After an extraction, preserving as much of the alveolar ridge as possible can make subsequent implant placement considerably more predictable. But when it comes to filling the extraction socket, clinicians now have several options.
Platelet-rich fibrin (PRF) has gained considerable interest because it is autologous and can be prepared chairside. But can PRF alone preserve the dimensions of an extraction socket as effectively as a bone graft?
Researchers searched PubMed/MEDLINE, Scopus and the Cochrane Central Register of Controlled Trials for studies comparing PRF with bone graft materials for alveolar ridge preservation. Nine studies met the inclusion criteria and were included in the analysis.
Overall, sockets treated with PRF experienced significantly greater loss of both ridge height and ridge width than those treated with bone grafts.
For ridge height, the pooled analysis showed significantly greater dimensional loss with PRF, with a standardized mean difference of 0.37. The difference was even more evident for ridge width, where PRF demonstrated significantly greater loss, with a standardized mean difference of 0.44.
This suggests that when preservation of the original ridge dimensions is the primary objective, bone graft materials may offer an advantage over PRF alone.
What happened when the graft material was standardized?
One challenge when comparing bone grafting studies is that different graft materials may produce different results.
The researchers therefore performed an additional analysis including only studies in which the same graft material—freeze-dried bone allograft—was used.
Here, the picture became slightly more nuanced.
There was no significant difference between PRF and the bone graft in terms of ridge height change. However, PRF still resulted in significantly greater loss of ridge width.
This distinction is clinically relevant because preservation of ridge width can be particularly important when planning future implant placement.
Interestingly, the superiority of grafting did not extend to every outcome investigated. When bone density was compared, the researchers found no significant difference between PRF and bone graft groups.
Importantly, the authors assessed the certainty of the findings using the GRADE system.
Evidence supporting the differences in ridge height and width was rated as moderate, while evidence concerning bone density was considered low certainty.
This means the results are meaningful, but they are not the final word on the subject.
Only nine studies were available for inclusion, and the authors specifically called for further research to confirm the findings.
The conclusion, therefore, should not be that PRF has no role in extraction socket management. Rather, this review addresses a much more specific question: if the clinical objective is to minimise dimensional changes in the alveolar ridge, can PRF alone provide preservation comparable to a bone graft?
Based on the currently available evidence, the answer appears to favour grafting.
For clinicians considering PRF as a substitute for graft material during alveolar ridge preservation, the findings suggest some caution—particularly when maintaining ridge width is important for future treatment. With only nine studies available, however, further research is needed before drawing definitive conclusions about the relative roles of PRF and bone grafts in socket preservation.