Synergistic benefits on combining injectable platelet-rich fibrin and bone graft porous particulate materials

The main aim of this study was to perform an integrative review on the enhanced bone healing by combining a flowable (injectable) platelet-rich fibrin (PRF) and bone graft porous materials. A bibliographical search was carried out on several databases (PubMed, Embase, Cochrane, Scopus, and Web of Science) for relevant studies on the combined effect of platelet-rich fibrin and bone substitutes for bone healing. The chemical, biologic, and physical properties of flowable PRF combined with bone graft biomaterials were discussed in this review. The repair of different bone defects was reported such as alveolar cleft reconstruction, sinus floor elevation, socket preservation, jaw defects, and impacted teeth. Regarding studies evaluating alveolar cleft defects, results showed potential benefits of PRF to enhance bone formation when mixed with autogenous bone graft. Two studies on socket preservation found enhanced bone growth when combining PRF to bone substitutes, although one study found similar results with or without bone substitutes. Also, the addition of PRF to demineralized bovine bone mineral improved the bone healing in the repair of jaw defects. No synergistic effect was reported in bone formation when PRF was associated to particulate bone graft in sinus floor elevation. The combination of PRF and bone graft materials revealed significant outcomes when compared to solely use of bone graft materials in alveolar cleft and jaw defects. In socket preservation, bone healing was improved when PRF and bone graft materials were applied in comparison to the solely use of PRF. On the reconstruction of larger bone defects, PRF can be mixed with a low resorption rate graft material to maintain biological and mechanical stability into the bone defect. In fact, PRF and particulate graft materials appear to exhibit a synergistic effect during bone tissue healing.