Anti-inflammatory Effect of Platelet-Rıch Fıbrın
Condition: Surgical Complication; Pain, Postoperative; Edema Face
MeSH terms: Pain, Postoperative
Study type: Interventional

Summary: 
      This study evaluated the anti-inflammatory effect of platelet-rich fibrin (PRF) applied to
      the extraction socket after impacted mandibular third molar surgery with subjective and
      objective parameters. A total of 48 patients who had fully impacted wisdom teeth in bilateral
      and similar positions were included in the study. The control group was formed with the
      standard extraction of the lower third molars, and the PRF group was formed with local PRF
      application in addition to standard impacted tooth surgery (n=96). The anti-inflammatory
      activity of PRF on postoperative 2nd and 7th days was evaluated subjectively by clinical
      parameters and objectively by biochemical parameters.

      Subjective parameters were pain assesment, swelling measurements on the face and limitation
      of mouth opening. Objective data is the analysis of serum values and anti-inflammatory
      markers in the blood.
    

Detailed description: 
      Operations All surgical procedures were performed by the same surgeon, with the same flap
      design and the same surgical technique. 2 ml of a local anesthetic solution containing 40
      mg/ml articaine HCl and 0.006 mg/ml epinephrine HCl was used for N. alveolaris inferior and
      N. buccalis blockage. The mucoperiosteal flap was removed by making a horizontal incision
      starting from the retromolar region, through horizontally in the buccal, circular around the
      neck of the mandibular second molar, and continuing vertically at the mesial half of the
      mandibular second molar tooth. Alveolotomy and/or division of teeth and/or roots were
      performed with sterile tungsten carbide burs with an electric controlled motor rotating at
      20,000 rpm under 0.9% saline irrigation during operation. Roots were removed from the alveoli
      with the help of a bein elevator placed on the buccal and/or mesial parts of the teeth. After
      tooth extraction, the bone, soft tissue residues, and debris in the area were removed, and
      the socket was irrigated with 0.9% saline. In the control group, primary suturing was
      performed after bleeding control without any application to the extraction socket, while in
      the PRF group, PRF was applied to the socket just before suturing (Fig 2). All patients were
      prescribed antibiotics (amoxicillin-clavulanic acid, 1gr, 2x1) (Augmentin-BID,
      GlaxoSmithKline, London, England), analgesic (Acetaminophen, 500 mg, 3x1) (Parol, Atabay,
      Istanbul, Turkey) and mouthwash (120 mg %0.12 chlorhexidine gluconate and 150 mg %0.15
      benzydamine hydrochloride, 200 ml, 3x1) (Kloroben, Drogsan, Ankara, Turkey) after the
      surgical procedure.

      PRF Preparation Blood sampling was performed through the peripheral antecubital vein by
      selecting a suitable branule for the patient's vascular structure with a closed vacuum
      system. PRFs were prepared according to the method of Choukron et al.(2001). 10 ml blood
      samples were inserted in a centrifuge device (Intra-Lock International Inc., Boca Raton,
      USA), under 2700 rpm for 12 min using high speed. The platelet-rich fibrin layer remaining
      between the acellular plasma and red blood cells in the tube was separated with the help of
      scissors or a scalpel.

      Obtaining edema, pain, and serum marker data A visual analog scale (VAS) of 100 mm was given
      to the patients to determine the severity of pain on the operation day and on the 2nd and 7th
      postoperative days, with 0 indicating no pain and 100 indicating the worst pain they had ever
      experienced. In order to evaluate the severity of edema, the tragus - buccal comissura and
      lateral canthus - gonion distances of the patients were measured using a flexible ruler
      before the operation and on the 2nd and 7th days postoperatively, and the results were
      recorded. To evaluate the trismus level, the interincisal distance of the patients was
      measured with a flexible ruler before the operation and on the 2nd and 7th days
      postoperatively in both groups. The progression of swelling and trismus was measured in
      millimeters and evaluated by comparing with the value obtained at baseline14.

      For objective data, ESR values were measured using the Vision ESR analyzer (YHLO Biotech Co.,
      Shenzhen, China), and CRP values were measured using the BN II nephelometric analyzer
      (Siemens Healthcare Diagnostics, Marburg, Germany). IL-6 levels (pg/ml) were determined using
      the Human IL-6 Elisa Kit (Elabscience Biotechnology Co., Wuhan, China) and TNF-a levels
      (pg/ml) were determined using the Human TNF-α Elisa Kit (Elabscience Biotechnology Co., was
      measured using Wuhan, China).

      Statistical Evaluation Data were analyzed with the IBM SPSS® V23 (IBM Company, Chicago, IL,
      United States) package program. Mann-Whitney U test was used to compare non-normally
      distributed data according to paired groups, and an independent two-sample t-test was used to
      compare normally distributed data. The significance level was taken as p<0.05.
    

Intervention name(s): Platelet rich fibrin application
Intervention type(s): Other
Intervention description(s): PRFs were prepared by obtaining10 ml blood samples from each patinet and inserting them in a centrifuge device (Intra-Lock International Inc., Boca Raton, USA), under 2700 rpm for 12 min using high speed. The platelet-rich fibrin layer remaining between the acellular plasma and red blood cells in the tube was separated with the help of scissors or a scalpel. After the tooth extraction in the experimental group PRF located to the extraction socket.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Diagnostic
Keywords: platelet-rich-fibrin; edema; Serum markers; trismus