Efficacy of Leukocyte and Platelet-Rich Fibrin (L-PRF) as an adjunct to Open Flap Debridement (OFD) in periodontal intrabony defects: a systematic review and meta-analysis.

BACKGROUND

Leukocyte and platelet-rich fibrin (L-PRF) is an autologous biomaterial used in periodontal regenerative therapy due to its scaffold properties and sustained release of growth factors. This study aimed to evaluate the efficacy of L-PRF as an adjunct to open flap debridement (OFD) in the treatment of periodontal intrabony defects.

METHODS

In accordance with PRISMA guidelines, a literature search of PubMed, Scopus, Web of Science and Cochrane CENTRAL was conducted up to November 2025 by two independent reviewers for randomized controlled trials (RCTs) evaluating L-PRF as an adjunct to OFD. Primary outcomes assessed were changes in probing depth (PD) and clinical attachment level (CAL); secondary outcomes included changes in radiographic bone fill (RBF) and gingival margin level (GML). Risk of bias and certainty of evidence were assessed using Cochrane RoB 2 and the GRADE approach, respectively. Pooled mean differences (MD) and 95% confidence intervals (CI) were calculated. Exploratory subgroup analyses evaluated lesion type, application protocols and centrifugation settings.

RESULTS

Twenty-three RCTs were included. Twelve studies had low risk of bias, eight had some concerns and three had high risk. At 9 months (16 studies), L-PRF + OFD significantly improved PD (MD: 1.11 mm; 95% CI: 0.84-1.38) and CAL (MD: 1.13 mm; 95% CI: 0.79-1.48) compared with OFD alone (p < 0.05). Secondary outcomes (RBF and GML) also showed significant improvements. The certainty of evidence ranged from very low to moderate. Subgroup analyses suggested that defect morphology, application approach and centrifugation parameters may influence outcomes; however, these findings are exploratory and based on limited data.

CONCLUSIONS

Adjunctive L-PRF appears to provide additional clinical and radiographic benefits in the management of periodontal intrabony defects when used as an adjunct to OFD. However, overall confidence in these findings is limited by very low to moderate certainty of evidence and substantial heterogeneity. Although outcomes may be influenced by defect characteristics and preparation protocols, current evidence does not support definitive clinical recommendations. Further well-designed, standardized multicenter RCTs with longer follow-up are required.

TRIAL REGISTRATION: PROSPERO registration number CRD42020168521.