Beneficial Effect of Platelet-Rich Fibrin as an Adjunct to Nonsurgical Therapy After Subgingival Professional Mechanical Plaque Removal for Periodontitis: A Systematic Review and Meta-Analysis.

Background and Objectives: Periodontitis is an inflammatory disease that compromises the supporting structures of the teeth, leading to irreversible tissue damage and tooth loss. While subgingival professional mechanical plaque removal (PMPR) remains the gold standard treatment, there is increasing interest in adjunctive therapies. Platelet-rich fibrin (PRF) has gained attention as a promising biomaterial to enhance periodontal healing and regeneration. This study aimed to evaluate the clinical and immunological effectiveness of PRF as an adjunct to PMPR. Materials and Methods: Clinical studies published between January 2019 and August 2024 were included from the ProQuest, PubMed, PMC, ScienceDirect, Scopus, and EBSCO databases. Seven studies met the inclusion criteria, focusing on adults with periodontitis treated with PRF + PMPR compared to PMPR alone. Primary outcomes included changes in clinical and immunological parameters. Risk of bias was assessed using the Cochrane ROB2 tool. Meta-analysis was conducted using both fixed-effect and random-effects models, depending on heterogeneity. Results: The meta-analysis demonstrated significant improvements in clinical outcomes in the PRF + PMPR group, with reductions in probing pocket depth (SMD: -1.43 mm; 95% CI: -2.05 to -0.81; p < 0.00001), clinical attachment level (SMD: -1.34 mm; 95% CI: -1.95 to -0.73; p < 0.0001), bleeding on probing (SMD: -0.75 mm; 95% CI: -1.11 to -0.39; p < 0.00001), gingival recession (SMD: -0.79 mm; 95% CI: -1.33 to -0.25; p = 0.004), and gingival index (SMD: -0.82 mm; 95% CI: -1.37 to -0.28; p = 0.003). Favorable trends were also observed in IL-10, TGF-β, VEGF, PDGF-BB, periostin, and type I collagen levels. Conclusions: PRF enhances clinical and immunological outcomes and supports periodontal tissue stability when used as an adjunct to non-surgical therapy.