Platelet-rich fibrin May Improve Early Recovery After Endodontic Microsurgery: Study

A new study published in the Journal of Clinical Medicine found that Platelet-rich fibrin (PRF) may be a useful adjunct in endodontic microsurgery (EMS), particularly for reducing postoperative pain and improving early soft-tissue healing during the first postoperative week. However, current evidence does not demonstrate consistent benefits for long-term bone regeneration or overall clinical–radiographic healing, and PRF cannot yet be considered a predictable substitute for bone grafts or regenerative biomaterials in large or non-contained defects. Given the heterogeneous studies and moderate-to-very-low certainty of evidence, well-designed randomized controlled trials using standardized cone-beam computed tomography (CBCT)-based outcomes are needed to establish its role.

The review evaluated the role of PRF as an adjunctive treatment in EMS by separately examining patient-centered postoperative outcomes and radiographic measures of bone healing. Conducted in accordance with PRISMA 2020 guidelines and prospectively registered in PROSPERO, this study analyzed randomized controlled trials and comparative clinical studies published through April 2026. This research searched 6 major scientific databases and included 17 clinical reports representing 16 independent datasets.

Patients treated with PRF-based interventions experienced significantly lower pain levels during the first postoperative week when compared with conventional treatment alone. Meta-analysis demonstrated a moderate but statistically significant reduction in early postoperative pain, highlighting PRF's potential to improve patient comfort during the critical healing phase.

This study assessed clinical-radiographic healing, CBCT-based volumetric bone regeneration, bone density, and outcomes in complex defects. Although CBCT imaging indicated that PRF might accelerate early bone formation, the advantage was not consistently maintained at follow-up periods ranging from 6 to 12 months. Overall, no clear superiority of PRF over standard treatment was demonstrated for sustained bone regeneration.

Also, the review found that current evidence does not support replacing bone grafts or other regenerative biomaterials with PRF in large or non-contained surgical defects. While PRF may enhance the biological environment for healing, its regenerative potential appears limited when substantial bone reconstruction is required.

Using the GRADE framework, researchers rated the certainty of evidence as moderate for early postoperative pain reduction but very low for volumetric bone regeneration. The conclusions were influenced by considerable clinical and methodological differences among studies, including variations in PRF preparation protocols, surgical techniques, outcome measurements, and relatively small sample sizes.

Overall, PRF represents a promising adjunct for improving early postoperative recovery after endodontic microsurgery, particularly by reducing pain and supporting soft-tissue healing.

Reference:

Valdivieso Del Pueblo, C., Montero-Miralles, P., León-López, M., Segura-Sampedro, J. J., Cabanillas-Balsera, D., Martín-González, J., & Segura-Egea, J. J. (2026). Clinical outcomes of platelet-rich fibrin in endodontic microsurgery: A systematic review and meta-analysis. Journal of Clinical Medicine, 15(16), 6392. https://doi.org/10.3390/jcm15166392