Assistant Professor, Department of Oral and Maxillofacial Surgery, School of Dentistry, Kashan University of Medical Sciences, Kashan, Iran.
Assistant Professor, Department of Prosthodontics, School of Dentistry, Kashan University of Medical Sciences, Kashan, Iran.
J Oral Maxillofac Surg. 2024 Jun;82(6):671-683. doi: 10.1016/j.joms.2024.02.014. Epub 2024 Mar 5.
Several measures have been implemented to minimize the side effects of impacted third molar (M3) removal including the use of platelet-rich fibrin (PRF).
This study compared the effects of three modifications of PRF (leukocyte-PRF [L-PRF], advanced-PRF [A-PRF], and advanced-PRF plus [A-PRF +]) on the side effects of impacted M3 removal.
STUDY DESIGN, SETTING, AND SAMPLE: This double-blinded randomized controlled trial was conducted at the Oral Surgery Department of Kashan University between September 2022 and May 2023 on patients undergoing mandibular impacted M3 removal. Exclusion criteria were age over 30, local inflammation and infection, medication usage, and systemic disease.
The independent variable was the PRF product grouped into four categories (control, L-PRF, A-PRF, and A-PRF+). Study subjects were randomly distributed among the four groups.
MAIN OUTCOME VARIABLE(S): The main outcome variables were postoperative sequelae including measures of soft tissue healing, pain, analgesic use, alveolar osteitis, trismus, and swelling. Subjects were assessed at baseline and on days 1, 2, 3, and 7 postsurgery.
Age, sex, duration of surgery, and side of surgery were the covariates.
Changes at different time points were analyzed using repeated measures analysis of variance. Pairwise comparisons were performed if significant. P values ≤.05 were considered statistically significant.
The sample consisted of 64 subjects (16 per group). All three modifications of PRF yielded significantly better soft tissue healing index than the control group on days 2, 3, 7, and 14 postoperatively (P > .05). A-PRF and A-PRF + had significantly better healing index than L-PRF on the third day (P = .02, P = .01). All the study groups significantly reduced visual analog scale pain score than the control group on days 1, 2, and 3. A-PRF and A-PRF + had significantly lower visual analog scale scores than L-PRF on the second day (P = .003, P = .02). No significant difference was found in maximum mouth opening during follow-up sessions (P = .2). Study groups had less facial swelling on days 2 and 3 than the control group (P < .05).
L-PRF, A-PRF, and A-PRF + can improve postoperative outcomes after M3 removal but may not impact trismus. A-PRF and A-PRF + may be more effective than L-PRF in promoting soft tissue healing and reducing pain. A-PRF and A-PRF + have comparable results.
为了尽量减少阻生第三磨牙（M3）拔除的副作用，已经采取了多种措施，包括使用富含血小板纤维蛋白（PRF）。
本研究比较了三种 PRF 改良方法（白细胞 PRF [L-PRF]、先进 PRF [A-PRF]和先进 PRF 加 [A-PRF+]）对 M3 拔除副作用的影响。
研究设计、地点和样本：这是一项在 2022 年 9 月至 2023 年 5 月期间在卡尚大学口腔外科进行的双盲随机对照试验，纳入了接受下颌阻生 M3 拔除的患者。排除标准为年龄超过 30 岁、局部炎症和感染、用药和全身疾病。
自变量是 PRF 产品，分为四组（对照组、L-PRF、A-PRF 和 A-PRF+）。研究对象随机分配到四组。
主要结局变量是术后后遗症，包括软组织愈合、疼痛、镇痛药物使用、牙槽骨炎、牙关紧闭和肿胀的测量。受试者在基线和术后第 1、2、3 和 7 天进行评估。
年龄、性别、手术持续时间和手术侧为协变量。
使用重复测量方差分析分析不同时间点的变化。如果有显著差异，则进行两两比较。P 值≤.05 被认为具有统计学意义。
样本包括 64 名受试者（每组 16 名）。所有三种 PRF 改良方法在术后第 2、3、7 和 14 天的软组织愈合指数均明显优于对照组（P>.05）。A-PRF 和 A-PRF+在第三天的愈合指数明显优于 L-PRF（P=.02，P=.01）。所有研究组在术后第 1、2 和 3 天的视觉模拟评分疼痛均明显低于对照组。A-PRF 和 A-PRF+在第二天的视觉模拟评分明显低于 L-PRF（P=.003，P=.02）。在随访期间，最大张口度无显著差异（P=.2）。研究组在第 2 和 3 天的面部肿胀程度明显低于对照组（P<.05）。
L-PRF、A-PRF 和 A-PRF+可以改善 M3 拔除后的术后结果，但可能不会影响牙关紧闭。A-PRF 和 A-PRF+在促进软组织愈合和减轻疼痛方面可能比 L-PRF 更有效。A-PRF 和 A-PRF+的结果相当。
