Evaluation of the Efficacy of Platelet-Rich Plasma versus Platelet-Rich Fibrin in Alleviating Postoperative Inflammatory Morbidities after Lower Third Molar Surgery: A Double-Blind Randomized Study.

BACKGROUND: Postoperative morbidities following impacted lower third molar (M3) surgery is of concern. The influence of platelets concentrates on postoperative inflammatory sequelae of M3 is promising. However, the comparative efficacy of platelet-rich fibrin (PRF) to platelet-rich plasma (PRP) in ameliorating postoperative morbidities remains controversial. OBJECTIVE: The study aimed to compare the bioactive effects of PRP and PRF on postoperative pain, swelling, and trismus after impacted M3 surgery. SUBJECTS AND METHODS: A randomized, parallel-group study of 50 subjects was designed. Preoperative and postoperative swelling, degree of mouth opening and pain were assessed on days 1, 3, and 7. Linear mixed model analysis was used to compare the effects of treatment, time-point assessment within the group, and treatment with time interaction. RESULTS: Interaction estimates show statistically significant pain reduction with PRF (p = 0.00, 95% CI [-0.95, -0.25]. Trismus based on a time-point assessment within the PRP and PRF groups was significantly reduced (p =0.01, 95% CI [0.06, 0.38]) and (p = 0.00, 95% CI [0.12, 0.44]) respectively. Facial swelling within the PRP and PRF groups were significantly decreased (p = 0.00, 95% CI [-0.30, -0.06]) and (p = 0.00, 95% CI [-0.37, -0.13) respectively. There were no statistically significant differences between the groups for trismus and swelling. Age was a significant predictor of trismus in both groups (p = 0.04, 95% CI [-0.07, -0.01]). CONCLUSION: PRF was more effective in reducing postoperative pain compared to PRP. Furthermore, the study shows that platelet concentrates positively modulate post-inflammatory sequelae of impacted M3 surgery.

CONTEXTE: Les morbidités postopératoires consécutives à une chirurgie de la troisième molaire inférieure (M3) impactée sont préoccupantes. L'influence des concentrés plaquettaires sur les séquelles inflammatoires postopératoires de M3 est prometteuse. Cependant, l'efficacité comparative de la fibrine riche en plaquettes (PRF) et du plasma riche en plaquettes (PRP) dans l'amélioration des morbidités postopératoires reste controversée. OBJECTIF: L'étude visait à comparer les effets bioactifs du PRP et du PRF sur la douleur, l'enflure et le trismus postopératoires après une chirurgie M3 impactée. SUBJETS ET MÉTHODES: Une étude randomisée en groupes parallèles de 50 sujets a été conçue. Le gonflement préopératoire et postopératoire, le degré d'ouverture de la bouche et la douleur ont été évalués les jours 1, 3 et 7. Une analyse de modèle mixte linéaire a été utilisée pour comparer les effets du traitement, l'évaluation ponctuelle au sein du groupe et le traitement avec l'interaction temporelle. RÉSULTATS: Les estimations d'interaction montrent une réduction statistiquement significative de la douleur avec le PRF (p = 0.00, IC à 95 % [­0.95, ­ 0.25]. Le trismus basé sur une évaluation ponctuelle dans les groupes PRP et PRF a été significativement réduit (p = 0.01, 95 % IC [0.06, 0.38]) et (p = 0.00, IC 95 % [0.12, 0.44]) respectivement Le gonflement du visage dans les groupes PRP et PRF a été significativement diminué (p = 0.00, IC 95 % [­0.30, ­0.06 ]) et (p = 0.00, IC 95 % [­0.37, ­0.13) respectivement. Il n'y avait pas de différences statistiquement significatives entre les groupes pour le trismus et le gonflement. L'âge était un prédicteur significatif du trismus dans les deux groupes (p = 0.04, 95 % IC [­0.07, ­0.01]). CONCLUSION: Le PRF était plus efficace pour réduire la douleur postopératoire que le PRP. De plus, l'étude montre que les concentrés plaquettaires modulent positivement les séquelles postinflammatoires de la chirurgie M3 impactée. Mots clés: concentrés plaquettaires, douleur, gonflement, trismus, troisième molaire.

Do the bioactive effects of platelet-rich plasma and platelet-rich fibrin influence the oral health related quality of life following impacted third molar surgery? A randomized comparative study.

AIM: 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. PATIENTS AND METHODS: 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. RESULTS: 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). CONCLUSION: 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.