Abstract
Background
Pain, swelling and alveolar osteitis are commonly associated with the surgical removal of impacted third molars. Minimising these will optimise recovery and allow earlier return to normal functions, thereby improving patients’ quality of life. Platelet-rich fibrin (PRF) is an autologous platelet concentrate proposed to reduce postoperative third molar complications such as pain, swelling and alveolar osteitis. In addition to being relatively cheap, simple and non-invasive to perform, PRF is an acceptable alternative to animal-derived products. While the literature indicates favourable findings of PRF use in third molar surgery, the data remains inconclusive. Surgical removal of impacted third molars will be referred to as “third molar surgery” for the remainder of this thesis.
Objectives
To investigate the clinical effects of intraoperative use of advanced platelet-rich fibrin (A-PRF) on postoperative pain and facial swelling after third molar surgery.
Methods
This study was a single-centre, single-blind, randomised, placebo-controlled trial involving 70 participants with symmetrical mandibular third molar impactions. They were randomly assigned an ID number, determining each participant's intervention and control side for this split-mouth design. The participants’ third molar surgeries were performed under local anaesthesia with IV sedation under standardised conditions with an identical surgical approach. Premedication consisting of 40mg parecoxib, 8mg dexamethasone and 30μg fentanyl was administered to each participant. Following the third molar removal, the intervention socket was dressed with an A-PRF plug and SurgisponTM, while the control socket only received SurgisponTM. The blinded participants completed a 7-day diary to record their postoperative pain on the visual analogue scale (VAS) and their facial swelling on a 5-point ordinal scale. They were also assessed clinically for postoperative complications on days 2 (D2) and 7 (D7). In addition, 3D stereophotography images were taken using the 3dMDtrioTM system on D2 and D7. Comparisons were made against baseline measurements taken preoperatively on surgery day to calculate the volumetric changes. Ancillary data from this study include information on dental anxiety and participants’ oral health-related quality of life.
Results
There were no differences in the mean VAS scores and facial volumes between the two sides across the seven days. Participants from both sides did not develop any alveolar osteitis; thus, there was no difference in the incidence between the A-PRF and control sides. Qualitative data analysis showed a higher proportion of the A-PRF side being 'pain-free' and 'swelling-free' on D2 than the control side, but the results were not statistically significant.
Conclusions
The use of A-PRF in third molar sockets did not appear to confer an additional reduction in postoperative pain and swelling when other preventive strategies like pre-emptive analgesia and corticosteroid administration have been employed. Improvements shown through qualitative data merit further research to explore its potential benefits in compromised healing environments