Platelet-rich fibrin combined with demineralized tooth matrix enhances periodontal regeneration following impacted third molar surgery: a randomized controlled clinical trial.

Background Third molar impaction surgery is one of the most commonyet challenging procedures done as a part of minor oral surgery. Years of research and improvisation of techniques have been done, yet there are still a lot of postoperative sequelae after surgical removal of the impacted tooth. In our study, we have compared the efficacy of dexamethasone diluted saline solution over plain saline solutionused as an irrigant in the reduction of postoperative sequelae for lower third molar surgery. Aim The aim of the study was to evaluate the efficacy of dexamethasone dilutedsaline solution over plain saline solutionin the reduction of postoperative sequelae for lower third molar surgery. Materials and methods The research was conducted atSaveetha Dental College and Hospitalin the Department of Oral and Maxillofacial Surgery. The study consisted of 48 individuals, 24 of whom haddexamethasone saline as an irrigant (8 mg of dexamethasone was diluted in 100 ml of plain saline) (Group 1), and 24 inwhom plain saline was used as an irrigant (Group 2) in the lower third molar surgery. Patients were evaluated postoperatively for pain and swelling. The postoperative swelling was measured on postoperative day two and day seven.Postoperative pain was measured onday two, day four, and day seven after surgery using a visual analog scale. Data were analyzed using SPSS (IBM Corp., Armonk, NY) with P-values less than 0.05 considered statisticallysignificant. The statistical test used to compare the outcomes between the two groups was the independent samples t-test. Results It was found that study participants in the dexamethasone saline irrigation group reported statistically significantly lesser pain than participants receiving plain saline irrigation on day two (P = 0.001), day four (P = 0.001), and day seven (P = 0.001), respectively. Also, there was a reduction in swelling among participants in the dexamethasone saline irrigation group when compared to the normal saline irrigation group, which was statistically significant (P = 0.001) on day two, while the postoperative swelling was not statistically significant onday seven (P = 0.08) between the two study groups. Conclusion Based on the results obtained, it can be concluded thatdexamethasone saline solution (8 mg/100 mL) was more effective as an irrigantin reducing the postoperative sequelaethan regular saline solution in the lower third molar surgery.

Background: Mandibular third molar surgery can lead to neurosensory disturbances due to potential damage to the inferior alveolar nerve. Platelet-rich fibrin (PRF), an autologous blood-derived biomaterial, has been proposed as a potential adjunct to enhance nerve regeneration and improve clinical outcomes following these procedures. Objective: This meta-analysis aimed to evaluate the effectiveness of autologous PRF in enhancing nerve regeneration following mandibular third molar surgery based on available randomized controlled trials. Material and Methods: A comprehensive search was conducted across multiple databases, including PubMed, Cochrane Library, Web of Science, and Embase for randomized controlled trials evaluating PRF application after mandibular third molar surgery. Studies were assessed for quality using the Cochrane risk-of-bias tool. Data on nerve regeneration outcomes and related clinical parameters were extracted and analyzed. Results: Four studies met the inclusion criteria, with only one study directly measuring nerve regeneration outcomes. This study demonstrated significant improvement in the brush directional stroke discrimination test (BDSD) in the PRF group (p < 0.001), though no significant differences were observed in two-point discrimination (TPD) and self-reported neurosensory disturbance (SR-NSD). The other studies focused on related clinical outcomes, including pain, swelling, trismus, and bone healing, consistently showing the benefits of PRF application. Meta-analysis of pain reduction showed a standardized mean difference of -0.74 (95% CI: -0.97 to -0.52) favoring PRF. Conclusions: While limited evidence suggests PRF may enhance nerve regeneration following mandibular procedures, more research specifically focused on neurosensory outcomes after third molar surgery is needed. PRF consistently demonstrates benefits for pain reduction, swelling control, and improved healing, making it a promising adjunctive treatment. Future studies should incorporate standardized neurosensory testing to better evaluate PRF's impact on nerve regeneration.

To compare the effects of platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) on oral health-related quality of life (OHQoL) following impacted mandibular third molar (M3) surgery. A prospective, randomized study of 50 subjects was designed. Participants were divided equally into the PRP and PRF groups. The OHQoL was assessed using the OHQoL-UK instrument preoperatively and on postoperative days (PODS) 1, 3, and 7. Categorical variables were presented as frequencies and proportions. The linear mixed model analysis was used to determine the effects of PRF and PRP on overall OHQoL with respect to time, treatment, and treatment by time-point interaction. The analysis was also performed for the physical, social, and psychological domains. Fifty subjects were analyzed. The time-point assessment of the overall OHQoL was significant within the PRP and PRF groups (P-values of 0.01 and 0.000002, respectively). The time-point analysis was also significant in both study groups at all domain levels (P < 0.05). A comparison of treatment by time-point interaction for the overall OHQoL between the study groups was insignificant (P = 0.217). Treatment by time-point interaction for OHQoL between the study groups at social and psychological domain levels was insignificant, however, at the physical domain level, PRF had a significantly better effect on OHQoL (P = 0.016). The study showed that the overall OHQoL was not significantly different between the PRP and PRF groups after M3 surgery. However, PRF had a significant influence on OHQoL at the physical domain level.

Background: Latent third molar extraction is the most common surgery in dentistry. Common complications of this surgery include pain, swelling, and trismus. To control these side effects, several drugs have been developed and evaluated in various studies. However, the present study is the first one to compare the effects of ibuprofen and ketorolac on pain, swelling, and trismus after molar surgery. Methods: This study was a split-mouth clinical trial. To conduct the trial, 20 candidates were selected from among patients referring to Surgery Department of the Dentistry School at Yazd Shahid Sadoughi University of Medical Sciences for mandibular third molar removal surgery. The patients were divided into two groups after the surgery: one group received ibuprofen, and the other one received ketorolac. Pain, swelling, and trismus were evaluated prior to the surgical procedure, 24 hours later, and one week after the surgery. Data were analyzed by SPSS software version 22 by using Wilcoxon statistical tests and paired t test. Results: Ibuprofen and ketorolac had similar effects on pain relief (P value&gt;0.05). Studying the two groups produced similar results regarding improvement in mouth opening (P value&gt;0.05). Improvement pace of the postoperative swelling was significantly faster in the group receiving ketorolac compared to the one receiving ibuprofen (P value &lt;0.05). Conclusions: It was concluded that ibuprofen and ketorolac had positive and almost similar effects on pain control, edema, and trismus after molar surgery. However, ketorolac was more effective in controlling edema after surgery.

BackgroundThis study aimed to review translational studies focusing on third molar removal surgeries through a systematic analytical approach.Material and MethodsA PROSPERO-registered systematic review (CRD42017060455) was conducted following the PRISMA statement to summarize current knowledge on gene expression in third molar surgeries. A search was performed in PubMed’s Medline and Scopus databases, without date or language restrictions, using the logical expression {[(Third molar) OR (preemptive) OR (cyclooxygenase inhibitors) OR (acute inflammation) AND (gene expression)]}.ResultsAll studies included in the analysis evaluated gene expression in a third molar extraction model, using the preemptive analgesia methodology in seven investigations. The sample analyzed was obtained from gingival tissue biopsy (n=4), blood (n=1), transudate (n=1) and gingival tissue biopsy/transudate (n=1). There were differences with respect to evaluated genes, drug protocol, sample studied, and method for evaluating gene expression.ConclusionsThird molar surgeries were found to be associated with different COX-related gene expression patterns. Although inflammatory events following the surgical procedure are associated with COX isoforms, data from preemptive analgesia studies are scarce, especially from studies correlating gene expression and clinical parameters. In the future, from a clinical perspective, identifying the molecular targets of a drug based on individual gene expression may be helpful to delineate specific third molar, surgery-related, preemptive analgesia protocols. Key words:Third molar, gene expression, preemptive analgesia, systematic review.

Background: More and more studies were being conducted to improve healing after third molar surgery. The aim of this study was to evaluate the effect of PRF on soft tissue and periodontal pocket healing, alveolar bone resorption distal to the second molar after lower third molar surgical removal. Methods: A Randomized, controlled clinical trial and split-mouth design was performed on 26 healthy patients who had an indication of impacted lower third molars extraction on both sides with symmetrical orientation and the same difficult index. All patients had the same extraction protocol on both sides at the Department of Oral Surgery, Faculty of Odonto-stomatology, University of Medicine and Pharmacy, Ho Chi Minh City. PRF was applied on one side, whereas the other was left empty as the control group. Assessing the soft tissue healing, periodontal pocket depth and distal bone resorption of the study and control groups after third molar removal surgery. Data obtained were statistically analyzed. Results: There is a statistically significant difference in soft tissue healing on the 3rd and 7th postoperative days and distal bone resorption (p&lt;0.05) on the 3rd and 6th postoperative months between two groups. Periodontal pocket depth of the study group showed more reduction than the control group but was not significantly different. Conclusion: Using PRF can help improve soft tissue healing and lower distal bone resorption after surgical extraction of impacted lower third molars. PRF appears to reduce periodontal pocket depth but still needs more research to conclude.

Introduction: Surgical removal of third molars has been well- known for causing stressful situation for the majority of the patients. Increasing serum glucose level is expected following acute rise in epinephrine level or probably local anesthetic injection. This study was designed to compare blood glucose levels before and after third molar surgery. Materials and Methods: In this prospective clinical trial study, candidates for third molar removal surgery were enrolled. Blood glucose level was measured by glucometer before and 10 minutes after surgery in each patient and the result were compared. Results: The mean blood glucose in 92 patients before the procedure were 110.82±15.38 mg/dl and after surgery, it increased significantly to 123.95±16.87 mg/dl (P<0.001). The only variable that effects the blood glucose level in this study was the type of local anesthetic (P = 0.019). Conclusion: The current study showed that there is a significant increase in blood glucose level in patients undergoing surgical removal of impacted third molar teeth.

Effect of Platelet-Rich Fibrin on Frequency of Alveolar Osteitis Following Mandibular Third Molar Surgery: A Double-Blinded Randomized Clinical Trial

Introduction: The extraction of retained third molars can present surgical complications, causing various alterations to the patient, such as pain after the intervention, inflammation during the next 24 to 72 hours, jaw pain, among others. Objective: To compare the effectiveness of physiological healing vs. the use of platelet-rich fibrin at the time of bone and gingival tissue healing in lower third molar surgeries by means of a bibliographic review and thereby identify the properties and factors that promote healing. cicatrization. Materials and methods: Qualitative and descriptive bibliographic review, based on the PRISMA (2020) method, inclusion and exclusion criteria were used, in addition to search strings created using MeSH terms and Boolean operators to search the databases, PubMed, ScienceDirect, and Scielo. Results: A total of 12 scientific articles with valid information for the investigation were obtained. It was determined that platelet-rich fibrin is better than physiological healing for bone and gingival tissue healing in lower third mandibular surgeries. Conclusion: It is concluded that the application of Platelet Rich Fibrin (PRF) promotes the healing process of the tissues and reduces discomfort such as pain, inflammation and bleeding after mandibular third molar surgery, although advanced Platelet Rich Fibrin variants (A-PRF) and leukocyte- and platelet-rich fibrin (L-PRF) are more efficient than simple PRF

There is no conclusive evidence from clinical trial studies regarding preemptive analgesic interventions. Clinical trials are necessary to evaluate the efficacy of preemptive analgesic interventions already demonstrated in animal studies. Thus, it is necessary to evaluate the analgesic effect of preoperative administration of ibuprofen alone or coadministered with dexamethasone after third molar surgery. A randomized, double-blind, and controlled clinical trial was conducted with 94 bilateral symmetrical third molar surgeries. Preemptive analgesic medication was randomly defined: ibuprofen or placebo and ibuprofen + dexamethasone or placebo was administered to patients who served as their own control (split mouth). The variables analyzed were postoperative pain through visual analog scale (VAS), total number of rescue analgesic (TNRA), and patient satisfaction. Data were analyzed with the Mann-Whitney test. There was no significant difference (p > 0.05) between ibuprofen and placebo for postoperative pain (VAS) and TNRA. Patients consumed less analgesics (TNRA) for dexamethasone + ibuprofen (p < 0.05) and felt more comfortable in the postoperative period after surgery (p < 0.05). The preemptive analgesia with ibuprofen was insufficient to inhibit central sensitization, whereas its association with dexamethasone was more effective in preventing pain in third molar surgery.

Does the piezoelectric surgical technique produce fewer postoperative sequelae after lower third molar surgery than conventional rotary instruments? A systematic review and meta analysis

Background: Surgical extraction of impacted mandibular third molars is commonly associated with post-operative inflammatory sequelae, causing distress to patients and affecting their quality of life. This study aimed to investigate the effect of using autologous platelet-rich fibrin (PRF) on post-operative pain, facial swelling, and trismus following mandibular third molar surgery.&#x0D; Methods: In this single-blinded prospective randomized controlled trial, 90 participants aged 18-35 years were enrolled. Eligible patients underwent surgical extraction of impacted mandibular third molars under local anesthesia between October 2017 and June 2018 at the Oral and Maxillofacial Surgery clinic of Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria. Participants were randomly assigned to either the PRF group or the non-PRF group. PRF was placed in the extraction socket of the PRF group, while the non-PRF group received a blood clot. Post-operative pain, facial swelling, and trismus were measured as outcomes. Longitudinal data analysis using generalized estimating equations was employed, adjusting for confounding factors, with statistical significance set at p &lt; 0.05.&#x0D; Results: The PRF group exhibited significantly lower pain scores (3.02 mm; p &lt; 0.001), reduced facial swelling (0.55%; p = 0.01), and decreased trismus (4.52%; p = 0.05) compared to the non-PRF group.&#x0D; Conclusion: Placement of PRF in the extraction socket following mandibular third molar surgery resulted in decreased post-operative pain, facial swelling, and trismus. These findings suggest that PRF may have a beneficial impact on the inflammatory outcomes of third molar surgeries.&#x0D; &#x0D;

BackgroundThird molar surgery is associated with various postoperative complications (PC). Different strategies, including the application of platelet-rich fibrin (PRF), have been implemented to reduce PC. Digital technologies have proven useful in objectively assessing postoperative facial swelling. This study aimed to evaluate the effect of PRF on reducing facial swelling after lower third molar surgery using a 3D face scanner.MethodsA randomized split-mouth clinical trial was set up and 32 patients (18 to 32 years), requiring extraction of both mandibular third molars, were recruited at the Oral Surgery Clinic of the Magna Graecia University of Catanzaro. The primary predictive variable was the application or not of PRF plugs and membranes in the post-extraction socket. Primary outcome variable was facial swelling recorded with a face scanner preoperatively (T0), after three (T1) and seven (T2) days. Qualitative and quantitative data analysis were conducted following an automated and standardized imaging analysis workflow using the 3D Slicer software. Secondary outcome variables were trismus, recorded by measuring the maximum buccal opening with a caliper, pain, recorded using a visual analogue scale (VAS), and duration of the surgery. Descriptive and bivariate analysis were performed by setting the significance level = 0.05.ResultsAll patients exhibited a significant increase in facial swelling at T1, followed by a subsequent reduction from day 3 to day 7, with a slight persistence of edema observed on the seventh day. No significant data emerged from the statistical analysis conducted. Linear differences in PRF group reported improved values of postoperative swelling only in the T1-T2 and T0-T2 phases of analysis. Volumetric differences favored PRF group compared with control group in all phases. VAS was lower in PRF group only at T2, compared with control group.ConclusionsApplication of PRF in post-extraction sockets showed effectiveness in reducing facial swelling. Its advantages, including accessibility, cost-effectiveness, and absence of adverse reactions, make it an optimal treatment choice in reducing post-surgical sequelae.

Effect of platelet-rich fibrin on the control of alveolar osteitis, pain, trismus, soft tissue healing, and swelling following mandibular third molar surgery: an updated systematic review and meta-analysis

Evaluation of postoperative complications after mandibular third molar surgery with the use of platelet-rich fibrin: a systematic review and meta-analysis