Efficacy of Leukocyte Platelet Rich Fibrin (L-PRF) Versus L-PRF with βeta Tri-calcium Phosphate (β-TCP) Bone Graft in Mandibular Impacted Third Molar Surgery: A Split-Mouth Double Blinded Randomized Control Study

Stephenson, George Samyo; Pandyan, Deepak Abraham; Chandran, Satheesh; Narasimman, Deenadayalan; Premkumar, Karthik Kattur; Rajendran, Balamurugan; Pethuraj, Vijayalakshmi

doi:10.30476/dentjods.2025.106480.2667

Efficacy of Leukocyte Platelet Rich Fibrin (L-PRF) Versus L-PRF with βeta Tri-calcium Phosphate (β-TCP) Bone Graft in Mandibular Impacted Third Molar Surgery: A Split-Mouth Double Blinded Randomized Control Study

Document Type : Original Article

Authors

George Samyo Stephenson ¹

Deepak Abraham Pandyan ¹

Satheesh Chandran ¹

Deenadayalan Narasimman ¹

Karthik Kattur Premkumar ¹

Balamurugan Rajendran ²

Vijayalakshmi Pethuraj ³

¹ Dept. of Oral and Maxillofacial Surgery, Madha Dental College and Hospital, Chennai, India.

² Oral and Maxillofacial Surgeon and Oral Implantologist, Dept. of Dentistry, RYA MADRAS COSMO Foundation Hospital, Chennai, India.

³ Orthodontist, Private Clinical Practitioner, Chennai, India.

https://doi.org/10.30476/dentjods.2025.106480.2667

Abstract

Background: Mandibular third molar removal surgically exhibits severe pain, edema, limitation in mouth opening, impaired wound healing, and delayed bone formation postoperatively.
Purpose: To compare the effectiveness of leukocyte platelet-rich fibrin (L-PRF) and L-PRF with β-Tricalcium phosphate (β-TCP) bone graft on postoperative outcomes after mandibular impacted third molar surgery.
Materials and Method: This split-mouth double-blinded randomized controlled study was conducted on 100 patients, who presented for bilateral extraction of mandibular impacted third molars. Group I included 50 patients who were subjected to L-PRF, and group II included 50 patients who were subjected to L-PRF with β-TCP in the extracted socket after removal of the mandibular third molar. The surgical site bleeding was assessed intraoperatively. The pain, swelling, and trismus were evaluated on the 1^st, 3^rd, and 7^th postoperative days. Wound healing was evaluated on the 3^rd and 7^th postoperative days, and bone density was assessed on the 3^rd postoperative month using cone beam computed tomography (CBCT).
Results: Group II patients experienced reduced surgical site bleeding, less postoperative swelling, maximum mouth opening, and improved bone regeneration (p Value< 0.05). Group I patients exhibited faster wound healing and less postoperative pain (p< 0.05).
Conclusion: The results of our study indicate that L-PRF combined with β-TCP remains an excellent and promising biocompatible material for achieving better postoperative outcomes compared to L-PRF alone.

Keywords

Platelet rich fibrin

βeta-tricalcium phosphate

Wound healing

Bone density

Mugalbayeva MA, Mirzakulova UR, Zaitenova GB, Uglanov ZS. A combination of beta-tricalcium phosphate, plasmogel, and platelet-rich plasma improves long-term bone tissue restoration after complicated lower third molar surgery: A non-randomized controlled trial. Contemp Clin Dent. 2024; 15: 84-88.
Nourwali I. The effects of platelet-rich fibrin on post-surgical complications following removal of impacted wisdom teeth: A pilot study. J Taibah Univ Med Sci. 2021; 16:521-528.
Alzahrani AA, Murriky A, Shafik S. Influence of platelet rich fibrin on post-extraction socket healing: A clinical and radiographic study. Saudi Dent J. 2017; 29:149-155.
Noh NZ, Mohamed NA, Noor E. Platelet concentrates effect on bone regeneration in dental surgery: A narrative review. Dent Rev. 2022; 2:100047.
Raja VS, Naidu EM. Platelet-rich fibrin: Evolution of a second-generation platelet concentrate. Indian J Dent Res. 2008; 19: 42-46.
Castillo GF, Miranda ME, Bojorque JA, Barragán KI, García DV. Gingival and bone tissue healing in lower third molar surgeries. Comparative study between use of platelet rich fibrin versus physiological healing. Rev Odontol Mex. 2017; 21: e112-e118.
Kumar K, Singh R, Mugal V, Dhingra N, Priyadarshni P, Bandgar S. Preservation of alveolar ridge using graft material after tooth extraction: A clinical trial. J Pharm Bioallied Sci. 2021; 13: S456-S460.
Daif ET. Effect of a multiporous beta-tricalicum phosphate on bone density around dental implants inserted into fresh extraction sockets. J Oral Implantol. 2013; 39: 339-344.
Choi YJ, Chang H, Kim MJ, Lee J, Lee B. Efficacy of pure beta tricalcium phosphate graft in dentoalveolar surgery: a retrospective evaluation based on serial radiographic images. Maxillofac Plastic Reconstructive Surg. 2023; 25: 1-7.
Dohan DM, Choukroun J, Diss A, Dohan SL, Dohan AJ, Mouhyi J, et al. Platelet-rich fibrin (PRF): A second-generation platelet concentrate. Part III. Leucocyte activation: A new feature for platelet concentrates? Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006; 101: E51-E55.
He L, Lin Y, Hu X, Zhang Y, Wu H. A comparative study of platelet-rich fibrin (PRF) and platelet-rich plasma (PRP) on the effect of proliferation and differentiation of rat osteoblasts in vitro. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009; 108: 707-713.
Dohan Ehrenfest DM, Rasmusson L, Albrektsson T. Classification of platelet concentrates: From pure plateletrich plasma (P-PRP) to leucocyte- and platelet-rich fibrin (L-PRF). Trends Biotechnol. 2009; 27: 158-167.
Pavani MP, Reddy KR, Reddy BH, Biraggari SK, Babu CH, Chavan V. Evaluation of platelet-rich fibrin and tricalcium phosphate bone graft in bone fill of intrabony defects using cone-beam computed tomography: A randomized clinical trial. J Indian Soc Periodontol. 2021; 25:138-143.
Karayurek F, Kadiroglu ET, Nergiz Y, Coskun Akcay N, Tunik S, Ersoz Kanay B, et al. Combining platelet rich fibrin with different bone graft materials: an experimental study on the histopathological and immunohistochemical aspects of bone healing. J Craniomaxillofac Surg. 2019; 47: 815–825.
Fromme GA, Mackenzie RA, Gould AB, Lund BA, Offord KP. Controlled Hypotension for Orthognathic Surgery. Anesth Analg. 1986; 65:683-686.
Singh A, Kohli M, Gupta N. Platelet rich fibrin: A novel approach for osseous regeneration. J Maxillofac Oral Surg. 2012; 11: 430–434.
Trybek G, Rydlinska J, Aniko-Włodarczyk M, Jaron A. Effect of platelet- rich fibrin application on non-infectious complications after surgical extraction of impacted mandibular third molars. Int J Environ Res Public Health. 2021; 18: 8249.
Gulşen U, Şenturk MF. Effect of platelet rich fibrin on edema and pain following third molar surgery: A split mouth control study. BMC Oral Health. 2017; 17: 1–6.
Ozgul O, Senses F, Er N, Tekin U, Tuz HH, Alkan A, et al. Efficacy of platelet rich fibrin in the reduction of the pain and swelling after impacted third molar surgery: Randomized multicenter split-mouth clinical trial. Head Face 2015; 11: 1-5.
Uyanik LO, Bilginaylar K, Etikan I. Effects of platelet-rich fibrin and piezosurgery on impacted mandibular third molar surgery outcomes. Head Face Med. 2015; 11: 1-7.
Daugela P, Grimuta V, Sakavicius D, Jonaitis J, Juodzbalys G. Influence of Leukocyte- and Platelet Rich Fibrin (L-PRF) on the outcomes of impacted mandibular third molar removal surgery: A split- mouth randomised clinical trial. Quintessence Int. 2018; 49: 377-388.
Sunil SP, Shashikala R, Anuradha V, Vaibhav N, Balaraj BV, Vishwas K. Mandibular Third Molar Extraction Wound Healing with and Without Combination of Platelet-Rich Fibrin and Beta Tricalcium Phosphate as Grafting Material: A Comparative Prospective Study. Int J Sci Stud. 2023; 10: 50-60.
Iasella JM, Greenwell H, Miller RL, Hill M, Drisko C, Bohra AA, et al. Ridge Preservation with Freeze-Dried Bone Allograft and a Collagen Membrane Compared to Extraction Alone for Implant Site Development: A Clinical and Histologic Study in Humans. J Periodontology. 2003; 74: 990–999.
Araujo MG, Lindhe J. Ridge preservation with the use of Bio-Oss collagen: a 6-month study in the dog. Clin Oral Implants Res. 2009; 20:433-440.
Jain V, Triveni MG, Kumar ABT, Mehta DS. Role of platelet-rich-fibrin in enhancing palatal wound healing after free graft. Contemp Clin Dent. 2012; 3: S240-S243.
Emadi N, Safi Y, Bagheban AA, Asgary S. Comparison of CT-number and gray scale value of different dental materials and hard tissues in CT and CBCT. Iran Endod J. 2014; 9: 283-286.
Ehrenfest DM, de Peppo GM, Doglioli P, Sammartino G. Slow release of growth factors and thrombospondin-1 in Choukroun’s platelet-rich fibrin (PRF): a gold standard to achieve for all surgical platelet concentrates technologies. Growth Factors. 2009; 27: 63-69.
Baeyens W, Glineur R, Evrard L. The use of platelet concentrates: platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) in bone reconstruction prior to dental implant surgery. Rev Med Brux. 2010; 31: 521-527.
Park JK, Joo HJ, Lee ES, Jang HS, Lim JS, Kwon JJ. The effect of PRF and PRP for new bone formation of beta-TCP in skull of white rabbit. J Korean Assoc Maxillofac Plast Reconstr Surg. 2011; 33:19-25.
Kim BJ, Kwon TK, Baek HS, Hwang DS, Kim CH, Chung IK, et al. A comparative study of the effectiveness of sinus bone grafting with recombinant human bone morphogenetic protein 2-coated tricalcium phosphate and platelet-rich fibrin-mixed tricalcium phosphate in rabbits. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012; 113: 583-592.
Elmohandes W. Evaluation of beta tricalcium phosphate mixed with platelet rich fibrin for rehabilitation of atrophic maxilla with implant installation. Int J Oral Maxillofac Surg. 2013; 42: 1261.
Claflin RS. Healing of disturbed and undisturbed extraction wounds. J Am Dent Assoc. 1936; 23: 945-959.
Jahangiri L, Devlin H, Ting K, Nishimura I. Current perspectives in residual ridge remodeling and its clinical implications: A review. J Prosthet Dent. 1998; 80: 224-237.