Clinical efficacy of platelet-rich fibrin therapy during oral surgical interventions in cigarette smokers: A systematic review of randomized controlled trials.

OBJECTIVES

A limited number of randomized controlled trials have assessed the efficacy of platelet-rich fibrin (PRF) therapy during oral surgical interventions in cigarette smokers. A systematic review of the currently available literature remains undocumented. The aim of this systematic review was to evaluate the clinical efficacy of adjunctive PRF therapy for enhancing wound healing and tissue regeneration and repair during oral surgical interventions in cigarette smokers.

MATERIALS AND

METHODS

The research question was: "In adult cigarette smokers undergoing OSI, does adjunctive PRF therapy, compared with non-PRF or conventional comparator interventions, improve wound healing or tissue regeneration and repair?" A literature search was conducted in accordance with PRISMA guidelines. Indexed databases and Google Scholar were searched without time and language restrictions through June 2026. The risk of bias was assessed using the Cochrane Risk of Bias-2 tool. The certainty of evidence for each clinical outcome was evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach. Disagreements were resolved via discussion.

RESULTS

Three randomized controlled trials reported in four publications were included. One trial was reported in two publications describing different outcomes and follow-up periods. The number of participants in the individual trials ranged from 18 to 102 individuals. Sample-size estimation was performed in two of the three trials. One trial, reported in two publications, evaluated socket preservation and reported short-term soft-tissue healing and postoperative pain outcomes as well as 6-month radiographic and histologic outcomes. In general, all studies demonstrated that PRF improved healing. One study had a high risk of bias, and the remaining studies demonstrated some concerns. The certainty of evidence ranged from very low to moderate in the included studies.

CONCLUSIONS

The available evidence suggests that adjunctive PRF therapy promotes post-extraction healing in cigarette smokers; however, its clinical efficacy remains inconclusive given the limited number of clinical trials, methodological heterogeneity, risk-of-bias concerns, and low-to-moderate certainty of evidence. Further well-designed, adequately powered RCTs with standardized PRF protocols and long-term follow-up are warranted.

CLINICAL RELEVANCE: The available evidence suggests that PRF may favor post-extraction healing in cigarette smokers. Although a lower numerical occurrence of dry socket was reported in PRF-treated sockets in one RCT, the current evidence is insufficient to establish a preventive effect. Overall, PRF appears promising; however, definitive clinical conclusions remain limited by the small number of trials, methodological limitations, and low-to-moderate certainty of evidence.