Comparative efficacy of platelet-rich fibrin protocols for alveolar ridge preservation: a systematic review and network meta-analysis

Abstract Objectives This systematic review and network meta-analysis (NMA) aimed to evaluate the effects of platelet-rich fibrin (PRF) in alveolar ridge preservation (ARP), as well as to compare and rank different PRF protocols according to their relative effectiveness. Methods Electronic searches were conducted in five databases for studies published up to April 13, 2026. The protocol was registered in PROSPERO (CRD420251168408). Eligible studies were randomized clinical trials with at least one group treated with PRF alone and a control group without PRF treatment, reporting imaging assessments of bone formation at the extraction site. The systematic review evaluated alveolar ridge dimensional preservation as the primary outcome, and soft tissue healing and pain as secondary outcomes. The NMA evaluated cone-beam computed tomography-based dimensional changes of the alveolar ridge from baseline to 3- or 4-months follow-up using a Bayesian random-effects model. Treatment effects were expressed as mean differences with their corresponding confidence and credibility intervals, and treatment ranking was performed using the surface under the cumulative ranking curve (SUCRA). The quality of the included studies and certainty of evidence were assessed using the RoB 2 and CINeMA approaches. Results Forty-two trials were included in the systematic review, and six were included in the NMA. PRF showed more consistent benefits in terms of alveolar ridge dimensional preservation, soft tissue healing, and reduced postoperative morbidity compared with spontaneous healing (SH). The stick bone also showed favorable results compared with grafting materials alone. In the NMA, no significant differences were observed among interventions at 3 months; however, leukocyte-platelet-rich fibrin (L-PRF) demonstrated the highest probability of efficacy for buccal (SUCRA = 80%), palatal (73%), and horizontal ridge preservation (79%). At 4 months, T-PRF showed significantly lower vertical dimensional reduction than SH for buccal and palatal sites, with the highest treatment ranking probabilities. Conclusions PRF protocols may be used as adjunctive approaches in ARP, particularly to improve soft tissue healing and postoperative comfort. L-PRF and T-PRF showed the highest probability of efficacy for dimensional preservation. However, due to the heterogeneity of the available studies and the low certainty of evidence, further randomized clinical trials with standardized protocols are needed.