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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 15  |  Issue : 1  |  Page : 21-30

Efficacy of platelet-rich fibrin on pain, edema, and healing in mandibular third molar surgery: A split-mouth randomized study


Department of Oral and Maxillofacial Surgery, Army Dental Centre (Research and Referral), New Delhi, India

Date of Submission22-Jul-2020
Date of Acceptance02-Dec-2020
Date of Web Publication09-Mar-2021

Correspondence Address:
Sadhana Jayanth Perumal
Department of Oral and Maxillofacial Surgery, Army Dental Centre (Research and Referral), Delhi Cantt, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JODD.JODD_48_20

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  Abstract 


Context: The postoperative sequelae after third molar surgery include pain, swelling and trismus, distal bone loss along with prolonged sensitivity due to root exposure or increased probing depth. Platelet rich fibrin (PRF) appears to accelerate physiologic healing due to the development of effective neovascularization, accelerated wound closing with fast cicatricial tissue remodelling and reduced incidence of infectious events. The mechanism of action of PRF on pain and edema is not fully understood and it is possible that this effect could be a reflection of better and faster healing of the socket.
Aim: The aim is to assess the influence of PRF on pain, edema, and wound healing of the socket after surgical extraction of mandibular third molars.
Settings and Design: This randomized controlled study was conducted on 60 patients with bilateral impacted mandibular third molars, reporting to the Department of Oral and Maxillofacial Surgery, Army Dental Centre (Research and Referral).
Subjects and Methods: Surgical removal of the impacted mandibular molars of both sides was planned with a gap of 4 weeks between the two sides and appointments were given accordingly. Study side-Surgical extraction followed by placement of PRF in socket and closure and control side-Surgical extraction followed by closure.
Statistical Analysis: Preoperative and postoperative measurement of visual analog scale scores for pain, edema, interincisal opening, and gray level histogram values of orthopantomograph was subjected to statistical analysis. The normality of data was analyzed using the Kolmogorov–Smirnov test. The Mann–Whitney U and Wilcoxon Signed-Rank tests were used to check mean differences.
Results: We observed a reduction in pain and swelling with improvement in interincisal and greater reduction in pocket depth distal to the second molar on the PRF side. Soft-tissue healing index scores and gray level histogram values for the study side were higher compared to the control side.
Conclusions: Further clinical studies to evaluate and assess the applications of PRF in maxillofacial surgery are needed.

Keywords: Healing, platelet-rich fibrin, postoperative sequelae, third molar


How to cite this article:
Roy I D, Saxena V, N Babu B K, Perumal SJ. Efficacy of platelet-rich fibrin on pain, edema, and healing in mandibular third molar surgery: A split-mouth randomized study. J Dent Def Sect. 2021;15:21-30

How to cite this URL:
Roy I D, Saxena V, N Babu B K, Perumal SJ. Efficacy of platelet-rich fibrin on pain, edema, and healing in mandibular third molar surgery: A split-mouth randomized study. J Dent Def Sect. [serial online] 2021 [cited 2021 Apr 18];15:21-30. Available from: http://www.journaldds.org/text.asp?2021/15/1/21/310964




  Introduction Top


Wound healing is a natural response to tissue injury involving a cascade of complex, orderly, and elaborate events guided by the release of soluble mediators and signals capable of influencing the accumulation of circulating cells at the injury site. Tissue recovery is stimulated by blood plasma, various growth factors, and cytokines produced by platelets.[1],[2] Surgical extraction of impacted mandibular third molars is one of the most performed procedure by Oral and Maxillofacial surgeons. The immediate postoperative sequelae after third molar surgery include pain, swelling, and trismus. The delayed sequelae are mostly seen on the distal surface of the second molar due to the distal bone loss, which includes prolonged sensitivity due to root exposure or increased probing depth.[3],[4]

Platelets and especially the growth factors they contain in combination with plasma proteins are expected to participate in tissue regeneration, healing process, and blood clot formation. The primary intention for the application of platelet concentrates in clinics is the activation of proliferation, migration, and differentiation of the available cell reserve in the wound area, ultimately leading to a successful regenerative process. This is of high importance, especially when the number of cells in the place of tissue injury is reduced.[5] Among the biomaterials being used, which are based on the function of platelets, are platelet-rich plasma (PRP) and platelet-rich fibrin (PRF).[6],[7]

PRF basically consists of a fibrin matrix polymerized in a tetramolecular structure, with incorporated platelets, leukocyte, cytokines, and circulating stem cells along with leukocyte derived cytokines, platelet-derived growth factor (PDGF), transforming growth factor-beta (TGF-β), epidermal growth factor (EGF), fibroblast growth factor (FGF), KGF, insulin-like growth factor (IGF), platelet-derived EGF, interleukin 8 (IL-8), tumor necrosis factor (TNF ) alpha, connective tissue growth factor (CTGF), and granulocyte macrophage-colony-stimulating factor.[8],[9],[10],[11] The slow fibrin polymerization during PRF processing leads to the intrinsic incorporation of platelet cytokines and glycan chains in the fibrin meshes. From a clinical standpoint, this biomaterial appears to accelerate physiologic healing due to the development of effective neovascularization, accelerated wound closing with fast cicatricial tissue remodeling, and reduced incidence of infectious events. The mechanism of action of PRF on pain and edema is not fully understood and it is possible that this effect of PRF could be a reflection of better and faster healing of the socket.

At present, the clinical evidence regarding the effect of PRF on the postoperative sequelae, i.e., pain and edema after third molar surgery, is sparse. Therefore, this study was conducted to assess the influence of PRF on pain, edema, and wound healing of the socket after surgical extraction of mandibular third molars.


  Subjects and Methods Top


This randomized controlled study was conducted on sixty patients with bilateral impacted mandibular third molars patients, reporting to the Department of Oral and Maxillofacial Surgery, Army Dental Centre (Research and Referral), fulfilling the inclusion criteria. The period of study was from November 1, 2017, to February 28, 2019. Individuals between the age of 18–35 years, with bilateral impacted third molars falling under the similar classification as per Pell and Gregory classification and without significant medical diseases or any blood dyscrasias, were included in the study. Exclusion criteria included individuals with active suppuration or pathology in relation to the tooth, inflammatory or connective tissue diseases, allergy to local anesthetics, history of long-term medications, and chronic medications with antihistamines, nonsteroidal anti-inflammatory drugs, steroids, and antidepressants. Informed written consent was obtained from all the patients included in the study. Surgical removal of the impacted mandibular molars of both sides was planned with a gap of 4 weeks between the two sides, and appointments were given accordingly. The selection of sides for control and intervention was made by the lottery method. Study side-surgical extraction followed by placement of PRF in socket and closure with 3-0 silk sutures and control side-surgical extraction followed by closure with 3-0 silk sutures.

Procedure

A standardized operative procedure was carried out by a single right-handed operator for all the patients after preoperative evaluation. As per departmental protocol, the instruments required for the procedure were autoclaved and laid out on a trolley [Figure 1]. The patient was made to rinse with 0.12% chlorhexidine for 30 s. Aseptic scrubbing and draping were done. Under strict aseptic precautions, 2 ml of 2% lignocaine with 1:80,000 adrenaline was used for an inferior alveolar nerve block, lingual nerve block, and long buccal nerve block. A standard Ward's incision or a modified Ward's incision was given for all the cases. In cases where the crown or part of crown of the tooth was visible intraorally, a standard ward's incision was placed. In cases where the tooth was completely covered by mucosa, a modified ward's incision was placed. To eliminate bias, the same incision was planned and placed for the control and study side. A full-thickness mucoperiosteal flap was raised to expose the tooth and surrounding alveolar bone. Moore and Gilby collar technique for bone removal was used in all cases. Buccal bone guttering was done using a round bur and a straight fissure bur no 701. The radiographs were analyzed preoperatively and the arc of rotation of the tooth was determined. Tooth sectioning was done using a straight fissure bur no 703 if interference to removal was found on analysis. The tooth was then delivered using elevators. After extraction, granulation tissue, follicular remnants and bony spicules were removed from the socket and then the socket was irrigated with 50 ml of isotonic saline solution [Figure 2]a,[Figure 2]b,[Figure 2]c.On the study side, the socket was filled with PRF clot, and the flap was primarily closed with 3-0 silk sutures [Figure 3]a and [Figure 3]b. On the control side, primary closure of the extraction was done using 3-0 silk sutures [Figure 4]a and [Figure 4]b.
Figure 1: Instrument trolley

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Figure 2: (a-c) Tooth removal

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Figure 3: (a and b) Study side

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Figure 4: (a and b) Control side

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Method of preparation of autologous platelet-rich fibrin

Five milliliters of whole venous blood of the patient was drawn [Figure 5]a and [Figure 5]b and collected in a sterile test tube without anticoagulant [Figure 6]a. The test tube was then placed in a centrifugal machine and centrifuged at 3000 revolutions/min for 10 min in MedicoTM R-303 centrifuge [Figure 6]b.
Figure 5: (a and b) Blood collection

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Figure 6: ( a) Collection of blood in sterile test tube. (b) MedicaTM R-303 centrifuge

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The blood in the test tube settled into the following layers [Figure 7]a:
Figure 7: (a) Test tube with the three separate layers. (b) Collection of PRF

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  • Red lower fraction containing red blood cells
  • Upper straw-colored cellular plasma
  • Middle fraction containing the fibrin clot.


The upper straw-colored layer was discarded and the middle fraction collected, 2 mm below the lower dividing line, which is the PRF [Figure 7]b. This was manipulated carefully and placed into the socket.

Postoperative care

Postoperatively, all patients were prescribed a 3-day course of amoxicillin + clavulanate 1000 mg-twice daily, tinidazole 500 mg-twice daily, a combination of ibuprofen 400 mg + paracetamol 325 mg-thrice daily and chlorhexidine mouthwash 0.12%-thrice daily (mouth rinsing to commence after 24 h). All patients were given comprehensive instructions on the importance of maintenance of oral hygiene and jaw physiotherapy postoperatively.

Postoperative follow-up and data collection

Follow-up was done at 2 days, 1 week, 3 months, and 6 months and data was collected with respect to the pain, edema, and healing of socket post-extraction.

Pain

A visual analog scale (VAS) was used to evaluate postoperative pain [Figure 8]. A 10-point VAS with a score of 0 equals “no pain” and 10 equals “severely painful” was used to assess pain. Patients were given a questionnaire with instructions to record their pain and discomfort level using the visual analog scale. The patient marked the appropriate response on the scale at 6 h, 12 h, then 1, 2, 3, 4, 5, 6, and 7 days after surgery.
Figure 8: Visual analog scale

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Edema

Facial measurements were done using a flexible ruler.[12]Measurements of the face were done, as shown in [Figure 9]a,[Figure 9]b,[Figure 9]c,[Figure 9]d. To reduce variation and bias, these measurements were done by the same operator on postoperative day 2 and day 7.
Figure 9: The preoperative measuremnets of the face was collecetd using four anatomical landmarks (12) i.e., lateral canthus of the eye (LC), tragus of the ear (TR), commissure of mouth (CO) and the gonion (GO) (a) and three imaginary lines i.e., TR-LC (b), TR-CP (c), CO-GO (d)

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Interincisal opening

The distance between the incisal edges of maxillary and mandibular central incisors was recorded on postoperative day 2 and day 7 [Figure 10]a.
Figure 10: (a) Interincisal distance. (b) Measurement of pocket depth distal to second molar

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Healing: Soft-tissue healing was assessed on the 7th postoperative day using the healing index reported by Landry et al.[13] Pocket depth distal to the second molar was measured using Michigan “O” probe with Williams marking at 3 months and 6 months postoperative period and compared to the preoperative values [Figure 10b]. Orthopantomograms taken at 3 months and 6 months after extraction were analyzed and assessed. Radiographic assessment was made using Adobe Photoshop CS 6 version 13.0.1 and digital orthopantomograph images in JPEG format [Figure 11]. Bone density at the region of interest (ROI) was represented in the form of gray-level histogram value. Histogram illustrates how the pixels in an image are distributed and its analysis provides us with mean intensity value, standard deviation, median intensity value and the total number of pixels used to calculate the histogram. These values are indicative of the bone density of ROI. The histogram values for the control and study side were measured for orthopantomograms taken at 3 months and 6 months post-extraction.
Figure 11: An anlyasis of orthopantomograph using Adobe Photoshop CS 6 version

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Statistical analysis

The obtained data in terms of preoperative and postoperative measurement of VAS scores for pain, edema, interincisal opening, and gray level histogram values of orthopantomogram were subjected to statistical analysis. The normality of data was analyzed using the Kolmogorov–Smirnov test. The Mann Whitney U and Wilcoxon Signed-Rank tests were used to check mean differences wherever appropriate. SPSS (Statistical Package for the Social Sciences) Version 24.0 (IBM Corporation, Chicago, USA) was used for the statistical analysis.

Ethical dimension

Whole project outline was put up to the ethical committee, Army Dental Centre (Research and Referral) and prior clearance was achieved before taking up the cases. Informed written consent was taken from each patient in a language which he/she best comprehended [Appx C].


  Results Top


A total of 60 subjects fulfilling the inclusion criteria were included in the study. The mean age of the study population was 27.16 ± 5.04. There were 47 males and 13 females [Table 1].
Table 1: Demographic details of the study population

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The mean difficulty index score was compared between the study and control side [Graph 1] and [Table 2]. The analysis done by the Mann–Whitney U test showed no statistically significant difference in mean difficulty index score between the study and control side (P = 0.344).

Table 2: Comparison of mean difficulty index scores between study side and control side

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The mean preoperative inter-incisal distance (mm) was compared with the measurements on the 2nd and 7th postoperative day for the study side and control side [Table 3]. Furthermore, the mean interincisal distance on the 2nd postoperative day and 7th postoperative day was compared. There was a marginal improvement in interincisal distance on the 2nd and 7th postoperative days on the study side when compared to the control side, but no statistically significant inference could be derived [Graph 2].
Table 3: Comparison of mean inter-incisal distance (mm) pre-operatively and post-operatively at day 2 and day 7 between study side and control side

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The mean preoperative tragus-lateral canthus (TR-LC) distance (mm) was compared with the measurements on the 2nd and 7th postoperative day for the study side and control side [Table 4]. No clinical or statistically significant differences (Wilcoxon Signed Rank test) in TR-LC distance (mm) were noted between the groups.
Table 4: Comparison of mean Tragus-Lateral canthus distance in mm pre-operatively and post-operatively at day 2 and day 7 between study side and control side

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The mean tragus-commissure distance (mm) preoperatively and postoperatively at day 2 and day 7 were compared [Graph 3]. On comparison, there was a increase in the of swelling at study side on postoperative day 2. However, a clinically significant decrease in the swelling was noted on postoperative day 7 at the test side. The analysis done by Wilcoxon Signed Rank test showed no statistically significant differences in mean Tragus-Commissure distance (mm) preoperatively (P = 0.435) and postoperatively at day 2 (P = 0.398) and day 7 (P = 0.335) [Table 5].

Table 5: Comparison of mean Tragus-Commissure distance (mm) pre-operatively and post-operatively at day 2 and day 7 between study side and control side

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The mean preoperative Commissure-Gonion distance (mm) was compared with the measurements on 2nd and 7th postoperative days for the study side and control side [Graph 4]. It was seen that the edema resolved faster at the study side on the postoperative day 7 when compared to the control side. Although the results were clinically significant, no statistically significant differences (Wilcoxon Signed Rank test) in mean Commissure-Gonion distance (mm) preoperatively (P = 0.782) and postoperatively at day 2 (P = 0.930) and day 7 (P = 0.352) were noted [Table 6]

.
Table 6: Comparison of mean Commissure-Gonion distance (mm) pre-operatively, 2nd post-operative day and 7th post-operative day between study side and control side

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The mean preoperative pocket depth distal to the second mandibular molar (mm) was compared to postoperative measurements after 3 and 6 months for the study side and control side control side [Graph 5]. The analysis done by the Mann–Whitney U test showed both clinically and statistically significant differences in mean pocket depth (mm) preoperatively (P = 0.036) and postoperatively after 3 months (P < 0.001). The mean preoperative pocket depth of the control side (3.05 ± 1.41) was higher than the study side (2.41 ± 1.73). After 3 months, the mean pocket depth of the control side (6.05 ± 1.65) was higher than the test side (4.10 ± 1.88). There were no statistically significant differences in mean pocket depth (mm) postoperatively after 6 months (P = 0.348) [Table 7].

Table 7: Comparison of mean pocket depth distal to second molar (mm) pre-operatively and post-operatively after 3 and 6 months between study side and control side

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The mean soft-tissue healing index score on day 7 was compared between the test and control side [Graph 6]. The analysis done by Mann–Whitney U test showed clinically and statistically significant difference in mean soft-tissue healing index score on day 7 between the study side and control side (P < 0.001). The mean soft -tissue healing index score of the study side (3.83 ± 0.80) was higher than the control side (3.23 ± 0.62) [Table 8].

Table 8: Comparison of mean soft tissue healing index score on day 7 post-operatively between study side and control side

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The mean VAS score postoperatively after 6 h, 12 h and at day 1, 2, 3, 4, 5, 6 and 7 were compared between the study side and control side [Graph 7]. The analysis done by the Mann–Whitney U test showed statistically significant differences in mean VAS score postoperatively at day 3 (P < 0.001), 4 (P < 0.001), and 5 (P = 0.002). The mean VAS score at day 3 of the control side (2.86 ± 1.25) was higher than the study side (1.80 ± 0.93). Similarly, at day 4, the mean VAS score of the control side (1.83 ± 1.23) was higher than the study side (0.26 ± 0.75). Similar results were also seen at day 5. No statistically significant differences in mean VAS score postoperatively were seen after 6 h (P = 0.110) and 12 h (P = 0.571), day 1 (P = 0.389), day 2 (P = 0.113), day 6 (P = 0.257), and day 7 (P = 0.122) [Table 9].

Table 9: Comparison of mean Visual Analog Scale (VAS) score post-operatively after 6 hrs, 12 hrs and at day 1, 2, 3, 4, 5, 6 and 7 between study side and control side

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The mean gray level histogram value postoperatively after 3 and 6 months between test and control site were compared [Graph 8]. Higher values of gray level histogram were noted on the study side at both postoperative 3 months and 6 months. The analysis done by the Mann–Whitney U test showed no statistically significant differences in mean grey level histogram value postoperatively after 3 (P = 0.291) and 6 months (P = 0.181) [Table 10].

Table 10: Comparison of mean grey level histogram value post-operatively after 3 and 6 months between study side and control side

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  Discussion Top


Mandibular third molars generally erupt between the ages of 18 and 21 years.[14] The impaction rate is higher for mandibular third molars when compared with other teeth. The mandibular third molar impaction can be due to the inadequate space between the distal of the second mandibular molar and the anterior border of the ascending ramus of the mandible, unfavorable angulation or path of eruption of the tooth, angulation of roots, malposition of the tooth germ, lack of sufficient eruption force, and theory of phylogenetic regression.[15] In our study, the patients were in the age group of 18-35 years, with the mean age being 27.16 ± 5.04. Researchers suggest that females have a higher incidence of mandibular third molar impaction when compared to males.[15],[16] Of the 60 patients included in our study, 78.3% were male, which could be attributed to the demographic of our study population. Various reasons for removal of the third molar are caries and its sequelae, recurrent pericoronitis, periodontal defect distal to the second molar, odontogenic cysts, root resorption of adjacent teeth, and dental crowding. In our study, the most common cause for extraction was recurrent pericoronitis.

Surgical removal of third molars is often associated with postoperative pain, swelling, and trismus. Periodontal defects may develop distal to the second molar after surgical extraction of the third molar due to excessive bone loss.[3],[4],[17] This may lead to increased food impaction distal to the second molar or increased sensitivity.[18]

Faster healing of the extraction socket will restore normal functioning and reduce the overall discomfort to the individual. Studies have shown that platelet concentrates have the potential to hasten the healing process.

PRP was found to reduce pain, swelling, and alveolar osteitis (AO), as well as improve soft- and hard-tissue healing after mandibular third molar extractions.[19],[20],[21] However, the preparation and placement of PRP is a complicated and time-consuming procedure. Furthermore, PRP has poor mechanical properties that discourage many surgeons from routinely using it after extractions.[22] To compensate for the shortcomings of PRP, PRF, a second-generation platelet concentrate, was introduced by Choukron et al.[23] in 2001. Its preparation is simpler and inexpensive without the additional biochemical blood handling involved in the preparation of PRP. Similar to natural healing, slow polymerization during PRF preparation generates a fibrin network that enhances cell migration and proliferation. Dense fibrin network as a result of activation could entrap growth factors for longer and protect them from proteolysis.[8] Platelets are activated as a result of contact with the wall of the tube. Being a reservoir of platelets, leukocytes, cytokines, and immune cells, PRF allows slow release of cytokines-TGF-β, PDGF, vascular endothelial growth factor, EGF, FGF, KGF, IGF, platelet-derived EGF, IL-8, TNF alpha, CTGF and granulocyte macrophage colony-stimulating factor-which play a critical role in angiogenesis, tissue healing, and cicatrization.[8],[9],[11],[24]

Various studies have been conducted to assess the effects of PRF on sequelae of surgical extraction of third molars. Singh et al., Uyanik et al., Kumar et al. assessed the postoperative pain and edema following placement of PRF in the extraction socket. Eshghpour et al. studied effect of PRF on the incidence of AO following surgical extractions. Kumar et al. and Baslarli et al. studied the effect of PRF on periodontal pocket distal to the second molar postsurgical removal of the third molar. Singh et al., Baslarli et al., Kumar et al., and Gurbuzer et al. studied the effect of PRF on soft- and hard-tissue healing. The following study was conducted to assess the effect of PRF on postoperative pain, edema, and healing of the socket following surgical extraction of the mandibular third molar.

In our study, the postoperative pain was assessed using VAS score. There was a statistically significant difference in the pain described by the patients for the study side on the 3rd, 4th, and 5th postoperative days. Apart from that, the difference in the mean VAS scores on the study side was consistently lower compared to the control side. This is in concurrence with the studies conducted by Uyanik et al.[25] and Kumar et al.[26] In contrast, a study conducted by Singh et al.[27] reported no effect of PRF on postoperative pain in third molar surgery. The reduction in pain could be attributed to the accelerated healing process seen in the extraction socket after placement of PRF.

The effect of PRF on postoperative edema after surgical extraction was also measured in our study. It was seen that on the study side, there was a greater change in dimension in the TR-CO line on the 2nd postoperative day. However, there was a marked fall in this edema in the next 5 days and the TR-CO measurements on the study side were closer to the preoperative values when compared to the control side. A similar pattern was seen on comparing the preoperative measurement of CO-GO line to the measurements on the 2nd and 7th postoperative days. The results obtained were clinically appreciable but statistically insignificant. Therefore, we concluded that the placement of PRF causes an early increase in postoperative edema but also leads to a faster resolution of the symptom. This could be attributed to the higher quantity of trapped cytokines (IL-1, IL-6), which can induce an initial increase in swelling but also aid in rapid healing of the socket, thereby leading to a faster resolution of the swelling.[28] The mean preoperative interincisal distance was compared to the mean interincisal distance at the 2nd and 7th postoperative days. There was a marginal improvement noted on the study side when compared to the control side for both the 2nd and 7th postoperative days, but the difference was not statistically significant. These results are in concurrence with the studies conducted by Kumar et al.[26] and Uyanik et al.[29]

Singh et al.[27] evaluated the effect of PRF on soft-tissue healing and concluded that placement of PRF in the extraction socket post-surgical extraction can lead to accelerated soft-tissue healing. Similar results were seen in our study. It was seen that the mean soft-tissue healing index score on the 7th postoperative day was higher for the study side (3.83 ± 0.80) when compared to the control side (3.23 ± 0.62). This data were also found to be statistically significant (P < 0.001). The growth factors and cytokines present in PRF have been shown to promote fibroblast proliferation, increase tissue vascularity, rate of collagen formation, mitosis of mesenchymal stem cells, and endothelial cells which play key roles in soft-tissue healing. This activity, together with increased vessel ingrowth, is mediated by PDGF and TGF.[30] During the fibrin matrix remodeling, PRF is able to progressively release the enmeshed cytokines, which might explain the clinically observed accelerated epithelization and healing on the study side as compared to the control side.[24]

Our results showed a marked decrease in the mean pocket depth on the study side at 3 months postoperative compared to the control side. This finding was clinically and statistically significant. Similar results were seen in the study by Kumar et al. The study by Baslarli et al. showed an insignificant difference between the PRF and non-PRF groups. This indicates that the placement of PRF in the extraction socket postsurgical extraction of the third molar leads to an accelerated reduction in the pocket depth distal to the second molar.

Gurbuzer et al.,[31] Singh et al., Baslarli et al., and Kumar et al. studied the effect of placing PRF in extraction socket postsurgical extraction on hard-tissue healing using sequential radiographs. All the authors reported a statistically nonsignificant variation between the study and control sites. In this study, the study side showed higher values of gray level histogram when compared to the study side at both 3 months and 6 months postoperative period. However, the values were found to be statistically insignificant. The growth factors present in PRF have been shown to accelerate bone repair and promote fibroblast proliferation, increase rate of collagen formation and induce mitosis of mesenchymal stem cells as well as osteoblasts.[27],[30]

The efficacy of PRF on pain, edema, and healing in mandibular third molar surgery was evaluated in this study. We observed a reduction in pain and swelling with improvement in the interincisal opening on the study side. A greater reduction in periodontal pocket depth distal to the second molar was seen on the PRF side, which was statistically significant. Soft-tissue healing index scores and grey level histogram values indicating radiographic bone fill for the study side were higher compared to the control side.

Further clinical studies with larger sample sizes and better assessment modalities to evaluate and assess the applications of PRF in Oral and Maxillofacial surgery are needed.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initial s will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10]



 

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