Analgesic effects of platelet-rich fibrin (PRF): A systematic review

Platelet-rich fibrin (PRF), a second-generation autologous platelet concentrate, has gained significant interest for its anti-inflammatory and regenerative characteristics. While its role in tissue healing is well-recognized, the analgesic potential of PRF remains under-investigated.

The primary objective of this systematic review was to critically evaluate any pain-reported outcome of PRF across all medical and dental procedures in human studies. The secondary objective was to also evaluate outcomes regarding swelling reduction with PRF and other patient-reported outcomes such as quality of life and analgesic consumption in all included studies.

A systematic search of PubMed, Scopus, Web of Science, and Google Scholar databases was performed for comparative clinical studies assessing PRF's influence on postoperative pain. Eligible studies included human clinical trials comparing PRF with non-PRF controls, with pain-reported outcomes as the primary outcome. Data on swelling and other patient-reported outcomes, including analgesic use and quality of life, was also evaluated as a secondary objective; however, studies that evaluated these outcomes alone were excluded. A total of 200 comparative clinical studies were included, covering a diverse range of procedures including third molar extractions, palatal wound healing, mucogingival procedures, periodontal/bone procedures, maxillary sinus lifts, endodontic procedures, orthodontic procedures, oral lesions, alveolar osteitis, oroantral communications, medically induced osteonecrosis of the jaw, temporomandibular joint disorders, orthopedic procedures, facial surgery and aesthetics, and other fields of medicine. However, heterogeneity in PRF preparation methods and outcome measures precluded a meta-analysis.

Almost all studies reported reduced pain levels in the PRF group compared with non-PRF controls, with additional benefits observed in terms of swelling reduction, decreased analgesic use, and improved patient-reported outcomes. Importantly, it was observed that procedures that tend to generate the most patient-reported pain, such as 3rd molar extractions and autogenous soft tissue grafting from the hard palate, generally reported much lower pain scores following PRF use (72%-85% of studies) and significantly reduced postoperative analgesic use (87.5% of studies).

The autologous nature of PRF, along with the sustained release of bioactive factors, likely plays a vital role in modulating inflammation and promoting tissue healing, hence enhancing patient comfort and recovery. As PRF continues to gain traction in clinical practice, integrating well-designed comparative studies with standardized outcome measures will be necessary to completely understand its therapeutic potential and inform evidence-based guidelines regarding its application.