Title Platelet Rich Fibrin (PRF) Improves Clinical Outcomes of Class II Furcation Defects When Used as an Adjunct to Open Flap Debridement (OFD) Procedures Compared to OFD Alone
Clinical Question Does the application of PRF during open flap debridement improve clinical outcomes for periodontal pocket depth, clinical attachment level, and bone fill for patients with grade II furcation defects compared to open flap debridement alone?
Clinical Bottom Line For the treatment of patients with grade II furcation defects, the addition of PRF to the open flap debridement procedure compared to open flap debridement alone has been shown to lead to better clinical outcomes in several RCTs. OFD with adjunctive PRF improves pocket depth reduction, vertical attachment gain, and furcal defect depth reduction compared to OFD alone.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
35329540Pepelassi/202219 RCTsMeta-Analysis
Key resultsKey Results: L-PRF used in OFD procedures for furcation defects appear to have statistically significant beneficial impacts on PPD reduction, horizontal and vertical CAL gain and defect depth (DD) reduction compared with OFD alone. “Regarding PD reduction and CAL gain, statistically significant difference was found favoring the L-PRF group (mean difference: 1.20, 95% CI: 0.97, 1.42) and (mean difference: 1.06, 95% CI: 0.88, 1.23). In terms of DD reduction, the use of L-PRF led to a statistically significant improvement with mean difference of 1.56 mm and 95% CI: 1.48, 1.63.“
32635413Tarallo/20208 RCTsMeta-Analysis
Key resultsKey Results: PRF+OFD compared to OFD alone showed a mean of 1.73 mm greater pocket depth reduction, a mean of 1.42 mm greater vertical clinical attachment gain, and a mean of 1.54 mm of reduction in vertical furcation depth when used to treat Class II furcation defects. There was no statistically significant difference for recession.
Evidence Search (PRF) AND (Furcation)) AND (Periodontal defect)) OR (L-PRF)) OR (platelet rich fibrin)) AND (furcation defect)
Comments on
The Evidence
For Pepelassi’s review, there was a limited number of randomized controlled trials (RCT) available that studied furcation defects. All included studies were randomized controlled trials. There were four different PRF preparation protocols between the 19 included studies, but all studies used specifically L-PRF. This reduces some but not all the questions regarding which if any PRF is superior to others. Of the 19 studies included in the review, only 4 had evidence on furcation defects. Of these 4, only 2 RCTs compared OFD +L-PRF vs. OFD alone. Follow-up periods were at least 6 months, but long-term follow-up is missing. Overall risk of bias was calculated to be unclear risk to low risk of bias. Tarallo included several preparation protocols for PRF, but did exclude PRP and other preparations that are not considered a type of PRF. This makes it difficult to determine superiority between the different preparations of PRF and if certain ones were more beneficial than others in clinical outcomes. There was a large age range of subjects. Only mandibular molars were included in this review. Follow-up period was only 6-9 months. Of the 8 RCTs included in the review, only 5 were relevant to this clinical question. Three of these were determined to have a low risk of bias, one had a moderate risk of bias, and the last was high risk for bias. Both reviews followed “Cochrane’s Handbook for Systematic Reviews of Interventions” and reported their findings using the PRISMA guidelines.
Applicability The amount of research supporting the use of PRF in furcation defects is limited, but promising. The type of PRF and protocols used for preparation of the material varies widely and should be considered carefully when using PRF. There is more evidence treating furcation defects with other materials and methods at this point with similar results that have been shown with PRF. Clinicians should consider the limited evidence when making treatment decisions for their patients. In clinical situations that are limited to OFD alone vs OFD+PRF, the implement of the PRF can be encouraged due to current evidence of positive outcomes, and the low risk for adverse outcomes or complications.
Specialty (Periodontics)
Keywords OFD, Open Flap Debridement, L-PRF, Furcation Defect, Periodontal Defect, Periodontal Pocket, PRF
ID# 3533
Date of submission 10/16/2023
E-mail sides@uthscsa.edu
Author Jackson Sides
Co-author(s) Kylie Yineman
Co-author(s) e-mail yineman@uthscsa.edu
Faculty mentor Charles Powell
Faculty mentor e-mail powellc2@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
None available
Comments and Evidence-Based Updates on the CAT
None available