Use of platelet-rich fibrin for the treatment of periodontal intrabony defects: a systematic review and meta-analysis

Objectives This study aims to compare the treatment outcomes of periodontal intrabony defects by using platelet-rich fibrin(PRF) with other commonly utilized modalities.Materials and methods The eligibility criteria comprised randomized controlled trials (RCTs) comparing the clinical outcomesof PRF with that of other modalities. Studies were classified into 10 categories as follows: (1) open flap debridement (OFD) aloneversus OFD/PRF; (2) OFD/bone graft (OFD/BG) versus OFD/PRF; (3) OFD/BG versus OFD/BG/PRF; (4–6) OFD/barriermembrane (BM), OFD/PRP, or OFD/enamel matrix derivative (EMD) versus OFD/PRF; (7) OFD/EMD versus OFD/EMD/PRF; (8–10) OFD/PRF versus OFD/PRF/metformin, OFD/PRF/bisphosphonates, or OFD/PRF/statins. Weighted means andforest plots were calculated for probing depth (PD), clinical attachment level (CAL), and radiographic bone fill (RBF).Results From 551 articles identified, 27 RCTs were included. The use of OFD/PRF statistically significantly reduced PD andimproved CAL and RBF when compared to OFD. No clinically significant differences were reported when OFD/BG wascompared to OFD/PRF. The addition of PRF to OFD/BG led to significant improvements in CAL and RBF. No differenceswere reported between any of the following groups (OFD/BM, OFD/PRP, and OFD/EMD) when compared to OFD/PRF. Noimprovements were also reported when PRF was added to OFD/EMD. The addition of all three of the following biomolecules(metformin, bisphosphonates, and statins) to OFD/PRF led to statistically significant improvements of PD, CAL, and RBF.Conclusions The use of PRF significantly improved clinical outcomes in intrabony defects when compared to OFD alone withsimilar levels being observed between OFD/BG and OFD/PRF. Future research geared toward better understanding potentialways to enhance the regenerative properties of PRF with various small biomolecules may prove valuable for future clinicalapplications. Future research investigating PRF at histological level is also needed.Clinical relevance The use of PRF in conjunction with OFD statistically significantly improved PD, CAL, and RBF values,yielding to comparable outcomes to OFD/BG. The combination of PRF with bone grafts or small biomolecules may offer certainclinical advantages, thus warranting further investigations.