Platelet-Rich Fibrin in Bone Regeneration: A Systems Biology Approach to Mechanisms and Clinical Translation

Medicine/Surgery

Platelet-rich fibrin (PRF), a second-generation autologous platelet concentrate, represents a paradigm shift in regenerative biomaterials. Distinguished by its three-dimensional fibrin matrix, PRF orchestrates a sustained, sequential release of growth factors and cytokines, establishing a biomimetic osteogenic niche [1, 2]. This review systematically deconstructs the preparation-property-function relationship of PRF and its derivatives (L-PRF, A-PRF, i-PRF, T-PRF), linking centrifugal parameters to quantifiable scaffold architecture and release kinetics [3, 4]. A central thesis posits that PRF's efficacy stems from a tripartite mechanism: direct osteogenic programming of progenitor cells via BMP/Smad and MAPK/ERK pathways [5, 6]; potentiation of mature osteoblast function and matrix mineralization [7]; and strategic remodeling of the healing microenvironment through coupled angiogenesis and immunomodulation [8, 9]. Evidence-based clinical appraisal confirms its utility in oral and maxillofacial surgery, with data indicating a 35-50% enhancement in bone density and healing rates in procedures such as sinus augmentation and alveolar ridge preservation [10, 11]. However, clinical translation is impeded by protocol heterogeneity and suboptimal degradation kinetics [12]. We conclude by proposing a roadmap integrating engineered PRF composites with tunable properties and AI-optimized preparation protocols to transition PRF from a biological tool to a standardized, next-generation therapeutic platform [13, 14].

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