OpenLB
Open Library of Bioscience
Advanced Search
Periodontology 2000
Mar 24, 2025;

Platelet-rich plasma (PRP) versus injectable platelet-rich fibrin (i-PRF): A systematic review across all fields of medicine.

Nima Farshidfar, Mohammad Amin Amiri, Nathan E Estrin, Paras Ahmad, Anton Sculean, Yufeng Zhang, Richard J Miron
Author Information
  1. Nima Farshidfar: Department of Periodontology, University of Bern, Bern, Switzerland. ORCID
  2. Mohammad Amin Amiri: Oral and Dental Disease Research Center, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran.
  3. Nathan E Estrin: Lake Erie College of Osteopathic Medicine School of Dental Medicine, Bradenton, Florida, USA.
  4. Paras Ahmad: Department of Research, Advanced PRF Education, Jupiter, Florida, USA.
  5. Anton Sculean: Department of Periodontology, University of Bern, Bern, Switzerland.
  6. Yufeng Zhang: Department of Oral Implantology, University of Wuhan, Wuhan, China. ORCID
  7. Richard J Miron: Department of Periodontology, University of Bern, Bern, Switzerland.
PMID: 40125556 DOI: 10.1111/prd.12626

Abstract

This systematic review aimed to evaluate all available evidence across all fields of medicine regarding the comparative effectiveness of platelet-rich plasma (PRP) versus injectable platelet-rich fibrin (i-PRF). A comprehensive search was conducted in PubMed, Scopus, and Web of Science up to September 30, 2024. Following a thorough screening process, studies were divided into in vitro, in vivo, and clinical studies based on their tissue/clinical indications. The initial search generated 2192 articles, of which 23 met the inclusion criteria. The findings demonstrated that i-PRF yielded higher platelet concentrations and offered a more sustained, long-term release of growth factors over time when compared to PRP. Overall, it was determined from in vitro studies that i-PRF significantly improved the activity of many cell types, including for skin, cartilage, periodontal, bone, soft tissue around dental implants, and pulp cells. In vivo outcomes also generally indicated that i-PRF outperformed PRP in cartilage and testicular regeneration. However, in orthodontic tooth movement, PRP was found to lead to superior short-term effects, while i-PRF showed more beneficial long-term effects. Clinical studies also found superior outcomes of i-PRF in skin regeneration, cartilage, and pulp regeneration. Outcomes regarding orthodontic tooth movement utilizing i-PRF or PRP remain controversial. In 72% of studies, i-PRF was found to lead to better outcomes across the various fields of medicine when compared to PRP, whereas 24% found no differences between the groups. Reasons and inconsistencies across the studies may be attributed to protocol differences and tissue types. Overall, additional clinical studies are needed with well-designed research and centrifugation protocols to better understand the regenerative potential of platelet concentrates in medicine. i-PRF offers a more sustained and prolonged release of growth factors and was favored in the majority of studies over PRP and should, therefore, be favored for the majority of medical and dental applications.

Keywords

I���PRF L���PRF bio���PRF platelet���rich fibrin platelet���rich plasma

References

  1. Barootchi S, Tavelli L, Vinueza MEG, et al. Autologous platelet concentrates in root coverage procedures. Periodontol 2000. 2025;97:215���235.
  2. Ivanovski S, Lee RS, Fernandez���Medina T, Pinto N, Andrade C, Quirynen M. Impact of autologous platelet concentrates on the osseointegration of dental implants. Periodontol 2000. 2025;97:271���286.
  3. Miron RJ, Moraschini V, Estrin N, et al. Autogenous platelet concentrates for treatment of intrabony defects���A systematic review with meta���analysis. Periodontol 2000. 2025;97:153���190.
  4. Moraschini V, Miron RJ, Mourao CFAB, et al. Antimicrobial effect of platelet���rich fibrin: a systematic review of in vitro evidence���based studies. Periodontol 2000. 2025;94:131���142.
  5. Siawasch S, Yu J, Castro A, Temmerman A, Teughels W, Quirynen M. Autologous platelet concentrates after third molar extraction: A systematic review. Periodontol 2000. 2025;97:131���152.
  6. Siawasch SAM, Yu J, Castro AB, et al. Autologous platelet concentrates in alveolar ridge preservation: A systematic review with meta���analyses. Periodontol 2000. 2025;97:104���130.
  7. Davies C, Miron RJ. Autolougous platelet concentrates in esthetic medicine. Periodontol 2000. 2025;97:363���419.
  8. Marx RE, Carlson ER, Eichstaedt RM, Schimmele SR, Strauss JE, Georgeff KR. Platelet���rich plasma: Growth factor enhancement for bone grafts. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998;85:638���646.
  9. Marx RE. Platelet���rich plasma (PRP): what is PRP and what is not PRP? Implant Dent. 2001;10:225���228.
  10. Lubkowska A, Dolegowska B, Banfi G. Growth factor content in PRP and their applicability in medicine. J Biol Regul Homeost Agents. 2012;26:3S���22S.
  11. Ehrenfest DMD, Andia I, Zumstein MA, Zhang C���Q, Pinto NR, Bielecki T. Classification of platelet concentrates (Platelet���Rich Plasma���PRP, Platelet���Rich Fibrin���PRF) for topical and infiltrative use in orthopedic and sports medicine: current consensus, clinical implications and perspectives. Muscles Ligaments Tendons J. 2014;4:3���9.
  12. Marx RE. Platelet���rich plasma: evidence to support its use. J Oral Maxillofac Surg. 2004;62:489���496.
  13. Miron RJ, Fujioka���Kobayashi M, Sculean A, Zhang Y. Optimization of platelet���rich fibrin. Periodontol 2000. 2025;94:79���91.
  14. Calciolari E, Dourou M, Akcali A, Donos N. Differences between first���and second���generation autologous platelet concentrates. Periodontol 2000. 2025;97:52���73.
  15. Kobayashi E, Fl��ckiger L, Fujioka���Kobayashi M, et al. Comparative release of growth factors from PRP, PRF, and advanced���PRF. Clin Oral Investig. 2016;20:2353���2360.
  16. Quirynen M, Siawasch S, Temmerman A, et al. Do autologous platelet concentrates (APCs) have a role in intra���oral bone regeneration? A critical review of clinical guidelines on decision���making process. Periodontol 2000. 2023;93:254���269.
  17. Dohan DM, Choukroun J, Diss A, et al. Platelet���rich fibrin (PRF): a second���generation platelet concentrate. Part I: technological concepts and evolution. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;101:e37���e44.
  18. Amiri MA, Farshidfar N, Hamedani S. The potential application of platelet���rich fibrin (PRF) in vestibuloplasty. Maxillofac Plast Reconstruct Surg. 2021;43:20.
  19. Miron RJ, Moraschini V, Estrin NE, et al. Periodontal regeneration using platelet���rich fibrin. Furcation defects: a systematic review with meta���analysis. Periodontol 2000. 2025;97(1):191���214.
  20. Amiri MA, Farshidfar N, Miron RJ, et al. The potential therapeutic effects of platelet���derived biomaterials on osteoporosis: A comprehensive review of current evidence. Int J Biomater. 2023;2023:9980349.
  21. Pinto N, Yu J, Koirala S, et al. L���PRF in extra���oral wound care. Periodontol 2000. 2025;97:342���362.
  22. Wei Y, Cheng Y, Wei H, et al. Development of a super���hydrophilic anaerobic tube for the optimization of platelet���rich fibrin. Platelets. 2024;35:2316745.
  23. Dohan DM, Choukroun J, Diss A, et al. Platelet���rich fibrin (PRF): a second���generation platelet concentrate. Part II: platelet���related biologic features. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;101:e45���e50.
  24. Miron RJ, Pikos MA, Estrin NE, et al. Extended platelet���rich fibrin. Periodontol 2000. 2024;94:114���130.
  25. Choukroun J, Ghanaati S. Introducing the low���speed centrifugation concept. Platelet rich fibrin in regenerative dentistry: Biological background and clinical indications. John Wiley & Sons, Ltd; 2017:33���46.
  26. Choukroun J, Ghanaati S. Reduction of relative centrifugation force within injectable platelet���rich���fibrin (PRF) concentrates advances patients��� own inflammatory cells, platelets and growth factors: the first introduction to the low speed centrifugation concept. Eur J Trauma Emerg Surg. 2018;44:87���95.
  27. Miron RJ, Fujioka���Kobayashi M, Bishara M, Zhang Y, Hernandez M, Choukroun J. Platelet���rich fibrin and soft tissue wound healing: a systematic review. Tissue Eng Part B Rev. 2017;23:83���99.
  28. Miron RJ, Gruber R, Farshidfar N, Sculean A, Zhang Y. Ten years of injectable platelet���rich fibrin. Periodontol 2000. 2024;94:92���113.
  29. Farshidfar N, Jafarpour D, Firoozi P, et al. The application of injectable platelet���rich fibrin in regenerative dentistry: A systematic scoping review of In vitro and In vivo studies. Jpn Dent Sci Rev. 2022;58:89���123.
  30. Farshidfar N, Amiri MA, Jafarpour D, Hamedani S, Niknezhad SV, Tayebi L. The feasibility of injectable PRF (I���PRF) for bone tissue engineering and its application in oral and maxillofacial reconstruction: from bench to chairside. Biomater Adv. 2022;134:112557.
  31. Miron RJ, Fujioka���Kobayashi M, Hernandez M, et al. Injectable platelet rich fibrin (i���PRF): opportunities in regenerative dentistry? Clin Oral Investig. 2017;21:2619���2627.
  32. Miron RJ, Zhang Y. Autologous liquid platelet rich fibrin: A novel drug delivery system. Acta Biomater. 2018;75:35���51.
  33. Pocaterra A, Caruso S, Bernardi S, Scagnoli L, Continenza M, Gatto R. Effectiveness of platelet���rich plasma as an adjunctive material to bone graft: a systematic review and meta���analysis of randomized controlled clinical trials. Int J Oral Maxillofac Surg. 2016;45:1027���1034.
  34. Blanco J, Caram��s J, Quirynen M. A narrative review on the use of autologous platelet concentrates during alveolar bone augmentation: Horizontal (simultaneous/staged) and vertical (simultaneous/staged). Periodontol 2000. 2025;97:236���253.
  35. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.
  36. Chai J, Jin R, Yuan G, Kanter V, Miron RJ, Zhang Y. Effect of liquid platelet���rich fibrin and platelet���rich plasma on the regenerative potential of dental pulp cells cultured under inflammatory conditions: a comparative analysis. J Endod. 2019;45:1000���1008.
  37. Fern��ndez���Medina T, Vaquette C, Ivanovski S. Systematic comparison of the effect of four clinical���grade platelet rich hemoderivatives on osteoblast behaviour. Int J Mol Sci. 2019;20:6243.
  38. Karde PA, Sethi KS, Mahale SA, Khedkar SU, Patil AG, Joshi CP. Comparative evaluation of platelet count and antimicrobial efficacy of injectable platelet���rich fibrin with other platelet concentrates: An in vitro study. J Indian Soc Periodontol. 2017;21:97���101.
  39. Kour P, Pudakalkatti PS, Vas AM, Das S, Padmanabhan S. Comparative evaluation of antimicrobial efficacy of platelet���rich plasma, platelet���rich fibrin, and injectable platelet���rich fibrin on the standard strains of Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans. Contemp Clin Dent. 2018;9:S325���s330.
  40. Li Y, Song P, He J, et al. Comparison Between Injectable Platelet���rich Fibrin and Platelet���rich Plasma in Ameliorating UVA���induced Photoaging in Human Dermal Fibroblasts via the Activation of TGF�����/Smad Signaling Pathway. Photochem Photobiol. 2022;98:1395���1401.
  41. Wang X, Yang Y, Zhang Y, Miron RJ. Fluid platelet���rich fibrin stimulates greater dermal skin fibroblast cell migration, proliferation, and collagen synthesis when compared to platelet���rich plasma. J Cosmet Dermatol. 2019;18:2004���2010.
  42. Wang X, Zhang Y, Choukroun J, Ghanaati S, Miron RJ. Behavior of gingival fibroblasts on titanium implant surfaces in combination with either Injectable���PRF or PRP. Int J Mol Sci. 2017;18:331.
  43. Wang X, Zhang Y, Choukroun J, Ghanaati S, Miron RJ. Effects of an injectable platelet���rich fibrin on osteoblast behavior and bone tissue formation in comparison to platelet���rich plasma. Platelets. 2018;29:48���55.
  44. Xu K, Deng X, Ye M, et al. Injectable platelet���rich fibrin promotes proliferation and trichogenic inductivity of dermal papilla cells through activating TGF�����/Smad signaling pathway. Cell Mol Biol. 2024;70:158���163.
  45. Zheng S, Zhang X, Zhao Q, Chai J, Zhang Y. Liquid platelet���rich fibrin promotes the regenerative potential of human periodontal ligament cells. Oral Dis. 2020;26:1755���1763.
  46. Alaa S, Fouda AM, Grawish ME, Abdelnaby YL. The effect of submucosal injection of platelet���rich fibrin vs. platelet���rich plasma on orthodontic tooth movement in rabbits; 28���days follow���up. Int Orthod. 2023;21:100715.
  47. Eisa EFM, Ezzeldein SAM, Mohammed HA, Abdallah AA, Ghonimi WAM, Abd El Raouf M. Comparison of the therapeutic effect of platelet���rich plasma and injectable platelet���rich fibrin on testicular torsion/detorsion injury in rats. Sci Rep. 2024;14:18045.
  48. Abo���Heikal MM, El���Shafei JM, Shouman SA, Roshdy NN. Evaluation of the efficacy of injectable platelet���rich fibrin versus platelet���rich plasma in the regeneration of traumatized necrotic immature maxillary anterior teeth: A randomized clinical trial. Dent Traumatol. 2024;40:61���75.
  49. Akka�� E, Esen A. Which of the autologous blood products administered simultaneously with arthrocentesis is more effective in terms of clinical outcomes? J Stomatol Oral Maxillofac Surg. 2024;125:101998.
  50. Ammar AM, Al���Sabbagh R, Hajeer MY. Evaluation of the effectiveness of the platelet���rich plasma compared to the injectable platelet���rich fibrin on the rate of maxillary canine retraction: a three���arm randomized controlled trial. Eur J Orthod. 2024;46:cjad056.
  51. Atsu N, Ekinci���Aslanoglu C, Kantarci���Demirkiran B, Caf N, Nuhoglu F. The comparison of platelet���rich plasma versus injectable platelet rich fibrin in facial skin rejuvenation. Dermatol Ther. 2023;2023:1���6.
  52. Diab NAF, Ibrahim ASM, Abdallah AM. Fluid platelet���rich fibrin (PRF) versus platelet���rich plasma (PRP) in the treatment of atrophic acne scars: A comparative study. Arch Dermatol Res. 2023;315:1249���1255.
  53. Naji RE, Zeitounlouian TS, Alomari E, Youssef M. Evaluation of the efficacy of platelet���rich plasma (PRP) and injectable platelet���rich fibrin (i���PRF) in the acceleration of canine retraction: A randomized controlled trial. J Int Oral Health. 2022;14:243���253.
  54. Sharma P, Aurora JK, Dubey KN, Tandon P, Tiwari S. A comparative analysis between intra articular injections of injectable platelet rich fibrin versus platelet rich plasma in the management of temporomandibular disorders: A randomized control trial. Natl J Maxillofac Surg. 2023;14:249���255.
  55. Vingender S, D��ri F, Schmidt P, Hermann P, Vaszilk�� MT. Evaluation of the efficiency of hyaluronic acid, PRP and I���PRF intra���articular injections in the treatment of internal derangement of the temporomandibular joint: A prospective study. J Craniomaxillofac Surg. 2023;51:1���6.
  56. Abd El Raouf M, Wang X, Miusi S, et al. Injectable���platelet rich fibrin using the low speed centrifugation concept improves cartilage regeneration when compared to platelet���rich plasma. Platelets. 2019;30:213���221.
  57. Tian K, Ye J, Zhong Y, et al. Autologous i���PRF promotes healing of radiation���induced skin injury. Wound Repair Regen. 2023;31:454���463.
  58. Gruber R. How to explain the beneficial effects of platelet���rich plasma. Periodontol 2000. 2025;97:95���103.
  59. Miron RJ. Understanding Platelet Rich Fibrin. Quintessence; 2021.
  60. Wend S, Kubesch A, Orlowska A, et al. Reduction of the relative centrifugal force influences cell number and growth factor release within injectable PRF���based matrices. J Mater Sci Mater Med. 2017;28:188.
  61. Nagaoka S, Murata S, Kimura K, Mori T, Hojo K. Antimicrobial activity of sodium citrate against Streptococcus pneumoniae and several oral bacteria. Lett Appl Microbiol. 2010;51:546���551.
  62. Rahul M, Lokade A, Tewari N, et al. Effect of intracanal scaffolds on the success outcomes of regenerative endodontic therapy���a systematic review and network meta���analysis. J Endod. 2023;49:110���128.
  63. Kyyak S, Blatt S, Pabst A, Thiem D, Al���Nawas B, K��mmerer PW. Combination of an allogenic and a xenogenic bone substitute material with injectable platelet���rich fibrin���A comparative in vitro study. J Biomater Appl. 2020;35:83���96.
  64. Farshidfar N, Amiri MA, Firoozi P, Hamedani S, Ajami S, Tayebi L. The adjunctive effect of autologous platelet concentrates on orthodontic tooth movement: a systematic review and meta���analysis of current randomized controlled trials. Int Orthod. 2022;20:100596.
  65. G��le�� A, Bakkalba���� B, Cumbul A, Uslu ��, Alev B, Yarat A. Effects of local platelet���rich plasma injection on the rate of orthodontic tooth movement in a rat model: A histomorphometric study. Am J Orthod Dentofacial Orthop. 2017;151:92���104.
  66. Zapata���Sifuentes M, Quispe���Salcedo A, Watanabe T, Kawase T, Ohshima H. Effect of leukocyte and platelet���rich plasma on osseointegration after implant placement in mouse maxilla. Regen Ther. 2024;26:741���748.
  67. Fujioka���Kobayashi M, Miron RJ, Moraschini V, Zhang Y, Gruber R, Wang HL. Efficacy of platelet���rich fibrin on bone formation, part 2: Guided bone regeneration, sinus elevation and implant therapy. Int J Oral Implantol. 2021;14:285���302.
  68. Miron RJ, Fujioka���Kobayashi M, Moraschini V, Zhang Y, Gruber R, Wang HL. Efficacy of platelet���rich fibrin on bone formation, part 1: Alveolar ridge preservation. Int J Oral Implantol. 2021;14:181���194.
  69. Miron RJ, Moraschini V, Del Fabbro M, et al. Use of platelet���rich fibrin for the treatment of gingival recessions: a systematic review and meta���analysis. Clin Oral Investig. 2020;24:2543���2557.
  70. Miron RJ, Zucchelli G, Pikos MA, et al. Use of platelet���rich fibrin in regenerative dentistry: a systematic review. Clin Oral Investig. 2017;21:1913���1927.
  71. Miron RJ, Chai J, Fujioka���Kobayashi M, Sculean A, Zhang Y. Evaluation of 24 protocols for the production of platelet���rich fibrin. BMC Oral Health. 2020;20:310.
  72. Fujioka���Kobayashi M, Kono M, Katagiri H, et al. Histological comparison of Platelet rich fibrin clots prepared by fixed���angle versus horizontal centrifugation. Platelets. 2021;32:413���419.
  73. Miron RJ, Chai J, Zheng S, Feng M, Sculean A, Zhang Y. A novel method for evaluating and quantifying cell types in platelet rich fibrin and an introduction to horizontal centrifugation. J Biomed Mater Res A. 2019;107:2257���2271.
  74. Qiu Y, Bao S, Wei H, et al. Bacterial exclusion and wound healing potential of horizontal platelet���rich fibrin (H���PRF) membranes when compared to 2 commercially available collagen membranes. Clin Oral Investig. 2023;27:4795���4802.
  75. Shirakata Y, Sena K, Nakamura T, et al. Histological evaluation of gingival and intrabony periodontal defects treated with platelet���rich fibrin using different protocols: A canine study. Oral Health Prev Dent. 2021;19:537���546.
  76. Fujioka���Kobayashi M, Katagiri H, Kono M, et al. Improved growth factor delivery and cellular activity using concentrated platelet���rich fibrin (C���PRF) when compared with traditional injectable (i���PRF) protocols. Clin Oral Investig. 2020;24:4373���4383.
  77. Miron RJ, Chai J, Zhang P, et al. A novel method for harvesting concentrated platelet���rich fibrin (C���PRF) with a 10���fold increase in platelet and leukocyte yields. Clin Oral Investig. 2020;24:2819���2828.
  78. Miron RJ, Horrocks NA, Zhang Y, Horrocks G, Pikos MA, Sculean A. Extending the working properties of liquid platelet���rich fibrin using chemically modified PET tubes and the Bio���Cool device. Clin Oral Investig. 2022;26:2873���2878.
  79. Miron RJ, Kawase T, Dham A, Zhang Y, Fujioka���Kobayashi M, Sculean A. A technical note on contamination from PRF tubes containing silica and silicone. BMC Oral Health. 2021;21:135.
Journal Article Review

Word Cloud

Created with Highcharts 10.0.0i-PRFPRPstudiesacrossmedicinefoundfieldsplatelet-richplasmafibrincartilageoutcomesregenerationsystematicreviewregardingversusinjectablesearchin vitroclinicalplateletsustainedlong-termreleasegrowthfactorscomparedOveralltypesskintissuedentalpulpalsoorthodontictoothmovementleadsuperioreffectsbetterdifferencesfavoredmajorityplatelet���richaimedevaluateavailableevidencecomparativeeffectivenesscomprehensiveconductedPubMedScopusWebScienceSeptember302024Followingthoroughscreeningprocessdividedin vivobasedtissue/clinicalindicationsinitialgenerated2192articles23metinclusioncriteriafindingsdemonstratedyieldedhigherconcentrationsofferedtimedeterminedsignificantlyimprovedactivitymanycellincludingperiodontalbonesoftaroundimplantscellsIn vivogenerallyindicatedoutperformedtesticularHowevershort-termshowedbeneficialClinicalOutcomesutilizingremaincontroversial72%variouswhereas24%groupsReasonsinconsistenciesmayattributedprotocoladditionalneededwell-designedresearchcentrifugationprotocolsunderstandregenerativepotentialconcentratesoffersprolongedthereforemedicalapplicationsPlatelet-rich:I���PRFL���PRFbio���PRF

Similar Articles

Cited By