Platelet-Rich Fibrin Versus Collagen Matrix For Gingival Recession: A Systematic Review and Meta-Analysis

Abstract

Root coverage with a connective tissue graft needs a palatal wound. Platelet-rich fibrin (PRF) and collagen matrices avoid it, but no review has pooled trials comparing them. We searched PubMed, Scopus and Cochrane CENTRAL on 18 October 2026 for randomized trials of RT1–RT2 recession with at least 6 months of follow-up. Risk of bias (RoB 2) and certainty (GRADE) were rated. Mean differences were pooled with random-effects (REML) models and Hartung–Knapp–Sidik–Jonkman (HKSJ) intervals, and split-mouth trials were analysed as paired data. PRF instead of collagen and PRF added to collagen were analysed separately. The review was unregistered, had no protocol and was self-funded. Seven trials were included. In five trials (158 patients or sites), PRF instead of collagen gave 14.7 percentage points more mean root coverage (95% CI 8.9 to 20.5; low certainty; modified HKSJ interval 5.2 to 24.1) and 0.44 mm less residual recession (95% CI −0.59 to −0.30; moderate certainty). Keratinized tissue width and gingival thickness did not differ, and attachment level was inconsistent. In two split-mouth trials (37 patients), PRF added to collagen did not change recession depth (MD −0.05 mm; 95% CI −0.78 to 0.68; very low certainty). Five of seven trials had a high risk of bias. PRF may give more root coverage than collagen, but the trials are small, mostly at high risk of bias, and the interval is wide. PRF added to collagen showed no clear benefit. Sixteen trials without usable results were unclassified. Assessor-blinded 12-month trials are needed.