Abu Alfaraj Turki M, Alruwaili Balqees M, Alnasser Raghad F, Alqahtani Salwa H, Alrajhi Taif N, Alqahtani Mushabab A, Alqahtani Saleh S, Alrashed Abdullah R, Alhashim Nasser S
Periodontics, Dental Department, Ministry of National Guard Health Affairs, Madinah, SAU.
College of Dentistry, Al-Jouf University, Al-Jouf, SAU.
Cureus. 2025 Jul 30;17(7):e89082. doi: 10.7759/cureus.89082. eCollection 2025 Jul.
Platelet-rich fibrin (PRF) has gained popularity as an autologous biomaterial used to enhance bone healing. This systematic review and meta-analysis aimed to assess whether the use of PRF alone achieves comparable osteogenic outcomes to conventional bone grafts. It involved a comprehensive search of the databases PubMed, Scopus, and Google Scholar for articles published from 2019-2024, seeking to identify clinical studies comparing PRF alone to grafts or controls in bone regeneration procedures. Primary outcomes in the studies included histologic bone formation (%), radiographic bone gain (mm), and implant success. Risk of bias was evaluated using the Cochrane risk-of-bias tool for randomized trials (RoB 2) for RCTs and ROBINS-I (Risk Of Bias In Non-randomised Studies - of Interventions) for non-RCTs. Meta-analysis employed the random-effects model (95% confidence intervals (CIs), and evidence certainty was graded via the GRADE approach (Grading of Recommendations Assessment, Development and Evaluation). Of 142 screened studies, 18 met the inclusion criteria (nine RCTs, five CCTs, and four observational studies), encompassing extraction sockets, sinus augmentations, and periodontal defects. In large defects, PRF alone demonstrated inferior bone volume versus grafts (MD: -12.4%, 95% CI: -15.2 to -9.6; p<0.001; I² = 32%) but reduced ridge resorption versus natural healing in sockets (MD: 1.2 mm, 95% CI: 0.8-1.6; p<0.01). Heterogeneity in PRF protocols (centrifugation speeds of 700-3000 rpm) and outcome measures was high. Overall, the certainty of evidence was low for PRF's equivalence to grafts. While PRF exhibits osteopromotive properties, current evidence does not support its use as a standalone graft substitute in major defects. PRF may serve as an adjunct or alternative in small, contained defects (e.g., socket preservation), but standardized protocols and long-term RCTs are needed to further validate its efficacy.
富血小板纤维蛋白（PRF）作为一种用于促进骨愈合的自体生物材料已受到广泛关注。本系统评价和荟萃分析旨在评估单独使用PRF是否能取得与传统骨移植相当的成骨效果。研究全面检索了PubMed、Scopus和谷歌学术数据库中2019年至2024年发表的文章，以寻找在骨再生手术中将单独使用PRF与移植或对照进行比较的临床研究。研究的主要结局包括组织学骨形成（%）、影像学骨增量（mm）和植入成功率。使用Cochrane随机试验偏倚风险工具（RoB 2）评估随机对照试验（RCT）的偏倚风险，使用非随机干预研究的偏倚风险工具（ROBINS-I）评估非RCT的偏倚风险。荟萃分析采用随机效应模型（95%置信区间（CI）），并通过GRADE方法（推荐分级评估、制定和评价）对证据确定性进行分级。在142项筛选研究中，18项符合纳入标准（9项RCT、5项CCT和4项观察性研究），涵盖拔牙窝、窦底提升和牙周缺损。在大的骨缺损中，单独使用PRF与移植相比，骨体积较差（MD：-12.4%，95%CI：-15.2至-9.6；p<0.001；I² = 32%），但与拔牙窝自然愈合相比，能减少牙槽嵴吸收（MD：1.2 mm，95%CI：0.8 - 1.6；p<0.01）。PRF方案（700 - 3000 rpm的离心速度）和结局测量的异质性较高。总体而言，PRF与移植等效性的证据确定性较低。虽然PRF具有促进骨生成的特性，但目前的证据不支持将其用作主要骨缺损的独立移植替代物。PRF可作为小的局限性骨缺损（如拔牙窝保存）的辅助或替代方法，但需要标准化方案和长期RCT来进一步验证其疗效。
