The Effect of Platelet-Rich Fibrin in Preventing Alveolar Osteitis Following Mandibular Third Molar Surgery: A Systematic Review and Meta-Analysis

Alveolar osteitis (AO) is a common and painful complication following mandibular third molar extraction, often resulting in delayed healing and increased postoperative morbidity. Platelet-rich fibrin (PRF) has been proposed as a biologically active adjunct that can enhance socket healing and stabilize postextraction blood clots. This systematic review and meta-analysis aimed to evaluate the effectiveness of PRF in preventing AO after mandibular third molar extraction. A comprehensive literature search was conducted in PubMed/MEDLINE, Scopus, Cochrane Central Register of Controlled Trials, and Google Scholar from database inception to the most recent update. Randomized controlled trials comparing PRF application with no PRF or conventional extraction care and reporting AO incidence were included. Data extraction and risk-of-bias assessment were performed independently using the Cochrane Risk-of-Bias 2 tool. A meta-analysis was conducted using a random-effects model, and effect estimates were expressed as risk ratios (RRs) with 95% confidence intervals (CIs). Sensitivity analysis for unmeasured confounding was performed using the E-value approach. Seven randomized controlled trials involving 776 extraction sites (388 PRF and 388 control) were included. The meta-analysis demonstrated a significant reduction in AO incidence with PRF application (RR = 0.33; 95% CI = 0.20-0.55; p < 0.05), corresponding to an approximately 67% reduction in relative risk. Heterogeneity among studies was negligible, and funnel plot inspection, along with Egger's test, suggested a low likelihood of publication bias. The certainty of evidence for the primary outcome was rated as moderate. Sensitivity analysis yielded an E-value of 5.51, indicating the robustness of the observed effect to potential unmeasured confounding. Within the limitations of the available evidence, PRF appears to be a safe and effective adjunct for reducing the incidence of AO following mandibular third molar extraction. Further standardized, high-quality trials are warranted to optimize the clinical protocols and confirm the long-term benefits.