Prevention of Localized Osteitis in Mandibular Third-Molar Sites Using Platelet-Rich Fibrin

Abstract

Purpose. To review our experience utilizing platelet rich fibrin (PRF), which is reported to aid in wound healing of extraction sites, for the prevention of localized osteitis following lower third-molar removal. Materials and Methods. PRF was placed in the mandibular third-molar extraction sites, 200 sites total, on 100 consecutive patients treated in our practice, by the authors. The patients were managed with standard surgical techniques, intraoperative IV antibiotic/steroid coverage, and routine postoperative narcotic analgesics/short-term steroid coverage. All patients were reevaluated for localized osteitis within 7–10 days of the surgery. A comparison group consisted of 100 consecutive patients who underwent bilateral removal of indicated mandibular wisdom teeth and did not receive PRF placement within the lower third molar surgical sites. Results. The incidence of localized osteitis (LO) following removal of 200 lower third molars with simultaneous PRF placement within the extraction site was 1% (2 sites out of 200). The group of patients whose mandibular 3rd molar sockets were not treated with PRF demonstrated a 9.5% (19 sites out of 200) incidence of localized osteitis. The latter group also required 6.5 hours of additional clinical time to manage LO than the study group who received PRF. Conclusions. This retrospective review demonstrated that preventative treatment of localized osteitis can be accomplished using a low cost, autogenous, soluble, biologic material, PRF, that PRF enhanced third-molar socket healing/clot retention and greatly decreased the clinical time required for postoperative management of LO.

Optimized Platelet‐Rich Fibrin With the Low‐Speed Concept: Growth Factor Release, Biocompatibility, and Cellular Response

“…Another important aspect of leukocyte biology that has not been discussed in this study, but again shows much clinical relevance, is the fact leukocytes are the responsible cell type acting to prevent infiltrating pathogens 32 , 33 . In light of this fact, it becomes of interest to note that PRF placed into extraction sockets has been shown to greatly decrease the rate of complications and infections 8 . Hoaglin and Lines 8 reported that filling third molar extraction sockets with PRF led to a 10‐fold decrease in osteomyelitis infections compared with natural healing.…”

“…In light of this fact, it becomes of interest to note that PRF placed into extraction sockets has been shown to greatly decrease the rate of complications and infections 8 . Hoaglin and Lines 8 reported that filling third molar extraction sockets with PRF led to a 10‐fold decrease in osteomyelitis infections compared with natural healing. This study, performed on 200 patients, used bilateral extractions (one side filled with PRF, the other left to naturally heal) and provided good scientific evidence for the reduced rate of infection after healing with PRF 8 …”

“…Since its introduction in 2001, 1 PRF has been extensively used in dentistry for a variety of procedures, and its effectiveness has been demonstrated for extraction socket management, 8 gingival recessions, 9–11 intrabony defect regeneration, 12 , 13 and sinus elevation procedures 7 . Major advantages include having completely immune‐compatible growth factors collected at relatively no costs without anticoagulants 14–17 .…”

The use of bioactive factors to enhance bone regeneration: A narrative review

“…Most of the available RCTs and controlled studies comparing L‐PRF to unassisted socket healing reported a benefit when L‐PRF was applied in terms of early (up to 8 weeks) (Alzahrani, Murriky & Shafik, ; Hauser, Gaydarov, Badoud, Vazquez & Bernard, ) and late (up to 16 weeks) (Temmerman, Vandessel, Castro, Jacobs & Teughels, ; Varghese, Manuel & Kumar, ) radiographic bone fill and horizontal/vertical alveolar preservation (Appendix S3), faster soft tissue healing, reduced pain and reduced post‐extraction sequelae (Marenzi, Riccitiello, Tia, Lauro & Sammartino, ; Ozgul, Senses, Er, Tekin & Tuz, ; Singh, Kohli & Gupta, ; Suttapreyasri & Leepong, ; Temmerman et al., ; Varghese et al., ; Zhang, Ruan, Shen, Tan & Huang, ). Moreover, the use of L‐PRF in third molars’ extractions has been associated with an improvement in second molars’ periodontal parameters (Kumar, Prasad, Ramanujam, Dexith & Chauhan, ) and a nearly tenfold decrease in the incidence of osteomyelitis compared to natural healing (Hoaglin & Lines, ). However, other RCTs and controlled studies did not confirm significant advantages when comparing L‐PRF to unassisted socket healing in terms of alveolar bone resorption and bone density (Girish Rao, Bhat, Nagesh, Rao & Mirle, ; Srinivas, Das, Rana, Qureshi & Vaidya, ; Zhang et al., ), periodontal parameters (Baslarli, Tumer, Ugur & Vatankulu, ), bone scintigraphy outcomes (Baslarli et al., ; Gurbuzer, Pikdoken, Urhan, Suer & Narin, ), post‐operative morbidities, prevention of dry socket and soft tissue closure (Asmael, Jamil & Hasan, ; Asutay, Yolcu, Gecor, Acar & Ozturk, ; Yerke, Jamjoom, Zahid & Cohen, ).…”

Treatment of Dry Socket With Platelet-Rich Fibrin

“…[7] Dry socket causes serious physical suffering for the patient, requires extra time and resources for its treatment, making it a socially significant illness. [8] The etiology of dry socket is not fully clarified, but the fibrinolysis and collapse of the blood coagulum as a result of bacterial invasion is the most common cause. [9] The causes of dry socket may be different: traumatic extraction, age, sex, smoking, contraceptive use, high concentration anesthetic, intraligamentary anesthesia, localization of the tooth, etc.…”