Comparative Evaluation of Autologous Bone Grafting With and Without PRP or PRF in Cleft Alveolus Reconstruction: A Prospective Randomized Study

Abstract

Objective

To evaluate the effectiveness of autologous bone grafting alone, with platelet-rich plasma (PRP), and with platelet-rich fibrin (PRF) in the treatment of cleft alveolus.

Design

Randomized controlled clinical trial.

Setting

Department of Oral and Maxillofacial Surgery at a tertiary care center.

Patients, Participants

Seventy-five patients aged 7 to 20 years with alveolar clefts, randomized (1:1:1) into 3 groups (n = 25 each).

Interventions

Group 1: Autologous bone graft alone. Group 2: Autologous bone graft + PRP. Group 3: Autologous bone graft + PRF.

Main Outcome Measure(s)

Primary-radiographic bone formation (bone density) and bone bridge quality (Bergland score). Secondary-postoperative pain (VAS), surgical site complications (composite SSC: infection, fistula, graft exposure), and donor-site morbidity.

Results

PRF demonstrated the highest radiographic bone density at 6 months and a more favorable Bergland distribution versus control (P < .05). Grade I Bergland success was highest in the PRF group (64%). Early postoperative VAS pain scores were significantly lower with PRF (Kruskal-Wallis P < .05). Overall postoperative complications were low and comparable across groups (SSC, nonsignificant). Age-stratified analyses (7-12 vs 13-20 years) preserved the direction of effect (PRF ≥ PRP > control) but were exploratory and underpowered.

Conclusions

Adjunctive PRP/PRF with autologous bone grafting may improve clinical outcomes in alveolar cleft reconstruction, with PRF appearing to provide a modest advantage in bone formation and early pain reduction. Findings are preliminary and warrant confirmation in larger, blinded studies with longer follow-up.

Keywords

cleft alveolus platelet-rich fibrin bone grafting PRP alveolar cleft repair alveolar bone grafting.

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