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Title Using Platelet Rich Fibrin Following Surgical Extraction of Third Molars Reduces Incidence of Alveolar Osteitis and Promotes Soft Tissue Healing
Clinical Question In a patient with impacted mandibular third molars requiring surgical extraction, does placement of platelet rich fibrin (PRF) in the extraction socket prevent alveolar osteitis (AO) and encourage bone and soft tissue healing?
Clinical Bottom Line Using PRF following surgical extraction of third molars significantly reduces incidence of alveolar osteitis and increases rate of soft tissue healing. Most of the studies agreed that it also promotes osseous healing, but only two studies found significant results when measuring this outcome. At worst, the difference between PRF and control, when measuring osseous healing, was negligible.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 27195227Doiphode/201630 patients having extraction of bilateral impacted mandibular third molarsSplit-mouth randomized controlled trial
Key resultsPatients were divided into two groups: Group I was control; Group II was divided into two subgroups: Group IIa, in which the left extraction site was filled with platelet rich plasma (PRP) gel, Group IIb, in which the right extraction site was filled with platelet rich fibrin (PRF). The control side showed a 33.3% incidence of wound dehiscence, group IIa (PRP side) showed dehiscence in 20% of cases, and group IIb (PRF side) did not show any dehiscence. All groups showed a decrease in probing depth distal to the second molar, but group IIb (PRF side) showed the lowest pocket depth at 2, 4, and 6 months postoperatively (P < .01). All groups showed a decrease in alveolar bone height (measured from CEJ at the distal of 2nd molar to alveolar crest), with group IIb (PRF side) showing the greatest decrease at 2, 4, and 6 months postoperatively (P < .05). Groups IIa (PRP side) and IIb (PRF side) showed a highly significant difference in increase of bone density adjacent to the extraction socket and the bone formed in the extraction socket at 2, 4, and 6 months postoperatively when compared to the control side (P < .05). However, there was no statistically significant difference between groups IIa (PRP side) and IIb (PRF side) in bone density.
#2) 25037182Eshghpour/201478 patients undergoing surgical extraction of bilateral impacted mandibular third molars.Split-mouth double-blinded randomized controlled trial
Key resultsOne socket received PRF and the other served as a control. The overall frequency of AO was 14.74% for all surgeries, 25.81% in control sites and 9.86% in sites treated with PRF (relative risk = 0.44; P = .042).
#3) 24431807Girish/201322 patients undergoing surgical extraction of bilateral third molars.Split-mouth randomized controlled trial
Key resultsOne side was randomly chosen to be treated with PRF, the other was the control. The PRF-treated sites showed greater bone density on average than the control sites. However, these results were not statistically significant (P > .05).
#4) 27195227Hoaglin/2013200 patients requiring surgical extraction of mandibular third molars. Nonrandomized controlled trial
Key results100 consecutive patients were the control group and did not receive PRF; 100 consecutive patients were treated with PRF in both extraction sites. The incidence of AO was significantly decreased in patients treated with PRF (P = .0001). The frequency of AO was 9.5% in the control group (19 sites out of 200) and 1% in the PRF treated group (2 sites out of 200).
#5) 25659357Kumar/201531 patients requiring surgical extraction of a single impacted mandibular third molar. Randomized controlled trial
Key resultsSixteen patients received treatment with a PRF membrane following the extraction, 15 patients served as control. Soft tissue healing (measured by pocket depth distal to the mandibular second molar) 3 months postoperatively decreased significantly in the PRF group (P < .001). Bone density at 3 months postoperatively was greater in the PRF group than the control group, but this result was not statistically significant.
Evidence Search ("blood platelets"[MeSH Terms] OR ("blood"[All Fields] AND "platelets"[All Fields]) OR "blood platelets"[All Fields] OR "platelet"[All Fields]) AND rich[All Fields] AND ("fibrin"[MeSH Terms] OR "fibrin"[All Fields]) AND extraction[All Fields]
Comments on
The Evidence
Most of these studies had split-mouth study designs, which is helpful for studying this type of procedure. The studies also had similar inclusion criteria (greater than 18 years of age, normal platelet count, sites where primary closure is possible) and exclusion criteria (underlying systemic disease, immunocompromised, pregnancy, smokers, periodontal disease, acute local infection). There was also adequate follow-up in the studies. One study was a double-blind study, the rest were not. Double-blinding is difficult to achieve because it requires multiple surgeons: one to perform the extractions, another to place the PRF, and yet another to analyze the healing. There were no competing interests for the investigators as PRF is an autologous material.
Applicability Surgical extraction of third molars is a common procedure performed by dentists. It is estimated that between 60% and 85% of the population undergo third molar extraction. Advantages of PRF include its ease of use and inexpensive nature of its preparation. Furthermore, none of the studies reported any harm from treating patients with PRF. Therefore, PRF has potential usefulness in the scenarios mentioned above but must be studied further.
Specialty/Discipline (General Dentistry) (Oral Surgery)
Keywords Platelet rich fibrin, PRF, extractions, third molars, wisdom teeth, surgical extraction
ID# 3253
Date of submission: 05/18/2017spacer
E-mail vegajs@livemail.uthscsa.edu
Author Josue Vega
Co-author(s) e-mail
Faculty mentor/Co-author Edward Ellis, III, DDS, MS
Faculty mentor/Co-author e-mail ellise3@uthscsa.edu
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