Impact of Platelet-rich Plasma and Platelet-rich Fibrin in Mandibular Third Molar Extraction: A Systematic Review

Aim: This study aims to evaluate the impact of platelet-rich fibrin (PRF) and platelet-rich plasma (PRP) on pain, swelling, trismus, soft tissue healing and bone regeneration following mandibular third molar extraction. Material and methods: A systematic review was conducted from a period of January 2014 to June 2024 using PRISMA guidelines. The search strategy included databases such as Scopus, PubMed, Google Scholar, and Cochrane Central Register of Controlled Trials, using key terms related to “PRF”, “PRP”, oral surgery, and third molars. PICO criteria followed were - Patient and population (P): Patient with mandibular third molar impacted tooth. Intervention (I): PRF; Comparator or control group (C): PRP; Outcomes (O): Impact on pain, swelling, trismus, soft tissue healing and bone regeneration following mandibular third molar extraction. National Heart, Lung, and Blood Institute (NHLBI) quality assessment tool was also employed. Data was extracted and analyzed. Results: Six articles met the inclusion criteria. Both materials showed potential in promoting bone and soft tissue regeneration. Out of which 1 was a split-mouth prospective clinical study, 3 were split-mouth comparative study, 2 were unilateral randomized comparative prospective study. While four studies showed a significant improvement in the soft tissue wound healing and increase in bone density in PRF site comparatively, two studies showed no significant difference between PRF and PRP with regard to pain, trismus, swelling and bone formation in the third molar extraction socket region after the placement. Based on NHLBI quality assessment tool, all the studies scored predominantly one, and hence were found good. Conclusion: Both “PRF” and “PRP” positively influence healing after mandibular third molar extraction. Platelet-rich fibrin offers an advantage due to its ease of preparation and complete autologous nature. Clinical significance: The impacted third molars created a variety of problems and required their extraction. Because mandibular third molars have denser cortical bone, they are more likely to experience postoperative complications. Successful surgical extraction typically occurs between ages 24 and 30, but outcomes vary based on several factors, including operator experience and patient characteristics. Recent advancements emphasize the role of oxygen and growth factors in wound healing, particularly “PRP” and “PRF”.