PRP and PRF in Dentistry and Oral Surgery – Evidence, Applications and Differences

PRP and PRF: same origin, different preparation

Both approaches use the patient’s own blood. Their biological and clinical properties, however, are shaped by anticoagulation, activation, fibrin architecture, cellular distribution and the exact processing protocol.

PRF is a family of protocols

Common terms include L-PRF, A-PRF/A-PRF+, i-PRF, T-PRF, CGF and H-PRF. They represent different processing concepts and are not automatically biologically or clinically interchangeable.^[18]

Direct PRP-versus-PRF comparisons do not justify a blanket claim that PRF is generally “better”. In intrabony defects, a large systematic review found benefits of PRF versus OFD alone, but no significant overall superiority over PRP, EMD or bone graft/substitute materials.^[3]

Evidence in 2026: where PRF is well studied – and where it is not

This interactive overview is not a formal GRADE assessment. It provides a qualitative orientation based on current clinical studies, meta-analyses and guidelines.

The four-level scale is an editorial orientation, not a validated evidence score. Different questions, protocols and outcomes cannot be compared directly.

Biological basis: more than “more platelets”

After activation, platelets release signalling proteins such as PDGF, TGF-β and VEGF involved in cell migration, angiogenesis and matrix remodelling. PRF adds a three-dimensional fibrin matrix to this signalling function.

A classic PRP study also showed that growth-factor concentrations correlated only weakly with platelet counts (r_p = 0.35).^[2] Platelet concentration alone is therefore not an adequate quality marker.

Gingivitis: do not confuse wound healing with causal therapy

Biofilm control remains central in plaque-induced gingivitis. PRP or PRF do not remove that cause. A 2026 RCT evaluated i-PRF, T-PRF and hyaluronic acid after gingivectomy/gingivoplasty. Several postoperative wound-healing measures improved versus natural healing, but follow-up was only 28 days.^[19]

Periodontitis: strongest PRF data in regenerative surgery

Non-surgical use

Results for i-PRF added to scaling and root planing are inconsistent. A 2025 split-mouth RCT involving 24 patients found no significant additional clinical or radiographic benefit at 90 days.^[20]

Intrabony defects

Here the evidence base is stronger. A review of 55 RCTs found benefits of PRF + OFD versus OFD alone.^[3] A 2026 meta-analysis of 23 RCTs quantified approximately 1.11 mm additional PPD reduction and 1.13 mm additional CAL gain at nine months; certainty ranged from very low to moderate depending on the outcome.^[4]

Furcations and recession coverage

Positive data are available from 20 RCTs for Class II furcations.^[5] In gingival recession, CAF + PRF can outperform CAF alone, while direct comparisons found CAF + connective-tissue graft to achieve greater root coverage or keratinised-tissue width.^[21]

Peri-implantitis: an interesting adjunct, not an established PRF standard

Current guidelines prioritise biofilm control, mechanical instrumentation, defect assessment and indication-specific surgery.^[7] The German S3 guideline could not issue a treatment recommendation for PRF in peri-implant diseases.^[8]

A 2026 meta-analysis found better radiographic bone measures with regenerative approaches, but no consistent advantages for PPD, BOP, suppuration, recession or CAL.^[9] A small i-PRF case series of 14 implants showed improvement in some measures, but no implant met a strict success criterion.^[10]

PRP and i-PRF for TMJ disorders: low-level evidence

Two retrospective studies published in 2026 evaluated PRP or i-PRF for arthrogenic TMD/internal derangement. In a 12-month cohort, pain improved after arthrocentesis in all groups; there were no clear group differences for the primary pain outcome, although some secondary findings favoured PRP + hyaluronic acid.^[26]

A second three-group study of 48 patients compared arthrocentesis alone, arthrocentesis + i-PRF and i-PRF alone. i-PRF groups had lower pain scores and greater mouth opening at several time points, but small groups and retrospective design limit inference.^[27]

Extraction sockets, dry socket and MRONJ

Third-molar surgery

A 2026 meta-analysis of seven RCTs and 776 extraction sites found a relative risk of 0.33 for alveolar osteitis with PRF versus control; certainty for this outcome was rated moderate.^[11] Another meta-analysis of 28 RCTs found less pain on several postoperative days, while soft-tissue and bone-healing effects were less consistent.^[12]

Ridge preservation

A 2026 meta-analysis of 18 RCTs found less vertical ridge loss and, at several time points, more newly formed bone than spontaneous healing.^[14] PRF should nevertheless not be presented as a universal substitute for volume-stable grafting materials.

MRONJ: separate prevention from treatment

In patients receiving antiresorptive or antiangiogenic medication, a 2026 meta-analysis found a lower observed MRONJ risk after extraction with PRF (RR 0.29), but GRADE certainty was very low.^[22] For established MRONJ, an RCT did not demonstrate a statistically significant added benefit of L-PRF to surgery.^[23]

Implant surgery: small ISQ effects, long-term benefit uncertain

A meta-analysis of 12 studies and 456 implants found higher secondary implant stability with PRF: about +3.34 ISQ at four weeks, +2.53 at six weeks and +3.37 from twelve weeks onward. Certainty was low.^[15]

ISQ is a technical surrogate measure. A statistically higher value does not prove better implant survival or long-term “osseointegration”. Based on the evidence available at the time, the German S3 guideline did not make a recommendation for PRF in immediate implantation.^[8]

Sinus lift, GBR and augmentation: PRF as an adjunct rather than a replacement

A meta-analysis of five RCTs involving 140 patients found approximately +7.07 percentage points newly formed bone and −7.93 percentage points residual graft material with L-PRF + DBBM compared with DBBM alone.^[16] This suggests an effect on histomorphometry and graft maturation, not a demonstrated long-term implant-survival benefit.

In contrast, an older two-centre RCT of PRP + autogenous bone in sinus augmentation found no clinically or statistically relevant benefit in bone volume.^[17] PRP and PRF findings should therefore not be transferred indiscriminately. In larger GBR or augmentation defects, PRF does not automatically replace volume-stable grafts or membranes.

Centrifugation, rotor and tubes: the protocol is part of the product

The major methodological weakness in the PRF literature is protocol heterogeneity. Centrifuge, rotor geometry, RCF, time, tube surface, blood volume and the interval from blood draw to centrifugation can alter the final preparation. RPM alone is therefore insufficient.

Low-speed concepts and horizontal centrifugation

Lower RCF can alter cell distribution and cell counts in laboratory studies, but universal clinical superiority has not been shown. A 2025 review found advantages of horizontal over fixed-angle centrifugation in 11 of 13 direct comparisons, predominantly for process and laboratory outcomes.^[24]

Tube material

Laboratory and preclinical work suggests that silica- or silicone-containing surfaces can influence PRF matrix properties and cellular responses.^[25] This is not proof of universal clinical harm. Intended purpose and manufacturer instructions remain decisive.

German regulatory framework

The 2023 German Dental Association (BZÄK) guideline, issued in agreement with the Paul-Ehrlich-Institut, specifies the generally accepted scientific and technical standard for obtaining small quantities of autologous blood and preparing dental blood products under § 28 TFG in conjunction with §§ 12a and 18 TFG.^[1]

• Strictly autologousThe blood product is used in the same patient from whom it was obtained.
• Medicinal-product lawAutologous blood products are medicinal products; § 13(2b) AMG provides an exemption from a manufacturing licence under defined conditions.
• NotificationManufacturing activity must be notified to the competent state authority before it begins under § 67 AMG.
• Blood volume and timingDepending on the procedure, approximately 20 to a maximum of about 80 ml; processing and application should be prompt.
• Devices and consumablesUse validated process parameters and consumables specified for the procedure.
• TrainingAt least six hours of theoretical and practical training or the prior-experience provision specified in the guideline.
• DocumentationDocument blood collection, preparation and application; retain records for at least ten years.
• Quality management / SOPsIntegrate standard operating procedures, responsibilities and device maintenance into the practice quality-management system.

Practical interpretation in 2026

PRF is not a universal “regeneration booster”. Benefit depends on indication, comparator, defect morphology, PRF variant and processing protocol. The comparatively strongest clinical evidence concerns periodontal intrabony defects and extraction sockets, particularly alveolar osteitis after third-molar surgery.

Evidence is substantially weaker for peri-implantitis and TMD. Implant-stability and sinus-augmentation data show positive surrogate or histomorphometric signals without established long-term benefit. PRP remains scientifically relevant; modern oral literature is simply more PRF-heavy in many questions. That does not establish general superiority of PRF.

Frequently asked questions