Applications and considerations of FRP in endodontic surgery: a literature review
Main Article Content
Abstract
Introduction: Fibrin-rich plasma (FRP) is a biomaterial—a natural fibrous clot enriched with platelets, leukocytes, and a high concentration of endogenous growth factors. It is used in dentistry and maxillofacial surgery for bone regeneration, bone graft covering, among other applications. Objective: To characterize the efficacy and safety of FRP in endodontic surgery. Methodology: Searches were conducted on various database platforms, including Elsevier, Springer Link, and PubMed, using keywords and Boolean operators (AND and OR) to optimize results. The PRISMA 2020 model was used to screen articles based on predefined eligibility criteria. Articles were assessed for risk of bias using the ROB-2 tool for randomized trials. Results: A total of nine studies were included in this review. The total sample size was approximately 290 patients, all of whom were adults. The differences between the total sample and the control groups were negligible. Efficacy was measured using the following parameters: total hemostasis, mean pain score, changes in the root canal area, reduction in apical diameter, periradicular healing, and palatal mucosal thickness. Conclusion: Overall, the use of FRP showed superior results compared with other therapeutic methods; however, very few articles reported significant differences in the efficacy measurement parameters. Regarding adverse effects, the intervention groups experienced no complications, while complications were minimal in the control groups. General Area of Study: Odontology. Specific area of study: endodontics. Type of study: A literature review.
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Cedillo Riera, A. D., Piedra Andrade, R. B., & Rodriguez Reyes, F. G. (2026). Applications and considerations of FRP in endodontic surgery: a literature review. Anatomía Digital, 9(2), 119 - 136. https://doi.org/10.33262/anatomiadigital.v9i2.3684
Section
Articulos de revisión bibliográfica
References
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14. Ramachandran N, Singh S, Podar R, Kulkarni G, Shetty R, Chandrasekhar P. A comparison of two pulp revascularization techniques using platelet-rich plasma and whole blood clot. Journal of Conservative Dentistry: JCD [Internet]. 2020 [cited 2026 Jan 5];23(6):637-643. Available from: https://pubmed.ncbi.nlm.nih.gov/34083923/
15. Rajendra K, Vempalli S, Kadiyala M, Sharma V, Karipineni S, Gunturu S, et al. Effect of platelet-rich fibrin versus chitosan-based Axiostat hemostatic agent following dental extraction in cardiac patients on antiplatelet therapy: A comparative study. National Journal of Maxillofacial Surgery [Internet]. 2021 [cited 2026 Jan 5];12(3):361-366. Available from: https://pubmed.ncbi.nlm.nih.gov/35153432/
16. Sarkar S, Prashanth NT, Shobha ES, Rangan V, Nikhila G. Efficacy of Platelet Rich Fibrin versus chitosan as a hemostatic agent following dental extraction in patients on antiplatelet therapy. Journal of Oral Biology and Craniofacial Research [Internet]. 2019 [cited 2026 Jan 5];9(4):336-9. Available from: https://pubmed.ncbi.nlm.nih.gov/31467833/
17. Cerqueira-Neto ACCL, Prado MC, Pereira AC, Oliveira ML, Vargas-Neto J, Gomes BPFA, et al. Clinical and Radiographic Outcomes of Regenerative Endodontic Procedures in Traumatized Immature Permanent Teeth: Interappointment Dressing or Single-Visit? Journal of Endodontics [Internet]. 2021 [cited 2026 Jan 5];47(10):1598-608. Available from: https://pubmed.ncbi.nlm.nih.gov/34310980/
18. Lana JF, Purita J, Everts PA, De Mendonça Neto PAT, de Moraes Ferreira Jorge D, Mosaner T, et al. Platelet-Rich Plasma Power-Mix Gel (ppm)-an orthobiologic optimization protocol rich in growth factors and fibrin. Gels (Basel, Switzerland) [Internet]. 2023 [cited 2026 Jan 5];9(7):553. Available from: https://pubmed.ncbi.nlm.nih.gov/37504432/
19. Liu X, Huang X, Liu N, Zhu L, Zhao S, Tang S, et al. Advances in smart stimuli-responsive materials for oral wound healing. Frontiers in Chemistry [Internet]. 2025 [cited 2026 Jan 5]; 13:1725373. Available from: https://www.frontiersin.org/articles/10.3389/fchem.2025.1725373
20. Zhang T, Yuan M, Hao X, Gao H, Teng M, Hu F, et al. Innovative biomaterials in promoting intraoral wound healing: mechanisms, applications, and challenges. Materials Today Bio [Internet]. 2025 Dic [cited 2026 Jan 5]; 35:102470. Available from: https://pubmed.ncbi.nlm.nih.gov/41255422/
21. Soto Zumbana JA, Piedra Andrade RB, Lugo Pinto MA, Rodriguez Reyes FG. Applied regenerative endodontics: periapical surgery and sealing of root drilling with A-PRF and photodynamic therapy. Case Report. Anatomía Digital [Internet]. 2025Apr.22 [cited 2026Jan.5];8(2):89-101. Available from: https://doi.org/10.33262/anatomiadigital.v8i2.3402
22. González Guachizaca GV, Morocho Morocho NP, Lugo Pinto MA, Rodriguez Reyes FG. Endodontic regeneration with A-PRF and I-PRF in a permanent tooth with immature apex: a clinical case report. Anatomía Digital [Internet]. 2025Nov.13 [cited 2026Jan.5];8(4):57-63. Available from: https://doi.org/10.33262/anatomiadigital.v8i4.3558
23. Rosales Salcedo GV, Molina Barahona RM, Silva Erráez C, Morales Navarro D. Clinical and imaging evaluation of platelet-rich fibrin in post-exodontic bone regeneration. A systematic review. Anatomía Digital [Internet]. 2025Jun.23 [cited 2026Jan.05];8(2.2):27-25. Available from: https://doi.org/10.33262/anatomiadigital.v8i2.2.3423
24. Rubio Uzho KA, Molina Barahona RM, Cruz Proaño ED, Vásquez Palacios AC. Imagin evaluation of platelet-rich fibrin in post-exodontic bone regeneration. A systematic review. Anatomía Digital [Internet]. 2025Jul.28 [cited 2026Jan.05];8(3.2):6-28. Available from: https://doi.org/10.33262/anatomiadigital.v8i3.2.3458
2. Campo López KA, Ortiz Ramírez SN, Jaramillo Echeverry A, Colmenares Molina PA. Regeneración ósea en tratamientos periodontales con el uso de Plasma Rico en Fibrina: Revisión exploratoria. Journal Odontológico Colegial [Internet]. 2023 [citado 5 Ene 2026];16(31). Disponible en: http://revistas.unicoc.edu.co/index.php/joc/article/view/443
3. Zambrano-Bravo MK, Santos-Vera KM. Utilización de plasma rico en fibrina (PRF) como complemento en técnicas de injerto óseo: tendencias actuales y perspectivas terapéuticas. Innova Scientific Journal [Internet]. 2025 Jul 31 [citado 5 Ene 2026];3(3):315-35. Disponible en: https://innovasciencejournal.omeditorial.com/index.php/home/article/view/86
4. Peña Sisto M, Alí Pérez NA, Robinson Rodríguez RJ, Arzuaga Sierra C M, Clavería Clark RA. Terapia regenerativa con plasma rico en plaquetas en adultos afectados por lesiones endoperiodontales. MEDISAN [Internet]. 2021 [citado 5 Ene 2026];25(2). Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S1029-30192021000200305
5. Ramos Ramírez J, Ramos Manotas J, Díaz Caballero A. Regeneración ósea con fibrina rica en plaquetas en una cirugía apical. Revista Cubana de Estomatología [Internet]. 2023 [citado 5 Ene 2026];60(1). Disponible en: http://scielo.sld.cu/scielo.php?pid=S0034-75072023000100010&script=sci_arttext&tlng=pt
6. Quirynen M, Blanco J, Wang H ‐L., Donos N, Temmerman A, Castro A, et al. Instructions for the use of L‐PRF in different clinical indications. Periodontology 2000 [Internet]. 2025 [cited 2026 Jan 5];97(1):420-432. Available from: https://pubmed.ncbi.nlm.nih.gov/38803016/
7. Zárate Giménez R. Biomateriales utilizados en Endodoncia. Revista Científica Ciencias de la Salud y Sociedad [Internet]. 2024 [citado 5 Ene 2026];1(1):63-70. Disponible en: https://revistascientificas.uc.edu.py/index.php/rccss/article/view/18
8. Higgins JPT, Savović J, Page MJ, Elbers RG, Sterne JAC. RoB 2 tool: A revised Cochrane risk of bias tool for randomized trials [Internet]. Bristol: University of Bristol; 2025 [cited 2026 Jan 5]. Available from: https://www.riskofbias.info/welcome/rob-2-0-tool
9. Parise GK, Costa BN, Nogueira ML, Sassi LM, Schussel JL. Efficacy of fibrin-rich platelets and leukocytes (L-PRF) in tissue repair in surgical oral procedures in patients using zoledronic acid-case-control study. Oral and Maxillofacial Surgery [Internet]. 2023 [cited 2026 Jan 5];27(3):507-512. Available from: https://pubmed.ncbi.nlm.nih.gov/35739366/
10. Álvarez-Medina R, Guerrero ME, Córdova-Limaylla NE, López-Llamosas LE, Huamaní-Echaccaya JL, Palomino-Zorrilla JJ, et al. Effect of fibrin-rich plasma and collagen sponge on healing of the palatal mucosa. Journal of Clinical and Experimental Dentistry [Internet]. 2023 [cited 2026 Jan 5];15(7):e551-60. Available from: https://pubmed.ncbi.nlm.nih.gov/37519316/
11. Youssef A, Ali M, ElBolok A, Hassan R. Regenerative endodontic procedures for the treatment of necrotic mature teeth: A preliminary randomized clinical trial. International Endodontic Journal [Internet]. 2022 [cited 2026 Jan 5];55(4):334-346. Available from: https://pubmed.ncbi.nlm.nih.gov/35030270/
12. Mittal N, Baranwal HC, Kumar P, Gupta S. Assessment of pulp sensibility in the mature necrotic teeth using regenerative endodontic therapy with various scaffolds – randomised clinical trial. Indian Journal of Dental Research [Internet]. 2021 [cited 2026 Jan 5];32(2):216-220. Available from: https://pubmed.ncbi.nlm.nih.gov/34810392/
13. Rizk HM, Salah Al-Deen MSM, Emam AA. Comparative evaluation of Platelet Rich Plasma (PRP) versus Platelet Rich Fibrin (PRF) scaffolds in regenerative endodontic treatment of immature necrotic permanent maxillary central incisors: A double blinded randomized controlled trial. The Saudi Dental Journal [Internet]. 2020 Jul [cited 2026 Jan 5];32(5):224-231. Available from: https://pubmed.ncbi.nlm.nih.gov/32647469/
14. Ramachandran N, Singh S, Podar R, Kulkarni G, Shetty R, Chandrasekhar P. A comparison of two pulp revascularization techniques using platelet-rich plasma and whole blood clot. Journal of Conservative Dentistry: JCD [Internet]. 2020 [cited 2026 Jan 5];23(6):637-643. Available from: https://pubmed.ncbi.nlm.nih.gov/34083923/
15. Rajendra K, Vempalli S, Kadiyala M, Sharma V, Karipineni S, Gunturu S, et al. Effect of platelet-rich fibrin versus chitosan-based Axiostat hemostatic agent following dental extraction in cardiac patients on antiplatelet therapy: A comparative study. National Journal of Maxillofacial Surgery [Internet]. 2021 [cited 2026 Jan 5];12(3):361-366. Available from: https://pubmed.ncbi.nlm.nih.gov/35153432/
16. Sarkar S, Prashanth NT, Shobha ES, Rangan V, Nikhila G. Efficacy of Platelet Rich Fibrin versus chitosan as a hemostatic agent following dental extraction in patients on antiplatelet therapy. Journal of Oral Biology and Craniofacial Research [Internet]. 2019 [cited 2026 Jan 5];9(4):336-9. Available from: https://pubmed.ncbi.nlm.nih.gov/31467833/
17. Cerqueira-Neto ACCL, Prado MC, Pereira AC, Oliveira ML, Vargas-Neto J, Gomes BPFA, et al. Clinical and Radiographic Outcomes of Regenerative Endodontic Procedures in Traumatized Immature Permanent Teeth: Interappointment Dressing or Single-Visit? Journal of Endodontics [Internet]. 2021 [cited 2026 Jan 5];47(10):1598-608. Available from: https://pubmed.ncbi.nlm.nih.gov/34310980/
18. Lana JF, Purita J, Everts PA, De Mendonça Neto PAT, de Moraes Ferreira Jorge D, Mosaner T, et al. Platelet-Rich Plasma Power-Mix Gel (ppm)-an orthobiologic optimization protocol rich in growth factors and fibrin. Gels (Basel, Switzerland) [Internet]. 2023 [cited 2026 Jan 5];9(7):553. Available from: https://pubmed.ncbi.nlm.nih.gov/37504432/
19. Liu X, Huang X, Liu N, Zhu L, Zhao S, Tang S, et al. Advances in smart stimuli-responsive materials for oral wound healing. Frontiers in Chemistry [Internet]. 2025 [cited 2026 Jan 5]; 13:1725373. Available from: https://www.frontiersin.org/articles/10.3389/fchem.2025.1725373
20. Zhang T, Yuan M, Hao X, Gao H, Teng M, Hu F, et al. Innovative biomaterials in promoting intraoral wound healing: mechanisms, applications, and challenges. Materials Today Bio [Internet]. 2025 Dic [cited 2026 Jan 5]; 35:102470. Available from: https://pubmed.ncbi.nlm.nih.gov/41255422/
21. Soto Zumbana JA, Piedra Andrade RB, Lugo Pinto MA, Rodriguez Reyes FG. Applied regenerative endodontics: periapical surgery and sealing of root drilling with A-PRF and photodynamic therapy. Case Report. Anatomía Digital [Internet]. 2025Apr.22 [cited 2026Jan.5];8(2):89-101. Available from: https://doi.org/10.33262/anatomiadigital.v8i2.3402
22. González Guachizaca GV, Morocho Morocho NP, Lugo Pinto MA, Rodriguez Reyes FG. Endodontic regeneration with A-PRF and I-PRF in a permanent tooth with immature apex: a clinical case report. Anatomía Digital [Internet]. 2025Nov.13 [cited 2026Jan.5];8(4):57-63. Available from: https://doi.org/10.33262/anatomiadigital.v8i4.3558
23. Rosales Salcedo GV, Molina Barahona RM, Silva Erráez C, Morales Navarro D. Clinical and imaging evaluation of platelet-rich fibrin in post-exodontic bone regeneration. A systematic review. Anatomía Digital [Internet]. 2025Jun.23 [cited 2026Jan.05];8(2.2):27-25. Available from: https://doi.org/10.33262/anatomiadigital.v8i2.2.3423
24. Rubio Uzho KA, Molina Barahona RM, Cruz Proaño ED, Vásquez Palacios AC. Imagin evaluation of platelet-rich fibrin in post-exodontic bone regeneration. A systematic review. Anatomía Digital [Internet]. 2025Jul.28 [cited 2026Jan.05];8(3.2):6-28. Available from: https://doi.org/10.33262/anatomiadigital.v8i3.2.3458