Efficacy of Platelet-Rich Plasma in Post-extraction Healing of Mandibular Third Molars: A Clinical and Radiographic Evaluation

Abstract

Introduction: Healing of extraction sockets is a critical factor in oral and maxillofacial surgery, particularly when preserving alveolar bone and periodontal stability is essential. Platelet-rich plasma (PRP), an autologous concentrate of growth factors, has gained attention for its potential to enhance bone regeneration and soft-tissue healing. This study aimed to evaluate the clinical and radiographic outcomes of PRP application in extraction sockets after impacted mandibular third molar surgery.

Materials and methods: Forty patients who underwent impacted mandibular third molar extraction were divided into two groups according to clinical decision-making in conjunction with patient preference: the PRP group, in which PRP was applied in the extraction socket, and the non-PRP group, which received standard post-extraction care. Clinical parameters, including probing depth and wound closure, and radiographic assessments of alveolar bone level and bone density were recorded at baseline, one month, three months, and six months postoperatively.

Results: The application of PRP resulted in significant improvements in alveolar bone preservation and periodontal health, with a notable reduction in probing depth compared to the non-PRP group. Although PRP did not show a significant difference in bone density between the groups, a sustained increase over time suggested a positive effect on bone remodeling. PRP also accelerated wound healing, with initial dehiscence observed, but improved closure by day seven, indicating a biphasic influence on tissue repair.

Conclusion: PRP demonstrated potential benefits in enhancing soft and hard tissue healing after mandibular third molar extraction. Its ability to promote periodontal stability and wound closure suggests its clinical utility for oral surgical procedures. However, larger randomized controlled trials with extended follow-up are needed to establish standardized protocols and confirm their long-term efficacy.

Keywords: extraction; platelet rich plasma; sockets; third molars; wound healing.

Figure 1. Platelet-rich plasma (PRP) gel preparation.

A: whole venous blood at first centrifugation at 1000 rpm for 10 min with formation of supernatant containing PRP; B: PRP, buffy coat, and the upper 1–2 mm layer of red blood cells transferred into a fresh tube; C: at second centrifugation at 1000 rpm for 10 min; D: the upper layer was discarded and the remaining lower layer mixed thoroughly to obtain concentrated PRP (cPRP); E: cPRP added with 10% calcium chloride for activation; F: formation of PRP gel. This figure illustrates the preparation of PRP gel from venous blood drawn from a patient in the PRP cohort (arrows marking the stages), with the patient’s informed consent for its use.

Figure 2. Surgical removal of mandibular third molar with platelet-rich plasma (PRP) gel placement in the PRP cohort.

A: crestal incision; B: crestal with sulcular incision to raise the flap; C: removal of mandibular left third molar; D: placement of PRP gel; E: flap closure with sutures; F: postoperative healing. This figure illustrates surgical removal with the placement of PRP gel into the extraction socket of a patient in the PRP cohort (arrows marking the stages), with the patient’s informed consent for its use.

Figure 3. Assessment of alveolar bone level (ABL) and bone density (BD) in grayscale values in platelet-rich plasma (PRP) cohort

A: ABL at three months; B: BD at three months; C: ABL at six months; D: BD at six months. This figure illustrates the intraoral periapical radiographic assessment of ABL and BD of a patient in the PRP cohort, with the patient’s informed consent for its use.