Efficacy of platelet-rich fibrin (PRF) in regenerative endodontic treatment of immature permanent teeth: a systematic review

Immature permanent teeth with pulp necrosis present a complex clinical challenge, as conventional treatment methods (calcium hydroxide apexification, mineral trioxide aggregate apical plug) do not promote continued root development or dentin wall thickening. Platelet-rich fibrin (PRF) has emerged as a promising scaffold in regenerative endodontic treatment (RET), yet evidence regarding its efficacy remains fragmented. Objective. To systematically synthesize clinical evidence on the efficacy of PRF in regenerative endodontic treatment of immature permanent teeth. Material and methods. This systematic review followed PRISMA 2020 guidelines. Searches were conducted in PubMed, Scopus, Cochrane Library, eLibrary, CyberLeninka, and Google Scholar (2018–2026). Inclusion criteria: human studies, PRF application (L-PRF, A-PRF, i-PRF) for immature permanent teeth, reporting of clinical and/or radiographic outcomes. Results. Twenty studies were included (4 RCTs, 1 controlled clinical trial, 1 observational study, 14 clinical cases and case series) comprising 210 treated teeth. Positive clinical outcomes (symptom resolution, periapical healing) were reported in 95.0% of studies. Radiographic dentin thickness increase was observed in 80.0% of studies, apical closure in 75.0%, and root lengthening in 70.0%. Comparison of PRF formulations showed comparable outcomes between L-PRF, A-PRF, and i-PRF. Several studies demonstrated the superiority of PRF over blood clot in achieving apical closure. Risk of bias was moderate in most included studies. Conclusion. PRF application in regenerative endodontics of immature permanent teeth demonstrates high rates of clinical and radiographic success. The strongest evidence supports L-PRF and A-PRF. Protocol heterogeneity and the limited number of high-quality RCTs preclude definitive clinical recommendations, underscoring the need for further standardized research.