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      Healing Potential of Platelet Rich Fibrin in Impacted Mandibular Third Molar Extraction Sockets

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          Abstract

          Background:

          Healing of both hard and soft tissues have become one of the great challenges, faced in clinical research in development of bioactive surgical additives responsible for regulating inflammation and increasing healing. Platelet-rich fibrin (PRF) represents a new step in the platelet gel therapeutic concept with simplified processing minus artificial biochemical modification.

          Aims and Objectives:

          The aim of this study is to evaluate the effectiveness of PRF on soft-tissue healing and bone tissue healing in terms of postoperative pain, postoperative swelling, soft tissue healing, and the quality of bone healing at the mandibular third molar socket.

          Materials and Methods:

          A clinical study will be done on patients reporting to the Department of Oral and Maxillofacial Surgery in Government Dental College, Srinagar, requiring disimpaction of bilateral mesioangular impacted mandibular third molars in 60 patients.

          Results:

          The present prospective clinical study evaluates the effect of PRF in healing of mandibular third molar extraction sockets. There was no difference in the age gender and type of impaction between the two groups as the mean postoperative pain score (visual analog scale) was lower for the PRF group (Group A) at all points of time when compared with the control (Group B), and this was statistically significant ( P < 0.05). The mean percentage swelling was lower for the PRF group (Group A) at all points of time when compared with the control (Group B). Evaluating the effect of treatments (with or without PRF) on lamina dura score shows that in both the groups at different time periods, significant ( P < 0.001) difference was observed on lamina dura score.

          Conclusion:

          The results of the present study suggest that application of autologous PRF gel has a beneficial effect on the healing of extraction sockets after third molar surgery.

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          Most cited references17

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          Platelet-rich plasma: clinical applications in dentistry.

          Platelet-rich plasma, or PRP, has become a valuable adjunct in wound healing in dentistry. Postsurgically, blood clots initiate the healing and regeneration of hard and soft tissues. Clinicians and scientists are investigating the use of PRP in dentistry as a way to enhance the body's natural wound-healing mechanisms. TYPES OF ARTICLES REVIEWED: The authors reviewed scientific articles that discuss the basic knowledge of wound healing mechanisms and that directly studied the growth factors shown to be concentrated in PRP. They also reviewed articles written by clinicians and researchers in dentistry fields, including oral and maxillofacial surgery and periodontics to determine applications of PRP in the field of dentistry. All of the reviewed articles expressed promise in PRP use and in the growth factors expressed by the platelets concentrated in PRP-namely platelet-derived growth factor, or PDGF, and transforming growth factor-beta, or TGF-beta--as an adjunct to postsurgical wound healing. Both PDGF and TGF-beta have been shown in vivo to accelerate wound healing through different mechanisms. The development of an autologous PRP has been shown to be relatively easy, to be effective as a surgical adjunct, to retain high levels of the desired growth factors after preparation and to be clinically effective in accelerating postsurgical healing in both periodontal and oral surgery applications. PRP has proven to be effective at improving surgical results in a variety of procedures in the field of oral and maxillofacial surgery. PRP also shows promise in periodontal regenerative therapy and should continue to be studied by scientists and clinicians alike.
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            Autologous fibrin adhesive in mandibular reconstruction with particulate cancellous bone and marrow.

            Displacement of bone graft particles during their placement, neck flap closure, and insertion of the freeze-dried mandibular crib housing the graft to the glenoid fossa is a commonly encountered problem during major mandibular reconstruction with autogenous particulate cancellous bone and marrow. Autologous fibrin adhesive proved to be a solution as demonstrated in a series of 33 cases. In addition to adhesive and hemostatic properties, it helped the remodeling process begin about 50% earlier by providing the substratum for migration of mesenchymal cells, accelerating revascularization and migration of fibroblasts, stimulating the growth of both fibroblasts and osteoblasts, and slowing the multiplication of microorganisms. Bony incorporation and remodeling were detected radiographically at the fourth postoperative week compared with the eighth week in bone grafts without autologous fibrin adhesive.
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              Platelet rich fibrin: a novel approach for osseous regeneration.

               : To evaluate the efficacy of autologous platelet rich fibrin in soft tissue healing and bone regeneration in mandibular third molar extraction sockets. The study was conducted in 20 patients visiting in outpatient department of Oral and Maxillofacial Surgery, requiring extraction of bilateral mandibular third molar, following extraction platelet rich fibrin (PRF) was placed in one extraction sockets, the other socket was studied as the control sites with no PRF. The patient were assessed for post operative pain, soft tissue healing and trabecular pattern in healing bone. Radiological assessment of the extraction site was done for period of 3 months to evaluate the change in bone density. Pain was less in study side compare to control site soft tissue was healing was better in study site. Evaluation of trabecular bone formation started earlier in PRF site compare to control site. The evaluation of bone density by radiological assessment showed the grey level value calculated after 3 months at the PRF site well comparatively higher than the average baseline value of the bone density at the extraction site in control site. The study showed that autologous PRF is biocompatible and has significantly improved soft tissue healing. Bone regeneration and increase in bone density in extraction sockets. However, a more elaborate study with a large number of clinical cases is essential to be more conclusive regarding its efficacy.
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                Author and article information

                Journal
                Ann Maxillofac Surg
                Ann Maxillofac Surg
                AMS
                Annals of Maxillofacial Surgery
                Medknow Publications & Media Pvt Ltd (India )
                2231-0746
                2249-3816
                Jul-Dec 2018
                : 8
                : 2
                : 206-213
                Affiliations
                [1]Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Srinagar, Jammu and Kashmir, India
                Author notes
                Address for correspondence: Dr. Manzoor Dar, Room No 202, Department of Oral and Maxillofacial Surgery, Government Dental College, Srinagar, Jammu and Kashmir, India. E-mail: itsdrmann@ 123456yahoo.com
                Article
                AMS-8-206
                10.4103/ams.ams_181_18
                6327825
                30693233
                d4fae2e8-152a-4e09-8339-6425cf8e6ca7
                Copyright: © 2018 Annals of Maxillofacial Surgery

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                Categories
                Original Article - Comparative Study

                disimpaction,platelet-rich fibrin,third molar
                disimpaction, platelet-rich fibrin, third molar

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