The removal of impacted wisdom teeth is a commonly carried out surgical procedure in maxillofacial surgery. Apart from the usual complications of postoperative bleeding and wound infection, the most painful one is alveolar osteitis. This is mainly 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. The use of leukocyte and platelet-rich fibrin is well documented. L-PRF is made as a concentrate from the patients' blood and includes platelets, and growth factors and other factors such as PGDF, TGFb-1 and IGF (platelet-derived growth factor, transforming growth factor-beta, insulin-like growth factor) and various cytokines as well. The membrane importantly provides a fibrin scaffolding matrix 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. All the impacted teeth were vertically impacted. The patients were all aged 18-30, non-smokers with no active infections or other comorbidities. Patients were randomly divided into three groups and after extraction had a L-PRF membrane, L-PRF membrane and HA sponge that adsorbed exudate from the membrane during pressing or nothing applied to the socket. All the surgical procedures were carried out by same surgeon with no change in technique. The results showed that healing was better for both the L-PRF and L-PRf+HA sponge were better than the control group at seven,14 and 21 days. There was one case of osteitis and one of postoperative infection in the control group but none in either of the two groups. This might be a small study but it does suggest that the use of easily prepared preparation of L-PRF with or without HA sponge can be used to reduce the risk of postoperative osteitis or infections. It might be useful to asses this in other surgical settings. It certainly would benefit from a larger study group to confirm the initial findings. Similar techniques are gaining acceptance and being used more widely, especially with implant placement and bone regeneration techniques.

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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