Effectiveness of platelet-rich fibrin concentrates in alveolar ridge preservation after tooth extraction: A systematic review of randomized clinical trials with tomographic evaluation

Purpose To systematically review the scientific evidence on the effect of Platelet-Rich Fibrin (PRF) concentrates' application on tomographically evaluated alveolar ridge preservation in post-extraction sockets.Methods A systematic search was conducted in seven electronic databases, and two additional bases as sources of gray literature, with no language or date restrictions. Randomized clinical trials comparing the use of PRF concentrates with placebo or no intervention were included. Tooth extractions were performed atraumatically, and alveolar ridge preservation was assessed by cone-beam computed tomography, measuring ridge width (horizontal) and height (vertical) changes. Two reviewers assessed the risk of bias with RoB 2.0 tool. Meta-analysis and GRADE assessment were also performed.Results A total of 2843 studies were initially identified. After duplicate removal and screening, 13 studies were included in the qualitative analysis, totaling 599 evaluated sockets. The included studies, published between 2016 and 2024, presented several methodological differences and reported controversial effects of PRF and L-PRF, compared to control groups. Individual risk of bias varied from high to some concerns mainly related to poor blinding and lack of reporting details. In meta-analysis, pooled estimates did not show statistical significance for either alveolar ridge width or height. Certainty of evidence was rated very low due to small sample size and wide confidence intervals crossing the null effect line.Conclusion Based on very low evidence, the application of PRF concentrates did not demonstrate appreciable benefits or harms for alveolar ridge preservation. However, these findings should be interpreted with caution due to data heterogeneity and bias concerns in primary studies. Thus, the evidence is insufficient to recommend its sole use as a predictable ridge preservation technique, and there is a current need on well-designed and standardized randomized clinical trials in this research field.Registration Protocol registered in the PROSPERO database (CRD42025638069).