Effects of Leukocyte-Platelet-Rich Fibrin (L–PRF) on Pain, Soft Tissue Healing, Growth Factors, and Cytokines after Third Molar Extraction: A Randomized, Split-Mouth, Double-Blinded Clinical Trial

Abstract

This study assessed the effects of leukocyte-platelet-rich fibrin (L–PRF) on soft tissue healing and the correlation with the local concentration of growth factors (GF) and cytokines in the dental socket of lower third molars. Forty lower-third molars (20 participants) were included in this randomized, double-blinded, split-mouth study. After extractions, randomized sides received alveolar filling with L–PRF on one side and a natural blood clot on the other side. The pain was assessed for up to seven days and soft tissue healing (Landry index) for 14 days post-extraction. Swabs were collected from the surgical sites for GF and cytokine assessment by flow luminometry. Participants reported lower postoperative pain on the sides grafted with L–PRF, which also presented increased tissue healing scores (p < 0.05). There were increased levels of all GFs and several cytokines at the L–PRF site at day one, while vascular endothelial growth factor (VEGF), IL–10, and IL1–RA remained higher throughout for seven days (p < 0.05). VEGF concentration at L–PRF sites correlated positively with the participants’ blood platelet content (ρ = 0.769). PDGF correlated negatively with pain experience on days 2 and 3, and positively with soft tissue healing scores, while FGFb presented a weak correlation with a reduction of pain on day 3. The use of L–PRF improves the soft tissue healing process and decreases postoperative pain after the third molar extractions, which correlates with an increase in the local concentration of growth factors such as PDGF and FGFb.

Effect of Leucocyte and Platelet Rich Fibrin (L-PRF) in Postoperative Sequelae of Impacted Mandibular Third Molar Surgery - A Split Mouth Randomized Controlled Trial

“…In the metaanalysis by Xiang et al, (19), it was found that most studies revealed that application of PRF to extraction sockets significantly reduced pain on the postoperative third day and swelling on the postoperative first day. Soft tissue healing and cicatrization indices showed significant difference from baseline values only on the 7th day in most of the studies (20).…”

Effect of leukocyte and platelet-rich fibrin on free gingival graft healing: A clinical and histological study in rabbits

“… 6 This can be the reason for the acceleration of wound healing with L-PRF, which has been seen in other intraoral surgeries, including tooth extraction. 7 , 9 This index is an observer-dependent index, and different indicators have been used in these studies. Perhaps these reasons can explain the differences in the results.…”

“…Recent evidence on the use of L-PRF in oral applications suggests that it improves soft tissue wound healing, periodontal regeneration, and healing of extraction sockets. 7 - 9 In most of these procedures, L-PRF is placed below oral mucosal gingival flaps.…”

Standardization of Animal Models and Techniques for Platelet-Rich Fibrin Production: A Narrative Review and Guideline

“…In the past two decades, platelet-rich fibrin (PRF) has become increasingly popular in medicine and dentistry for its potential use in wound healing and tissue regeneration [ 4 , 5 , 6 , 7 , 8 ]. However, PRF’s development deviated from the typical research process as it was first used in humans before being studied in vitro and with animal models [ 9 ].…”