Platelet-rich fibrin as a therapeutic modality for oroantral communication closure: a systematic review and meta-analysis

Background Oroantral communication (OAC) is an abnormal connection between the oral cavity and maxillary sinus, often occurring after posterior maxillary tooth extraction. If untreated, OAC can progress to oroantral fistulas (OAFs), leading to chronic sinusitis and treatment failure. Platelet-rich fibrin (PRF), an autologous biomaterial with regenerative potential, has been proposed as a therapeutic option. This study aimed to evaluate the efficacy and safety of PRF in the closure of OACs/OAFs. Methods This systematic review and meta-analysis followed PRISMA guidelines and was registered with PROSPERO. A comprehensive literature search was conducted in April 2025 across Cochrane, PubMed, Google Scholar and Web of Science. Studies were selected using PICO criteria: patients with OACs/OAFs; PRF as a standalone or adjunct intervention; comparison to conventional treatments; outcome of successful closure; and human studies published in English or Arabic. Data extraction and risk of bias assessment were performed independently by multiple reviewers using Cochrane RoB 2, MINORS, and MMS tools. Meta-analysis was conducted using Review Manager software. Results Nineteen studies including 442 patients were included. PRF demonstrated high closure rates, often within three weeks, with enhanced mucosal and bone healing. Minimal complications were reported. Although methodological heterogeneity and moderate-to-high risk of bias were observed, the overall findings support the beneficial role of PRF in OAC/OAF management, particularly in minor to moderate defects. Conclusion PRF is a safe, effective, and minimally invasive adjunct for the closure of OACs/OAFs. Its application is associated with significantly reduced patient morbidity, including less pain, lower analgesic consumption, minimal swelling, and greater overall comfort. Furthermore, as a minimally invasive and entirely autologous material, PRF eliminates the risks of immunogenic reactions or disease transmission, while its application helps preserve critical anatomical structures like the buccal sulcus, which is essential for future prosthetic rehabilitation. Systematic Review Registration PROSPERO CRD420251028634.