L-PRF membranes for recession coverage
Introduction
Gingival recession is a highly prevalent condition, affecting over 95% of individuals (Romandini et al. 2020). If untreated, it has a high likelihood of progression over time (Rios et al. 2021). Although gingival recession is not directly associated with tooth loss, it can lead to negative sequelae, such as esthetic concerns, dental hypersensitivity, and carious/non-carious cervical lesions. A substantial body of evidence supports the efficacy of combining a coronally advanced flap (CAF) with a connective tissue graft (CTG) for root coverage, which is currently considered the gold standard treatment. However, CTG harvesting is associated with several drawbacks, including postoperative discomfort, extended recovery time, injury to the greater palatine artery, intra- and postoperative bleeding, necrosis of the palatal flap, sensory disorders, and epithelial cyst formation at the treated site (Travelli et al., 2022). Numerous randomized controlled trials (RCTs) indicate that L-PRF membranes can be considered a viable alternative to CTG.
Protocol: step by step
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prepare incisions,
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elevate a trapezoidal-shaped flap with a split-full-split approach in coronal-apical direction,
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de-epithelialize the papillae,
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complete an optimal root planing,
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suture several L-PRF membranes together (absorbable sutures),
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place the L-PRF graft on the exposed connective tissue (receptor bed), over the recession(s) and the exposed bone, and suture it to the periosteum,
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suture with a coronally advanced flap, ensuring it stays passively in position to cover the graft (stabilize with interrupted sutures, sling sutures in the most coronal aspect of the papillae),
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inform the patient about postoperative care, including changes in food intake and oral hygiene.
step-by-step flow chart
Cases
(d = day, w = week, m = month, y = year)
1: Multiple recession coverage: CAF with double layer L-PRF membranes
d 0: multiple recessions, but the patient refused a free gingival graft.
d 0: superficial incisions.
d 0: elevated flap with a split-full-split approach in coronal-apical direction and de-epithelialized papillae.
d 0: the L-PRF graft (several layers thick) is placed on the receptor bed, and over the recession(s) and exposed bone; the graft is sutured to periosteum.
d 0: stabilisation of tension-free, coronally advanced flap.
6 m: nearly complete coverage of all recessions.
Before and 1 year after recession therapy with an acceptable outcome, considering the fact that a connective tissue graft (CTG) was not used.
Courtesy S. Yilmaz
Data:
RCTs comparing a CAF + connective tissue graft with a CAF + L-PRF only
Abbreviations: RCT = randomized controlled trial, CAF = coronally advanced flap, CTG = connective tissue graft, L-PRF = leukocyte- and platelet-rich fibrin, TUN = tunnel technique, VISTA = vestibular incision subperiosteal tunnel approach, KTW = keratinized tissue width, mRC, mean root coverage, SD = standard deviation.
Conclusion
Twelve RCTs explored the effectiveness of a coronally advanced flap (CAF) + L-PRF membranes underneath for treating type 1 gingival recessions (without interproximal attachment loss or noticeable tooth displacement), relative to the gold standard treatment, a CAF + a connective tissue graft (CTG). When considering all studies together (297 sites treated with CTG, 312 with L-PRF), the overall mean percentage of root coverage was 86.6 % for a CTG and 81.9 % for sites with L-PRF (updated from Barootchi et al. 2025).
Although 9 of the 12 studies reported superior results for a CTG, the overall difference is minimal. Furthermore, the L-PRF approach offers significant advantages in patient-reported outcome measures, as it eliminates the need for harvesting a CTG.
Important notice
Clinical experience:
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To achieve optimal results, it is recommended to apply 4 layers of L-PRF membranes under the coronally advanced flap. Culhaoglu and co-workers (2018) reported a root coverage of 80% for a CTG, 70% when using 4 L-PRF membranes, versus 56% when applying only 2 L-PRF membranes.
Additional Benefits:
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Improved patient-reported outcome measures (PROMs), including reduced pain, less postoperative bleeding, and faster soft-tissue healing.
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The treatment is easier because there is no need for a connective tissue graft harvesting.
What is the benefit of adding L-PRF membranes to a CAF when compared to a CAF alone?
The impact of adding L-PRF membranes under the coronally advanced flap during recession coverage was confirmed in a recent systematic review with network meta-analysis (Barootchi et al. 2025). The combination of CAF and L-PRF demonstrated a statistically significant higher "mean root coverage" than CAF alone, with an estimated difference of 6.1% (95% CI [1.83,10.42], p=0.02).
Interesting references
Several videos and/or cases on this webpage are discussed more in detail in the following book: Quirynen M & Pinto N 2022. Leukocyte- and Platelet-Rich Fibrin in Oral Regenerative Procedures. Quintessence Publishing;
ISBN: 978-1-78698-105-9