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

Abstract

Surgical removal of impacted mandibular third molars constitutes one of the most frequently performed procedures within oral surgery. This surgery procedure is associated with many post-operative complications. Advanced platelet-rich fibrin (A-PRF) belongs to the second generation of platelet concentrates and is rich in numerous growth factors. The aim of this study was to assess the influence of A-PRF on selected clinical features following the surgical removal of impacted mandibular third molars. The research was conducted on 100 generally healthy patients, who underwent a lower third molar odontectomy in Department of Oral Surgery, Medical University of Gdańsk, Poland, between 2018 and 2019. The research group consisted of 50 patients (immediate A-PRF socket filling) and control group (50 patients without A-PRF socket filling). During the study, the following clinical features were assessed: pain (visual analog scale), analgesics intake, the presence of trismus, edema, hematomas within the surrounding tissues (e.g., cheek), prevalence of pyrexia, dry socket, secondary bleeding, presence of hematomas, skin warmth in the post-operative area, and bleeding time observed by the patient were analyzed on the 3rd, 7th, and 14th day after the procedure. There was a significant association between A-PRF socket filling and pain intensity, the analgesics intake, trismus, and edema on the 3rd and the 7th day (p < 0.05). The presence of hematomas and skin warmth on the 3rd day after the surgery (p < 0.05) were also statistically associated with A-PRF use. The study showed that in reducing the incidence of postoperative complications, A-PRF was more important than the position of the tooth or the duration of the procedure. The growth factors in A-PRF reduce postoperative complications, such as pain, trismus, edema, analgesics intake, presence of hematomas, and skin warmth, after mandibular wisdom teeth odontectomy.

The Influence of the Hyaluronic Acid Gel on the Postoperative Sequelae following Surgical Removal of the Impacted Mandibular Third Molar in Comparison with the A-PRF: A Randomized Controlled Trial

“…This study showed that pain significantly decreased in both HA and A-PRF groups compared to the control group. These results agreed with several previous studies demonstrating the effectiveness of HA gel or A-PRF in reducing postoperative pain [ 1 , 16 , 17 ].…”

“…The antiedematous properties of HA could be attributed to its osmotic buffering capabilities in addition to delaying leukocyte migration via adhering to its receptor CD44 [ 29 , 30 ], and the antiedematous properties of A-PRF could be attributed to its ability in minimizing the risk of inflammation in the surgical site [ 1 ].…”

“…Other clinical signs, including facial or neck hematomas, persistent alveolus bleeding, pyrexia, and dry socket symptoms, may be observed. These symptoms are prevalent after mandibular third molar surgical removal, considered one of the most challenging and time-consuming oral surgical procedures [ 1 ].…”

Effect of Leucocyte and Platelet Rich Fibrin (L-PRF) in Postoperative Sequelae of Impacted Mandibular Third Molar Surgery - A Split Mouth Randomized Controlled Trial

“…The factors that determine the difficulty of the surgical procedure of avulsion of the third molar are depth and space available for removal of the impacted mandibular third molar, the angulation of the tooth, root spacing, size of the bone septum, presence or absence of a dilated tooth follicle, periodontal space, bone density, and the relation to the inferior alveolar nerve. Other factors that influence the occurrence of non-infectious complications after this procedure are the experience of the surgeon, the choice of the operating method, the time of the procedure, and soft tissue trauma (14). The regenerative potential of platelets has been harnessed and used in the field of oral and maxillofacial surgery.…”

Efficacy of submucosal injection of hyaluronidase after mandibular third molar surgery: a randomized controlled trial

“…Previous studies assessed various modalities including systemic or local corticosteroids 3 , 18 , 19 , natural substance 2 , platelet concentrates 20 , 21 , and adjuvant laser therapy 22 for reducing postoperative swelling and trismus or pain after surgical extraction of M3M. For several decades in the area of dentistry or maxillofacial surgery, HUD, has been investigated in only a few studies regarding postoperative swelling after guided bone regeneration (GBR) with simultaneous dental implant placement 23 or efficacy of anesthesia for irreversible pulpitis 9 .…”