Treating with Platelet Rich Fibrin After Wisdom Teeth Removal

An interesting article titled “Evaluation of Treatment Outcome After Impacted Mandibular Third Molar Surgery With the Use of Autologous Platelet-Rich Fibrin: A Randomized Controlled Clinical Study,” appears in the Journal of Oral and Maxilofacial Surgery written by Nilima Kumar and et al. (vol 73, pp. 1042-1049). The article sets out to explore the effect of platelet-rich fibrin (PRF) on postoperative pain, swelling, trismus, periodontal healing near the second molar, and progress of bone regeneration in upper wisdom teeth extraction sockets.

Clinicians have identified a subpopulation of patients having wisdom teeth removed that are at ‘‘high risk’’ for periodontal defects after wisdom teeth removal (such as greater than 26 years old, pre-existing periodontal defects [attachment level, >3 mm; probing depth, >5 mm]; and horizontal or mesioangular impaction). The authors studied a patient sample that consisted of 31 patients with mesioangular or horizontal upper impacted wisdom teeth. Patients in the study were randomized by the closed-envelope method and divided into 2 groups. In one group, 16 patients had a impacted mandibular wisdom tooth surgically removed and PRF was placed into the extraction socket followed by flap approximation. The control group  had 15 patients treated with surgical removal of the impacted mandibular wisdom tooth and flap reapproximation.

Patients were evaluated and compared preoperatively, postoperatively on the first postoperative day, at 1 month, and at 3 months. In the study, pain (P = .017), swelling (P = .022), and interincisal distance (P = .040) were less in the case group compared with the control group on the first postoperative day and this difference was statistically
significant. Periodontal pocket depth decreased from the preoperative baseline in the case (P < .001) and control (P = .014) groups to 3 months postoperatively. Bone density, overall density, and trabecular pattern scores at 1 and 3 months postoperatively, was greater in the case group compared with the control group but was not a statistically significant difference.

Socket healing is a highly coordinated sequence of biochemical, physiologic, cellular, and molecular responses involving numerous cell types, growth factors, hormones, cytokines, and other proteins, which are directed toward restoring tissue integrity and functional capacity after injury. The presence and removal of impacted wisdom teeth
can negatively affect the periodontium of adjacent second molars as reflected in the disruption of the periodontal ligament, root resorption, and pocket depth associated with loss of attachment.

Because the literature suggests PRF is superior to some other treatments in inducing soft and hard tissue healing owing to a sustained release of growth factors, PRF was chosen. A statistically important decrease in pain, swelling, and restriction in mouth opening was observed when treating impacted wisdom teeth sockets with platelet-rich fibrin. Of course a study with a larger sample size is warranted to better make sure the result holds.

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