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 outcomes of PRF with that of other modalities. Studies
were classified into 10 categories as follows: (1) open flap debridement (OFD) alone
versus OFD/PRF; (2) OFD/bone graft (OFD/BG) versus OFD/PRF; (3) OFD/BG versus OFD/BG/PRF;
(4-6) OFD/barrier membrane (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 and forest 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 and improved CAL and RBF when
compared to OFD. No clinically significant differences were reported when OFD/BG was
compared to OFD/PRF. The addition of PRF to OFD/BG led to significant improvements
in CAL and RBF. No differences were reported between any of the following groups (OFD/BM,
OFD/PRP, and OFD/EMD) when compared to OFD/PRF. No improvements 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 with similar levels
being observed between OFD/BG and OFD/PRF. Future research geared toward better understanding
potential ways to enhance the regenerative properties of PRF with various small biomolecules
may prove valuable for future clinical applications. Future research investigating
PRF at histological level is also needed.
