and biological outcomes.

The table compares centrifugation approaches according to speed, rotor design, fibrin structure, cellular distribution, and expected regenerative potential. These differences are clinically relevant because the centrifugation protocol determines the biological quality of the platelet concentrate used for implant surface biofunctionalization. Adapted from [4,6,3].

Closed-field implant surface biofunctionalization

To combine these growth factors in a simplified and quick clinical step, a new in vitro study evaluated the combination of the use of concentrated growth factor (CGF) and the liquid phase of CGF (LPCGF) on dental implant surfaces.

In this study, CGF was obtained, and to incorporate the CGF onto the implant surface, these tubes were inserted into a second device (Round Up) and centrifuged for 5s. This resulted in a biologically active implant surface capable of promoting neo angiogenesis and tissue regeneration.

Table 5: Comparison of implant surface biofunctionalization techniques for VEGF enrichment.

This table compares conventional immersion-based approaches with rapid closed-field mechanical coating techniques. The comparison highlights the potential advantage of centrifugation-assisted implant permeation in reducing chairside time while maintaining VEGF delivery to the implant surface. Adapted from [5].

Results and Discussion

Biological outcomes of horizontal and fixed-angle centrifugation

The results of this study focus on the central concept of the present article, namely, the biological advantages of centrifugation protocols and the added value of a closed-field technique for implants. Specifically, this approach allows the incorporation of fibrin and vascular endothelial growth factor (VEGF) directly onto the implant surface, representing a biologically driven and innovative strategy.

The differences between fixed-angle and horizontal centrifugation systems are summarized in (Table 3).

Analysis of samples obtained using horizontal centrifugation demonstrated a pronounced early release of key growth factors, including platelet-derived growth factor-BB (PDGF-BB), fibroblast growth factor-2 (FGF-2), and VEGF, within the first 24h [4].

This initial burst was followed by a sustained and continuous release of growth factors over a period of up to three weeks, indicating prolonged biological activity that may support early angiogenesis and subsequent osteogenesis at the implant–bone interface [4]. These findings highlight that horizontal centrifugation may provide improved biological characteristics compared to fixed-angle centrifugation systems, particularly in terms of cell distribution, fibrin quality, and growth factor availability.

Growth factor release kinetics

The dynamic release of growth factors during the first 28 days was tested by [5], who incubated CGF, A-PRF, CGF-SB, and A-PRF-SB for 28 days, with the supernatant collected on days 1, 7, 14, 21, and 28.

Growth factors, platelet-derived growth factor-BB (PDGF-BB), vascular endothelial growth factor (VEGF), and basic fibroblast growth factor (bFGF), were quantified using multiplex assays. Transforming growth factor-β1 (TGF-β1) and insulin-like growth factor-1 (IGF-1) were measured using ELISA.

Figure 5: Growth factor release kinetics from platelet concentrate preparations over 28 days.

The graph demonstrates cumulative release patterns of PDGF-BB, VEGF, bFGF, TGF-β1, and IGF-1 from different platelet concentrate formulations. The sustained release profile supports the potential role of platelet concentrates in prolonged angiogenic and osteogenic stimulation during early implant healing. Adapted from [4].

Figure 6: Preparation and separation of platelet concentrate fractions after centrifugation.

The diagram illustrates blood fractionation into erythrocytes, buffy coat, plasma, and fibrin-rich platelet concentrate layers. This separation process forms the biological basis for obtaining fibrin matrices enriched with platelets, leukocytes, and growth factors. Adapted from [1,6].

Anti-inflammatory biological effects of PRF

Regarding its anti-inflammatory properties, Li et al. examined the effects of liquid H-PRF in relation to hyaluronic acid (HA), a well-established anti-inflammatory agent commonly used in cartilage regeneration.

Their results demonstrated that both liquid H-PRF and HA significantly suppressed the expression of catabolic mediators, including ADAMTS-5 and matrix metalloproteinase-13 (MMP-13), whose inhibition may prevent the progression of osteoarthritis.

In addition, both treatments markedly reduced inflammatory responses, as evidenced by significant downregulation of the mRNA expression levels of IL-6, IL-1β, tumour necrosis factor-α (TNF-α), and cyclooxygenase-2 (COX-2). These findings suggest that platelet concentrates may contribute to the modulation of inflammatory responses during tissue regeneration.

Figure 7: VEGF concentration following horizontal platelet-rich fibrin preparation.

The graph compares VEGF levels among L-PRF, H-PRF, and Alb-PRF preparations. The higher VEGF concentration observed in H-PRF supports the biological relevance of centrifugation orientation and protocol design in regenerative dentistry. Adapted from [3].

Implant surface biofunctionalization using CGF and LPCGF

The closed-field technique utilized two different cup-tubes, namely white and red tubes, to obtain distinct CGF fractions.

White cup-tubes allowed the collection of the liquid phase of concentrated growth factor (LPCGF), which consisted of non-polymerized liquid fibrin. Red cup-tubes were used to obtain polymerized CGF fibrin.

The CGF is characterized by a dense fibrin network containing various cellular components, including stem cells and growth factors, which play a crucial role during the early phases of wound healing [1].

Following platelet aggregation, degranulation begins immediately and continues for approximately 7–8 days, allowing the sustained release of bioactive molecules [1].

Implant surface interaction and VEGF release

Scanning electron microscopy (SEM) analysis demonstrated an intimate interaction between CGF and the implant surface, with the formation of a well-organized fibrin network adhering to the implant microtopography.

Furthermore, VEGF release from CGF-coated implants was significantly increased on the first day (approximately 70%), remained nearly constant on the second day, and subsequently decreased by approximately 15% on the third day.

Figure 8: ELISA quantification of VEGF release from CGF and LPCGF.

The graph shows VEGF release from concentrated growth factor and the liquid phase of concentrated growth factor over a 3-day period. CGF demonstrated a higher early VEGF release, suggesting stronger immediate angiogenic potential. Values are expressed as mean ± standard deviation; p < 0.05 indicates statistical significance. Adapted from [5].

Figure 9: VEGF release from CGF- and LPCGF-permeated implant surfaces.

The graph demonstrates VEGF release from implants coated with CGF or LPCGF over 3 days. CGF-permeated implants showed greater VEGF release than LPCGF-permeated implants, supporting the potential of CGF coating to create a biologically active implant surface. Values are expressed as mean ± standard deviation; p < 0.05 indicates statistical significance. Adapted from [5].

These findings suggest that CGF-coated implant surfaces may provide a biologically active interface capable of enhancing angiogenesis and tissue regeneration during early implant healing.

 

Table 6: Comparative biological effects of CGF and LPCGF on implant surfaces.

This table compares CGF and LPCGF in relation to fibrin structure, VEGF release pattern, surface interaction, and potential clinical relevance. CGF may provide stronger fibrin-based surface adherence and early VEGF release, whereas LPCGF may offer a more liquid-phase coating approach. Adapted from [5].

It is important to emphasize that the use of specific implants, such as SLA, was crucial for achieving a better implant micro-surface, enabling the growth factors to settle on the inner surface of the load implant, which was specifically designed to be coated with the patient’s CGF. From a clinical perspective, it would be important to evaluate whether a slow, gradual release of VEGF by LPCGF over time would be more effective than a quick release of VEGF by CGF.

In fact, the presence of VEGF on the implant surface was crucial, as this growth factor could improve osseointegration of the dental implant.

Figure 10: Proposed chairside workflow for autologous platelet concentrate application in implant dentistry.

The diagram summarizes the clinical sequence of blood draw, centrifugation, PRF/CGF preparation, implant coating, and implant placement. This workflow illustrates how autologous platelet concentrates may be integrated into routine implant procedures to support early biological healing. Adapted from [2,5].

Conclusions and Future Work

The use of growth factors as a biomimetic approach to dental implant therapy represents a significant advancement in modern implantology. The application of optimized centrifugation techniques, such as horizontal centrifugation and round-up systems, has the potential to be a game-changer in clinical practice by enhancing biological performance and saving significant clinical time for dental implants. Although many of these approaches are still under experimental investigation, current evidence is promising and supports the continued development of affordable and clinically accessible devices to promote the adoption of horizontal centrifugation protocols in dentistry.

Several challenges must be considered, including the need for venous blood collection and patient education in regenerative dentistry. In some patients, blood collection may be difficult or contraindicated, highlighting the importance of developing alternative strategies. Therefore, future research should focus on identifying biomolecules or biomimetic substances capable of mimicking the effects of VEGF and producing comparable regenerative outcomes.

Furthermore, existing studies have indicated that VEGF levels decrease within a few days to one week after application. This underscores the necessity of developing suitable carriers or booster systems capable of maintaining effective VEGF concentrations throughout the healing period, thereby maximizing angiogenesis and supporting long-term osseointegration.

References

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