The removal of impacted wisdom teeth is a common surgical procedure with possible complications including postoperative bleeding and wound infection and alveolar osteitis. Preventing osteitis is dependent on retaining the blood clot in the socket with no infection. There are several techniques to keep this clot intact and allow for healing including the use of leukocyte and platelet-rich fibrin(L-PRF). L-PRF is made as a concentrate from the patients’ blood and includes platelets, platelet-derived growth factor (PDGF), transforming growth factor-beta (TGFb-1), insulin-like growth factor (IGF) and various cytokines as well. The membrane importantly provides a fibrin scaffolding matrix which allows for healing. Hyaluronic acid (HA) is a major component of the extracellular matrix and can be used as well with various platelet preparations to accelerate wound healing, reduce scarring, protect the wound, and decrease postoperative discomfort or pain.

This study from a single unit in Turkey is a randomised, prospective double-blind control study. It seeks to assess if L-PRF alone or with an HA sponge reduces the risk of postoperative complications. Sixty patients were split into three groups. All patients had elective extraction of a unilateral partially erupted mandibular third molar. The patients were all aged 18-30, non-smokers with no active infections or other comorbidities. Patients were randomly divided into three groups after extraction: L-PRF membrane, L-PRF membrane and HA sponge or nothing applied to the socket. The results showed that healing was better for both the L-PRF, and L-PRf+HA sponge than the control group at seven, 14 and 21 days. There was only one case of osteitis and one of postoperative infection in the control group. This might be a small study, but it does suggest that easily prepared L-PRF with or without HA sponge can be used to reduce the risk of postoperative osteitis or infections.

Effects of leukocyte- and platelet-rich fibrin alone and combined with hyaluronic acid on early soft tissue healing after surgical extraction of impacted mandibular third molars: A prospective clinical study.
Afat IM, Akdoğan ET, Gönül O.
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Sunil K Bhatia

Royal Shrewsbury Hospital, Shrewsbury, UK.

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