Do Platelet-Rich Concentrates Improve the Adverse Sequelae of Impacted Mandibular Third Molar Removal?

Amir Yari; Paniz Fasih; Nader Ghotbi; Ashkan Badkoobeh; Ali Goodarzi; Mohammad Hosseini Hooshiar

doi:10.1016/j.joms.2024.02.014

Do Platelet-Rich Concentrates Improve the Adverse Sequelae of Impacted Mandibular Third Molar Removal?

J Oral Maxillofac Surg. 2024 Mar 5:S0278-2391(24)00130-7. doi: 10.1016/j.joms.2024.02.014. Online ahead of print.

Authors

Amir Yari¹, Paniz Fasih², Nader Ghotbi³, Ashkan Badkoobeh⁴, Ali Goodarzi⁵, Mohammad Hosseini Hooshiar⁶

Affiliations

¹ Assistant Professor, Department of Oral and Maxillofacial Surgery, School of Dentistry, Kashan University of Medical Sciences, Kashan, Iran. Electronic address: amir.yari@hotmail.com.
² Assistant Professor, Department of Prosthodontics, School of Dentistry, Kashan University of Medical Sciences, Kashan, Iran.
³ General Dentist, Isfahan Azad University, School of Dentistry, Isfahan, Iran.
⁴ Department of Oral and Maxillofacial Surgery, School of Dentistry, Qom University of Medical Sciences, Qom, Iran.
⁵ Department of Oral and Maxillofacial Surgery, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran.
⁶ Dental Research Center, Dentistry Research Institute, Tehran University of Medical Sciences & Department of Periodontology, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran. Electronic address: smh.hooshiar@gmail.com.

PMID: 38513712
DOI: 10.1016/j.joms.2024.02.014

Abstract

Background: Several measures have been implemented to minimize the side effects of impacted third molar (M3) removal including the use of platelet-rich fibrin (PRF).

Purpose: This study compared the effects of three modifications of PRF (leukocyte-PRF [L-PRF], advanced-PRF [A-PRF], and advanced-PRF plus [A-PRF +]) on the side effects of impacted M3 removal.

Study design, setting, and sample: This double-blinded randomized controlled trial was conducted at the Oral Surgery Department of Kashan University between September 2022 and May 2023 on patients undergoing mandibular impacted M3 removal. Exclusion criteria were age over 30, local inflammation and infection, medication usage, and systemic disease.

Independent variable: The independent variable was the PRF product grouped into four categories (control, L-PRF, A-PRF, and A-PRF+). Study subjects were randomly distributed among the four groups.

Main outcome variable(s): The main outcome variables were postoperative sequelae including measures of soft tissue healing, pain, analgesic use, alveolar osteitis, trismus, and swelling. Subjects were assessed at baseline and on days 1, 2, 3, and 7 postsurgery.

Covariates: Age, sex, duration of surgery, and side of surgery were the covariates.

Analyses: Changes at different time points were analyzed using repeated measures analysis of variance. Pairwise comparisons were performed if significant. P values ≤.05 were considered statistically significant.

Results: The sample consisted of 64 subjects (16 per group). All three modifications of PRF yielded significantly better soft tissue healing index than the control group on days 2, 3, 7, and 14 postoperatively (P > .05). A-PRF and A-PRF + had significantly better healing index than L-PRF on the third day (P = .02, P = .01). All the study groups significantly reduced visual analog scale pain score than the control group on days 1, 2, and 3. A-PRF and A-PRF + had significantly lower visual analog scale scores than L-PRF on the second day (P = .003, P = .02). No significant difference was found in maximum mouth opening during follow-up sessions (P = .2). Study groups had less facial swelling on days 2 and 3 than the control group (P < .05).

Conclusion and relevance: L-PRF, A-PRF, and A-PRF + can improve postoperative outcomes after M3 removal but may not impact trismus. A-PRF and A-PRF + may be more effective than L-PRF in promoting soft tissue healing and reducing pain. A-PRF and A-PRF + have comparable results.