Skip to main content

Advertisement

SpringerLink
Log in

Use of platelet- and leukocyte-rich fibrin (L-PRF) as a healing agent in the postoperative period of third molar removal surgeries: a systematic review

  • Review
  • Published:
Clinical Oral Investigations Aims and scope Submit manuscript

Abstract

Objective

The aim of this study was to analyze the effectiveness of L-PRF as a healing agent in the postoperative period of third molar extraction surgeries, as well as to investigate secondary effects, such as the reduction of pain, edema and other discomforts after the surgical intervention.

Materials and methods

The methodology adopted consisted of carrying out a systematic review of the literature, following the model outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The inclusion criteria were previously established according to a systematic review protocol approved by the Prospective Register of Systematic Reviews (PROSPERO) under number CRD42023484679. In order to carry out a comprehensive search, a search in five databases was carried out, PubMed, Web of Science, Scopus, Cochrane Library and Embase.

Results

The search resulted in the selection of randomized controlled trials that conformed to the established criteria. Two authors independently screened the records and extracted the data. The assessment of bias was conducted according to the guidelines recommended by the Cochrane Collaboration, using version 2 of the Cochrane tool for assessing the risk of bias in randomized trials (RoB 2).

Conclusion

This study demonstrated that L-PRF stands out by providing direct benefits to healing, vascularization and tissue regeneration. Clinical relevance: L-PRF plays an important role in reducing postoperative pain, edema, the incidence of alveolar osteitis and infections after third molar removal surgery, compared to patients who did not undergo the use of L-PRF.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Data availability

No datasets were generated or analysed during the current study.

References

  1. Sorg H, Tilkorn DJ, Hager S, Hauser J, Mirastschijski U (2017) Skin wound healing: an update on the current knowledge and concepts. Eur Surg Res 58(1–2):81–94. https://doi.org/10.1159/000455955

    Article  CAS  PubMed  Google Scholar 

  2. Ferguson MW, O’Kane S (2004) Scar–free healing: from embryonic mechanisms to adult therapeutic intervention. Philosophical Trans Royal Soc B: Biol Sci 359(1445):839–850. https://doi.org/10.1098/rstb.2004.1475

    Article  CAS  Google Scholar 

  3. Ko KI, Sculean A, Graves DT (2021) Diabetic wound healing in soft and hard oral tissues. Translational Res 236:72–86. https://doi.org/10.1016/j.trsl.2021.08.001

    Article  CAS  Google Scholar 

  4. Zhang S, Song S, Wang S, Duan Y, Zhu W, Song Y (2019) Type 2 diabetes affects postextraction socket healing and influences first-stage implant surgery: a study based on clinical and animal evidence. Clin Implant Dent Relat Res 21(3):436–445. https://doi.org/10.1111/cid.12736

    Article  PubMed  Google Scholar 

  5. Osunde OD, Saheeb BD, Adebola RA (2011) Comparative study of the effect of single and multiple suture techniques on inflammatory complications after third molar surgery. J Oral Maxillofac Surg 69(4):971–976. https://doi.org/10.1016/j.joms.2010.07.028

    Article  PubMed  Google Scholar 

  6. Coulthard P, Bailey E, Esposito M, Furness S, Renton TF, Worthington HV (2014) Surgical techniques for the removal of mandibular wisdom teeth. Cochrane Database Syst Reviews 7. https://doi.org/10.1002/14651858.CD004345.pub3

  7. Miron RJ, Zucchelli G, Pikos MA, Salama M, Lee S, Guillemette V et al (2017) Use of platelet-rich fibrin in regenerative dentistry: a systematic review. Clin Oral Invest 21:1913–1927. https://doi.org/10.1007/s00784-017-2133-z

    Article  Google Scholar 

  8. Pavlovic V, Ciric M, Jovanovic V, Trandafilovic M, Stojanovic P (2021) Platelet-rich fibrin: basics of biological actions and protocol modifications. Open Med 16(1):446–454. https://doi.org/10.1515/med-2021-0318

    Article  CAS  Google Scholar 

  9. Kiencało A, Jamka-Kasprzyk M, Panaś M, Wyszyńska-Pawelec G (2021) Analysis of complications after the removal of 339 third molars. Dent Med Probl 58(1):75–80. https://doi.org/10.17219/dmp/127028

    Article  PubMed  Google Scholar 

  10. Sifuentes-Cervantes JS, Carrillo-Morales F, Castro-Núñez J, Cunningham LL, Van Sickels JE (2021) Third molar surgery: past, present, and the future. Oral surgery, oral medicine, oral Pathology. Oral Radiol 132(5):523–531. https://doi.org/10.1016/j.oooo.2021.03.004

    Article  Google Scholar 

  11. Ghosh A, Aggarwal VR, Moore R (2022) Aetiology, Prevention and Management of Alveolar Osteitis-A Scoping Review. J Rehabil 49(1):103–113. https://doi.org/10.1111/joor.13268

    Article  Google Scholar 

  12. Daly BJ, Sharif MO, Jones K, Worthington HV, Beattie A (2022) Local interventions for the management of alveolar osteitis (dry socket). Cochrane Database Syst Reviews 9. https://doi.org/10.1002/14651858.CD006968.pub3

  13. Zahid T, Ghafoor S (2021) Molecular events in the clinicopathological diagnosis of alveolar osteitis. J Pak Med Assoc 71(2A):508–513. https://doi.org/10.47391/JPMA.491

    Article  PubMed  Google Scholar 

  14. La Rosa GRM, Marcianò A, Priolo CY, Peditto M, Pedullà E, Bianchi A (2023) Effectiveness of platelet-rich fibrin in controlling pain associated with alveolar osteitis: a scoping review. Clin Oral Invest 27(7):3321–3330. https://doi.org/10.1007/s00784-023-05012-3

    Article  Google Scholar 

  15. Rakhshan V (2018) Common risk factors of dry socket (alveolitis osteitis) following dental extraction: a brief narrative review. J Stomatology Oral Maxillofacial Surg 119(5):407–411. https://doi.org/10.1016/j.jormas.2018.04.011

    Article  CAS  Google Scholar 

  16. Yüce E, Kömerik N (2019) Potential effects of advanced platelet-rich fibrin as a wound-healing accelerator in the management of alveolar osteitis: a randomized clinical trial. Niger J Clin Pract 22(9):1189–1195. https://doi.org/10.4103/njcp.njcp_27_19

    Article  PubMed  Google Scholar 

  17. Gollapudi M, Bajaj P, Oza RR (2022) Injectable platelet-rich fibrin-a revolution in periodontal regeneration. Cureus 14(8). https://doi.org/10.7759/cureus.32663

  18. Shirbhate U, Bajaj P (2022) Third-generation platelet concentrates in Periodontal Regeneration: gaining Ground in the field of regeneration. Cureus 14(8). https://doi.org/10.7759/cureus.32664

  19. Damsaz M, Castagnoli CZ, Eshghpour M, Alamdari DH, Alamdari AH, Noujeim ZEF et al (2020) Evidence-based clinical efficacy of leukocyte and platelet-rich fibrin in maxillary sinus floor lift, graft and surgical augmentation procedures. Front Surg 7:537138. https://doi.org/10.3389/fsurg.2020.537138

    Article  PubMed  PubMed Central  Google Scholar 

  20. Page MJ, Moher D, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD et al (2021) PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. BMJ 372(160):1–36. https://doi.org/10.1136/bmj.n160

    Article  Google Scholar 

  21. Fan Y, Perez K, Dym H (2020) Clinical uses of platelet-rich fibrin in oral and maxillofacial surgery. Dental Clin N Am 64(2):291–303. https://doi.org/10.1016/j.cden.2019.12.012

    Article  Google Scholar 

  22. PROSPERO (n.d.). International prospective register of systematic reviews. About PROSPERO. Retrieved from https://www.crd.york.ac.uk/prospero/#aboutpage

  23. Ouzzani H, Hammady H, Fedorowicz Z, Elmagarmid A (2016) Rayyan — a web and mobile app for systematic reviews. Syst Reviews 5:210. https://doi.org/10.1186/s13643-016-0384-4

    Article  Google Scholar 

  24. Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJM, Gavaghan DJ et al (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17(1):1–12. https://doi.org/10.1016/0197-2456(95)00134-4

    Article  CAS  PubMed  Google Scholar 

  25. Fujioka-Kobayashi M et al (2021) Efficacy of platelet-rich fibrin on socket healing after mandibular third molar extractions. J Oral Maxillofacial Surg Med Pathol 33(4):379–388

    Article  Google Scholar 

  26. O’Sullivan L, Gallagher C, Ríordáin RN (2022) Effect of plasma rich in growth factors on quality of life following mandibular third molar removal: a double-blind randomized controlled trial. Int J Oral Maxillofac Surg 51(9):1237–1244

    Article  PubMed  Google Scholar 

  27. Barhate UH et al (2022) Effects of autologous leukocyte-platelet rich fibrin (L-PRF) on the rate of maxillary canine retraction and various biomarkers in gingival crevicular fluid (GCF): a split mouth randomized controlled trial. Int Orthod 20(4):100681

    Article  PubMed  Google Scholar 

  28. Antonio SCARANO et al (2021) Autologous platelet gel (APG): a preliminary evaluation of the Mechanical Properties after activation with autologous thrombin and calcium chloride. Materials 14(14):3941. https://doi.org/10.3390/ma14143941

    Article  CAS  Google Scholar 

  29. Kalyani P et al (2023) Effect of leucocyte and platelet Rich Fibrin (L-PRF) in postoperative sequelae of impacted mandibular third molar Surgery-A Split Mouth Randomized Controlled Trial. J Popul Ther Clin Pharmacol 30(6):128–133

    Google Scholar 

  30. Afat IM, Akdogan ET, Gonul O (2019) Effects of leukocyte-and platelet-rich fibrin alone and combined with hyaluronic acid on early soft tissue healing after surgical extraction of impacted mandibular third molars: a prospective clinical study. J Cranio-Maxillofacial Surg 47(2):280–286

    Article  Google Scholar 

  31. Da Silva MT et al (2021) 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. Appl Sci 11(4):1666

    Article  Google Scholar 

  32. Mourão CFAB et al (2020) The use of leukocyte-and platelet-rich fibrin in the management of soft tissue healing and pain in post-extraction sockets: a randomized clinical trial. J Cranio-Maxillofacial Surg 48(4):452–457

    Article  Google Scholar 

  33. Daugela P et al (2018) Influence of leukocyte-and platelet-rich fibrin (L-PRF) on the outcomes of impacted mandibular third molar removal surgery: a split-mouth randomized clinical trial. Quintessence Int, 49(5)

Download references

Funding

There was no funding for this research.

Author information

Authors and Affiliations

  1. Department of Clinical and Social Dentistry (DCOS), Health Sciences Center, Federal University of Paraíba (UFPB), João Pessoa, Paraíba, Brazil

    Eduardo Dias Ribeiro

  2. Health Sciences Center, Federal University of Paraíba (UFPB), João Pessoa, Paraíba, Brazil

    Ilan Hudson Gomes de Santana

  3. Centro Universitário de João Pessoa-UNIPÊ, João Pessoa, Paraíba, Brazil

    Mayara Rebeca Martins Viana

  4. Paraíba State Employees Health Care Institute - IASS, João Pessoa, Paraíba, Brazil

    Julliana Cariry Palhano Freire

  5. Bauru School of Dentistry, University of São Paulo (FOB-USP), Bauru, Brazil

    Osny Ferreira-Júnior & Eduardo Sant’Ana

Authors
  1. Eduardo Dias Ribeiro
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ilan Hudson Gomes de Santana
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mayara Rebeca Martins Viana
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Julliana Cariry Palhano Freire
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Osny Ferreira-Júnior
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Eduardo Sant’Ana
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

E.D.R and I.H.G.S: Responsible for the conception of the study, the design of the systematic review and the formulation of the research question. Played a central role in the selection of the inclusion and exclusion criteria for the studies. Actively participated in the search, selection and analysis of the articles. M.R.M.V: Contributed significantly to the literature review and search for evidence. Participated in the critical analysis of the included studies. Collaborated in writing and reviewing the study protocol. J.C.P.F: Involved in the initial screening of articles and the application of inclusion/exclusion criteria. Extracted data from some of the included studies. Participated in writing specific sections of the manuscript. O.F.J: Actively participated in interpreting the results. Proofread and edited the manuscript to ensure accuracy and clarity. E.S: Played a role in the coordination, guidance and logistical management of the systematic review. Participated in the review and final formatting of the manuscript.

Corresponding author

Correspondence to Ilan Hudson Gomes de Santana.

Ethics declarations

Ethical approval

As this was a systematic review, it was not necessary to obtain approval from the research ethics committee to carry out this study.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary Material 1

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ribeiro, E.D., de Santana, I.H.G., Viana, M.R.M. et al. Use of platelet- and leukocyte-rich fibrin (L-PRF) as a healing agent in the postoperative period of third molar removal surgeries: a systematic review. Clin Oral Invest 28, 241 (2024). https://doi.org/10.1007/s00784-024-05641-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00784-024-05641-2

Keywords

Search

Navigation