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

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.