Plasma Rich in Growth Factors (PRGF) in Intraoral Bone Grafting Procedures: A Systematic Review
While PRGF shows some promise in improving soft tissue healing and reducing post-operative pain and swelling, current evidence remains limited and inconsistent regarding its effectiveness in promoting new bone formation across intraoral grafting procedures.
Dr. Theo Katsaros
Periodontist
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Background & Clinical Context
Plasma Rich in Growth Factors (PRGF) is an autologous, leukocyte-free platelet concentrate prepared via a single centrifugation technique. It releases growth factors including TGF-β1, PDGF, VEGF, and IGF, with the aim of accelerating wound healing and promoting bone regeneration.
In vitro studies have shown PRGF stimulates fibroblast and osteoblast migration and proliferation. Pre-clinical work has demonstrated significant bone regeneration in peri-implant defects. Clinical applications have expanded to extraction socket management, sinus augmentation, ridge augmentation, chronic ulcer treatment, and orthopedic lesions — though the quality of controlled evidence supporting these uses has varied considerably.
Despite widespread clinical adoption, the evidence base for PRGF in formal bone augmentation procedures remained scattered and inconsistent.
Our systematic review was the first to rigorously evaluate PRGF across three clinically distinct procedures: ridge preservation, ridge augmentation, and maxillary sinus augmentation.
Key Findings by Procedure
Ridge Preservation
Two controlled trials compared PRGF-treated extraction sockets against natural blood clot healing, with conflicting results.
Study | Design | Primary outcome | PRGF effect on bone | Soft tissue / pain |
|---|---|---|---|---|
Anitua et al., 2015 | RCT | % regenerated bone volume at 10–12 weeks (CBCT + biopsy) | Significant benefit | Improved — lower pain & inflammation at days 3 & 7; thicker keratinized gingiva |
Farina et al., 2013 | CCT | Early bone deposition at 4–10 weeks (micro-CT + histomorphometry) | No significant benefit | Not assessed |
Interpreting the conflict
The differing results likely reflect timing of assessment: Farina evaluated early deposition (4–10 weeks), while Anitua assessed later-stage healing (10–12 weeks). PRGF's regenerative effect may manifest predominantly at later timepoints, consistent with its growth factor–driven mechanism of action.
Ridge augmentation
One RCT (Torres et al., 2010) examined PRGF membranes placed over titanium mesh (Ti-mesh) in 30 patients. No Ti-mesh exposures occurred in the PRGF group versus a 40% exposure rate in controls. Greater vertical and horizontal bone gain was recorded in PRGF-treated sites — attributed to maintained soft tissue closure rather than a direct osteogenic effect. No studies assessed post-operative symptomatology in this context.
Maxillary sinus augmentation
The most studied application, represented by five controlled trials with variable grafting materials (xenograft, β-TCP). Findings were predominantly mixed regarding new bone formation but more consistently positive for post-operative quality of life.
Outcome domain | Evidence direction | Notes |
|---|---|---|
New bone formation (%) | Conflicting | One study (Torres 2009) showed SS benefit; two others (Taschieri 2015, Comert Kilic 2017) found no difference. Two of three had only 5 patients. |
Vertical bone height gain | No benefit | Kilic & Gungormus 2016: no SS difference at 10 days or 6 months with β-TCP ± PRGF. |
Post-operative pain | Reduced — days 2–3 | Del Fabbro 2015: SS reduction in pain during 2nd and 3rd post-op days; no difference from day 4 onwards. |
Swelling & function | Improved — week 1 | Less hematoma, fewer limitations in chewing and speaking during the first post-operative week. |
Implant survival | No difference | 97.5% overall survival; no SS difference between PRGF and control groups across two studies. |
Summary of evidence
Soft tissue healing
Consistent benefit seen across ridge preservation and augmentation
Post-op symptomatology
Early reduction in pain and swelling (first 3–7 days)
Bone regeneration
Conflicting results across procedures and timepoints
Clinical bottom line
PRGF offers reliable short-term benefits in soft tissue healing and post-operative comfort across extraction socket management, ridge augmentation with Ti-mesh, and sinus floor elevation; largely consistent with its leukocyte-free, growth factor–rich composition.
Its role as a substitute for bone grafting materials or barrier membranes is not supported by current evidence. Its benefit on new bone formation remains inconclusive and procedure-dependent. Given its autologous nature, favorable safety profile, and ease of preparation, PRGF is a clinically reasonable adjunct where reduced post-operative morbidity is a patient priority.
For the practitioner
PRGF offers reliable short-term benefits in soft tissue healing and post-operative comfort across extraction socket management, ridge augmentation with Ti-mesh, and sinus floor elevation — largely consistent with its leukocyte-free, growth factor–rich composition. Its role as a substitute for bone grafting materials or barrier membranes is not supported by current evidence. Its benefit on new bone formation remains inconclusive and procedure-dependent. Given its autologous nature, favorable safety profile, and ease of preparation, PRGF is a clinically reasonable adjunct where reduced post-operative morbidity is a patient priority.
