The Role of Prp in Third Molar Extraction Wounds: A Clinical Study.

It has become more common that after a mandibular third molar impaction operation, platelet concentrates have been shown to be useful in aiding the healing process. The patients were examined on day 1, day 2, day 3, day 7, the first month, and the second month following surgery. There was a slew of parameters to investigate and tally up. Materials and
Methods: A total of 15 people with impacted mandibular third molars were included in the research. Patients' own blood platelets were used to make the transfusion more effective. One of the sockets was selected at random to serve as the test side. Instead of the other connector, the control socket was utilized.
Results: There was no statistical difference between the test and control groups when it came to pain or soft tissue healing, according to a Mann-Whitney U test used to analyze the data. T test was performed to check for edema and density in the bones. Bone density measurements on the test side were significant, whereas measurements of edema on the test side were not. There was no alveolar osteitis on any of the subjects' limbs.
Conclusion: Bone and soft tissue healing may be aided by platelet-rich plasma (PRP). Several growth components are included, which aid in the healing process. Copyright:

INTRODUCTION

Platelet concentrates are blood products used for hemorrhoidal prophylaxis during severe blood disorders. Oral operation can be eased using platelet concentrates[12] in cardiac patients under anticoagulant treatment.

In 1987, Ferrari initially applied rich plasma platelets to prevent homologous blood product transfusion as the autologous transfusion component in cardiac surgery after open-heart surgery.[3] Intra-articular injury was also treated with PRP; examples are arthritis, arthrofibrosis, cartilage abnormalities, meniscal damage, and chronic synovitis.[4] Platelet-rich plasma may be used in a variety of ways during oral and maxillofacial surgery.[5]

Increasing the concentration of autologous biomaterials at a wound site improves healing.[6]

The current study focuses on the efficiency of autologous concentrate platelets in third molar impaction surgeries. The hard and soft tissue cure caused by the concentrated platelet is examined.

MATERIALS AND METHODS

Between January and July 2020, this prospective double-blind, randomized control study was done in a Dental hospital. The Institutional Review Board and the Ethical Committee authorized the protocol of the study. All patients received informed permission.

Inclusion criteria:

Healthy nondiabetic individuals between 18 and 34 years of age.

Patients having bilaterally impacted mandibular third molars.

Absence of pericoronitis.

Absence of opposing traumatic occlusion or impinging upper third molars

Patients without any systemic diseases.

Female patients not on oral contraceptives.

Exclusion criteria:

Recent antibiotics or steroid use.

Systemic immunodeficiency, chemotherapy, and radiation therapy.

Non-localized odontogenic infection.

Surrounding tissue pathology or lesion.

Smokers/alcoholics.

Associated medical conditions contraindicating dental extraction.

Diabetic history >10 years (RBS >180 mg/dL).

Sample selection

The sample of the study comprised 15 patients (groups 1 and 2) with bilateral mandibular molar impacts and in a comparable position, including seven men and eight women. Of the 30 affected teeth in the categorization of Pell and Gregory, 21 were mesioangular, five were distoangular, and four were vertical.

Study groups

All patients were subjected to bilateral third-molar surgical removal. Both surgical sides were altered randomly in two groups: testing and control in each individual patient. One side had the third mandibular tooth removed and the socket sutured, while the other side had the third mandibular socket filled with PRP gel and sutured as a test side. Random selection was made of sockets where PRP is to be inserted. Patients were summoned back for follow-up on the first, second, third day, first, fourth, and two months.

The usual post-extraction instructions were provided, as were pressure packs. Three days of amoxicillin and diclofenac 500 mg three times a day were prescribed to the patients. Following the operation, all patients received 2 mg of dexamethasone intravenously. Chlorhexidine mouthwash should be used four times a day for 1 week. Postoperative discomfort, soft tissue healing, and alveolar osteitis are all assessed on the first, third, and seventh days after surgery.

One week, 4 weeks, and 8 weeks post-operative IOPA and OPG were obtained.

Clinical evaluation included assessment of pain, swelling, soft tissue healing, bone density, and alveolar osteitis.

Pain

Describes the evolution of self-reported pain measured in a visual analog scale (VAS) in the first 7 days after extraction. A 10-point visual analog scale (VAS)[7] with a score of 0 indicating no pain and 10 indicating very severe pain was used to assess pain on postoperative days 1, 3, and 7.

Swelling

The swelling on the operating side of the face was evaluated using five fixed locations and the averages were found.[8] The permanent points were the back of the tragedy on the midline, the lateral corner, the soft tissue pogonion (which is the most conspicuous point in the midline), the mid-line of the chin, and the bottom point of the angle of the mandible. A baseline measurement was conducted on the second and seventh days after surgery shortly before and comparable measures were taken. The difference between the post-op and pre-op measures has been computed. (Post swelling op − pre-op swelling). This method was described by Yakup Ustun et al.[9]

Soft tissue healing

Evaluation of soft tissue healing by Landry, Turnbull, and Howley.[10]

Radiographic evaluation for bone density

The preoperative measurement and the radiographic comparison of the density of the radiographic bones of PRP and non-PRP locations were performed on the first and the eighth week, respectively.

Assessment for alveolar osteitis[11]

The evaluation was carried out after surgery on the third day. The patient was questioned if the extraction socket was suffering from increasingly acute discomfort. Necrotic smell or gray coloration was examined for the socket.

RESULTS

The study included 15 fully reported patients. Upon conclusion of the clinical trial, patients were followed up by measures and data. This was a double-blind randomized experiment. Another investigator examined the results to prevent bias.

The following observations were made after analyzing the data. Seven male and eight female patients were present. They were 18–35 years of age and 25.16 years of age.

RESULTS OF CLINICAL ASSESSMENT

Assessment of pain

After surgery, the patient's pain level was measured using a visual analog scale (VAS) with a score of 2.91 on one side and 4.16 on the other (P = 0.002). On the third day, the site's average score was 2, 33, while the control site's average score was 2.91. (P = 0.091). On the seventh postoperative day, the test site's mean was 0.58, but the control side's was 0.91 (P = 0.293). Compared to other PRP sides, the PRP-side values were shown to be statistically significant for pain. There was a significant difference in the level of discomfort experienced by the test group and the operating checkpoint [Table 1].

Table 1

Pain assessment among test and control sites

	Mean	Standard deviation	P
Day 1
Test	2.91	1.02	0.002
Control	4.16	0.98
Day 3
Test	2.33	0.91	0.091
Control	2.91	0.87
Day 7
Test	0.58	0.67	0.293
Control	0.91	0.72

Assessment of soft tissue healing

On the first day after surgery, the mean cure assessment was 3.0 for control patients, whereas it was 3.08 for the test patients. 0.77 (statistical significance level). On the third day, the control side had a mean of 3.91 while the test side had a mean of 3.41 (P = 0.330). On the test side, the average was 4.75, compared to 4.6 on the control side one week later (P = 0.397). There were no statistically significant differences found between the test group and the control group in terms of their ability to repair soft tissue. This was probably due to the small sample size [Table 2].

Table 2

Soft tissue healing amongst test and control sites

	Mean	Standard deviation	P
Day 1
Test	3.08	0.77	0.77
Control	3.0	0.73
Day 3
Test	3.41	0.71	0.33
Control	3.91	0.83
Day 7
Test	4.75	0.34	0.39
Control	4.6	0.54

Assessment of grey value scale

To do this, the Adobe Photoshop software package was used. To conduct this study, the gray value was taken from the surgically removed apical third molar. The control side of the gray value scale had an average value of 140.91, whereas the test side had an average value of 128.63. (P = 0.054). At the end of the first month, the average gray value for the control was 145.58, while the average gray value for the test side was 133 (P = 0.029). There was a statistically significant difference in bone density between the groups who had PRP treatment and those who did not [Table 3].

Table 3

Gray value scores among test and control sites

	Mean	Standard deviation	P
Initial
Test	128.63	0.65	0.05
Control	140.91	1.23
After first month
Test	133.58	0.81	0.02
Control	145.38	0.83

Assessment of swelling

On the second postoperative day, the control side had a mean of 6.33 mm of swelling, whereas the test side had a mean of 6.39 mm of edema (P = 0.82). Test and control side average values were 3.1 and 3.2, respectively, on the seventh day after the procedure (P = 0.71). It had a statistical significance that could not be ignored. Because of this, PRP has no statistical significance for edema on the side of the test.

Assessment of alveolar osteitis

The third day was postoperatively examined for the dry socket. No dry socket in any of the sockets. None revealed dry socket on the control or the trial side. This revealed that PRP had no effect on dry sockets, according to the research. The sample sizes might be restricted. However, some studies have indicated that platelet concentrates are effective for reducing dry sockets [Table 4].[9]

Table 4

Swelling assessment amongst test and control sites

	Mean	Standard deviation	P
2nd Day
Test	6.39	0.99	0.82
Control	6.33	1.11
7th Day
Test	3.1	1.22	0.71
Control	3.2	0.98

DISCUSSION

Platelet concentrates may include little quantities of leukocytes that are used to synthesize interleukins that are implicated.

The PDGF is chemotactic for polymorphonucleocytes, macrophages, fibroblasts, and smooth muscle cells. Chemotaxis toward PDGF level activated TGF is promoted by this potent chemical attractor for hematopoietic, mesenchymal, and muscle cells. It also stimulates macro and neutrophils, fibroblast mitogenesis, and smooth muscle cells.[46]

For the whole extraction socket, the monitoring sites took 16 weeks to attain the same degree of radiographic density as the PRP therapy in 8 weeks.[11]

As a result of this fibrin concentration, the PRP gel enables stable blood coagulation and hence in early stages favors osseous defect repair. P = 0.05 at the end of 1st week, and P = 0.029 at the end of 2nd month. Both results were clinically significant and demonstrated that PRP is effective for bone density improvement. Alveolar osteitis may be treated with PRP.

A recent retrospective research also showed that PRP decreased alveolar osteitis by 62%.[12] It is hypothesized that this positive impact is associated with the high growth factor content of PRP and its capacity to start and stabilize blood coagulation in the socket.

Periodontal defect prevention post third molar surgery by PRP.[1314]

On the first and third days, there was less pain on the PRP side than on the non-PRP side. PRP gel has been demonstrated to significantly reduce post-surgical pain. At the end of the first postoperative day, P = 0.002 for clinically severe pain. This clinical experiment was conducted to evaluate PRP's effectiveness when administered alone because of this uncertainty in the literature.

SUMMARY AND CONCLUSION

Finally, the study carried out concludes that platelet-rich plasma has a good influence on bone density improvement, soft tissue healing, and pain reduction following the third mandibular molar impaction operation. However, we have no substantial advantage of PRP in preventing dry socket and in reducing edema after operation from our research.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.