PRF and growth factors Periodontal treatment

What is PRF in dental surgery?

PRF (platelet-rich fibrin) is a fibrin clot rich in platelets and white blood cells, made by spinning a sample of the patient's own blood in a centrifuge with no additives. Blood is drawn at the visit, and the tubes go into the centrifuge within 60 seconds. A 12-minute spin separates the blood into layers, and the PRF clot forms in the middle of the tube. PRF is used as a liquid, a clot or a pressed membrane, or mixed with graft particles.

PRF arrived in 2001 as a second-generation platelet concentrate. Products prepared from the patient's own blood usually need no formal regulatory approval. The number of clots, the amount of blood drawn and the centrifuge settings vary between studies, so results are hard to compare. Socket preservation is among its uses.

Does PRF help bone grafts heal?

PRF helps gum and soft tissue healing, and its role in forming new bone in grafts is not yet shown convincingly.

• Intrabony defects next to teeth: PRF added 1.7 mm of bone fill over flap surgery alone.
• Furcation defects: PRF added 1.3 mm of attachment gain over flap surgery alone.
• Socket preservation: PRF alone reduced cheek-side bone loss compared with natural healing.
• Sinus lifts: PRF with bovine mineral sped bone healing on biopsy, and the clinical evidence does not support routine use.
• Ridge augmentation: biologics gave no added clinical gain, and blood-derived products reduced early wound opening.
• Wisdom tooth sockets: PRF cut dry sockets tenfold.

A review of implant therapy found moderate evidence that PRF helps preserve the ridge after extraction and supports the early phase of implant healing. Sinus lift types and ridge augmentation describe those procedures.

What is Emdogain used for?

Emdogain is enamel matrix derivative, a gel of enamel proteins from developing pig teeth, applied to a cleaned root during gum surgery to regrow the tooth's attachment. Its proteins are mainly amelogenins, which take part in forming the root attachment during tooth development. The FDA approved Emdogain in 1996.

• The Cochrane review found 1.1 mm of added attachment gain over control treatment.
• Trials at low risk of bias showed a smaller effect of 0.62 mm.
• A newer meta-analysis found 1.14 mm of added attachment gain over flap surgery alone.
• Emdogain caused less swelling and pain after surgery than non-resorbable membranes.

Human biopsies show new cementum, ligament and bone after enamel matrix derivative, and it is applied to a dry, conditioned root with little or no blood contamination. Periodontal regeneration compares it with membranes and grafts.

What is GEM 21S (rhPDGF-BB)?

GEM 21S is recombinant human platelet-derived growth factor (rhPDGF-BB) mixed with a synthetic beta-tricalcium phosphate graft, approved by the FDA in 2005 for periodontal defects. The approval covers intrabony defects, furcation defects and gum recession associated with periodontal defects.

At 6 months, pivotal trial	rhPDGF-BB with beta-TCP	Beta-TCP alone
Linear bone gain	2.6 mm	0.9 mm
Defect fill	57%	18%

The pivotal trial treated intrabony defects of 4 mm or deeper. Attachment gain was faster in the first 3 months. By 6 months, the difference in attachment was no longer statistically significant. No serious adverse events were attributed to the treatment. The AAP Regeneration Workshop judged rhPDGF-BB with beta-TCP comparable to donor bone grafts and membranes for intrabony defects. Bone graft materials covers beta-TCP.

What is INFUSE bone graft (rhBMP-2)?

INFUSE is recombinant human bone morphogenetic protein-2 (rhBMP-2) on an absorbable collagen sponge, approved by the FDA in 2007 as an alternative to the patient's own bone for sinus augmentation and for ridge augmentation of defects associated with extraction sockets.

• Socket study: 85% of INFUSE patients grew enough bone for implants without more grafting.
• Sinus study: success with the patient's own bone was 11.8 percentage points higher.
• Sinus phase II trial: ridge height gains were similar for rhBMP-2 and bone graft at 4 months.

A meta-analysis found that rhBMP-2 increased bone height in ridge augmentation and did not perform as well as autograft or allograft in sinus grafting. In extraction sockets, rhBMP-2 maintained ridge height and increased width. INFUSE is contraindicated in pregnancy, near a tumor, at an infected site, and in people allergic to rhBMP-2 or bovine collagen. Sinus lift types covers the sinus procedure.

Sources

1. Castro AB et al. Regenerative potential of leucocyte- and platelet-rich fibrin, part A: intra-bony defects, furcation defects and periodontal plastic surgery. J Clin Periodontol 2017
2. Castro AB et al. Regenerative potential of leucocyte- and platelet-rich fibrin, part B: sinus floor elevation, alveolar ridge preservation and implant therapy. J Clin Periodontol 2017
3. Strauss FJ et al. The use of platelet-rich fibrin to enhance the outcomes of implant therapy: a systematic review. Clin Oral Implants Res 2018
4. Miron RJ et al. Use of platelet-rich fibrin in regenerative dentistry: a systematic review. Clin Oral Investig 2017
5. Suárez-López del Amo F, Monje A. Efficacy of biologics for alveolar ridge preservation, reconstruction and implant site development: an AAP best evidence systematic review. J Periodontol 2022
6. Pocaterra A et al. Effectiveness of platelet-rich plasma as an adjunctive material to bone graft: a systematic review and meta-analysis. Int J Oral Maxillofac Surg 2016
7. Del Fabbro M et al. Is platelet concentrate advantageous for the surgical treatment of periodontal diseases? A systematic review and meta-analysis. J Periodontol 2011
8. Esposito M et al. Enamel matrix derivative (Emdogain) for periodontal tissue regeneration in intrabony defects. Cochrane Database Syst Rev 2009
9. Rathva VJ. Enamel matrix protein derivatives: role in periodontal regeneration. Clin Cosmet Investig Dent 2011
10. Miron RJ et al. 30 years of enamel matrix derivative: mimicking tooth development as a clinical concept. Periodontol 2000 2025
11. Miron RJ et al. 30 years of enamel matrix derivative (EMD): systematic review with meta-analyses across multiple clinical indications. J Periodontal Res 2026
12. Sanz M et al. Treatment of stage I-III periodontitis: the EFP S3 level clinical practice guideline. J Clin Periodontol 2020
13. FDA PMA P930021, Emdogain enamel matrix derivative, approved 1996-09-30
14. FDA PMA P040013, GEM 21S growth-factor enhanced matrix, approved 2005-11-18
15. Nevins M et al. Platelet-derived growth factor stimulates bone fill and rate of attachment level gain: a multicenter randomized controlled trial. J Periodontol 2005
16. Kao RT et al. Periodontal regeneration, intrabony defects: a systematic review from the AAP Regeneration Workshop. J Periodontol 2015
17. FDA PMA P050053, INFUSE Bone Graft (Medtronic), approved 2007-03-09
18. FDA. Summary of Safety and Effectiveness Data, PMA P050053, INFUSE Bone Graft. 2007
19. Kelly MP et al. Systematic review and meta-analysis of rhBMP-2 in localized alveolar ridge and maxillary sinus augmentation. J Oral Maxillofac Surg 2016
20. Freitas RM et al. Alveolar ridge and maxillary sinus augmentation using rhBMP-2: a systematic review. Clin Implant Dent Relat Res 2015
21. Boyne PJ et al. De novo bone induction by rhBMP-2 in maxillary sinus floor augmentation. J Oral Maxillofac Surg 2005

Reviewed by Steve Schadt, Director of IT and Medical Compliance: 25 years in dentistry, medicine and HIPAA compliance. Updated 2026-10-02. Checked against the sources listed. General information, not medical advice.