Non-Cochrane · intervention · PM42652796
Clinical Outcomes of Platelet-Rich Fibrin in Endodontic Microsurgery: A Systematic Review and Meta-Analysis.
Valdivieso Del Pueblo Carlos, Montero-Miralles Paloma, León-López María, et al. · Journal of clinical medicine · 2026 · PubMed · doi:10.3390/jcm15166392
Findings
Population Patients undergoing endodontic microsurgery (periapical surgery) for periapical lesions of endodontic origin
2 findings
| Platelet-rich fibrin or its derivatives (L-PRF, A-PRF, A-PRF+, i-PRF, PRF membrane) as adjunct to endodontic microsurgery | Endodontic microsurgery without PRF (conventional surgery/control) | Clinical-radiographic healing success | OR 1.223 [0.303, 4.931] Very low Downgraded: risk of bias, imprecision 3 studies · 96 participants |
| Platelet-rich fibrin or its derivatives (L-PRF, A-PRF, A-PRF+, i-PRF, PRF membrane) as adjunct to endodontic microsurgery | Endodontic microsurgery without PRF (conventional surgery/control) | Early postoperative pain (VAS) First postoperative week | SMD -0.617 [-1.026, -0.208] Moderate Downgraded: imprecision 3 studies · 120 participants |
Included primary studies 17
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Gulsever 2025 Apicoectomy versus apical curettage in combination with or without L-PRF application: a randomized clinical trial. PMID:40057596 | 2025 | 1 other review | not stated | not extracted yet |
| Karan 2020 Assessment of bone healing after mineral trioxide aggregate and platelet-rich fibrin application in periapical lesions using cone-beam… PMID:31321573 | 2020 | 1 other review | not stated | not extracted yet |
| Karkle 2025 Impact of Advanced Platelet-Rich Fibrin on Early Bone Healing After Endodontic Microsurgery: A Randomized Controlled Trial. PMID:40075764 | 2025 | 1 other review | Clinical-radiographic healing success | not extracted yet |
| Soto-Penaloza 2020 Pain and quality of life after endodontic surgery with or without advanced platelet-rich fibrin membrane application: a randomized… PMID:31612327 | 2020 | 1 other review | Early postoperative pain (VAS) | not extracted yet |
| Tiwari 2021 Comparative analysis of platelet-rich fibrin, platelet-rich fibrin with hydroxyapatite and platelet-rich fibrin with alendronate in bone… PMID:33623234 | 2020 | 1 other review | not stated | not extracted yet |
| You 2023 Volumetric evaluation of effects of platelet-rich fibrin and concentrated growth factor on early bone healing after endodontic… PMID:37899448 | 2023 | 1 other review | not stated | not extracted yet |
| Arpitha 2023 Efficacy of mixture of injectable-platelet-rich fibrin and type-1 collagen particles on the closure of through-and-through periapical bone… PMID:37418583 | 2023 | this review only | Clinical-radiographic healing success | not extracted yet |
| Bhardwaj 2025 Platelet rich fibrin versus hydroxyapatite in the management of periapical inflammatory lesions: A prospective clinico-radiographic… DOI:10.1016/j.ajoms.2025.03.005 | 2025 | this review only | not stated | not extracted yet |
| Dhiman 2015 Effect of Platelet-rich Fibrin on Healing of Apicomarginal Defects: A Randomized Controlled Trial. PMID:25963290 | 2015 | this review only | Clinical-radiographic healing success | not extracted yet |
| Kavitha 2024 Comparative evaluation of platelet-rich plasma + β-tricalcium phosphate and platelet-rich fibrin + β-tricalcium phosphate for healing… PMID:39502761 | 2024 | this review only | not stated | not extracted yet |
| Kumar 2026 Two-dimensional and three-dimensional evaluation of bone regeneration using platelet-rich fibrin versus bone putty in large periapical… PMID:41940358 | 2026 | this review only | not stated | not extracted yet |
| Major 2025 PRF Membranes Enhance Postoperative Recovery After Periapical Surgery: A Single-Blind Randomized Pilot Trial Using 3D Imaging DOI:10.3390/oral5040098 | 2025 | this review only | Early postoperative pain (VAS) | not extracted yet |
| Meschi 2018 Root-end surgery with leucocyte- and platelet-rich fibrin and an occlusive membrane: a randomized controlled clinical trial on patients'… PMID:29524025 | 2018 | this review only | Early postoperative pain (VAS) | not extracted yet |
| Meschi 2020 Multi-modular bone healing assessment in a randomized controlled clinical trial of root-end surgery with the use of leukocyte- and… PMID:32418011 | 2020 | this review only | Early postoperative pain (VAS) | not extracted yet |
| Monga 2016 A comparative clinical study to evaluate the healing of large periapical lesions using platelet-rich fibrin and hydroxyapatite DOI:10.4103/0970-7212.184336 | 2016 | this review only | not stated | not extracted yet |
| Singh 2020 Evaluation of Hydroxyapatite Granules, CERAMENT™, and Platelet-rich Fibrin in the Management of Endodontic Apical Surgery. PMID:32690839 | 2020 | this review only | not stated | not extracted yet |
| Thanikasalam 2018 Evaluation of healing after periapical surgery using platelet-rich fibrin and nanocrystalline hydroxyapatite with collagen in combination… DOI:10.4103/endo.endo_55_17 | 2018 | this review only | not stated | not extracted yet |
Overlap with other reviews
Reviews that include the same primary studies are not independent evidence. Shared counts match studies by PMID, DOI or NCT, and otherwise by author and year (a probable match). Only the non-Cochrane dental reviews have study lists, so overlap with Cochrane reviews is not counted yet.
| Review | Shared studies | Jaccard |
|---|---|---|
| Context-dependent effectiveness of autologous platelet concentrates in regenerative endodontic procedures and periapical surgery: A… (2026) | 6 | 0.12 |
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Patients of any age undergoing endodontic microsurgery or periapical surgery for periapical lesions of endodontic origin | Patients with persistent or chronic apical periodontitis, large, apicomarginal and through-and-through periapical defects (16 datasets) |
| Intervention | PRF or derivatives (PRF, L-PRF, A-PRF, A-PRF+, i-PRF), alone or combined with biomaterials | PRF, L-PRF, A-PRF, A-PRF+, i-PRF and PRF combined with hydroxyapatite, collagen, beta-TCP or alendronate |
| Comparison | Surgery without PRF, spontaneous clot healing, hydroxyapatite, MTA, membranes, PRP, CGF, CERAMENT, bone putty or other active biomaterials | Surgery without PRF, empty defect/clot, hydroxyapatite, CGF, bone putty, CERAMENT, MTA, membranes, PRP |
| Outcomes | Primary: CBCT bone regeneration and radiographic healing; secondary: postoperative pain, analgesic consumption, edema, quality of life, soft-tissue healing, periodontal parameters, bone density, clinical-radiographic success | Postoperative pain (n=3 pooled); clinical-radiographic success (n=3 pooled); edema, quality of life, 2D radiographic healing, CBCT volumetric regeneration, bone density, complex defects (narrative) |
| Study designs | RCTs, prospective comparative clinical studies, parallel-group or split-mouth designs | 10 RCTs and 6 non-randomized comparative studies (reports/datasets as listed in Table 2) |
| Timing | Not specified | 7 days to 12 months |
AMSTAR 2 items
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | Partial Yes | Partial Yes | yes |
| 3Choice of study designs explained | No | No | yes |
| 4Comprehensive literature searchcritical | Partial Yes | Partial Yes | yes |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | Yes | Yes | yes |
| 8Included studies described in detail | Partial Yes | Partial Yes | yes |
| 9Risk of bias assessed satisfactorilycritical | RCT: Yes · NRSI: Yes | NRSI: Yes · RCT: Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: Yes · NRSI: N/A | NRSI: N/A · RCT: Yes | no |
| 12Impact of risk of bias on the pooled results | No | No | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | No | No | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Low | Low | yes |