Efeito da fibrina rica em plaquetas sobre dor, cicatrização de tecido mole, condição periodontal e reparo ósseo em alvéolos de terceiros molares mandibulares: ensaio clínico randomizado triplo-cego

Abstract

Surgical removal of third molars is a procedure routinely performed in dentistry often associated with inflammatory events which result in complications. Thus, several studies have attempted to find alternatives to not only reduce these effects but also to accelerate and improve the healing process, providing less morbidity and greater postoperative comfort. The platelet-rich fibrin (L-PRF) is an autologous platelet concentrate obtained through centrifugation which stimulates and accelerates the natural tissue repair process. It also helps the regeneration of soft and hard tissues. The literature still lacks well-designed clinical trials investigating the use of L-PRF in alveoli after lower third molar extraction. Therefore, the aim of this study was to evaluate the effects of L-PRF on pain, soft tissue healing, periodontal condition, and post-extraction bone repair of lower third molars. A randomized, prospective, triple-blind, split-mouth clinical trial was carried out with 28 volunteers (56 extractions) who needed the removal of mandibular third molars with similar patterns of bone impaction and surgical difficulty. Eligible patients were randomly allocated into two groups: G1 (without L-PRF), G2 (alveoli filled with L-PRF), whereby the removal of the two dental elements was performed at the same surgical time. Pain was evaluated through the visual analogue scale (VAS), whereas soft tissue healing was evaluated according to the scoring system proposed by Landry et al. (1988) and the periodontal probing of the lower second molar. Bone repair was determined through volumetric analysis using the ITK-SNAP software and through bone quality determined by fractal analysis using the ImageJ software. These analyses were performed by a calibrated examiner. The use of L-PRF reduced pain in the 7-day postoperative follow- up (p=0.019) and improved soft tissue healing after 1 month of follow-up (p=0.021) as well as probing depth (distal face) in 3 months postoperatively (p=0.011). There was a significant alveolar reduction 3 months after surgery (p<0.01) in both groups, although it was more significant in G1. Despite the suggestive results that L-PRF positively affects the initial bone healing process, there were no statistical differences related to the fractal dimension (p>0.05). Therefore, the present study demonstrated that the use of L-PRF improves postoperative clinical parameters of pain, soft tissue healing, and periodontal condition, suggesting that L-PRF has a beneficial effect in preserving the alveolar ridge and accelerating the initial repair process.