Autologous platelet rich plasma after third molar surgery: a comparative study

Use of autogenous tooth bone graft in osseous defects after the surgical removal of mandibular third molars: a systematic review and meta-analysis of randomized controlled trials

The objective of this systematic review and meta-analysis was to collectively summarize the available evidence on the use of autogenous tooth bone graft (ATBG) in osseous defects following mandibular third molar surgery. A literature search was performed in Scopus, MEDLINE/PubMed, and Cochrane Library to find randomized clinical trials that used ATBG to augment bone defects following impacted mandibular third molar surgery and compared this with normal healing or with other materials. Eight studies were included, six of which were included in the meta-analysis. The results showed that sites grafted with ATBG yielded significantly higher bone defect fill (standardized mean difference (SMD) 1.10, 95% confidence interval (CI) 0.20-1.99, P = 0.016) and significantly less probing depth (SMD -1.46, 95% CI -2.53 to -0.39, P = 0.007) when compared to the control, at 6 months postoperatively. Based on the GRADE system, the level of evidence on these outcomes was judged as moderate. Within the limitations, this study showed that the ATBG could be an alternative to other materials for augmenting bone defects following the surgical removal of an impacted mandibular third molar, offering the option of using the extracted tooth to produce a material that can be used for bone regeneration.

Autologous platelet concentrates after third molar extraction: A systematic review

Surgical removal of impacted mandibular third molars is often followed by postoperative sequelae like pain, swelling, trismus, etc. This systematic review explored the benefits of applying different autologous platelet concentrates (APCs) in the extraction socket of third molars. For this systematic review, PubMed, EMBASE, Web of Science, and Scopus have been utilized, initially yielding 544 papers. The search was narrowed to randomized controlled trials (RCTs, n = 59) published before 2024, all comparing the outcome of applying APCs in the extraction socket of surgically removed impacted mandibular third molars with unassisted healing (blood clot). Most RCTs primarily assessed the impact of APCs on postoperative sequelae. Some RCTs looked at soft- and hard-tissue healing. Eleven studies used PRP, three PRGF, and 45 L-PRF. A detailed analysis revealed a large heterogeneity between studies rendering a meta-analysis impossible. Moreover, the risk of bias was considered high. In the majority of RCTs, the application of an APC resulted in statistically significant reductions of postoperative sequelae (lower pain intensity, lower consumption of analgesics, less postoperative edema, and a lower incidence of trismus and alveolar osteitis), as well as a faster soft tissue healing, and qualitatively and quantitatively better bone healing. A minority of studies reported significant differences in periodontal parameters distally from the second molar.

Intra-socket application of Hyaluronic acid reduces pain and swelling following wisdom teeth removal

Background: Hyaluronic acid (HA) has the potential to promote wound healing. Pain and swelling with trismus are common sequalae post wisdom teeth removal. This study aims to investigate the effectiveness of intra-socket HA solution to reduce these uncomfortable post-operative events. Materials and methods: 30 patients underwent bilateral extractions of mandibular wisdom teeth for this study. Intra-socket application of 0.7 ml 20 mg/2 ml HA solution (Hyalgun) with Gel foam as a scaffold in study site versus Gel foam only on control site was conducted via a split mouth study design. Data collection of five facial reference points for swelling and maximum mouth opening was recorded during the pre-operative period and post-operative 2nd and 7th day. The VAS pain score at post-op 1st, 2nd and 3rd day and the number of analgesics for the 7-day post-operative duration were evaluated. Results: The HA group demonstrated statistically significant less swelling, trismus and analgesia consumption on the 2 and 7 days after surgery. VAS scores on day 1, 2 and 3 after surgery (P = 0.05) were significantly less in the HA group compared to the control group. Conclusion: The application of intra-socket HA has a positive effect for reducing postoperative pain and swelling with trismus after the lower third molar intervention (LTMI).

The effects of lyophilised platelet-rich plasma in third molar extraction sockets and its surrounding tissues

Objective

To determine the effects of repeated placement of quantified lyophilised platelet-rich plasma (LPRP) on the soft and hard tissue components.

Methods

Lyophilised platelet-rich plasma was topically placed, and later injected, into fresh sockets using the third molar surgical model, randomised according to the split-mouth approach. The control site received placebo. The application of LPRP was done intraoperatively, one month and two months postoperatively. The measured endpoints included post-operative pain, swelling, trismus, pocket depth at mid-distal adjacent second molar, soft tissue healing, and bone formation (which was assessed radiographically). Fifteen healthy young adults, aged between 21 and 35 years, visiting the Oral and Maxillofacial Surgery Clinic at the University of Malaya were recruited for this study.

Results

There was no significant difference in post-operative pain, swelling size, trismus, and bone healing within their specific timelines during this study. However, the LPRP group showed significant reduction in pocket depth at the two-month post-operative period, suggesting that LPRP improves soft tissue healing.

Conclusion

Soft tissue healing, measured as the change of periodontal pocket depth, showed significant reduction, suggesting the benefit of LPRP for soft tissue healing. However, bone regeneration and reduction of post-operative sequelae showed no improvement even after quantification and repeated LPRP application.

A systematic review and meta-analysis on the effectiveness of xenograft to prevent periodontal defects after mandibular third molar extraction

Background

To evaluate the use of guided bone regeneration with xenograft to prevent periodontal defect in the distal aspect of the second molar after the surgical removal of the mandibular third molar.

Material and Methods

Three electronic databases (Pubmed, Cochrane Library and Scopus) were searched in April 2020. Randomized clinical trials in non-smokers and healthy patients, with at least six months follow-up, comparing periodontal probing depth, clinical attachment level, alveolar bone level and adverse events were selected by two independent investigators. The risk of bias assessment of the selected studies was evaluated by means of the Cochrane Collaboration’s Tool. Finally, a meta-analysis of the outcomes of interest was performed.

Results

Despite 795 articles were found in the initial search, only three randomized controlled clinical trials were included. Pooled results favoured the use of the xenograft plus collagen membrane over the spontaneous healing in terms of periodontal probing depth gain (MD=2.36; 95% CI 0.69 to 4.03; P=0.005) and clinical attachment level gain (MD=2.52; 95% CI 0.96 to 4.09; P=0.002). No other statistically significant differences were found.

Conclusions

Within the limitations of the present review, the xenograft plus collagen membrane exhibited better periodontal results than spontaneous healing without increasing postoperative complications. However, future well-designed studies with larger samples are required to confirm our results.

Key words:Third molar, tooth extraction, bone regeneration, xenograft.

Variations in reporting of clinician-reported outcome measures in third molar surgery: A focused review

Clinician-reported outcome measures (ClinRO measures) play a fundamental role in quality assurance throughout healthcare systems. With commissioners turning ever more frequently to ClinRO data to evaluate and compare individual hospital performance and casemix, and funding decisions increasingly relying on these data, agreed core outcome sets (COS) are essential for the collection of standardised specialty-specific outcomes. Beyond their role in service commissioning, COS enable standardisation of outcomes in clinical studies, allowing comparisons to be drawn between similar trials as well as pooling of data for systematic reviews and metaanalyses. This review explores those ClinRO measures most commonly reported in the third molar literature, highlighting inconsistencies in ClinRO selection, measurement and reporting among researchers. We recognise here a prime opportunity for the specialty to address this lag in COS relative to other surgical specialties. With the Quality Outcomes in Maxillofacial Surgery (QOMS) overseeing the institution of many subspecialty-specific national databases in recent years, OMFS is well placed to develop a series of COS for each subspecialty domain for the benefit of researchers, clinicians and ultimately, patients.

Calcium Sulfate and Plasma Rich in Growth Factors Enhance Bone Regeneration after Extraction of the Mandibular Third Molar: A Proof of Concept Study

The aim of this study was to evaluate the mixture of Calcium Sulfate and Plasma Rich in Growth Factors (CaSO4 + PRGF) as a bone-graft substitute in extracted mandibular third molar (MTM) alveoli during a 4-month period. Bilateral MTM extractions were performed in 10 patients (18-25 years) at the Oral-Surgery-Clinic of the Universidad Autónoma de Yucatán (UADY). A CaSO4 + PRGF mixture was placed in the right alveolus (Experimental Group (EG)) and a natural blood clot in the left (Control Group (CG)). Monthly X-ray controls were performed using a gray scale to measure Bone Regeneration (BR). A non-parametric Sign Test was used to evaluate Radiopacity/Bone Regeneration (Ro/BR) over 4 months, and a Friedman's non-parametric test was used for intra-group analysis over these months. The study was approved by the Centro de Investigaciones Regionales (Dr. Hideyo Noguchi, UADY Bioethics Committee, ID 0026-2015). Using a non-parametric test of the sign, the EG showed significant difference of Ro/BR between groups p = 0.002 (p < 0.05). Significant differences were observed in all quadrants and areas p = 0.002 (p < 0.05) except in area A in month 4 (p = 0.016), which could be explained by its being the closest to native bone. EG CaSO4 + PRGF showed a higher degree of bone regeneration compared to CG.

Efficacy of Sticky Bone as a Novel Autologous Graft for Mandibular Third Molar Extraction Socket Healing - An Evaluative Study

Introduction

Recently, initiation and enhancement of extraction socket healing has been amplified by platelet concentrates, whereas the positive role of Sticky bone has been focused on maintaining alveolar bone dimensions. This study aimed to determine the effectiveness of Sticky Bone for socket grafting of mandibular third molars (M3Ms) in terms of soft- and hard-tissue healing.

Materials and Methods

This split-mouth prospective trial constituted prophylactic removal of M3Ms with Sticky bone grafted in the study site as a primary predictor variable. Patients underwent 3 months of mandatory follow-up where pain, swelling, interincisal mouth opening, and gingival healing were measured on the 3^rd, 7^th, and 14^th day using the Numeric Rating Scale, anatomic landmarks, steel metric ruler, and criteria given by Landry et al. respectively. Radiological healing was calculated based on the height of the socket, Kelly's Index, and histogram values immediately after the procedure at 1 week, 1 month, and 3 months, respectively. Statistical comparison was made using Paired t-test. P < 0.05 was considered significant.

Results

Forty-seven patients (mean 26.83 ± 6.58 years) demonstrated significantly lesser pain, swelling, and better gingival healing at the study site on multiple periods of follow-up. Rapid bone formation with superior density, lesser alveolar resorption, earlier bone blending, and trabecular formation were noticed on the study site with a significant difference at all time intervals.

Discussion

Sticky bone was chosen as the graft owing to advantages such as simple preparation, convenient handling characteristics, safety, evident postoperative patient comfort, better retention of the clot, enhanced soft-tissue healing, absence of infection, and decreased osseous deformation as compared to the control site. This study validated the role of Sticky bone as an indispensable component of regenerative therapy in the orofacial osseous tissues as it was an ideal biologic graft with fibrin rich structure.

Conclusion

This study validated the role of Sticky bone as an indispensable component of regenerative therapy in the orofacial osseous tissues as it was an ideal biologic graft with fibrin rich structure.

Efficacy of platelet rich plasma (PRP) on mouth opening and pain after surgical extraction of mandibular third molars

Introduction: Surgery of mandibular third molar teeth for removal is one of the most common procedures undertaken in oral and maxillofacial surgery departments. The complications created by the post extraction wound healing and physiological consecution of third molar surgery can affect patients' quality of life. Platelet rich plasma (PRP) is an autologous concentrate of platelets suspended in the Plasma that accelerates healing by concentration of growth factors which lessen the inflammation and as a result pain and trismus. Materials and methods: A Study was conducted on 130 patients at the department of Oral and Maxillofacial Surgery, FUCD Islamabad, for a period of 6 months after ethical approval. The patients with impacted mandibular wisdom teeth were selected and divided equally into two equal groups. The pain score was measured using the visual analogue scale (VAS) and trismus was measured using Vernier caliper before the surgery, immediately after surgery, on 3rd and 7th follow up visits. Results: The mean postoperative pain on 7th day was significantly lower in the PRP group with statistically significant P-value <0.0001. Trismus was also less reported in the PRP group with P-value <0.00065. Conclusion: Platelet Rich Plasma is effective to lessen trismus and pain after surgical removal of mandibular third molar teeth.

Comparative study on alveolar bone healing in postextraction socket versus healing aided with autologous platelet-rich fibrin following surgical removal of bilateral mandibular impacted third molar tooth: A radiographic evaluation

Aim:

This study was to evaluate and compare the bone regeneration potential of autologous platelet-rich fibrin (PRF) placed in one of the extracted sockets after the surgical removal of bilateral impacted mandibular third molars.

Patients and Methods:

Twenty-five patients (10 females and 15 males; 18–35 years old) were taken for surgical removal of bilateral impacted mandibular third molar, performed in the same session. The autologous PRF was placed in one of the extracted sockets whereas the opposite side was taken as control side, and primary closure was done. Radiographic examination with orthopantomogram was done preoperatively and 1 month, 3 months, and 6 months postoperatively to assess the degree of bone regeneration at the extracted site and compare it with the control side using MATLAB software and the data are statistically analyzed using paired t-test.

Results:

PRF side had better healing and bone formation when compared with the control side as indicated by significant P values of (P = 0.06>5%) 1 month, (P = 0.00<1%) 3 month, and (P = 0.00<1%) 6 month postoperatively. The repeated-measures ANOVA showed a significant difference seen on 1^st, 3^rd, and 6^th months postoperatively on PRF side (P = 0.001).

Conclusion:

The autologous PRF improves and fastens the bone regeneration and healing in the extracted sockets.

[Ultrasonic examination of the breast adipose grafts after mammoplasty]

AIM

To present the results of PRP-adipose grafts implanatation.

MATERIAL AND METHODS

The study included 25 patients after transplantation of autologous adipose tissue. Autotransplantation was performed to correct volume defects of breast and to restore lost volume after polyacrylamide gel removal in 4 patients; after mastectomy in 6 cases; after complicated replacement using silicone endoprostheses in 11 patients; after previous reduction in 2 cases; after augmentation mammoplasty in 2 cases. Mean age of patients was 42 years. Patients were divided into 2 groups. Group 1 included 12 patients in whom pure adipose tissue was transplanted. Group 2 consisted of 13 patients who received autologous fat with platelet-rich plasma (PRP).

RESULTS

Dynamic ultrasonic monitoring showed early resorption processes (liponecrosis foci) after autologous fat injection. Locally increased vascular pattern of breast tissue is an inflammatory sign requiring anti-inflammatory therapy. PRP-adipose grafts have improved outcomes.

Evaluation of inorganic bovine bone graft in periodontal defects after third molar surgery

Aim:

This study evaluated the e cacy of inorganic bovine bone graft (IBB) in periodontal defect after mandibular third molar (3M) surgery.

Methods:

The authors conducted a split-mouth, prospective, randomized, blinded, placebo-controlled clinical trial involving 20 participants with a mean age of 21.60 ± 6.5 years who had symmetrical bilateral lower 3M randomly assigned to receive IBB or left empty (blooding clot). The clinical variables studied were probing depth and clinical attachment level (CAL) at preoperative and postoperative periods of 10, 30, and 60 days. Radiographic measures included the distance from the alveolar bone crest to the cementoenamel junction and the bone density at 30 and 60 days postsurgical procedure. For statistical analysis, we used the paired t-test at a level of signi cance of 5%.

Results:

It was observed a reduction in pocket depth and CAL in both groups, but IBB did not provide better results than blooding clot (P > 0.05). On the other hand, IBB group showed an increased in the bone density, and a decrease in the periodontal defect on the distal surface of second molar (2M) after 30 and 60 days of surgery compared to the control group (P < 0.05).

Conclusion:

The use of inorganic bone graft (GenOx) did not enhance the probing depth after 3M removal. Although the radiographic ndings have showed an increase in bone density and a decrease in the periodontal defect on the distal surface of the 2M, we cannot recommend the use of IBB as a treatment for periodontal defect prevention after 3M removal.

Platelet derivatives in regenerative medicine: an update

Prior preclinical and clinical studies support the use of platelet-derived products for the treatment of soft and hard tissue lesions. These regenerative effects are controlled by autocrine and paracrine biomolecules including growth factors and cytokines contained in platelet alpha granules. Each growth factor is involved in a phase of the healing process, such as inflammation, collagen synthesis, tissue granulation, and angiogenesis collectively promoting tissue restitution. Platelet derivatives have been prepared as platelet-rich plasma, platelet gel, platelet-rich fibrin, and platelet eye drops. These products vary in their structure, growth factors, composition, and cytokine concentrations. Here, we review the current use of platelet-derived biological products focusing on the rationale for their use and the main requirements for their preparation. Variation in the apparent therapeutic efficacy may have resulted from a lack of reproducible, standardized protocols for preparation. Despite several individual studies showing favorable treatment effects, some randomized controlled trials as well as meta-analyses have found no constant clinical benefit from the application of platelet-derived products for prevention of tissue lesions. Recently, 3 published studies in dentistry showed an improvement in bone density. Seven published studies showed positive results in joint regeneration. Five published studies demonstrated an improvement in the wound healing, and an improvement of eye epithelial healing was observed in 2 reports. Currently, at least 14 ongoing clinical trials in phase 3 or 4 have been designed with large groups of treated patients (n > 100). Because the rationale of the therapy with platelet-derived compounds is still debated, a definitive insight can be acquired only when these large randomized trials will be completed.

Clinical and radiographic evaluation of the efficacy of platelet-rich plasma combined with hydroxyapatite bone graft substitutes in the treatment of intra-bony defects in maxillofacial region

OBJECTIVE

The aim of this study is to evaluate the efficacy of platelet-rich plasma (PRP) clinically and radiographically when combined with bovine derived hydroxyapatite (HA) bone grafting materials and resorbable collagen membranes for the treatment of intra-bony defects frequently seen at the distal aspect of mandibular second molars following the surgical extraction of fully impacted mandibular wisdom teeth.

STUDY DESIGN

Eighteen patients were scheduled for post-operative visits at 1, 3 and 6 months post-operatively, probing depths were measured and digital panoramic radiographs were taken.

RESULTS

There were no significant differences on probing depths among two groups. Radiographic assessment also showed no significant difference among groups at 1st and 6th month intervals, while 3 months post-operatively the amount of radiographic density at the PRP side was significantly higher.

CONCLUSION

Combined use of PRP and bovine-derived HA graft materials for the treatment of intra-bony defects might be an appropriate approach when the main goal is providing earlier bone regeneration.

Effects of platelet-rich plasma and cell coculture on angiogenesis in human dental pulp stem cells and endothelial progenitor cells

INTRODUCTION

Platelet-rich plasma (PRP) has been described as platelet concentrate. Growth factors released by activated platelets can improve wound vasculogenesis and enhance wound healing. In this study, we used PRP instead of serum to culture human dental pulp stem cells (hDPSCs) and endothelial progenitor cells (EPCs) and investigated revascularization ability. The effect of hDPSC and EPC coculture on vasculogenesis was also studied.

METHODS

PRP was prepared by secondary centrifugation. Real-time polymerase chain reaction and Western blotting were used to determine the expression of vasculogenesis-related factors vascular endothelial growth factor, platelet-derived growth factor, fetal liver kinase 1 (Flk-1), and stromal cell-derived factor 1 (SDF-1) in cultured hDPSCs and EPCs. The cells were divided into 4 groups: EPCs + 10% fetal bovine serum (FBS), EPCs + 10% PRP, EPCs + hDPSCs + 10% FBS, and EPCs + hDPSCs + 10% PRP. Then, the formation of vessel-like structures was tested by the tube formation assay.

RESULTS

On day 3, the expression levels of all the markers in the coculture groups were much higher than in the single-culture groups and were also higher in the PRP groups compared with the FBS groups (P < .05), except for SDF-1. Expression levels were significantly higher in the experimental groups (EPCs + 10% PRP, EPCs + hDPSCs + 10% FBS, and EPCs + hDPSCs + 10% PRP) than in the control group (EPCs + 10% FBS) and in the PRP groups/coculture groups compared with the FBS groups/single-culture groups (P < .01). The tube formation assay showed the area of vessel-like structures formed by the PRP group to be larger than in the FBS group (P < .05).

CONCLUSIONS

PRP and coculture can both promote vasculogenesis, and PRP can promote EPCs to form vessel-like structures.

Platelet-rich plasma in bone regeneration: engineering the delivery for improved clinical efficacy

Human bone is a tissue with a fairly remarkable inherent capacity for regeneration; however, this regenerative capacity has its limitations, and defects larger than a critical size lack the ability to spontaneously heal. As such, the development and clinical translation of effective bone regeneration modalities are paramount. One regenerative medicine approach that is beginning to gain momentum in the clinical setting is the use of platelet-rich plasma (PRP). PRP therapy is essentially a method for concentrating platelets and their intrinsic growth factors to stimulate and accelerate a healing response. While PRP has shown some efficacy in both in vitro and in vivo scenarios, to date its use and delivery have not been optimized for bone regeneration. Issues remain with the effective delivery of the platelet-derived growth factors to a localized site of injury, the activation and temporal release of the growth factors, and the rate of growth factor clearance. This review will briefly describe the physiological principles behind PRP use and then discuss how engineering its method of delivery may ultimately impact its ability to successfully translate to widespread clinical use.