The Use of PRF for Hard and Soft Tissue Grafting
While PRF shows modest benefits in ridge preservation and root coverage procedures, current evidence remains insufficient to strongly support its use in periodontal and peri-implant regenerative surgery.
Dr. Theo Katsaros
Periodontist
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Background & clinical context
Platelet-rich fibrin (PRF) is a second-generation autologous platelet concentrate developed by Dr. Joseph Choukroun. Its preparation requires a single centrifugation cycle with no activators or anticoagulants, producing a fibrin clot that can be applied as a graft material, mixed with bone substitutes, or compressed into a membrane.
PRF has been incorporated into an expanding range of regenerative oral surgery procedures. This review evaluates the clinical trial evidence across three domains: management of infrabony periodontal defects, implant site development (ridge preservation, ridge augmentation, and sinus augmentation), and mucogingival surgery.
Key findings by procedure
Infrabony defect management
Four controlled studies evaluated PRF in the treatment of infrabony periodontal defects, using various comparators including open flap debridement (OFD) alone, autogenous bone graft (ABG), DFDBA, and PRP.
Study | Comparison | Key outcome | PRF effect |
|---|---|---|---|
Ajwani et al. | PRF + OFD vs. OFD alone | PD reduction, AL gain, radiographic bone fill at 9 months | Partial benefit — radiographic bone fill SS greater (1.45 vs. 0.80 mm); PD and AL improvements not SS |
Mathur et al. | PRF vs. autogenous bone graft | PD, AL, radiographic defect fill at 6 months | No significant difference — comparable improvements across all parameters |
Agarwal et al. | DFDBA + PRF vs. DFDBA alone | PD, AL, radiographic bone defect at 12 months | Significant benefit — all inter-group differences SS in favour of PRF addition |
Bajaj et al. | PRF vs. PRP vs. OFD (furcation defects) | PD, AL, radiographic defect fill at 9 months | Both SS vs. OFD — PRF and PRP not SS different from each other |
Note on Agarwal et al.
In this study, PRF membranes were used to cover the grafting material in both the test and control groups — meaning the PRF membrane was not exclusive to the test arm. This complicates interpretation of the inter-group differences and should be considered when applying these findings clinically.
Ridge preservation
Three studies compared PRF against either blood clot, β-TCP, or DFDBA for dimensional ridge preservation following tooth extraction.
Study | Comparison | Assessment method | PRF effect |
|---|---|---|---|
Alzahrani et al. | PRF vs. blood clot | Cast measurements + periapical radiographs at 1, 4, 8 weeks | Significant benefit — less horizontal ridge reduction at weeks 4 and 8; radiographic bone fill SS at all timepoints |
Temmerman et al. | PRF vs. no grafting (split-mouth) | CBCT superimposition at 3 months; patient-reported pain | Significant benefit — less buccal plate height reduction and width reduction at coronal aspect; lower pain days 3–5 |
Das et al. | PRF vs. β-TCP | Clinical and radiographic at 6 months | Inconclusive — comparable mean values but no inter-group statistical comparison performed |
PRF + DFDBA vs. DFDBA alone | DFDBA ± PRF (collagen membrane both groups) | Height and width loss at 90 and 180 days | Width reduction SS lower in PRF group; height difference not SS |
Ridge augmentation
Controlled clinical trial data for PRF in ridge augmentation is extremely limited.
One study by Moussa et al. evaluated PRF membranes placed over autogenous palatal block grafts in the anterior maxilla. At 4 months, bone width gain was marginally greater in the PRF group, but the only statistically significant finding was reduced graft resorption in the PRF group.
No conclusions regarding PRF as a standard adjunct for ridge augmentation can be drawn from a single study.
Maxillary sinus augmentation
Three controlled studies assessed PRF addition to sinus grafting procedures using demineralized bovine bone mineral (DBBM), β-TCP, or FDBA. None demonstrated a histomorphometric benefit from PRF addition.
Study | Graft material | New bone formation | PRF effect |
|---|---|---|---|
Nizam et al. (split-mouth) | DBBM ± PRF | 21.25% (control) vs. 21.38% (PRF) | No benefit |
Comert Kilic et al. | β-TCP ± PRP or PRF | 33.49% (control) vs. 32.03% (PRF) | No benefit |
Gurler & Delilbasi | FDBA ± PRF (post-op outcomes) | Post-op pain, edema, function over 1 week | No significant difference — healing index higher for PRF but not SS |
Mucogingival surgery
Five studies examined PRF in root coverage procedures, using it as an adjunct to coronally advanced flap (CAF) alone or in combination with connective tissue graft (CTG).
Study | Comparison | Root coverage | Notable finding |
|---|---|---|---|
Gupta et al. | CAF + PRF vs. CAF alone | 93.27% vs. 92.20% at 3 months; 91.00% vs. 86.60% at 6 months | Slight margin stability advantage — PRF group more stable 3–6 months; KT width increase SS at 6 months |
Thamaraiselvan et al. | CAF + PRF vs. CAF alone | 74.16% vs. 65.00% (not SS) | No significant difference — gingival thickness reduced more in PRF group |
Agarwal et al. | CAF + PRF vs. CAF + AM vs. CAF alone | Higher recession reduction in PRF group | No inter-group statistics — directionally favourable for PRF |
Keceli et al. | CAF + CTG + PRF vs. CAF + CTG | 89.6% vs. 79.9% (SS) | SS benefit but minor — authors concluded marginal superiority does not warrant routine PRF use |
Tunali et al. (split-mouth) | CAF + PRF vs. CAF + CTG | 76.63% (PRF) vs. 77.36% (CTG) at 12 months | PRF comparable to CTG — no SS difference at 12 months in multiple recession defects |
Summary of evidence quality
Ridge preservation
Consistent benefit over unassisted healing for dimensional ridge maintenance
Mucogingival surgery
Slight advantage over CAF alone; comparable to CTG at 12 months
Sinus augmentation
No histomorphometric benefit demonstrated across three controlled studies
Clinical bottom line
For the practitioner
PRF shows its most consistent clinical benefit in ridge preservation — limiting dimensional changes compared to unassisted socket healing — and offers a modest advantage in soft tissue stability when combined with CAF for root coverage. Its role in sinus augmentation is not supported by current histomorphometric data, and its benefit in infrabony defect regeneration remains inconsistent across studies. Given the absence of a standardized preparation protocol and the moderate-to-high risk of bias across most published trials, PRF should be regarded as a promising adjunct requiring further high-quality evidence rather than a validated standard of care.
