Comparative Efficacy of Platelet-Rich Fibrin, Freeze-Dried Bone Allograft, or Spontaneous Healing for Alveolar Ridge Preservation: Systematic Review and Meta-Analysis

Abstract

Alveolar ridge preservation (ARP) is crucial for maintaining bone and soft-tissue integrity after tooth extraction, thereby facilitating future implant placement. Among various biomaterials, platelet-rich fibrin (PRF) and freeze-dried bone allograft (FDBA) are commonly used; however, their comparative effectiveness remains unclear. This systematic review and meta-analysis aimed to evaluate and compare the outcomes of PRF, FDBA, and spontaneous healing with blood clot in ARP, incorporating recent randomized controlled trials and comparative studies published up to June 2025. Electronic searches were conducted across multiple databases following the PRISMA 2020 guidelines, and the risk of bias was assessed using RoB-2 and ROBINS-I tools. Primary outcomes included changes in alveolar ridge height and width, while secondary outcomes encompassed histological, radiographic, implant-related, and patient-centered measures. Twenty studies were included for qualitative synthesis and sixteen for quantitative analysis. Meta-analyses showed no significant difference between PRF and FDBA in ridge height (SMD = −0.24; 95% CI: −0.56 to 0.08; p = 0.145) or width preservation (SMD = −0.16; 95% CI: −0.73 to 0.42; p = 0.597). PRF significantly reduced ridge height loss compared to spontaneous healing (SMD = −0.79; 95% CI: −1.33 to −0.25; p = 0.004) and enhanced histologic new bone formation (SMD = 1.43; 95% CI: 0.39 to 2.47; p = 0.007), while FDBA showed a non-significant trend toward benefit (SMD = −0.37; 95% CI: −0.86 to 0.11; p = 0.129). Moderate risk-of-bias and heterogeneity were observed among included studies. In conclusion, PRF and FDBA are both effective for alveolar ridge preservation, outperforming spontaneous healing. PRF offers biologically driven benefits in bone quality and soft-tissue healing, whereas FDBA provides greater structural stability. These findings suggest a promising clinical potential for PRF in improving bone quality at the implant site. Moreover, considering cost, preparation complexity, and site-specific needs, PRF may serve as a cost-effective, clinically favorable option for ARP. Future multi-center randomized trials with standardized PRF protocols and long-term follow-up are recommended.