The Journal of Contemporary Dental Practice

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 20 , ISSUE 10 ( October, 2019 ) > List of Articles


Effect of Advanced Platelet-rich Fibrin on Wound Healing after Third Molar Extraction: A Split-mouth Randomized Double-blind Study

Talal M Zahid

Keywords : Healing, Impacted third molar surgery, Pain, Platelet-rich fibrin, Regeneration, Swelling, Wound healing

Citation Information : Zahid TM. Effect of Advanced Platelet-rich Fibrin on Wound Healing after Third Molar Extraction: A Split-mouth Randomized Double-blind Study. J Contemp Dent Pract 2019; 20 (10):1164-1170.

DOI: 10.5005/jp-journals-10024-2666

License: CC BY-NC 4.0

Published Online: 01-06-2018

Copyright Statement:  Copyright © 2019; The Author(s).


Aim: To evaluate the potential of advanced platelet-rich fibrin (A-PRF) as a regenerative biomaterial for bone regeneration and postoperative sequelae after impacted third molar extractions. Materials and methods: This was a split-mouth, randomized, double-blind clinical trial. A total of 10 female patients in King Abdulaziz University Dental Hospital with bilateral impacted third molars were recruited into the study. Surgical extractions were performed on both sides of the mandible. Randomization was done by a coin toss; A-PRF was placed on the one side while the other side did not receive any intervention. Each patient acted as their own control. Both the patients and the investigators were blinded about the A-PRF side. The outcome on periodontal regeneration was made measuring pocket depth (PD), gum recession (GR), and clinical attachment level (CAL) before and at 1- and 3-months postoperatively. Pain, swelling, and healing were assessed on the 7th postoperative day. p value less than 0.05 was considered statistically significant. Results: An estimated 10 patients completed the study. There were no significant differences in PD, CAL, and GR between the two groups at any time point, although the data obtained were slightly favoring the A-PRF. However, a statistically significant reduction in pain and swelling was observed in the A-PRF group compared to the controls (p < 0.05). Conclusion: The findings of this study demonstrate A-PRF as a potential biomaterial for lessening the severity of pain and swelling after third molar surgery. Long-term trials with a larger sample size and more methodically sound assessment tools are needed to obtain more meaningful results on periodontal regeneration. Clinical significance: Placement of A-PRF clot in the extraction socket could lessen postoperative pain and increase patient comfort after third molar extraction. Trial registration: NCT03703479. Registered 8 October 2018

  1. Deliverska EG, Petkova M. Complications after extraction of impacted third molars-literature review. Journal of IMAB–Annual Proceeding Scientific Papers 2016;22:1202–1211. DOI: 10.5272/jimab.2016223.1202.
  2. Stella PEM, Falci SGM, et al. Impact of mandibular third molar extraction in the second molar periodontal status: a prospective study. J Indian Soc Periodontol 2017;21(4):285–290. DOI: 10.4103/jisp.jisp_79_1710.4103/jisp.jisp_79_17.
  3. Lee CT, Hum L, et al. The effect of regenerative periodontal therapy in preventing periodontal defects after the extraction of third molars: a systematic review and meta-analysis. J Am Dent Assoc 2016;147(9):709–719.e4. DOI: 10.1016/j.adaj.2016.03.005.
  4. Choukroun J, Adda F, et al. PRF: an opportunity in perio-implantology (in French). Implantodontie 2000;42:55–62.
  5. He Y, Chen J, et al. Local Application of Platelet-Rich Fibrin During Lower Third Molar Extraction Improves Treatment Outcomes. J Oral Maxillofac Surg 2017;75(12):2497–2506. DOI: 10.1016/j.joms.2017.05.034.
  6. Miron RJ, Zucchelli G, et al. Use of platelet-rich fibrin in regenerative dentistry: a systematic review. Clin Oral Investig 2017;21(6):1913–1927. DOI: 10.1007/s00784-017-2133-z.
  7. Choukroun J. Advanced PRF & i-PRF: Platelet Concentrates or Blood Concentrates? J Periodontal Med Clin Pract 2014;3.
  8. Shahram Ghanaati PB, Orlowska A, et al. Advanced Platelet-Rich Fibrin: A New Concept for Cell-Based Tissue Engineering by Means of Inflammatory Cells. J Oral Implantol 2014;40(6):679–689. DOI: 10.1563/aaid-joi-D-14-00138.
  9. Kobayashi E, Fluckiger L, et al. Comparative release of growth factors from PRP, PRF, and advanced-PRF. Clin Oral Investig 2016;20(9): 2353–2360. DOI: 10.1007/s00784-016-1719-1.
  10. Clark D, Rajendran Y, et al. Advanced platelet-rich fibrin and freeze-dried bone allograft for ridge preservation: a randomized controlled clinical trial. J Periodontol 2018;89(4):379–387. DOI: 10.1002/JPER.17-0466.
  11. Uyanık LO, Bilginaylar K, et al. Effects of platelet-rich fibrin and piezosurgery on impacted mandibular third molar surgery outcomes. Head Face Med 2015;11:25. DOI: 10.1186/s13005-015-0081-x.
  12. Yelamali T, Saikrishna D. Role of platelet rich fibrin and platelet rich plasma in wound healing of extracted third molar sockets: a comparative study. J Maxillofac Oral Surg 2015;14(2):410–416. DOI: 10.1007/s12663-014-0638-4.
  13. Marciani RD. Complications of third molar surgery and their management. Atlas Oral Maxillofac Surg Clin North Am 2012;20: 233–251. DOI: 10.1016/j.cxom.2012.06.003.
  14. Doiphode AM, Hegde P, et al. Evaluation of the efficacy of platelet-rich plasma and platelet-rich fibrin in alveolar defects after removal of impacted bilateral mandibular third molars. J Int Soc Prev Community Dent 2016;6(1):S47–S52. DOI: 10.4103/2231-0762.181167.
  15. Anwandter A, Bohmann S, et al. Dimensional changes of the post extraction alveolar ridge, preserved with Leukocyte- and Platelet Rich Fibrin: A clinical pilot study. J Dent 2016;52:23–29. DOI: 10.1016/j.jdent.2016.06.005.
  16. Castro AB, Meschi N, et al. Regenerative potential of leucocyte- and platelet-rich fibrin. Part A: intra-bony defects, furcation defects and periodontal plastic surgery. A systematic review and meta-analysis. J Clin Periodontol 2017;44(1):67–82. DOI: 10.1111/jcpe.12643.
  17. Varghese MP, Manuel S, et al. Potential for Osseous Regeneration of Platelet-Rich Fibrin-A Comparative Study in Mandibular Third Molar Impaction Sockets. J Oral Maxillofac Surg 2017;75(7):1322–1329. DOI: 10.1016/j.joms.2017.01.035.
  18. Daugela P, Grimuta V, et al. 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 Int 2018;49(5):377–388. DOI: 10.3290/j.qi.a40113.
  19. Zhang Y, Tangl S, et al. Effects of Choukroun's platelet-rich fibrin on bone regeneration in combination with deproteinized bovine bone mineral in maxillary sinus augmentation: a histological and histomorphometric study. J Craniomaxillofac Surg 2012;40(4): 321–328. DOI: 10.1016/j.jcms.2011.04.020.
  20. Ozgul O, Senses F, et al. Efficacy of platelet rich fibrin in the reduction of the pain and swelling after impacted third molar surgery: randomized multicenter split-mouth clinical trial. Head Face Med 2015;11:37. DOI: 10.1186/s13005-015-0094-5.
  21. Al-Hamed FS, Tawfik MA, et al. Efficacy of Platelet-Rich Fibrin After Mandibular Third Molar Extraction: A Systematic Review and Meta-Analysis. J Oral Maxillofac Surg 2017;75(6):1124–1135. DOI: 10.1016/j.joms.2017.01.022.
  22. Gulsen U, Senturk MF. Effect of platelet rich fibrin on edema and pain following third molar surgery: a split mouth control study. BMC Oral Health 2017;17(1):79. DOI: 10.1186/s12903-017-0371-8.
  23. Pradeep AR, Rao NS, et al. Comparative evaluation of autologous platelet-rich fibrin and platelet-rich plasma in the treatment of 3-wall intrabony defects in chronic periodontitis: a randomized controlled clinical trial. J Periodontol 2012;83(12):1499–1507. DOI: 10.1902/jop.2012.110705.
  24. Kumar N, Prasad K, et al. Evaluation of treatment outcome after impacted mandibular third molar surgery with the use of autologous platelet-rich fibrin: a randomized controlled clinical study. J Oral Maxillofac Surg 2015;73:1042–1049. DOI: 10.1016/j.joms.2014.11.013.
  25. Gandevivala A, Sangle A, et al. Autologous Platelet-rich Plasma after Third Molar Surgery. Ann Maxillofac Surg 2017;7(2):245–259. DOI: 10.4103/ams.ams_108_16.
  26. Sammartino G, Tia M, et al. Use of autologous platelet-rich plasma (PRP) in periodontal defect treatment after extraction of impacted mandibular third molars. J Oral Maxillofac Surg 2005;63(6):766–770. DOI: 10.1016/j.joms.2005.02.010.
  27. Sammartino G, Tia M, et al. Platelet-rich plasma and resorbable membrane for prevention of periodontal defects after deeply impacted lower third molar extraction. J Oral Maxillofac Surg 2009;67(11):2369–2373. DOI: 10.1016/j.joms.2009.04.093.
  28. Padma R, Shilpa A. A split mouth randomized controlled study to evaluate the adjunctive effect of platelet-rich fibrin to coronally advanced flap in Miller's class-I and II recession defects. J Indian Soc Periodontol 2013;17(5):631–636. DOI: 10.4103/0972-124X.119281.
  29. Eren G, Atilla G. Platelet-rich fibrin in the treatment of localized gingival recessions: a split-mouth randomized clinical trial. Clin Oral Investig 2014;18(8):1941–1948. DOI: 10.1007/s00784-013-1170-5.
  30. Keceli HG, Kamak G, et al. The Adjunctive Effect of Platelet-Rich Fibrin to Connective Tissue Graft in the Treatment of Buccal Recession Defects: Results of a Randomized, Parallel-Group Controlled Trial. J Periodontol 2015;86(11):1221–1230. DOI: 10.1902/jop.2015.150015.
  31. Jankovic S, Aleksic Z, et al. The coronally advanced flap in combination with platelet-rich fibrin (PRF) and enamel matrix derivative in the treatment of gingival recession: a comparative study. Eur J Esthet Dent 2010;5(3):260–273.
  32. Gupta S, Banthia R, et al. Clinical evaluation and comparison of the efficacy of coronally advanced flap alone and in combination with platelet rich fibrin membrane in the treatment of Miller Class I and II gingival recessions. Contemp Clin Dent 2015;6(2):153–160. DOI: 10.4103/0976-237X.156034.
  33. Moraschini V, Barboza Edos S. Use of Platelet-Rich Fibrin Membrane in the Treatment of Gingival Recession: A Systematic Review and Meta-Analysis. J Periodontol 2016;87(3):281–290. DOI: 10.1902/jop.2015.150420.
  34. Bilginaylar K, Uyanik LO. Evaluation of the effects of platelet-rich fibrin and piezosurgery on outcomes after removal of impacted mandibular third molars. Br J Oral Maxillofac Surg 2016;54(6):629–633. DOI: 10.1016/j.bjoms.2016.03.016.
  35. Singh A, Kohli M, et al. Platelet rich fibrin: a novel approach for osseous regeneration. J Maxillofac Oral Surg 2012;11(4):430–434. DOI: 10.1007/s12663-012-0351-0.
  36. Asutay F, Yolcu Ü, et al. An evaluation of effects of platelet-rich-fibrin on postoperative morbidities after lower third molar surgery. Nigerian journal of clinical practice 2017;20:1531–1536. DOI: 10.4103/1119-3077.181400.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.