L-PRF in intrabony defects: a real 1.1 mm gain, but evidence stays weak

Open flap debridement (OFD) remains a mainstay for treating periodontal intrabony defects, but clinicians have long sought biomaterials that improve regenerative outcomes without the cost or complexity of membranes and bone grafts. Leukocyte and platelet-rich fibrin (L-PRF) — an autologous, chairside-prepared scaffold rich in growth factors — has been proposed as one such adjunct. This systematic review and meta-analysis pooled evidence from 23 randomized controlled trials to determine whether adding L-PRF to OFD improves clinical and radiographic outcomes compared with OFD alone.

Following PRISMA methodology, two independent reviewers searched PubMed, Scopus, Web of Science and Cochrane CENTRAL through November 2025. Risk of bias (Cochrane RoB 2) was low in 12 of the 23 included trials, with some concerns in eight and high risk in three. At the 9-month follow-up (reported by 16 studies), L-PRF plus OFD produced statistically significant improvements over OFD alone: probing depth reduction of 1.11 mm (95% CI 0.84–1.38) and clinical attachment level gain of 1.13 mm (95% CI 0.79–1.48). Secondary outcomes — radiographic bone fill and gingival margin level — also favored the L-PRF group.

Exploratory subgroup analyses suggested that defect morphology, the application protocol, and centrifugation settings used to prepare the L-PRF may all influence the benefit seen, though the authors caution these findings are based on limited data. Overall certainty of evidence, graded with GRADE, ranged from very low to moderate — reflecting substantial heterogeneity across the pooled trials.

The clinical takeaway is measured rather than definitive: adjunctive L-PRF appears to provide real, statistically significant additional benefit in probing depth and attachment level gain — a magnitude (~1.1 mm on both measures) that is clinically meaningful, not just statistically so. But because certainty of evidence remains low-to-moderate and preparation protocols are not yet standardized, the authors stop short of a firm clinical recommendation, calling for larger, multicenter RCTs with longer follow-up and standardized L-PRF protocols.