Injectable platelet-rich fibrin based interventions for treatment of gingival black triangles: systematic review of clinical evidence.

Gingival black triangles, resulting from loss of the interdental papilla (IDP), adversely affect esthetics, phonetics, and periodontal health, and injectable platelet-rich fibrin (i-PRF) a growth factor-rich platelet concentrate, has emerged as a promising minimally invasive regenerative approach for papilla reconstruction. This study evaluates the clinical effectiveness of i-PRF in the management of gingival black triangles and IDP deficiencies. A systematic review was conducted according to PRISMA 2020 guidelines and registered in PROSPERO (CRD420261321819). Electronic searches of studies including human studies were performed for studies published between 2020 and 2025. Risk of bias was assessed using the Cochrane risk-of-bias tool for randomized trials and the JBI checklists for case reports and series. Fourteen studies met the inclusion criteria, including randomized controlled trials (RCTs), pilot studies, case series, and case reports. Most studies reported improvements in papillary height, papilla presence index, and reduction in black triangle dimensions following i-PRF therapy. Clinical outcomes were generally comparable to hyaluronic acid injections and connective tissue graft procedures, with reduced invasiveness and postoperative discomfort. i-PRF appears to be a promising minimally invasive option for managing gingival black triangles; however, larger RCTs with longer follow-up are needed to confirm long-term effectiveness.