Research trends in the use of platelet-rich fibrin for periodontal regeneration: A bibliometric analysis

Introduction

Periodontitis is a chronic inflammatory disease characterized by the progressive destruction of the tooth-supporting tissues. Intrabony defects and furcation involvement resulting from disease progression remain important clinical challenges in periodontal treatment. Although conventional periodontal therapy is effective in controlling inflammation and limiting disease progression, restoration of the lost cementum, periodontal ligament, and alveolar bone requires regenerative treatment approaches. Various strategies, including guided tissue regeneration, bone grafting, and biologically active agents, have therefore been used either alone or in combination. However, the predictability of periodontal regeneration may be influenced by several factors, including defect morphology, surgical technique, and the type of biomaterial used (1, 2).

Platelet-rich fibrin (PRF) is an autologous platelet concentrate used to promote periodontal wound healing and regeneration. Its three-dimensional fibrin-rich architecture provides a biological microenvironment containing platelets, leukocytes, and various bioactive mediators that may support cellular processes, angiogenesis, and tissue healing (3). Over time, the development of different PRF formulations, including leukocyte- and platelet-rich fibrin (L-PRF), advanced PRF (A-PRF), injectable PRF (i-PRF), and titanium-prepared PRF (T-PRF), has broadened its application in periodontal regenerative therapy and has stimulated a growing body of clinical and experimental research (2, 3).

Current clinical evidence suggests that PRF may provide additional benefits as an adjunct to regenerative therapy, particularly in the treatment of periodontal intrabony and furcation defects. Although systematic reviews and meta-analyses have reported improvements in clinical periodontal outcomes associated with the use of PRF, these findings should be interpreted with caution because of the heterogeneity in PRF formulations, regenerative protocols, and study designs (1, 2, 4).

As the scientific literature on PRF continues to expand, a comprehensive evaluation of the development and knowledge structure of this research field has become increasingly important. Bibliometric analysis enables the quantitative assessment of publication trends, influential authors and institutions, scientific collaborations, citation patterns, and major research themes. Previous bibliometric studies have examined the overall development and research trends of the PRF literature (5, 6), while global scientific output, collaboration networks, and thematic evolution in periodontal regeneration have also been investigated (7, 8). Nevertheless, considering the scope of the existing literature, bibliometric evidence specifically focused on the use of PRF in periodontal regeneration and integrating scientific productivity, citation impact, international research collaboration, and conceptual structure remains limited. Therefore, this study aimed to characterize the bibliometric landscape of the PRF and periodontal regeneration literature indexed in the Web of Science Core Collection; to identify publication trends and leading authors, countries, institutions, and journals; to examine citation and international collaboration patterns; and to elucidate the major research themes and knowledge structure of the field through author keyword co-occurrence analysis.

Materials and Methods

Bibliometric analyses

Descriptive and impact-based bibliometric indicators were analyzed to evaluate different aspects of the development of the scientific literature on PRF in periodontal regeneration.

To assess temporal trends, publications were categorized by publication year and annual scientific output was calculated. Scientific productivity was evaluated based on publication counts to identify the most productive authors, journals, countries/regions, and institutions. In addition to publication counts, the total number of citations received by the publications associated with each bibliometric unit was calculated using WoSCC citation data. This approach enabled the assessment of both scientific productivity and citation impact.

Author productivity was assessed based on the number of publications attributed to each author in the final dataset. Cumulative citation counts at the author level were calculated using the total WoSCC citation counts of the publications associated with each author. To account for potential inconsistencies arising from bibliographic database indexing, apparent variations in author names and initials were checked.

Journal productivity was evaluated according to the source journals in which the publications in the final dataset appeared. For each journal, the number of publications and the total number of citations received by those publications in WoSCC were calculated.

Results

Study selection and annual publication trends

The initial Web of Science Core Collection (WoSCC) search identified 359 publications. In accordance with the predefined study period, five publications from 2026 were excluded, and the remaining 354 records underwent title and abstract screening. Following independent assessment by two periodontologists, 83 publications that did not meet the predefined eligibility criteria were excluded. Consequently, 271 publications were included in the final bibliometric analysis. By study design, these comprised 148 clinical studies or clinical protocols (54.6%), 35 in vitro/ex vivo or animal studies (12.9%), 75 reviews or meta-analyses (27.7%), and 13 case reports or case series (4.8%).

Analysis of annual scientific output showed that the first WoSCC-indexed publications on PRF in periodontal regeneration appeared in 2009 (n = 2). Publication output remained relatively low between 2009 and 2015, followed by a marked increase from 2016 onward. The highest annual output was recorded in 2023 (n = 33). Notably, 149 publications appeared between 2021 and 2025, accounting for approximately 55.0% of the final dataset. The annual publication trend is presented in Figure 2.

Most productive institutions

Institutional analysis showed that the University of Bern and the Government Dental College & Research Institute were the most productive institutions, with 15 publications each. Publications affiliated with the University of Bern received a total of 1,731 citations, whereas those affiliated with the Government Dental College & Research Institute received 984 citations. The 10 most productive institutions and their citation counts are presented in Table 4.

Rank	Country/Region	Publications (n)	Total citations (n)
1	India	119	2,438
2	China	31	1,797
3	Italy	24	1,105
4	United States	23	1,895
5	Switzerland	17	1,748
6	Saudi Arabia	16	177
7	Egypt	14	213
8	Germany	13	838
9	Türkiye	13	239
10	Romania	10	261

Countries/regions were ranked primarily by publication count and secondarily by total citation count when publication counts were identical. Citation counts reflect WoSCC data retrieved on September 11, 2026. The analysis was based on the WoSCC C1 address field. Because internationally co-authored publications were counted once for each contributing country (full-counting approach), the sum of country-level publication counts does not equal 271.

Distribution of author keywords

Author keywords (DE) were available for 248 of the 271 publications, and 514 unique keywords were identified after standardization. The most frequent terms were “platelet-rich fibrin” (n = 127), “periodontal regeneration” (n = 67), “intrabony defect” (n = 51), “periodontitis” (n = 48), “regeneration” (n = 45), and “growth factors” (n = 35). The 15 most frequent standardized author keywords are presented in Table 6.

Rank	Standardized author keyword	Publications (n)
1	Platelet-rich fibrin	127
2	Periodontal regeneration	67
3	Intrabony defect	51
4	Periodontitis	48
5	Regeneration	45
6	Growth factors	35
7	Wound healing	21
8	Bone regeneration	19
9	Chronic periodontitis	19
10	Furcation defect	18
11	Platelet concentrate	18
12	Guided tissue regeneration	16
13	Platelet-rich plasma	14
14	Tissue engineering	14
15	Clinical trial	13

The analysis was performed using the Author Keywords (DE) field in WoSCC. Keywords were standardized using an explicit synonym map for abbreviation, spelling, and singular/plural variants (see Materials and Methods).

Discussion

This bibliometric study evaluated the temporal development of scientific output on platelet-rich fibrin (PRF) in periodontal regeneration, leading authors, journals, countries, and institutions, patterns of international scientific collaboration, citation impact, and the conceptual structure of the research field. The 271 publications included in the analysis indicate that PRF has attracted increasing research interest in periodontal regeneration in recent years. The main findings were the marked increase in scientific output, particularly after 2016; the leading contribution of India in terms of publication productivity; the Journal of Periodontology as the most productive source journal; the prominence of the University of Bern and the Government Dental College & Research Institute in institutional productivity; and the concentration of the research field around key concepts including PRF, regeneration, periodontal regeneration, periodontitis, intrabony defects, and growth factors.

Scientific output on PRF in periodontal regeneration showed a marked increase after 2016, with the highest annual number of publications recorded in 2023. Notably, the 149 publications published between 2021 and 2025 accounted for approximately 55% of the entire dataset, indicating that PRF-based periodontal regeneration has become a rapidly expanding research area in recent years. This trend is consistent with the findings of Yu and Chang (5), who reported a substantial increase in publications within the dental PRF literature, particularly in recent years, and Zhao et al. (6), who characterized PRF as an active and evolving research field. Increasing publication trends have also been reported in bibliometric studies focusing on periodontal regeneration in general (7), enamel matrix derivatives (EMD) (9), and minimally invasive periodontal surgery (10). Similar growth in research on platelet-rich plasma (PRP) and other platelet concentrates (11, 12) further suggests an increasing scientific interest in autologous platelet concentrates within regenerative medicine.

The growth of the PRF literature may be associated not only with its increasing clinical use but also with the development of different preparation protocols. Yu and Chang (5) identified the emergence of PRF derivatives, such as L-PRF, A-PRF, and i-PRF, as a potential factor contributing to the growing scientific interest, while Zhao et al. (6) highlighted concepts such as i-PRF, A-PRF, membrane, and centrifugation as emerging research themes. Similar patterns of bibliometric growth have also been reported in other areas of dentistry, including artificial intelligence and halitosis (13–15), suggesting that the broader acceleration of scientific output in contemporary dental research may also have contributed to this increase.

A.R. Pradeep was the most productive author in our study, with 15 publications, followed by R.J. Miron with 10 publications; however, Miron’s publications had a higher total citation count. In the broader bibliometric analysis of dental PRF research by Yu and Chang (5), Miron was identified as the most productive corresponding author, while Pradeep was also among the leading researchers. In contrast, Sculean emerged as a prominent author in the broader periodontal regeneration literature (7), while Sculean and Bern-based researchers were prominent in the EMD literature (9), and Cortellini, Harrel, and Trombelli were among the leading researchers in minimally invasive periodontal surgery (10). These differences suggest that author rankings may vary according to the specific scope of the research field and the counting methodology applied. Similar topic-specific patterns of leading researchers have also been reported in other dental bibliometric studies (13, 14, 16).

The Journal of Periodontology ranked first with 29 publications, which is highly consistent with previous bibliometric findings. The journal was identified as the leading source in the broader periodontal regeneration literature (7), the most frequently represented journal among highly cited studies on platelet derivatives (17), and one of the major scientific sources in the EMD literature (9). Its prominence has also been reported in research on periodontal disease and atherosclerosis (18), indicating that the Journal of Periodontology occupies an important position across multiple areas of periodontal research beyond PRF specifically.

One of the notable findings of our study was that India ranked first in publication productivity, with 119 publications. In contrast, Yu and Chang (5) identified Türkiye as the leading country in the broader PRF literature, whereas Zhao et al. (6) reported China as the leading contributor; in the broader field of periodontal regeneration, China and the United States were identified as the leading countries (7). These differences may largely reflect the narrower clinical scope of the present study. Previous PRF bibliometric analyses encompassed a wide range of applications, including oral surgery, implantology, sinus augmentation, extraction sockets, periodontal plastic surgery, and endodontics, whereas our analysis specifically focused on periodontal regeneration involving intrabony/infrabony and furcation defects. This narrower scope may have increased the relative contribution of India-based research groups that have produced substantial clinical research in these specific indications.

Country rankings may vary substantially depending on the specific research topic, as demonstrated by other dental bibliometric studies. For example, Italy and other European countries have shown prominent contributions in research on gingival recession and minimally invasive periodontal surgery (10, 19), whereas China has emerged as a leading contributor in studies on artificial intelligence in periodontal diseases and the relationship between periodontitis and Alzheimer’s disease (13, 20). The United States, in contrast, has been prominent in research addressing the association between periodontal disease and atherosclerosis (18). Different patterns of geographic concentration have also been reported in studies investigating systemic periodontal associations and other areas of dental research (21–23). Collectively, these findings indicate that overall scientific productivity does not necessarily predict a country’s relative contribution to research on a specific treatment approach or biomaterial.

Country rankings may also be influenced by the counting method applied. Yu and Chang (5) demonstrated that rankings differed depending on whether only the corresponding author’s country or the countries of all co-authors were considered. In the present study, all countries identified in the WoSCC C1 address field were included, and each participating country was counted in internationally co-authored publications; this methodological difference should therefore be considered when comparing our findings with previous studies. Although Türkiye ranked among the leading countries in the broader PRF literature, it ranked ninth in the present analysis. This finding may suggest that a substantial proportion of PRF research originating from Türkiye has focused on applications other than periodontal intrabony or furcation regeneration. However, this interpretation requires confirmation through an indication-specific content analysis.

Country productivity and international connectivity did not follow the same pattern. Although India was by far the most productive country, with 119 publications, only 12 of these involved international collaboration, and its total link strength was 16. In contrast, despite having lower overall publication outputs, the United States and Switzerland occupied highly connected positions within the collaboration network, with total link strengths of 51 and 47, respectively. The strongest bilateral collaboration was observed between China and the United States, while Switzerland showed strong collaborative links with China, Germany, the United States, and Japan. These patterns suggest that certain research centers may serve as important bridges for the international exchange of scientific knowledge in PRF-related periodontal regeneration research. Accordingly, productivity indicators based solely on publication counts may not fully capture the extent of international interaction within the research network. However, because the collaboration network reflects co-occurrence of countries in bibliographic address data, link strength should not be interpreted as an indicator of research quality or level of clinical evidence. The full collaboration network comprised 120 country/region pairs, whereas Figure 3 shows the 47 pairs with at least two joint publications; these counts therefore describe different network scopes.

The University of Bern and the Government Dental College & Research Institute shared the highest institutional productivity, with 15 publications each, consistent with the country- and author-level patterns observed in this study. The University of Bern was also identified as the most productive institution in the PRF analysis by Yu and Chang (5) and in the broader periodontal regeneration analysis by Hu et al. (7). The prominent contribution of Bern-based researchers to the EMD literature (9) further supports the institution’s sustained scientific productivity in periodontal regeneration beyond any single regenerative material. The Government Dental College & Research Institute reaching the same publication count as the University of Bern in the present study is also consistent with the substantial contribution of India to PRF research specifically focused on periodontal defects.

The 271 publications included in our study had received a total of 7,693 citations as of the data retrieval date. The most highly cited publication was the 2016 study entitled “Comparative release of growth factors from PRP, PRF, and advanced-PRF.” This study was also identified among the most highly cited publications in the broader PRF analysis by Zhao et al. (6), in which growth factors were highlighted as an important research theme. Similarly, Fardi et al. (17) identified growth factors, fibrin, and platelet derivatives among the major themes within the field. Taken together, these findings suggest that the scientific impact of PRF research has been shaped not only by studies evaluating clinical outcomes but also by investigations addressing its underlying biological mechanisms.

Publication age and article type should be considered when interpreting citation patterns. Fardi et al. (17) noted that PRP research may have a historical citation advantage because of its earlier emergence, whereas more recent PRF studies have also attracted substantial scientific attention. Bibliometric analyses of gingival recession (19) and regenerative endodontics (23) have similarly emphasized the influence of publication age on citation accumulation and the potential for review articles to receive high citation counts. Moreover, the considerable variation in citation patterns reported across different periodontal and systemic research fields (18, 21) indicates that citation performance may also be influenced by the scope of the topic and the size of its scientific audience. Therefore, citation counts in the present study should primarily be interpreted as indicators of scientific visibility and influence rather than as direct measures of methodological quality or strength of evidence.

The most frequently used author keywords in our study included “platelet-rich fibrin,” “periodontal regeneration,” “intrabony defect,” “periodontitis,” “regeneration,” and “growth factors.” This pattern suggests that the literature has developed around two closely related dimensions: the biological and regenerative properties of PRF and its clinical application in periodontal osseous defects. In the broader periodontal regeneration literature, “periodontal regeneration,” “tissue engineering,” “periodontitis,” “guided tissue regeneration,” and “regeneration” have been identified as major research themes (7), whereas “growth factor,” “platelet-rich plasma,” and “bone regeneration” have been highlighted in the broader PRF literature (6). Fardi et al. (17) also identified intrabony and furcation defects as important periodontal applications within the literature on platelet derivatives. Thus, the keyword profile observed in the present study largely overlaps with the thematic structures previously reported for both PRF and periodontal regeneration research.

The grouping of 32 keywords into three thematic clusters indicates an interconnected conceptual structure encompassing regenerative treatment approaches, periodontal defects, and biological healing mechanisms. These groups are based on statistical co-occurrence and should not be interpreted as evidence of clinical effectiveness. Similar methodological considerations regarding bibliometric networks have been emphasized in previous scientometric analyses of periodontal research (24).

One notable difference between the present study and the broader bibliometric literature on periodontal regeneration is the relatively limited visibility of advanced tissue-engineering concepts. Hu et al. (7) identified terms such as “3D printing,” “hydrogel,” “electrospinning,” “melt electrowriting,” and “exosome” as emerging themes in contemporary periodontal regeneration research. In contrast, the PRF-focused network in the present study remained predominantly centered on growth factors, wound healing, intrabony and furcation defects, and established regenerative approaches. Nevertheless, substantial thematic shifts over time have been reported across different areas of dental research (15, 18, 20, 22). Moreover, Zhao et al. (6) identified concepts such as i-PRF, A-PRF, and centrifugation as emerging research topics, suggesting that newer PRF formulations and preparation-related concepts may become increasingly prominent within future periodontal regeneration research.

The co-occurrence of terms such as “intrabony defect,” “furcation defect,” “guided tissue regeneration,” “clinical trial,” and “wound healing” reflects sustained clinical research interest in the use of PRF for periodontal regeneration. However, bibliometric visibility should not be equated with clinical effectiveness or strength of evidence. The need for multicenter and standardized research in minimally invasive periodontal surgery (10), calls for more rigorously designed controlled studies in the PRF literature (6), and the preclinical-to-clinical translational gap described in regenerative endodontics (23) collectively illustrate that a high volume of scientific output does not necessarily indicate maturity of the clinical evidence base. Future studies should therefore evaluate the additional clinical benefit of different PRF preparation protocols across well-defined defect morphologies and in combination with contemporary minimally invasive surgical approaches using rigorously designed controlled clinical trials.

A major strength of this study is the construction of a focused dataset specifically addressing PRF in periodontal regeneration rather than the entire dental PRF literature. By restricting the scope in this manner, the potential influence of publications related to implantology, sinus augmentation, extraction sockets, endodontics, and exclusively periodontal plastic surgical procedures on the bibliometric profile of intrabony and furcation regeneration was minimized. In addition, restricting the study period to publications available through December 31, 2025, prevented the incomplete publication output for 2026 from introducing an artificial decline in the annual publication trend.

Nevertheless, this study has several limitations. First, the analysis was based exclusively on the Web of Science Core Collection, and database selection is known to influence bibliometric findings. WoSCC and Scopus may retrieve different sets of publications on the same research topic (20), and previous dental bibliometric studies have used WoSCC, Scopus, PubMed, or combinations of multiple databases (7, 10, 13–15, 23). Therefore, the present findings should be interpreted within the indexing coverage of WoSCC. In addition, author, institution, and country rankings may be influenced by the counting and normalization methods applied; citation counts may be affected by publication age, article type, and self-citations; and keyword networks depend on author-selected terminology and decisions made during keyword standardization (5, 19, 21, 23, 24). Because experimental studies and reviews addressing PRF in periodontal regeneration were eligible, the citation-based rankings partly reflect the basic-science and review literature rather than clinical studies alone. Furthermore, the search did not include the stand-alone abbreviation “PRF,” so records using only this abbreviation may have been missed. Although these bibliometric indicators are valuable for characterizing the scientific structure and visibility of a research field, they should not be interpreted as direct measures of clinical effectiveness or methodological quality.

Overall, our findings indicate that the use of PRF in periodontal regeneration represents a growing research field with an increasingly distinct scientific profile. The expansion of scientific output, the prominent role of the Journal of Periodontology, the sustained productivity of the University of Bern, the strong international connectivity of the United States and Switzerland, and the conceptual emphasis on regeneration, growth factors, and wound healing are broadly consistent with previous bibliometric findings from the wider PRF and periodontal regeneration literature. In contrast, the leading contribution of India to PRF research specifically focused on periodontal regeneration and the predominance of intrabony and furcation defects and established regenerative concepts over advanced tissue-engineering technologies represent distinctive features of the present analysis. These findings suggest that further development of the field may benefit from standardized PRF protocols, integration with contemporary minimally invasive surgical approaches, and well-designed multicenter clinical studies.

Conclusion

This bibliometric analysis demonstrates the substantial growth of research on PRF in periodontal regeneration and provides an overview of its scientific productivity, citation impact, international collaboration patterns, and conceptual structure. The findings reveal a research landscape predominantly centered on periodontal regeneration, intrabony and furcation defects, growth factors, and wound healing, with distinct geographic patterns in scientific productivity and international collaboration. Although the field has expanded considerably in recent years, bibliometric prominence should not be interpreted as evidence of clinical effectiveness. Future research may benefit from standardized PRF preparation protocols and well-designed multicenter clinical studies evaluating PRF across clearly defined periodontal defects and contemporary regenerative surgical approaches.

Disclosures

Appendix