Alveolar ridge preservation using advanced platelet-rich fibrin versus concentrated growth factors: a randomized, controlled trial

While platelet concentrates, such as concentrated growth factors (CGF) and advanced platelet-rich fibrin (A-PRF), are promising autologous biomaterials, direct evidence comparing their efficacy for alveolar ridge preservation (ARP) is limited. This trial clinically and radiographically compared the effects of A-PRF and CGF on postoperative healing and ARP following impacted lower third molar extraction. A randomized, controlled trial was conducted with 60 patients, with impacted lower third molars were randomly allocated (1:1:1) into three groups (n = 20 each): A-PRF, CGF, and a natural-healing control. Clinical parameters were assessed as follows: postoperative pain and facial swelling were assessed on days 1, 3, and 7; wound healing was scored on day 7. Radiographic parameters were assessed by cone-beam computed tomography (CBCT) at baseline and at 3 months. Measurements included buccal and lingual alveolar bone height and alveolar ridge width. On the first postoperative day, pain and facial swelling were comparable across groups. By the third day, A-PRF and CGF showed significantly lower pain (1.0±0.7; 1.6±1.1) and swelling (11.2±4.7; 12.0±4.8) than the control (3.2±1.3; 36.9±11.7; P<0.001). By the seventh day, pain resolved completely in both interventions. Wound healing was significantly better for both CGF (3.6±0.5) and A-PRF (3.5±0.5) than the control (3.1±0.3; P=0.006), with no difference between interventions. Radiographically, the control group exhibited bone loss across all dimensions. Both CGF and A-PRF preserved alveolar bone width comparably (A-PRF: +0.38 ± 0.92 mm; CGF: +0.18 ± 0.79 mm; both vs. control: P ≤ 0.014). For buccal wall height, A-PRF demonstrated a significant mean gain (+1.32 ± 0.72 mm) over both the control (−0.07 ± 1.12 mm; P < 0.001) and CGF (+0.01 ± 1.6 mm; P = 0.012). For lingual wall height, A-PRF (+0.57 ± 0.86 mm) was significantly superior to the control (−0.06 ± 0.69 mm; P = 0.001), whereas CGF (+0.24 ± 0.98 mm) showed only a non-significant improvement. Both CGF and A-PRF significantly reduced pain and swelling and improved soft-tissue healing versus controls. Radiographically, both interventions preserved alveolar bone width. However, A-PRF preserved buccal wall height significantly better than CGF and control groups. This trial was retrospectively registered under the TCTR identification number TCTR20251028003 on 28 October 2025.