Platelet Concentrates in Alveolar and Periodontal Bone Regeneration: Adjunctive Benefits and Clinical Comparability with Conventional Approaches: A Systematic Review

Background Platelet concentrates (PCs), including platelet-rich fibrin (PRF) and its derivatives, have been increasingly investigated as autologous adjuncts in alveolar and periodontal regenerative procedures. This systematic review aimed to evaluate whether PCs improve clinical, radiographic, and histological outcomes compared with conventional regenerative approaches. Methods A comprehensive search of PubMed, Scopus, and Web of Science identified randomized clinical trials on intrabony and furcation defects, alveolar ridge preservation, alveolar cleft reconstruction, and periodontally accelerated osteogenic orthodontics (PAOO). Sixteen studies met the inclusion criteria. Results Overall, PCs, used alone as membranes or in combination with allograft materials, have been associated with significant clinical and radiographic improvements, with three main patterns of effect emerging across studies: (i) adjunctive benefit in selected outcomes (e.g., ridge width preservation and new bone formation when PRF was combined with graft materials); (ii) non-inferiority or equivalence compared with conventional regenerative approaches, particularly in periodontal intrabony defects; and (iii) lack of consistent superiority, as several studies reported comparable outcomes to standard techniques rather than clear advantages. In cleft reconstruction, PRF used in combination with allografts has shown comparable or non-inferior results to standard graft approaches, potentially reducing morbidity. Despite these favorable trends, evidence has been mixed in terms of platelet preparation protocols, defect types, additional biomaterials, and length of follow-up. The heterogeneity of the included studies and the absence of quantitative synthesis limit the strength of the conclusions. Conclusions Within these limitations, PCs appear to represent a valid complement or alternative to conventional regenerative strategies, primarily as an adjunct rather than a clearly superior approach, and further well-designed randomized clinical trials with standardized protocols and longer follow-up are needed to strengthen clinical recommendations.