Soft tissue healing and bony regeneration of impacted mandibular third molar extraction sockets, following postoperative incorporation of platelet-rich fibrin

Abstract

Introduction:Surgical removal of impacted mandibular third molars is one of the most commonly performed dentoalveolar surgeries by dental surgeons around the globe. It is known to be associated with clinically significant postoperative morbidity including swelling, pain, trismus, fever, and infection. In addition, the residual bony defect takes 7 months to 1 year to gradually fill with bone and to reossify.Aims and Objective:(1) To carry out a prospective study to evaluate differences in soft tissue healing and bony regeneration of impacted mandibular third molar extraction sites, with and without the incorporation of autologous platelet-rich fibrin (PRF) within the surgical wounds. (2) To also compare the incidence of short- and long-term posttreatment complications in both cases.Materials and Methods:Sixty patients were randomly inducted into two groups, consisting of 30 patients each. The first group, which served as the study group, consisted of patients in whom fresh autologous PRF were placed within the extraction site immediately following the surgical removal of the impacted mandibular third molar, before suturing of the mucoperiosteal flap. The second group, which served as the control froup, included those patients in whom the mucoperiosteal flaps were closed without incorporation of PRF within site. Both groups were evaluated and compared for postoperative pain, swelling, trismus, soft tissue healing, as well as bone fill of the extraction socket.Results:It was found that the study group in which autologous PRF had been incorporated into the operative site exhibited quick and complication-free soft tissue healing as well as a much quicker reossification and bone fill of the extraction socket, as compared to the control group in which no PRF was used.Conclusion:Incorporation of PRF within extraction sockets of impacted third molars proved to be beneficial for patients, yielding a quicker postoperative recovery with fewer complications such as postoperative swelling and edema, pain, and trismus; better overall postoperative results in terms of faster soft tissue healing as well as an earlier bony regeneration.

Effects of Autologous Platelet-Rich Fibrin in Post-Extraction Alveolar Sockets: A Randomized, Controlled Split-Mouth Trial in Dogs with Spontaneous Periodontal Disease

“…Many studies evaluating the effect of PRF in alveolar post-extraction sockets have been carried out in humans. In most of these studies, the use of PRF was clearly beneficial [ 13 , 20 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ], while in others the utility of PRF seemed to be more controversial, failing to show enhancement of the socket healing process [ 31 , 32 , 33 ]. In recent systematic reviews, definitive conclusions could not be drawn [ 34 , 35 , 36 , 37 ].…”

Efficacy of sticky bone as a novel autologous graft for mandibular third molar extraction socket healing - An evaluative study

“…Similarly, percentage increase in facial swelling, which was measured using fixed anatomic landmarks in accordance with the findings of multiple studies, reflected significantly better results for the study site up to one week with comparable results present at the end of 14 days. [ 13 18 35 ] These findings reinforce the efficacy of sticky bone in mitigating the adverse postoperative findings of pain and swelling as both sites undergo similar inflammatory process and eliminate any concern due to the presence of alloplastic bone graft in the polymerized mixture. [ 13 15 18 19 35 36 ] Moreover, as socket healing commences, hemostasis and coagulation result in the formation of a clot,[ 37 ] similar for both sites, but with better retention in the study group due the fibrin network of the AFG imparting an obvious mechanical advantage.…”

“…[ 13 18 35 ] These findings reinforce the efficacy of sticky bone in mitigating the adverse postoperative findings of pain and swelling as both sites undergo similar inflammatory process and eliminate any concern due to the presence of alloplastic bone graft in the polymerized mixture. [ 13 15 18 19 35 36 ] Moreover, as socket healing commences, hemostasis and coagulation result in the formation of a clot,[ 37 ] similar for both sites, but with better retention in the study group due the fibrin network of the AFG imparting an obvious mechanical advantage. Thus, the positive results for the study site promulgate its use to lessen patient's discomfort and derive better patient co-operation and compliance.…”

“…[ 17 ] Restoration of bony defect subsequent to surgical trauma represents a challenge in comprehensively treating patients who demand early, socially pleasing, and esthetic restorative options. [ 18 ] Healing of the socket is an intricate process wherein the clot fills the alveolus immediately after extraction, followed by the recruitment of constructive inflammatory cells and growth factors. [ 19 ] The accumulation of granulation tissue within the socket is followed by epithelium migration and the activity of osteoblasts and osteoclasts demonstrates alterations in the dimensions of alveolus, which leads to the deposition of bone within the entire socket with its radiopacity comparable to the adjacent bone at the end of 15 weeks.…”

Molecular and Cellular Aspects of Socket Healing in the Absence and Presence of Graft Materials and Autologous Platelet Concentrates: a Focused Review

“…L-PRP and P-PRP form loose fibrin meshwork after platelet activation and most of the growth factors are released within the first 24 hours of preparation [79]. In contrast, fibrin polymerizes under centrifugation in P-PRF and L-PRF, resulting in strong and dense fibrin network that entraps cells and their growth factors for sustained release, up to 28 days upon application [79,82]. Fibrin matrix is described as a favourable scaffold for mesenchymal stem cells proliferation, differentiation [83], vascular ingrowth [84] and is safe to be left exposed in oral cavity to guide epithelial cell migration to its surface, leading to natural wound reepithelization by secondary intention healing [85,86].…”