Assessment of periodontal regeneration with blood derivatives: a systematic review and network meta-analysis

This systematic review and network meta-analysis (NMA) evaluated the efficacy of autologous blood-derived products compared with open flap debridement (OFD) over time in patients with intrabony periodontal defects. Randomized clinical trials were included, and clinical attachment level (CAL) gain, probing depth (PD) reduction, and bone regeneration (BR) were assessed at 6, 9, and 12 months. Study selection followed the PRISMA-NMA guidelines, and the protocol was registered in PROSPERO (CRD420250651074). Risk of bias was assessed using RoB 2.0, and the certainty of evidence was evaluated with CINeMA. NMA was conducted using a random-effects model integrating direct and indirect comparisons, with treatment ranking based on Surface Under the Cumulative Ranking (SUCRA) probabilities. PRF-based protocols, alone or combined with adjunctive agents, were associated with favorable trends in CAL, PD, and BR outcomes, particularly at the 9-month follow-up. Combinations of PRF with alendronate or rosuvastatin achieved high ranking probabilities and may offer additional regenerative benefits; however, these findings should be interpreted cautiously given the variability in certainty across comparisons. Although statistically significant differences were not consistently observed at 12 months, some interventions maintained favorable point estimates and ranking probabilities over time. Although sustained statistical superiority was not consistently demonstrated, some interventions showed potentially favorable clinical outcomes that may contribute to periodontal stability. Overall, PRF-based therapies showed promising results, particularly at intermediate follow-up periods; however, the magnitude and durability of these effects remain uncertain. Further well-designed long-term clinical trials are required to clarify their role as adjunctive regenerative therapies.