Praganta Jesslyn, De Silva Harsha, De Silva Rohana, Tong Darryl C, Thomson W Murray
Specialist Oral Surgeon, Senior Professional Practice Fellow - Department of Oral Diagnostics and Surgical Sciences, Faculty of Dentistry, University of Otago, Dunedin, New Zealand.
Associate Professor, Consultant Oral and Maxillofacial Surgeon, Department of Oral Diagnostics and Surgical Sciences, Faculty of Dentistry, University of Otago, Dunedin, New Zealand.
J Oral Maxillofac Surg. 2024 May;82(5):581-589. doi: 10.1016/j.joms.2024.02.003. Epub 2024 Feb 10.
Postoperative 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.
This study compared postoperative pain and swelling between A-PRF and gelatin dressing in extraction sockets following mandibular M3 removal.
METHODS, SETTING, SAMPLE: This 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 and 40 years with bilaterally 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 VARIABLE: The 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 (VAS), and swelling using stereophotogrammetry.
Demographic characteristics (gender, ethnicity, and age), dental anxiety, smoking status, Pederson index, and intraoperative surgical time were the covariates.
The 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).The Alpha level was 0.05.
76 (87.3%) of 87 patients who met the eligibility criteria participated in the study, and 70 patients (65.7% female; age range 16-30 years) were included in the analysis. Mean visual analog scale 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 6.3 cm (95% CI 4.9, 7.7) and 6.6 cm (95% CI 5.5, 7.7), and by day 7 they were 1.1 cm (95% CI 0.5, 1.7) and 1.0 cm (95% CI 0.3, 0.7) on the A-PRF and control sides, respectively.
A-PRF placement in M3 sockets did not reduce postoperative pain and swelling over gelatin dressing alone.
拔除第三磨牙（M3）后的术后疼痛和肿胀可能使人虚弱，因此人们对使用高级富血小板纤维蛋白（A-PRF）来减轻其严重程度很感兴趣。
本研究比较了下颌M3拔除后拔牙窝内使用A-PRF和明胶敷料后的术后疼痛和肿胀情况。
方法、地点、样本：这项双侧、单盲、随机对照试验于2020年11月至2021年7月在奥塔哥大学口腔外科诊所完成。研究样本包括年龄在16至40岁之间、双侧下颌M3阻生且佩德森指数难度相似、被评定为美国麻醉医师协会（ASA）I或II级的患者。
预测因素/暴露因素/独立变量：暴露变量为M3拔牙窝处理。一个拔牙窝接受A-PRF和1块明胶敷料，另一个接受2块明胶敷料。
结局变量为7天内的术后疼痛和肿胀情况。疼痛采用视觉模拟量表（VAS）测量，肿胀采用立体摄影测量法测量。
人口统计学特征（性别、种族和年龄）、牙科焦虑、吸烟状况、佩德森指数和术中手术时间为协变量。
使用交叉表和McNemar检验比较两侧的分类变量，使用配对t检验比较连续变量。统计分析使用IBM SPSS Statistics for Windows（版本28）。α水平为0.05。
87名符合入选标准患者中的76名（87.3%）参与了研究，70名患者（65.7%为女性；年龄范围16至30岁）纳入分析。平均视觉模拟量表评分显示，A-PRF侧和对照侧之间无统计学显著差异，第2天分别为29.6（95%CI 23.9，35.3）和29.5（95%CI 23.5，35.5），到第7天降至12.6（95%CI 8.7，16.5）和14.2（95%CI 10.0，18.4）。同样，第2天平均面部肿胀峰值记录为6.3厘米（95%CI 4.9，7.7）和6.6厘米（95%CI 5.5，7.7），到第7天，A-PRF侧和对照侧分别为1.1厘米（95%CI 0.5，1.7）和1.0厘米（95%CI 0.3，0.7）。
在M3拔牙窝内放置A-PRF并不能比单独使用明胶敷料更有效地减轻术后疼痛和肿胀。
