Effect of Advanced Platelet-rich Fibrin on Wound Healing after Third Molar Extraction: A Split-mouth Randomized Double-blind Study

Abstract

Aim: To evaluate the potential of advanced platelet-rich fibrin (A-PRF) as a regenerative biomaterial for bone regeneration and postoperative sequelae after impacted third molar extractions. Materials and methods: This was a split-mouth, randomized, double-blind clinical trial. A total of 10 female patients in King Abdulaziz University Dental Hospital with bilateral impacted third molars were recruited into the study. Surgical extractions were performed on both sides of the mandible. Randomization was done by a coin toss; A-PRF was placed on the one side while the other side did not receive any intervention. Each patient acted as their own control. Both the patients and the investigators were blinded about the A-PRF side. The outcome on periodontal regeneration was made measuring pocket depth (PD), gum recession (GR), and clinical attachment level (CAL) before and at 1-and 3-months postoperatively. Pain, swelling, and healing were assessed on the 7th postoperative day. p value less than 0.05 was considered statistically significant.Results: An estimated 10 patients completed the study. There were no significant differences in PD, CAL, and GR between the two groups at any time point, although the data obtained were slightly favoring the A-PRF. However, a statistically significant reduction in pain and swelling was observed in the A-PRF group compared to the controls (p < 0.05). Conclusion:The findings of this study demonstrate A-PRF as a potential biomaterial for lessening the severity of pain and swelling after third molar surgery. Long-term trials with a larger sample size and more methodically sound assessment tools are needed to obtain more meaningful results on periodontal regeneration. Clinical significance: Placement of A-PRF clot in the extraction socket could lessen postoperative pain and increase patient comfort after third molar extraction. Trial registration: NCT03703479. Registered

The Use of Autogenous Particulated Dentin Mixed With Platelet Rich Fibrin in Surgically Removed Lower Third Molar Socket.

“…Results of the present study is in accordance with that of many investigators (23)(24)(25)(26) who found that grafting the distal to mandibular second molars resulted in a significant reduction in the probing pocket depth and clinical attachment level gain and in disagreement with Tabrizi et al (27) and Zahid and Nadershah (15) who found no difference in PD and CAL between the grafted and no grafted groups.…”

“…In spite of the great advantages of PRF in healing process, PRF single use seems to have no beneficial role in bone healing and have no effect on the periodontal status of the lower second molars after extraction of the mandibular third molars. The findings of Zahid and Nadershah (15) study demonstrated that A-PRF successfully act as a potential biomaterial for lessening the severity of pain and swelling after third molar surgery. They concluded that long-term trials with a larger sample size and more methodically sound assessment tools are needed to obtain more meaningful results on periodontal regeneration.…”

The Growth Factors in Advanced Platelet-Rich Fibrin (A-PRF) Reduce Postoperative Complications after Mandibular Third Molar Odontectomy

“…The authors emphasize that the incorrect assessment of pain may have been influenced by the fact that the procedures in all patients were performed bilaterally during one visit [ 37 ]. Zahid and Nadershah [ 38 ] performed a similar study. A statistically significant reduction in the pain was observed in the A-PRF side compared with the controls.…”

Non-conventional therapies for analgesia

“…In some articles, there was an efficient control with PRF for the items pain, edema, trismus, and bone repair accelerator (Zahid & Nadershah, 2019;Yüce & Kömerik, 2019;Kapse et al, 2019;Daugela et al, 2018;Kumar et al, 2015). However, some studies reported no significant effect in controlling pain, edema, and postoperative trismos (Torul et al, 2020;Ritto et al, 2019;Asutay et al, 2017) although the acceleration of tissue repair in the region is evident.…”

“…The articles that rated the effectiveness of platelet concentrates in controlling of postoperative pain in third molar surgery were the ones that presented the most significant amount of risk of bias. The small number of patients studied (Zahid & Nadershah, 2019) and the lack of an adequate placebo control group were some of them (Caymaz & Uyanik 2019;Afat et al, 2018). Although several studies on platelet concentrates on third molar surgery, the vast majority have been about socket healing, edema, and pain.…”