What is the recommended approach for using liquid Platelet-Rich Plasma (PRP) in the treatment of gingival recession?

Liquid PRF in Gingival Recession Treatment

Critical Clarification: Liquid PRF vs. L-PRF Membranes

Liquid PRF (liquid fibrinogen) is NOT recommended as a standalone treatment for gingival recession coverage—it serves only as a binding agent for bone augmentation procedures, not for root coverage. 1

The evidence base for gingival recession treatment focuses exclusively on L-PRF membranes (solid fibrin matrices), not liquid PRF. 2 These are fundamentally different materials with distinct clinical applications. 1

What Liquid PRF Actually Does

Liquid fibrinogen is prepared by:

• Drawing blood into plastic non-coated tubes (drawn last) 1
• Centrifuging for only 3 minutes, then immediately removing these tubes 1
• Aspirating the yellow fluid before it spontaneously coagulates (within 30 minutes) 1
• Using it to bind chopped L-PRF membranes with bone substitute material to create "L-PRF bone-blocks" for lateral bone augmentation 1

This liquid form has no documented role in treating gingival recession defects. 1

The Correct Approach: L-PRF Membranes for Recession

Surgical Protocol

For gingival recession treatment, use 3-4 solid L-PRF membranes (not liquid) as an adjunct to coronally advanced flap surgery. 2 This approach, recommended by the American Academy of Periodontology, provides:

• Significantly reduced postoperative pain compared to connective tissue grafts 2
• Slightly inferior aesthetic outcomes compared to the gold standard (CTG) 2
• Viable alternative when avoiding palatal harvesting is desired 2

Step-by-Step Technique

1. Create beveled incisions: Two horizontal beveled incisions mesial and distal to recession, positioned at distance equal to recession depth plus 1mm from papillae tips 2

2. Elevate split-full-split flap: Create trapezoidal flap, de-epithelialize papillae, perform thorough root planing 2

3. Prepare L-PRF membranes: Suture together 3-4 L-PRF membranes using absorbable 6-0 sutures (the number/thickness is critical for optimal results) 2

4. Position and stabilize: Place membranes on receptor bed and suture to periosteum for maximum graft stability 2

5. Coronally advance flap: Cover membranes by coronally advancing the flap to achieve primary closure 2

Postoperative Management

• Soft food only with no biting/chewing in treated area for 1 week 2, 3
• No mechanical cleaning of treated area for 1 week 2, 3
• Delay chlorhexidine until day 3-5 to avoid interfering with early healing 3
• 0.12% chlorhexidine rinses twice daily for 1 minute, continuing for at least 3 weeks 2, 3
• Prescribe analgesics as needed (pain reduction is a major advantage of L-PRF) 2

Evidence Limitations and Realistic Expectations

What the Research Shows

The International Society on Thrombosis and Haemostasis notes insufficient data exist to develop evidence-based guidelines for PRP in regenerative medicine due to poor standardization with significant variability in preparation methods, terminology, and quality. 2

First-generation liquid PRP (the older technology) showed no clinical benefit: A 2005 pilot study found that adding liquid PRP to coronally advanced flap provided no clinically measurable enhancements, with 83.5% root coverage for CAF alone versus 81.0% for CAF + liquid PRP (not statistically significant). 4

Second-generation L-PRF membranes (solid form) perform better but still fall short of connective tissue grafts: A 2024 meta-analysis found CTG with CAF showed higher reduction in recession depth compared to A-PRF (advanced PRF) with CAF. 5

Critical Pitfalls to Avoid

• Using liquid fibrinogen for recession coverage will fail—it's designed for bone augmentation only 1
• Using insufficient membrane thickness (fewer than 3-4 membranes) compromises outcomes 2
• Protocol violations or treatment by less experienced clinicians often explain failures 2
• Expecting equivalent aesthetic results to CTG will disappoint patients—L-PRF membranes are slightly inferior aesthetically 2

Alternative Growth Factor Approach

rhPDGF-BB with beta-tricalcium phosphate can promote root coverage with periodontal regeneration (new bone, cementum, and Sharpey fibers), but connective tissue grafts achieve significantly higher recession reduction and percentage of mean root coverage at 6 months. 1 Long-term data shows coverage decreases from 89.85% at 6 months to 74.10% at 5 years with growth factor approaches, versus 89.35% at 5 years with autogenous CTG. 6