Effect of Leucocyte and Platelet Rich Fibrin (L-PRF) in Postoperative Sequelae of Impacted Mandibular Third Molar Surgery - A Split Mouth Randomized Controlled Trial
Main Article Content
Keywords
Mandible, third molar, L-PRF, post-operative, pain, swelling, trismus, oral surgery, impacted teeth, innovative technique
Abstract
Objectives: The surgical removal of impacted mandibular third molars is one of the most common procedures in oral surgery, and also one of the most feared inciting procedures among patients due to the postoperative sequelae. Leukocyte and platelet rich fibrin (L-PRF) is an autologous biomaterial enmeshed with platelets, leukocytes and cytokines. The aim of this study is to assess the effect of placing platelet rich fibrin on post-operative healing and complications after impacted mandibular third molar removal.
Materials and Methods: This study is a split mouth randomized controlled trial. 25 patients with the same type of mandibular third molar impaction bilaterally were chosen for the study. Venous blood obtained from the patient and centrifuged at 2800 rpm for 12 minutes to obtain L-PRF. In the Case group the Socket was filled with L-PRF; and in the Control group the Socket was filled with standard blood clot. Post-operative swelling and pain score (VAS) assessed on the 1st, 3rd and 7th pos-operative days. Soft tissue healing index assessed on the 7th postoperative day. Post-operative complications, if any were noted. Statistical test - Mann-Whitney U test and Wilcoxon signed rank test were performed using SPSS version 20.0.
Results: L-PRF treated sites showed improved Healing Index (p<0.05) and reduced pain VAS scores (p<0.05) when compared to the control site. The post-operative swelling showed statistically significant reduction in the case group for the 1st and 3rd days (p<0.05). Only one L-PRF site and five control sites were affected with alveolar osteitis.
Conclusion: Within the limitations of this study, L-PRF exhibits the potential of improving the soft tissue healing and reducing the post-operative pain, swelling and incidence of alveolar osteitis following mandibular third molar removal.
References
2. Deeb MA. Role of platelet-rich fibrin (PRF) and platelet-rich plasma (PRP) in oro-facial tissue regeneration: a narrative review. Journal of Advanced Oral Research. 2020 May;11(1):5-11.
3. Daugela P, Grimuta V, Sakavicius D, Jonaitis J, Juodzbalys G. Influence of leukocyte-and platelet-rich fibrin (L-PRF) on the outcomes of impacted mandibular third molar removal surgery: A split-mouth randomized clinical trial. Quintessence International. 2018 May 1;49(5).
4. Malli Sureshbabu N, Selvarasu K, V JK, Nandakumar M, Selvam D. Concentrated Growth Factors as an Ingenious Biomaterial in Regeneration of Bony Defects after Periapical Surgery: A Report of Two Cases. Case Rep Dent. 2019 Jan 22;2019:7046203.
5. Ahad M, Gheena S. Awareness, attitude and knowledge about evidence based dentistry among the dental practitioner in Chennai city. J Adv Pharm Technol Res. 2016;9(11):1863.
6. PradeepKumar AR, Shemesh H, Jothilatha S, Vijayabharathi R, Jayalakshmi S, Kishen A. Diagnosis of Vertical Root Fractures in Restored Endodontically Treated Teeth: A Time-dependent Retrospective Cohort Study. J Endod. 2016 Aug;42(8):1175–80.
7. Jangid K, Alexander AJ, Jayakumar ND, Varghese S, Ramani P. Ankyloglossia with cleft lip: A rare case report. J Indian Soc Periodontol. 2015 Nov;19(6):690–3.
8. Kumar A, Sherlin HJ, Ramani P, Natesan A, Premkumar P. Expression of CD 68, CD 45 and human leukocyte antigen-DR in central and peripheral giant cell granuloma, giant cell tumor of long bones, and tuberculous granuloma: An immunohistochemical study. Indian J Dent Res. 2015 May;26(3):295–303.
9. Manohar J, Abilasha R. A Study on the Knowledge of Causes and Prevalance of Pigmentation of Gingiva among Dental Students [Internet]. Vol. 10, Indian Journal of Public Health Research & Development. 2019. p. 95. Available from: http://dx.doi.org/10.5958/0976-5506.2019.01859.x
10. Sekar D, Mani P, Biruntha M, Sivagurunathan P, Karthigeyan M. Dissecting the functional role of microRNA 21 in osteosarcoma. Cancer Gene Ther. 2019 Jul;26(7-8):179–82.
11. Girija SA, Jayaseelan VP, Arumugam P. Prevalence of VIM- and GIM-producing Acinetobacter baumannii from patients with severe urinary tract infection. Acta Microbiol Immunol Hung. 2018 Dec 1;65(4):539–50.
12. Maheswari TNU, Venugopal A, Sureshbabu NM, Ramani P. Salivary micro RNA as a potential biomarker in oral potentially malignant disorders: A systematic review. Ci Ji Yi Xue Za Zhi. 2018 Apr;30(2):55–60.
13. Subashri A, Maheshwari TNU. Knowledge and attitude of oral hygiene practice among dental students. J Adv Pharm Technol Res. 2016;9(11):1840.
14. Starzyńska A, Kaczoruk-Wieremczuk M, Lopez MA, Passarelli PC, Adamska P. The growth factors in advanced platelet-rich fibrin (A-PRF) reduce postoperative complications after mandibular third molar odontectomy. International Journal of Environmental Research and Public Health. 2021 Jan;18(24):13343.
15. Caymaz MG, Uyanik LO. Comparison of the effect of advanced platelet-rich fibrin and leukocyte-and platelet-rich fibrin on outcomes after removal of impacted mandibular third molar: A randomized split-mouth study. Nigerian journal of clinical practice. 2019 Apr 1;22(4):546.
16. Makki AZ, Alsulami AM, Almatrafi AS, Sindi MZ, Sembawa SN. The effectiveness of advanced platelet-rich fibrin in comparison with leukocyte-platelet-rich fibrin on outcome after dentoalveolar surgery. International Journal of Dentistry. 2021 May 8;2021:1-9.
17. Shetty M, Bhandary S. Applications of platelet rich fibrin in dentistry. Gülhane Tip Dergisi. 2022 Mar 1;64(1):1.
18. Al-Hamed FS, Tawfik MA, Abdelfadil E, Al-Saleh MA. Efficacy of platelet-rich fibrin after mandibular third molar extraction: a systematic review and meta-analysis. Journal of Oral and Maxillofacial Surgery. 2017 Jun 1;75(6):1124-35.
19. Xiang X, Shi P, Zhang P, Shen J, Kang J. Impact of platelet-rich fibrin on mandibular third molar
surgery recovery: a systematic review and meta-analysis. BMC oral health. 2019 Dec;19(1):1-0.
20. da Silva MT, de Almeida Barros Mourão CF, Mello-Machado RC, Montemezzi P, de Lima Barbosa R, Sartoretto SC, Leite PE, Javid K, Kawase T, Alves GG, Calasans-Maia MD. Effects of Leukocyte-Platelet-Rich Fibrin (L–PRF) on Pain, Soft Tissue Healing, Growth Factors, and Cytokines after Third Molar Extraction: A Randomized, Split-Mouth, Double-Blinded Clinical Trial. Applied Sciences. 2021 Feb 12;11(4):1666.
21. Rahman AS. Effects of platelet-rich fibrin in the surgical extraction of mandibular third molar: A systematic review and meta-analysis. SRM Journal of Research in Dental Sciences. 2022 Jul 1;13(3):101.
22. Bansal S, Garg A, Khurana R, Chhabra P. Platelet-rich fibrin or platelet-rich plasma–which one is better? an opinion. Indian Journal of Dental Sciences. 2017 Sep 1;9(5):49.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.