Immediate implant placement following tooth extraction is an increasingly used treatment concept in implant dentistry, offering benefits for reduced treatment time and patient satisfaction. However, it remains biologically demanding and requires strict indication, precise surgical execution, and careful patient selection. The simultaneous removal of a non-restorable tooth and placement of an implant in the fresh extraction socket aims to reduce overall treatment time, limit alveolar bone resorption, and improve patient comfort and satisfaction. However, this approach also demands strict biological conditions to ensure predictable osseointegration, soft tissue stability, and long-term prosthetic success (Ghanaati et. al. 2022).

In this context, the adjunctive use of autologous platelet concentrates — most prominently platelet-rich fibrin (PRF) — has gained clinical interest as a means to support early wound healing, particularly in extraction sockets. According to the current S3 Guideline (AWMF Reg.-Nr. 083–042) ( Ghanaati et al. 2022), the main validated indications for PRF are socket closure and ridge preservation. Its role in immediate implant placement is considered promising but not yet evidence based.

PRF aims to enhance the body’s natural healing cascade by providing a fibrin matrix enriched with growth factors, cytokines, and cellular elements directly at the surgical site (Choukroun et al. 2006; Ghanaati et al. 2014). Its proposed benefits include faster soft tissue closure, clot stabilization, improved angiogenesis, and early wound protection — which are particularly relevant to extraction socket healing. For immediate implant placement, these potential benefits remain adjunctive and should not replace established principles of bone grafting and flap management (de Almeida Barros Mourão et al. 2020; Sabri et al. 2024; Clark et al. 2018).

While various platelet concentrates share the goal of delivering autologous regenerative stimuli, PRF differs fundamentally from older PRP protocols in its preparation, structure, and clinical handling. PRP typically requires anticoagulants and exogenous activation, resulting in a liquid or gel that releases growth factors rapidly but lacks a structural scaffold. In contrast, PRF is produced by natural coagulation during immediate centrifugation without additives, forming a fibrin-rich matrix that supports both sustained cytokine release and mechanical wound stabilization (Acerra et al. 2025; Ghanaati et al. 2022).

Despite their growing popularity, robust evidence for the routine use of PRP and PRF in immediate implant placement remains limited. The latest S3 PRF Guideline (AWMF Reg.-Nr. 083–042) concludes that these concentrates can be considered helpful adjuncts to reduce postoperative discomfort and support early tissue healing but should not be viewed as replacements for bone grafts or sound surgical technique (Ghanaati et al. 2022; Choukroun et al. 2006).

This article reviews the biological basis and clinical protocols of PRP, PRF, and other autologous plasma-derived products, with special emphasis on their role in immediate implant placement. To illustrate their practical application, we present representative cases of immediate implant placement. The cases support the practical discussion of how these biologics can be integrated into modern implant workflows when used according to current scientific evidence and official clinical guidelines.

Immediate implant placement involves inserting an implant fixture directly into a fresh extraction socket during the same surgical session. The goal is to preserve alveolar bone and soft tissue contours. However, this approach places higher biological demands on the wound environment and benefits from stable clot formation and soft tissue support, where PRF may play a complementary role (Schiegnitz et al. 2024).

The biological integration of dental implants depends on a precisely coordinated sequence of healing events. After implant placement, the body initiates a cascade of regenerative phases – hemostasis, inflammation, proliferation, and remodeling – that together determine the quality and stability of osseointegration (Bartold & Ivanovski 2025). Each of these phases is governed by specific cellular responses and signaling molecules that influence vascularization, matrix deposition, and bone regeneration (ElHawary et al. 2021; Duda et al. 2023). As illustrated in Fig. 1, the initial formation of a blood clot is followed by immune cell infiltration, neovascularization, and, ultimately, bone remodeling around the implant surface. Autologous platelet concentrates such as PRF aim to modulate and enhance these biological phases by delivering concentrated growth factors and cellular elements directly to the site of healing (Duda et al. 2023; Bartold & Ivanovski 2025). Understanding the cellular mechanisms and temporal sequence of this regenerative process is essential for optimizing the use of PRF and PRP in implant therapy.

• Hemostasis: Immediately post-placement, a blood clot forms at the surgical site, initiating fibrin polymerization and platelet activation.
• Inflammation: Immune cells, including neutrophils and macrophages, infiltrate the site to clear debris and secrete cytokines and growth factors.
• Proliferation: Angiogenesis is activated, and granulation tissue forms; fibroblasts deposit collagen, and pre-osteoblasts migrate toward the implant surface.
• Remodeling: New bone is deposited, and woven bone matures into lamellar bone, securing long-term osseointegration of the implant.

This phase-dependent process underscores the importance of a stable healing environment, which may be enhanced by autologous biologics such as PRP and PRF.

Their proposed effect is not only to accelerate early angiogenesis and fibroblast migration but also to stabilize the clot mechanically (in the case of PRF), providing a biologic scaffold that supports cell ingrowth (Srinivas et al. 2018). However, as the S3 PRF Guideline clearly states, these benefits are adjunctive: no autologous blood concentrate can substitute for sound surgical principles such as precise implant positioning, flap design, or the use of appropriate bone graft materials where indicated (Ghanaati et al. 2022).

Understanding this biological basis is critical when planning immediate implants, especially when patient factors such as thin biotype, local inflammation, or poor bone density present additional challenges to predictable healing (Iram et al. 2024).

In oral implantology, enhancing wound healing and promoting tissue regeneration is of increasing clinical importance, particularly in immediate implant placement, alveolar ridge preservation, and augmentation procedures. Against this background, autologous blood concentrates such as platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) have emerged as widely used adjunctive therapies.

Both PRP and PRF are platelet-rich preparations derived from the patient's own blood, processed without the addition of foreign materials or drugs. Their regenerative potential is attributed to a high concentration of biologically active components – especially growth factors such as platelet-derived growth factor (PDGF), transforming growth factor beta (TGF-β1), and vascular endothelial growth factor (VEGF) – which play a central role in angiogenesis, cell migration, and proliferation (Marín Fermín et al. 2024). While PRP requires anticoagulants and exogenous activation (commonly with calcium chloride or thrombin), PRF is produced through a natural coagulation process initiated by simple centrifugation in glass or silica tubes. This results in the formation of a fibrin-rich matrix that serves as both a biologic scaffold and a sustained-release system for growth factors.

PRP and PRF are not currently considered to replace graft materials but are primarily used to support healing processes, improve tissue quality, and enhance early-stage regeneration in a variety of implant-related indications. According to the S3 PRF Guideline (AWMF Reg.-Nr. 083–042) (Ghanaati et al. 2022), these preparations may contribute to improved healing when used in clinically appropriate contexts but should be regarded as adjunctive, not essential, elements of treatment planning.