Effect of Advanced Platelet-Rich Fibrin (A-PRF) on Postoperative Level of Pain and Swelling Following Third Molar Surgery

Abstract

BackgroundPostoperative pain and swelling following third molar (M3) removal can be debilitating, and there is interest in using advanced platelet-rich fibrin (A-PRF) to reduce their severity. PurposeThis study compared postoperative pain and swelling between A-PRF and gelatin dressing in extraction sockets following mandibular M3 removal. Study design, setting, sampleThis split-mouth, single-blinded, randomized controlled trial was completed at the Oral Surgery clinic of University of Otago between November 2020 and July 2021. Patients aged between 16–40 years, with bilateral impacted mandibular M3 of similar Pederson index difficulty and deemed to be American Society of Anesthesiologists (ASA) I or II comprised the study sample. Predictor/exposure/independent variableThe exposure variable was M3 socket management. One socket received A-PRF and 1 gelatin dressing, while the other received 2 gelatin dressings. Main outcome variable(s)The outcome variables were postoperative pain and swelling over 7 days. Pain was measured using the visual analog scale, and swelling using stereophotogrammetry. CovariatesDemographic characteristics (gender, ethnicity, and age), dental anxiety, smoking status, Pederson index, and intraoperative surgical time were the covariates. AnalysesThe two sides were compared using cross-tabulations and the McNemar test for categorical and paired t-tests for continuous variables. Statistical analysis used IBM SPSS Statistics for Windows (Version 28). Alpha level was at 0.05. Results76 (87.3%) of 87 patients who met the eligibility criteria participated in the study, and 70 (65.7% female; age range 16-30 years) were included in the analysis. Mean VAS scores showed no statistically significant difference between the A-PRF and control sides, being 29.6 (95% CI 23.9, 35.3) and 29.5 (95% CI 23.5, 35.5) on day 2, and falling to 12.6 (95% CI 8.7, 16.5) and 14.2 (95% CI 10.0, 18.4) by day 7. Likewise, mean peak facial swelling on day 2 was recorded as 6.3cm3 (95% CI 4.9, 7.7) and 6.6cm3 (95% CI 5.5, 7.7), and by day 7 they were 1.1cm3 (95% CI 0.5, 1.7) and 1.0cm3 (95% CI 0.3, 0.7) on the A-PRF and control sides, respectively. Conclusions and RelevanceA-PRF placement in M3 sockets did not reduce postoperative pain and swelling over gelatin dressing alone.