Clinical effect of platelet-rich fibrin layering on peri-implant keratinized tissue
Abstract
P eri-implant tissues are very important for the long-term stability of dental implants. Sufficient width of keratinized tissue has been associated with lower levels of plaque formation, and reduced inflammation of the gingiva. Greater thickness of soft tissue has also been associated with less bone resorption. There is evidence that supports the notion that platelet-rich fibrin (PRF) can be used in enhancing the healing and regeneration of soft tissue. The primary objective of this study wa s to evaluate the effect of different numbers of PRF membrane layers on the thickness and width of keratinized tissue around dental implants during the early heal ing phase. Fifteen participants per group (N = 45) were sequentially assigned to one of three groups: single PRF membrane group, multiple PRF membrane group, and control group. A standardized two-stage implant placement proc e dure was performed . The outcomes included the estimation of keratinized tissue width (KTW) and thickness (KTT). The m e a surements were recorded preope ratively and six and twelve weeks postoperatively. The use of PRF either as a single me m brane or in three layers did not cause any significant increase in the keratinized tissue width at the postoperative 6-week or 12-week time points. At the same time, t he single and multiple PRF groups had significantly greater increases in the thickness of cre stal and buccal soft tissue compared with the control group at 12 weeks. Platelet-rich fibrin had minimal effect on the kerat i nized tissue width . However, its application , particularly in three layers, significantly enhanced the thickness of buccal and crestal tissue s .References
Al-Radha, A. S. D. (2023). Association of patient anthropometric measurements and dental implant treatment. Clinical, Cosmetic and Investigational Dentistry, 15, 51–61.
Alvarez-Medina, R., Guerrero, M. E., Córdova-Limaylla, N. E., López-Llamosas, L. E., Huamaní-Echaccaya, J. L., Palomino-Zorrilla, J. J., & Rosas-Díaz, J. C. (2023). Effect of fibrin-rich plasma and collagen sponge on healing of the palatal mucosa. Journal of Clinical and Experimental Dentistry, 15(7), e551–e560.
Ardila, C. M., Pertuz, M., & Vivares-Builes, A. M. (2023). Clinical efficacy of platelet derivatives in periodontal tissue regeneration: An umbrella review. International Journal of Dentistry, 2023, 1099013.
Baghele, O. N., & Bezalwar, K. V. (2022). A study to evaluate the prevalence of teeth without clinically detectable mucogingival junction. Journal of Indian Society of Periodontology, 26(2), 162–168.
Bayer, A., Wijaya, B., Rademacher, F., Möbus, L., Preuß, M., Singh, M., Tohidnezhad, M., Kubo, Y., Rodewald, M., Behrendt, P., Weitkamp, J.-T., Gläser, R., & Harder, J. (2021). Platelet-released growth factors induce genes involved in extracellular matrix formation in human fibroblasts. International Journal of Molecular Sciences, 22(19), 10536.
Cheruvu, R. N. S., Katuri, K. K., Dhulipalla, R., Kolaparthy, L., Adurty, C., & Thota, K. M. (2023). Evaluation of soft tissue and crestal bone changes around non-submerged implants with and without a platelet-rich fibrin membrane: A randomized controlled clinical trial. Dental and Medical Problems, 60(3), 437–443.
Elkashty, A. A.-R., Aboelmaaty, W. M., Helmy, S. M., Elewa, M. E., Mansour, A., & Ateia, I. M. (2023). Comparison of sub-epithelial connective tissue graft and platelet rich fibrin in peri-implant soft tissue augmentation: A randomized clinical split-mouth study. The Open Dentistry Journal, 16(1), e187421062211070.
Hassan, N. A., & Al-Radha, A. S. D. (2023). CBCT evaluation of quality and quantity of bones for immediate implant treatment planning in central incisor area in relation to arch form. The Scientific World Journal, 2023, 8863318.
Hassan, N. A., Al-Jaboori, A. S. K., & Al-Radha, A. S. D. (2022). Evaluation of cortical bone thickness of posterior implant sites using CBCT in Iraqi population. International Journal of Dentistry, 2022, 5723397.
Hussein, N. A., Jassim, R. K., & Abdul-Razzaq, R. W. (2024). Development of microstructure on titanium implant surface using CO2 laser processing. Mustansiria Dental Journal, 20(1), 42–52.
Jung, R. E., Becker, K., Bienz, S. P., Dahlin, C., Donos, N., Hammächer, C., Iglhaut, G., Liñares, A., Ortiz-Vigón, A., Sanchez, N., Sanz-Sánchez, I., Thoma, D. S., Valles, C., Weng, D., & Nart, J. (2022). Effect of peri-implant mucosal thickness on esthetic outcomes and the efficacy of soft tissue augmentation procedures: Consensus report of group 2 of the SEPA / DGI / OF workshop. Clinical Oral Implants Research, 33(2S), 100–108.
Kabir, L., Stiesch, M., & Grischke, J. (2021). The effect of keratinized mucosa on the severity of peri-implant mucositis differs between periodontally healthy subjects and the general population: A cross-sectional study. Clinical Oral Investigations, 25(3), 1183–1193.
Kobayashi, E., Flückiger, L., Fujioka-Kobayashi, M., Sawada, K., Sculean, A., Schaller, B., & Miron, R. J. (2016). Comparative release of growth factors from PRP, PRF, and advanced-PRF. Clinical Oral Investigations, 20(9), 2353–2360.
Lima, V. C. da S., Miguel, M. M. V., Ferraz, L. F. F., Filho, A. B. de M., Jardini, M. A. N., & Santamaria, M. P. (2022). Use of platelet-rich fibrin membranes with single implant placement for peri-implant mucosal thickness augmentation: A case series study. Clinical Advances in Periodontics, 12(1), 17–20.
Miron, R. J., Fujioka-Kobayashi, M., Bishara, M., Zhang, Y., Hernandez, M., & Choukroun, J. (2017). Platelet-rich fibrin and soft tissue wound healing: A systematic review. Tissue Engineering, Part B, Reviews, 23(1), 83–99.
Miron, R. J., Zucchelli, G., Pikos, M. A., Salama, M., Lee, S., Guillemette, V., Fujioka-Kobayashi, M., Bishara, M., Zhang, Y., Wang, H.-L., Chandad, F., Nacopoulos, C., Simonpieri, A., Aalam, A. A., Felice, P., Sammartino, G., Ghanaati, S., Hernandez, M. A., & Choukroun, J. (2017). Use of platelet-rich fibrin in regenerative dentistry: A systematic review. Clinical Oral Investigations, 21(6), 1913–1927.
Moeintaghavi, A., Ghanbari, H., Arab, H., Shiezadeh, F., & Jamali, M. (2023). Evaluation of soft tissue changes following platelet-rich fibrin in immediate implantation of posterior teeth: A randomized clinical trial. The Open Dentistry Journal, 17(1), e187421062309121.
Monje, A., González-Martín, O., & Ávila-Ortiz, G. (2023). Impact of peri-implant soft tissue characteristics on health and esthetics. Journal of Esthetic and Restorative Dentistry, 35(1), 183–196.
Nasir, M., & Abdul Rahman, H. (2016). Mechanical evaluation of pure titanium dental implants coated with a mixture of nano titanium oxide and nano hydroxyapatite. Journal of Baghdad College of Dentistry, 28(3), 38–43.
Ramanauskaite, A., Schwarz, F., & Sader, R. (2022). Influence of width of keratinized tissue on the prevalence of peri-implant diseases: A systematic review and meta-analysis. Clinical Oral Implants Research, 33(S2), 8–31.
Rawaa, Y. A.-R., & Mikdad, A. M. (2020). Anatomy respect in implant dentistry. Assortment, location, clinical importance (review article). Journal of Dental Problems and Solutions, 7, 68–78.
Rodas, M. A. R., Paula, B. L. de, Pazmiño, V. F. C., Lot Vieira, F. F. D. S., Junior, J. F. S., & Silveira, E. M. V. (2020). Platelet-rich fibrin in coverage of gingival recession: A systematic review and meta-analysis. European Journal of Dentistry, 14(2), 315–326.
Schwarz, F., & Ramanauskaite, A. (2022). It is all about peri-implant tissue health. Periodontology 2000, 88(1), 9–12.
Sculean, A., Gruber, R., & Bosshardt, D. D. (2014). Soft tissue wound healing around teeth and dental implants. Journal of Clinical Periodontology, 41(S1), S6–S22.
Strauss, F.-J., Nasirzade, J., Kargarpoor, Z., Stähli, A., & Gruber, R. (2020). Effect of platelet-rich fibrin on cell proliferation, migration, differentiation, inflammation, and osteoclastogenesis: A systematic review of in vitro studies. Clinical Oral Investigations, 24(2), 569–584.
Thoma, D. S., Naenni, N., Figuero, E., Hämmerle, C. H. F., Schwarz, F., Jung, R. E., & Sanz-Sánchez, I. (2018). Effects of soft tissue augmentation procedures on peri-implant health or disease: A systematic review and meta-analysis. Clinical Oral Implants Research, 29(S1), 32–49.
Wang, H.-L., & Zucchelli, G. (2019). Editorial: Significance of peri-implant keratinized mucosa width and soft tissue thickness. The International Journal of Periodontics and Restorative Dentistry, 39(6), 767–768.
Copyright (c) 2025 Regulatory Mechanisms in Biosystems

This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons «Attribution» 4.0 License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.


