Medication-related osteonecrosis of the jaw (MRONJ) is a challenging complication linked primarily to bisphosphonate therapy, resulting in impaired osteoclast activity and altered bone remodelling. Current preventive strategies focus on optimizing systemic conditions, evaluating the risks of antiresorptive treatment, and exploring adjunctive regenerative approaches such as platelet-rich fibrin (PRF). As interest grows in biologically driven therapies, this study aims to evaluate the effectiveness of PRF in the prevention and treatment of MRONJ and to identify areas requiring further high-quality research.

A systematic review and meta-analysis was conducted in accordance with PRISMA and MOOSE guidelines, including English-language studies published between 2013 and 2023. Comprehensive searches were performed across MEDLINE, Scopus, and Web of Science. Study quality was assessed using the Cochrane Collaboration’s risk-of-bias tool for randomized studies and the Newcastle–Ottawa Scale (NOS) for observational studies. The primary outcomes evaluated were MRONJ resolution rates, healing progression, and absence of infection in cases treated with PRF compared with conventional medical management.

A total of 11 studies involving 480 patients with MRONJ were included. The findings demonstrate that PRF provides significant therapeutic benefits, particularly in early-stage disease. In stage 1 MRONJ, PRF showed superior outcomes compared with conventional medical therapy (OR: 2.93, 95% CI: 1.54–5.59, P = 0.001). Improved results were also noted at the mandibular site (OR: 1.65, 95% CI: 0.86–3.17, P = 0.13), although the difference did not reach statistical significance. Overall, PRF was associated with markedly enhanced healing outcomes (OR: 4.45, 95% CI: 1.58–12.53, P = 0.005), supporting its role as a promising adjunct in selected MRONJ management protocols.

In conclusion, this review underscores the potential value of PRF in early MRONJ treatment and in specific anatomical contexts. Despite limitations in the existing literature, the evidence supports further rigorous investigation and suggests that PRF may serve as an effective adjunctive tool in MRONJ surgical and regenerative management.

Dr. Marwan Aljohani completed his clinical PhD in Oral and Maxillofacial Surgery (OMFS) at the University of Manchester in the United Kingdom in 2022. He is currently working as a Consultant and Assistant Professor of OMFS, teaching both undergraduate and postgraduate students, as well as providing clinical care in his specialty. Dr. Aljohani has also published more than 21 papers in international peer-reviewed journals.