Soft Tissue Healing and Bony Regeneration of Impacted Mandibular Third Molar Extraction Sockets, Following Postoperative Incorporation of Platelet-rich Fibrin

Abstract

Introduction: Surgical removal of impacted mandibular third molars is one of the most commonly performed dentoalveolar surgeries by dental surgeons around the globe. It is known to be associated with clinically significant postoperative morbidity including swelling, pain, trismus, fever, and infection. In addition, the residual bony defect takes 7 months to 1 year to gradually fill with bone and to reossify.

Aims and objective: (1) To carry out a prospective study to evaluate differences in soft tissue healing and bony regeneration of impacted mandibular third molar extraction sites, with and without the incorporation of autologous platelet-rich fibrin (PRF) within the surgical wounds. (2) To also compare the incidence of short- and long-term posttreatment complications in both cases.

Materials and methods: Sixty patients were randomly inducted into two groups, consisting of 30 patients each. The first group, which served as the study group, consisted of patients in whom fresh autologous PRF were placed within the extraction site immediately following the surgical removal of the impacted mandibular third molar, before suturing of the mucoperiosteal flap. The second group, which served as the control froup, included those patients in whom the mucoperiosteal flaps were closed without incorporation of PRF within site. Both groups were evaluated and compared for postoperative pain, swelling, trismus, soft tissue healing, as well as bone fill of the extraction socket.

Results: It was found that the study group in which autologous PRF had been incorporated into the operative site exhibited quick and complication-free soft tissue healing as well as a much quicker reossification and bone fill of the extraction socket, as compared to the control group in which no PRF was used.

Conclusion: Incorporation of PRF within extraction sockets of impacted third molars proved to be beneficial for patients, yielding a quicker postoperative recovery with fewer complications such as postoperative swelling and edema, pain, and trismus; better overall postoperative results in terms of faster soft tissue healing as well as an earlier bony regeneration.

Keywords: Bone fill; mandibular third molar extraction sockets; platelet-rich fibrin; platelet-rich plasma; reossification.

Figure 1

(a and b) Horizontally impacted 38 (c and d) transalveolar extraction under local anesthesia. (e) Autologous platelet-rich fibrin prepared using a tabletop centrifuge. (f-j) Red blood cell layer at the bottom of the centrifugation strata removed and the platelet-rich fibrin segment placed into the extraction socket, followed by flap closure

Figure 2

Ten Point Visual Analogue Scale for evaluation of post-surgical pain

Graph 1

Comparison of postoperative pain between the two Groups at 3 days postsurgery

Graph 2

Comparison of periodontal health of adjacent second molar between the two Groups at 8 weeks postsurgery

Graph 3

Comparison of overall bone density score of extraction sockets between the two groups at 8 weeks postsurgery

Graph 4

Comparison of trabecular pattern score of extraction sockets between the two groups at 8 weeks postsurgery

Graph 5

Comparison of total bone density of extraction sockets between the two groups at 8 weeks postsurgery

Figure 3

(Group 1) Orthopantomograms of two cases, preextraction (a and d) and 2 months postextraction with platelet-rich fibrin placement (b and e). (c and f) Intraoral periapical radiographs 2 months postextraction with platelet-rich fibrin placement showing dense and healthy bone fill in the extraction sockets

Figure 4

(a and b) (Group 1) Intraoral periapical radiographs of mandibular right third molar region (a) before extraction. (b) Two months postextraction with platelet-rich fibrin placement in extraction socket showing dense and healthy bone fill. (c and d) (Group 2) Intraoral periapical radiographs of mandibular right third molar region (c) before extraction. (d) Two months postextraction without platelet-rich fibrin placement showing incomplete bone fill/reossification of the extraction socket

Figure 5

(Group 2) Intraoral periapical radiographs of mandibular third molar region following routine extractions without platelet-rich fibrin placement in extraction sockets, (a and c) two months postextraction revealing radiolucent appearance of the root sockets. (b and d) Six months postextraction showing beginning of bone fill and trabeculations