Platelet-rich fibrin in dental extraction sockets of patients with planned or previous head and neck radiotherapy: a systematic review

Background Patients with head and neck cancer (HNC) planned for radiotherapy (RT) frequently require pre-treatment dental extractions. Osteoradionecrosis (ORN) is a serious late complication of RT. Maximising the extent of socket healing before RT commences is critical to the prevention of ORN. Platelet-rich fibrin (PRF) concentrates autologous growth factors and may accelerate socket healing. Purpose To analyse the literature and identify whether PRF supports earlier healing or reduced incidence of ORN. Study design, setting, sample This systematic review evaluates clinical evidence for PRF in dental extraction sockets in patients with planned or prior head and neck RT. PubMed/MEDLINE, Embase, Cochrane Library, Web of Science, and the HaNDLE-on-QoL database were searched from database inception to December 2025. Predictor/Exposure/Independent variable Studies of any design evaluating PRF in extraction sockets of patients with HNC receiving or planned for RT were eligible. Main outcome variable(s) The primary outcome variables were time to healing and incidence of ORN. Covariates Covariates were assessed based on reporting in individual studies. Analysis Studies were assessed for methodological robustness, including the PRISMA 2020 framework. Risk of bias was assessed using the Cochrane Risk of Bias (RoB) 2.0 tool. Results Two primary studies, both randomised controlled trials (RCTs), met the inclusion criteria for the qualitative synthesis; one systematic review with meta-analysis was retained separately as contextual evidence. Neither RCT demonstrated a statistically significant benefit over conventional socket management. The single systematic review identified only one eligible PRF study ( n = 11), precluding meta-analysis. No studies were conducted in the pre-RT setting. Conclusions Current evidence is insufficient to recommend the routine use of PRF for ORN prevention in this population. Critically, both RCTs were substantially underpowered and at high risk of type II error. Both studied only post-irradiated patients and administered antibiotics to every participant in both arms, which is likely to have suppressed the baseline ORN event rate. No pre-RT evidence exists, despite this representing the most clinically and biologically relevant scenario. Adequately powered, multicentre RCTs in the pre-RT setting are required. Clinical trial number Not applicable.